Hepatitis B is significantly associated with liver cancer, the fourth most common cause of cancer death among Asian Americans.1 Patients who become infected with HBV earlier in life are at a higher risk of becoming a chronic carrier. 2–4 HBV infection among Asian Americans is estimated to be about 10% and it varies in incidence and prevalence among Asian American subgroups.5 The infection typically occurs through mother-to-child transmission at birth. Babies and young children are more likely to develop chronic infections, which explains, in part, the high number of Asian Americans who are chronic HBV carriers.6
Chinese American males are six times more likely to report HBV-related liver cancer than Caucasians.7, 8 Among Chinese Americans, 46% knew that HBV could cause liver cancer, but only 35% reported that they had been tested for it.9 Forty-eight percent of Chinese immigrants in the United States reported that they had received the HBV blood test.10, 11 Southeast Asians have higher liver cancer rates than any other racial/ethnic group in the U.S. Yet, a survey of Cambodian immigrant women conducted in Seattle, Washington, indicated that only 38% had been serologically tested for HBV.12 Chronic infection rates of HBV among Vietnamese-American adults are between 7% and 14%.13 Our previous study of Vietnamese immigrant adults in Pennsylvania and New Jersey indicated that only 8.8% were screened for HBV.14
Educational level, gender, English fluency, and household income were associated with increased HBV knowledge and previous HBV testing among Asian Americans.15, 16 Study results have indicated that HBV screening may be influenced by Asian cultural factors, such as respect for authority and elders, karma, males as decision makers, saving face, Yin/Yang, and chi.17–21 Family members may not inform each other to protect their members and may believe that talking about illness (karma) manifests it. Male figures, such as a husband or eldest son, often determine decisions about HBV screening and vaccination for the family. Asian Americans may also not want to disagree with a physician; but they may simply not come back to the physician or take their medication as prescribed. The concepts of Yin/Yang may also be important because health entails being in balance; ill health can be restored by bringing back harmony through acupuncture or diet. Asian Americans are likely to use traditional Chinese medicine, Western medicine, or both.22, 23 These concepts have influenced many Asian American subgroups.24–27 These demographic and cultural factors may influence HBV screening rates.
Ma28 developed a Sociocultural Health Behavior Model by incorporating the major constructs of the Health Belief Model,29 Social Cognitive Theory,30,31 the Behavioral Model and access to medical care,32 The Sociocultural Health Behavior Model acknowledges that the complexity and interaction of multiple factors play a major role in many patient’s health-seeking behaviors. It explains health-seeking behavior by describing the relationships among individual, interpersonal, and environmental factors. This model describes relationships between individual health behavior and interaction with the environment. The interactions and multiple levels of influence of individual, interpersonal, and environmental factors underlying the health behavior are emphasized.
Since screening behavior is influenced by multiple factors, there is a need to identify the associations among these factors. The role of cultural factors is seldom included in a health behavior analysis. In addition to common theoretical components, this model includes cultural factors as a primary component. The model incorporates the interdependence of predisposing, enabling, need, family/social support, environmental health system, and cultural factors, all of which contribute to a particular health behavior or outcome. A number of variables can be included under cultural factors; these include notions of fatalism, birth in the U.S., years lived in the U.S., English fluency, use of native language at home, native food dietary habits, use of media sources in the native language, and attendance of native-themed social events.
The purpose of this community-based study was to apply the proposed Sociocultural Health Behavior Model to determine the relationship of factors proposed in the model to health behaviors related to HBV screening among Asian American adults.