As shown in , the four Asian American groups varied with respect to many demographic characteristics. All groups were predominantly female (52–65%), immigrants (93–97%), and married (72%). The Hmong sample was the youngest and had the lowest levels of education, household income and English fluency, consistent with Census data. The Vietnamese and Cambodian samples had the highest proportions of long-term residents in the United States (>10 years). The Korean sample had the highest level of education, followed by Vietnamese. The Korean sample had the least access to health care based on health insurance and regular provider and about one-third of the Hmong and Korean, but very few Vietnamese and Cambodian saw a traditional healer during the past 12 months.
Awareness of hepatitis B varied considerably among the four groups, ranging from 45% of Hmong who had heard of hepatitis B to 79% of Korean Americans. Knowledge of specific transmission routes varied within and between the groups. The majority of respondents in all groups correctly identified sharing needles and child birth as transmission channels (67–95%). Only 43–69% knew that HBV can be transmitted during sexual intercourse. Large proportions in all four groups incorrectly thought that HBV can be transmitted by coughing or sneezing and by sharing food, drink, or eating utensils. The knowledge score ranged from 3.3 among Hmong to 4.5 among Korean Americans (on a scale of 0–7).
Perceived susceptibility was highest among Korean Americans and lowest among Hmong, based on two questions shown in . Perceived severity of hepatitis B varied considerably depending on the specific question that was asked. One question that was asked in all four studies “Do you think hepatitis B causes liver cancer?” was most often answered affirmatively by Korean Americans and least often by Hmong. As one might expect, only small proportions of respondents (who never had a HBV test per inclusion criteria for this analysis) reported receipt of a doctor’s recommendation to get tested for HBV in the 3 groups that were asked this question. Thirty-eight percent of Vietnamese, but 70% of Cambodian believed that people avoid people with HBV (stigma). Sixty-eight percent of Hmong but 94% of Koreans believed that testing was efficacious for preventing liver problems.
Bivariate relationships between the knowledge score and other Health Behavior Framework factors are shown in . Age was consistently related to knowledge scores and 18–29 year olds had the highest knowledge scores in each sample. Length of stay in the United States was not related to knowledge scores in the Vietnamese and Hmong samples, while higher knowledge scores were found among more recent Korean American immigrants and long-term Cambodian American immigrants. In three of the four samples, higher education was associated with higher knowledge scores, and English fluency was consistently positively related to knowledge scores in all four samples.
As expected, respondents who had heard of hepatitis B prior to this survey had higher knowledge scores than those who were not aware of hepatitis B in all four samples. Knowledge scores were consistently higher among respondents who expressed higher perceived susceptibility to getting infected with HBV. Higher perceived severity was also associated with higher knowledge scores, except in the Korean sample, which had the highest knowledge scores overall. Respondents with higher knowledge scores were more likely to agree that people avoid people with HBV (stigma). Those with higher knowledge scores were also more likely to agree that testing can prevent liver problems. Not all of these relationships were statistically significant and some of the differences we observed within samples were small (see ).
These relationships were robust and did not change when we conducted analyses taking into account clustering in the Korean and the Cambodian sample. Additionally, the relationships between knowledge scores and other health beliefs (awareness, perceived susceptibility, severity, stigma, perceived efficacy of testing) did not change when we controlled for demographic characteristics within each sample, with one exception: After controlling for demographic characteristics in the Korean sample, the knowledge scores among people reporting stigma were significantly higher than among people who did not report stigma (data not shown).