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1.  Disparities in mammographic screening for Asian women in California: a cross-sectional analysis to identify meaningful groups for targeted intervention 
BMC Cancer  2007;7:201.
Breast cancer is the most commonly diagnosed cancer among the rapidly growing population of Asian Americans; it is also the most common cause of cancer mortality among Filipinas. Asian women continue to have lower rates of mammographic screening than women of most other racial/ethnic groups. While prior studies have described the effects of sociodemographic and other characteristics of women on non-adherence to screening guidelines, they have not identified the distinct segments of the population who remain at highest risk of not being screened.
To better describe characteristics of Asian women associated with not having a mammogram in the last two years, we applied recursive partitioning to population-based data (N = 1521) from the 2001 California Health Interview Survey (CHIS), for seven racial/ethnic groups of interest: Chinese, Japanese, Filipino, Korean, South Asian, Vietnamese, and all Asians combined.
We identified two major subgroups of Asian women who reported not having a mammogram in the past two years and therefore, did not follow mammography screening recommendations: 1) women who have never had a pap exam to screen for cervical cancer (68% had no mammogram), and 2) women who have had a pap exam, but have no women's health issues (osteoporosis, using menopausal hormone therapies, and/or hysterectomy) nor a usual source of care (62% had no mammogram). Only 19% of Asian women who have had pap screening and have women's health issues did not have a mammogram in the past two years. In virtually all ethnic subgroups, having had pap or colorectal screening were the strongest delineators of mammography usage. Other characteristics of women least likely to have had a mammogram included: Chinese non-U.S. citizens or citizens without usual source of health care, Filipinas with no health insurance, Koreans without women's health issues and public or no health insurance, South Asians less than age 50 who were unemployed or non-citizens, and Vietnamese women who were never married.
We identified distinct subgroups of Asian women at highest risk of not adhering to mammography screening guidelines; these data can inform outreach efforts aimed at reducing the disparity in mammography screening among Asian women.
PMCID: PMC2198916  PMID: 17961259
2.  Influence of American acculturation on cigarette smoking behaviors among Asian American subpopulations in California 
Using combined data from the population-based 2001 and 2003 California Health Interview Surveys, we examined ethnic and gender-specific smoking behaviors and the effect of three acculturation indicators on cigarette smoking behavior and quitting status among 8,192 Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese American men and women. After adjustment for potential confounders, current smoking prevalence was higher and the quit rate was lower for Korean, Filipino, and Vietnamese American men compared with Chinese American men. Women’s current smoking prevalence was lower than men’s in all six Asian American subgroups. South Asian and Korean American women reported lower quit rates than women from other ethnic subgroups. Asian American men who reported using only English at home had lower current smoking prevalence and higher quit rates, except for Filipino and South Asian American men. Asian American women who reported using only English at home had higher current smoking prevalence except for Japanese women. Being a second or later generation immigrant was associated with lower smoking prevalence among all Asian American subgroups of men. Less educated men and women had higher smoking prevalence and lower quit rates. In conclusion, both current smoking prevalence and quit rates vary distinctively across gender and ethnic subgroups among Asian Americans in California. Acculturation appears to increase the risk of cigarette smoking for Asian American women. Future tobacco-control programs should target at high-risk Asian American subgroups, defined by ethnicity, acculturation status, and gender.
PMCID: PMC3652889  PMID: 18418780
3.  Hidden Breast Cancer Disparities in Asian Women: Disaggregating Incidence Rates by Ethnicity and Migrant Status 
American journal of public health  2010;100(Suppl 1):S125-S131.
We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age.
To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses.
Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI=1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000–2004, the rate among US-born Filipina women exceeded that of White women.
These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors.
PMCID: PMC2837454  PMID: 20147696
4.  The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women 
BMC Cancer  2010;10:603.
In the US, foreign-born Hispanics tend to live in socioeconomic conditions typically associated with later stage of breast cancer diagnosis, yet they have lower breast cancer mortality rates than their US-born counterparts. We evaluated the impact of nativity (US- versus foreign-born), neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants) on breast cancer stage at diagnosis and survival among Hispanics.
We studied 37,695 Hispanic women diagnosed from 1988 to 2005 with invasive breast cancer from the California Cancer Registry. Nativity was based on registry data or, if missing, imputed from case Social Security number. Neighborhood variables were developed from Census data. Stage at diagnosis was analyzed with logistic regression, and survival, based on vital status determined through 2007, was analyzed with Cox proportional hazards regression.
Compared to US-born Hispanics, foreign-born Hispanics were more likely to be diagnosed at an advanced stage of breast cancer (adjusted odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.09-1.20), but they had a somewhat lower risk of breast cancer specific death (adjusted hazard ratio (HR) = 0.94, 95% CI: 0.90-0.99). Living in low SES and high enclave neighborhoods was associated with advanced stage of diagnosis, while living in a lower SES neighborhood, but not Hispanic enclave, was associated with worse survival.
Identifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.
PMCID: PMC2988754  PMID: 21050464
5.  Disparities in liver cancer incidence by nativity, acculturation, and socioeconomic status in California Hispanics and Asians 
Asians and Hispanics have the highest incidence rates of liver cancer in the US, but little is known about how incidence patterns in these largely immigrant populations vary by nativity, acculturation, and socioeconomic status (SES). Such variations can identify high-priority subgroups for prevention and monitoring.
Incidence rates and rate ratios (IRRs) by nativity among 5,400 Hispanics and 5,809 Asians diagnosed with liver cancer in 1988–2004 were calculated in the California Cancer Registry. Neighborhood ethnic enclave status and SES were classified using 2000 US Census data for cases diagnosed in 1998–2002.
Foreign-born Hispanic males had significantly lower liver cancer incidence rates than US-born Hispanic males in 1988–2004 (e.g., IRR=0.54, 95% confidence interval [CI]=0.50–0.59), whereas foreign-born Hispanic females had significantly higher rates in 1988–1996 (IRR=1.42, 95% CI=1.18–1.71), but not 1997–2004. Foreign-born Asian males and females had up to 5-fold higher rates than the US-born. Among Hispanic females, incidence rates were elevated by 21% in higher-enclave versus lower-enclave neighborhoods, and by 24% in lower- versus higher-SES neighborhoods. Among Asian males, incidence rates were elevated by 23% in higher-enclave neighborhoods and by 21% in lower-SES neighborhoods. In both racial/ethnic populations, males and females in higher-enclave, lower-SES neighborhoods had higher incidence rates.
Nativity, residential enclave status, and neighborhood SES characterize Hispanics and Asians with significantly unequal incidence rates of liver cancer, implicating behavioral or environmental risk factors and revealing opportunities for prevention.
Liver cancer control efforts should especially target foreign-born Asians, US-born Hispanic men, and residents of lower-SES ethnic enclaves.
PMCID: PMC3005535  PMID: 20940276
6.  Binge Drinking and Alcohol-Related Problems among U.S-Born Asian Americans 
Binge drinking (five drinks or more in a 2-hour sitting for men, or four or more drinks in a 2-hour sitting for women) and alcohol-related problems are a growing problem among Asian American young adults. The current study examines the socio-cultural (i.e., generational status and ethnic identity) determinants of binge drinking and alcohol-related problems across U.S.-born, young adult, Asian American ethnic groups. Data were collected from 1,575 Asian American undergraduates from a public university in Southern California. Chinese Americans consisted of the largest Asian ethnicity in the study followed by Vietnamese, Filipino, Korean, South Asian, Japanese, Multi-Asian, and “other Asian American”. Participants completed a web-based assessment of binge drinking, alcohol-related problems, ethnic identity, descriptive norms (i.e., perceived peer drinking norms) and demographic information. An analysis of variance was used to determine potential gender and ethnic differences in binge drinking and alcohol-related problems. Negative binomial regression was selected to examine the relationship between the predictors and outcomes in our model. There were no gender differences between Asian American men and women in regards to binge drinking, however men reported more alcohol-related problems. Japanese Americans reported the highest number of binge drinking episodes and alcohol-related problems, followed by Filipino, and Multi-Asian Americans (e.g., Chinese and Korean). Living off-campus, higher scores in descriptive norms, Greek status, and belonging to the ethnic groups Japanese, Filipino, Multi-Asian, Korean, and South Asian increased the risk of engaging in binge drinking. Quantity of alcohol consumed, Greek status, gender, Filipino, South Asian “Other” Asian, and lower ethnic identity scores were related to alcohol-related problems. Using one of the largest samples collected to date on socio-cultural determinants and drinking among U.S.-born Asian American young adults, the findings highlight the significant variability in drinking patterns between Asian American ethnic groups.
PMCID: PMC3489163  PMID: 22686146
Asian Americans; U.S-Born; binge drinking; alcohol-related problems
7.  Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S. 
Cancer Causes & Control   2007;19(3):227-256.
We report cancer incidence, mortality, and stage distributions among Asians and Pacific Islanders (API) residing in the U.S. and note health disparities, using the cancer experience of the non-Hispanic white population as the referent group. New databases added to publicly available SEER*Stat software will enable public health researchers to further investigate cancer patterns among API groups.
Cancer diagnoses among API groups occurring from 1 January 1998 to 31 December 2002 were included from 14 Surveillance, Epidemiology, and End Results (SEER) Program state and regional population-based cancer registries covering 54% of the U.S. API population. Cancer deaths were included from the seven states that report death information for detailed API groups and which cover over 68% of the total U.S. API population. Using detailed racial/ethnic population data from the 2000 decennial census, we produced incidence rates centered on the census year for Asian Indians/Pakistanis, Chinese, Filipinos, Guamanians, Native Hawaiians, Japanese, Kampucheans, Koreans, Laotians, Samoans, Tongans, and Vietnamese. State vital records offices do not report API deaths separately for Kampucheans, Laotians, Pakistanis, and Tongans, so mortality rates were analyzed only for the remaining API groups.
Overall cancer incidence rates for the API groups tended be lower than overall rates for non-Hispanic whites, with the exception of Native Hawaiian women (All cancers rate = 488.5 per 100,000 vs. 448.5 for non-Hispanic white women). Among the API groups, overall cancer incidence and death rates were highest for Native Hawaiian and Samoan men and women due to high rates for cancers of the prostate, lung, and colorectum among Native Hawaiian men; cancers of the prostate, lung, liver, and stomach among Samoan men; and cancers of the breast and lung among Native Hawaiian and Samoan women. Incidence and death rates for cancers of the liver, stomach, and nasopharynx were notably high in several of the API groups and exceeded rates generally seen for non-Hispanic white men and women. Incidence rates were lowest among Asian Indian/Pakistani and Guamanian men and women and Kampuchean women. Asian Indian and Guamanian men and women also had the lowest cancer death rates. Selected API groups had less favorable distributions of stage at diagnosis for certain cancers than non-Hispanic whites.
Possible disparities in cancer incidence or mortality between specific API groups in our study and non-Hispanic whites (referent group) were identified for several cancers. Unfavorable patterns of stage at diagnosis for cancers of the colon and rectum, breast, cervix uteri, and prostate suggest a need for cancer control interventions in selected groups. The observed variation in cancer patterns among API groups indicates the importance of monitoring these groups separately, as these patterns may provide etiologic clues that could be investigated by analytic epidemiological studies.
PMCID: PMC2268721  PMID: 18066673
Cancer; Incidence; Mortality; Race; Ethnicity; Asian; Pacific Islander; SEER Program
8.  Uncovering disparities in survival after non-small-cell lung cancer among Asian/Pacific Islander ethnic populations in California 
Asians may have better survival after non-small-cell lung cancer (NSCLC) than non-Asians. However, it is unknown whether survival varies among the heterogeneous U.S. Asian/Pacific Islander (API) populations. Therefore, this study aimed to quantify survival differences among APIs with NSCLC. Differences in overall and disease-specific survival were analyzed in the California Cancer Registry among 16,577 API patients diagnosed with incident NSCLC between 1988 and 2007. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models with separate baseline hazards by disease stage. Despite better overall and disease-specific survival among APIs compared with non-Hispanic Whites, differences were evident across API populations. Among women, Japanese (overall survival HR=1.16, 95% CI=1.06–1.27) and APIs other than those in the six largest ethnic groups (“other APIs”; HR=1.19, 95% CI=1.07–1.33) had significantly poorer overall and disease-specific survival than Chinese. By contrast, South Asian women had significantly better survival than Chinese (HR=0.79, 95% CI=0.63–0.97). Among men, Japanese (HR=1.15, 95% CI=1.07–1.24), Vietnamese (HR=1.07, 95% CI=1.00–1.16), and other APIs (HR=1.18, 95% CI=1.08–1.28) had significantly poorer overall and disease-specific survival than Chinese. Other factors independently associated with poorer survival were lower neighborhood SES, involvement with a non-university-teaching hospital, unmarried status, older age, and earlier year of diagnosis. APIs have significant ethnic differences in NSCLC survival that may be related to disparate lifestyles, biology, and especially health care access or use. To reduce the nationwide burden of lung cancer mortality, it is critical to identify and ameliorate hidden survival disparities such as those among APIs.
PMCID: PMC2764550  PMID: 19622719
non-small-cell lung cancer; survival; Asian Americans; Pacific Islanders; ethnic groups
9.  Papillary thyroid cancer incidence rates vary significantly by birthplace in Asian American women 
Cancer causes & control : CCC  2011;22(3):479-485.
To investigate how birthplace influences the incidence of papillary thyroid cancer among Asian American women.
Birthplace- and ethnic-specific age-adjusted and age-specific incidence rates were calculated using data from the California Cancer Registry for the period 1988–2004. Birthplace was statistically imputed for 30% of cases using a validated imputation method based on age at Social Security number issuance. Population estimates were obtained from the US Census. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for foreign-born vs. US-born women.
Age-adjusted incidence rates of papillary thyroid cancer among Filipina (13.7 per 100,000) and Vietnamese (12.7) women were more than double those of Japanese women (6.2). US-born Chinese (IRR=0.48, 95% CI: 0.40–0.59) and Filipina women (IRR=0.74, 95% CI: 0.58–0.96) had significantly higher rates than those who were foreign-born; the opposite was observed for Japanese women (IRR=1.55, 95% CI: 1.17–2.08). The age-specific patterns among all foreign-born Asian women and US-born Japanese women showed a slow steady increase in incidence until age 70. However, among US-born Asian women (except Japanese), substantially elevated incidence rates during the reproductive and menopausal years were evident.
Ethnic- and birthplace-variation in papillary thyroid cancer incidence can provide insight into the etiology of this increasingly common and understudied cancer.
PMCID: PMC3291661  PMID: 21207130
papillary thyroid cancer; incidence rates; birthplace; Asian American women; cancer surveillance
10.  Comparative analysis of lifestyle factors, screening test use, and clinicopathologic features in association with survival among Asian Americans with colorectal cancer 
Yi, M | Xu, J | Liu, P | Chang, G J | Du, X L | Hu, C-y | Song, Y | He, J | Ren, Y | Wei, Y | Yang, J | Hunt, K K | Li, X
British Journal of Cancer  2013;108(7):1508-1514.
Colorectal cancer (CRC) diagnoses and disease-specific survival (DSS) vary between ethnic groups in the United States. However, few studies have assessed differences among Asian subgroups.
The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with invasive CRC between 1988 and 2008. Differences in clinicopathologic features, and DSS rates were compared among Asian subgroups. The California Health Interview Survey was used to examine risk factors and screening patterns for CRC.
The study included 359 374 patients with 8.4% Asian. Patients in all Asian subgroups were younger (median: 68 years) at diagnosis than non-Hispanic white (NHW) patients (median: 72 years). Most Asian subgroups, except Hawaiians, had better DSS than NHW patients although Asian subgroups had more advanced disease than NHW. Indian/Pakistani patients had a higher 5-year DSS than other Asian subgroups. Obesity proportions were lower in Asian subgroups (<50.2%) than in NHW (59.8%). Vietnamese men and Korean women had the lowest proportions of CRC screening. Advance tumour stages were highly associated with worse DSS in each ethnicity group. High tumour grades were associated with worse DSS in NHW, Filipino, and Chinese. Older age at diagnosis was associated with worse DSS in most ethnicity groups except Hawaiian and Vietnamese.
Disparities exist between Asians and NHW with CRC, and among various Asian subgroups. Differences in cancer clinicopathologic features, patients' behavioural habits, lifestyle, and screening patterns may explain some differences in CRC survival observed among ethnic groups.
PMCID: PMC3629437  PMID: 23470470
Asian Americans; colorectal cancer; lifestyle factors; screening test; clinicopathologic; survival
11.  Cancer Incidence Trends Among Asian American Populations in the United States, 1990–2008 
National cancer incidence trends are presented for eight Asian American groups: Asian Indians/Pakistanis, Chinese, Filipinos, Japanese, Kampucheans, Koreans, Laotians, and Vietnamese.
Cancer incidence data from 1990 through 2008 were obtained from 13 Surveillance, Epidemiology, End Results (SEER) registries. Incidence rates from 1990 through 2008 and average percentage change were computed using SEER*Stat and Joinpoint software. The annual percentage change (APC) in incidence rates was estimated with 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. Rates for non-Hispanic whites are presented for comparison.
Prostate cancer was the most common malignancy among most groups, followed by lung, colorectal, liver, and stomach cancers. Breast cancer was generally the most common cancer in women, followed by colorectal and lung cancers; liver, cervix, thyroid, and stomach cancers also ranked highly. Among men, increasing trends were observed for prostate (Asian Indians and Pakistanis: APC 1990–2003 = 2.2, 95% CI = 0.3 to 4.1; Filipinos: APC 1990–1994 = 19.0, 95% CI = 4.5 to 35.4; Koreans: APC 1990–2008 = 2.9, 95% CI = 1.8 to 4.0), colorectal (Koreans: APC 1990–2008 = 2.2, 95% CI = 0.9 to 3.5), and liver cancers (Filipinos: APC 1990–2008 = 1.6, 95% CI = 0.4 to 2.7; Koreans: APC 1990–2006 = 2.1, 95% CI = 0.4 to 3.7; Vietnamese: APC 1990–2008 = 1.6, 95% CI = 0.3 to 2.8), whereas lung and stomach cancers generally remained stable or decreased. Among women, increases were observed for uterine cancer (Asian Indians: APC 1990–2008 = 3.0, 95% CI = 0.3 to 5.8; Chinese: APC 2004–2008 = 7.0, 95% CI = 1.4 to 12.9; Filipina: APC 1990–2008 = 3.0, 95% CI = 2.4 to 3.7; Japanese: APC 1990–2008 = 1.1, 95% CI = 0.1 to 2.0), colorectal cancer (Koreans: APC 1990–2008 = 2.8, 95% CI = 1.7 to 3.9; Laotians: APC: 1990–2008 = 5.9, 95% CI = 4.0 to 7.7), lung cancer (Filipinas: APC 1990–2008 = 2.1, 95% CI = 1.4 to 2.8; Koreans: APC 1990–2008 = 2.1, 95% CI = 0.6 to 3.6), thyroid cancer (Filipinas: APC 1990–2008 = 2.5, 95% CI = 1.7 to 3.3), and breast cancer in most groups (APC 1990–2008 from 1.2 among Vietnamese and Chinese to 4.7 among Koreans). Decreases were observed for stomach (Chinese and Japanese), colorectal (Chinese), and cervical cancers (Laotians and Vietnamese).
These data fill a critical knowledge gap concerning the cancer experience of Asian American groups and highlight where increased preventive, screening, and surveillance efforts are needed—in particular, lung cancer among Filipina and Korean women and Asian Indian/Pakistani men, breast cancer among all women, and liver cancer among Vietnamese, Laotian, and Kampuchean women and Filipino, Kampuchean, and Vietnamese men.
PMCID: PMC3735462  PMID: 23878350
12.  English Language Proficiency and Smoking Prevalence among California's Asian Americans 
Cancer  2005;104(12 Suppl):2982-2988.
The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females.
PMCID: PMC1810894  PMID: 16276539
public health; epidemiology; cancer; statistics
13.  Disparities in Colorectal Cancer Screening Rates among Asian Americans and Non-Latino Whites 
Cancer  2005;104(12 Suppl):2940-2947.
Among Asian Americans, colorectal cancer (CRC) is the second most commonly diagnosed cancer, and it is the third highest cause of cancer-related mortality. The 2001 California Health Interview Survey (CHIS 2001) was used to examine 1) CRC screening rates between different Asian-American ethnic groups compared with non-Latino whites and 2) factors related to CRC screening. The CHIS 2001 was a population-based telephone survey that was conducted in California. Responses about CRC screening were analyzed from 1771 Asian Americans age 50 years and older (Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese). The authors examined two CRC screening outcomes: individuals who ever had CRC screening and individuals who were up to date for CRC screening. For CRC screening, fecal occult blood test (FOBT), sigmoidoscopy/colonoscopy, and any other form of screening were examined. CRC screening of any kind was low in all populations, and Koreans had the lowest rate (49%). Multivariate analysis revealed that, compared with non-Latino whites, Koreans were less likely to undergo FOBT (odds ratio [OR], 0.40; 95% confidence interval [95% CI], 0.25–0.62), and Filipinos were the least likely to undergo sigmoidoscopy/colonoscopy (OR, 0.62; 95% CI, 0.44–0.88) or to be up to date with screening (OR, 0.68; 95% CI, 0.48–0.97). Asian Americans were less likely to undergo screening if they were older, male, less educated, recent immigrants, living with ≥ 3 individuals, poor, or uninsured. Asian-American populations, especially Koreans and Filipinos, are under-screened for CRC. Outreach efforts could be more focused on helping Asian Americans to understand the importance of CRC screening, providing accurate information in different Asian languages. Other strategies for increasing CRC screening may include using a more family-centered approach and using qualified translators.
PMCID: PMC1810896  PMID: 16276538
Asian American Network for Cancer Awareness, Research, and Training; cancer; Chinese; Vietnamese; Korean; Filipino; South Asian; Japanese; fecal occult blood test; sigmoidoscopy; colonoscopy
14.  What factors explain disparities in mammography rates among Asian American immigrant women? A population-based study in California 
The purpose of this study was to compare rates of screening mammography among immigrant women in five Asian American ethnic groups in California, and ascertain the extent to which differences in mammography rates among these groups are attributable to differences in known correlates of cancer screening.
Using 2009 data from the California Health Interview Survey, we compared the rates of mammography among Chinese, Filipino, Japanese, Korean, and Vietnamese immigrants 40 years and older. To assess the impact of Asian ethnicity on participation in screening, we performed multiple logistic regression analysis with models that progressively adjusted for acculturation, socio-demographic characteristics, access to health care and breast cancer risk factors, and examined the predicted probabilities of screening after adjusting for these factors.
Participation in screening mammography differed according to ethnicity, with Filipina and Vietnamese Americans having the highest rates and Korean Americans having the lowest rates of lifetime and recent (past two years) screening. These differences decreased substantially after adjusting for acculturation, socio-demographic factors and risk factors of breast cancer but differences still remained, most notably for Korean Americans, who continued to have the lowest predicted probability of screening even after adjustment for these factors.
This analysis draws attention to low mammography screening rates among Asian American immigrants, especially recent immigrants who lack health insurance. Given that their breast cancer incidence is rising with length of stay in the United States, it is very important to increase regular mammography screening in these groups.
PMCID: PMC3833860  PMID: 24183415
15.  Patient, hospital, and neighborhood factors associated with treatment of early-stage breast cancer among Asian American women in California 
Clinical guidelines recommend breast conserving surgery (BCS) with radiation as a viable alternative to mastectomy for treatment of early-stage breast cancer. Yet, Asian Americans (AA) are more likely than other groups to have mastectomy or omit radiation after BCS.
We applied polytomous logistic regression and recursive partitioning (RP) to analyze factors associated with mastectomy, or BCS without radiation, among 20,987 California AAs diagnosed with stage 0–II breast cancer from 1990–2007.
The percentage receiving mastectomy ranged from 40% among US-born Chinese to 58% among foreign-born Vietnamese. Factors associated with mastectomy included tumor characteristics such as larger tumor size, patient characteristics such as older age and foreign birthplace among some AA ethnicities, and additional factors including hospital (smaller hospital size, not NCI cancer center, low socioeconomic status (SES) patient composition, and high hospital AA patient composition) and neighborhood characteristics (ethnic enclaves of low SES). These hospital and neighborhood characteristics were also associated with BCS without radiation. Through RP, the highest mastectomy subgroups were defined by tumor characteristics such as size and anatomic location, in combination with diagnosis year and nativity.
Tumor characteristics and, secondarily, patient, hospital and neighborhood factors, are predictors of mastectomy and omission of radiation following BCS among AAs.
By focusing on interactions among patient, hospital, and neighborhood factors in the differential receipt of breast cancer treatment, our study identifies subgroups of interest for further study, and translation into public health and patient-focused initiatives to ensure that all women are fully informed about treatment options.
PMCID: PMC3406750  PMID: 22402290
16.  Survival of Distinct Asian Groups Among Colorectal Cancer Cases in California 
Cancer  2009;115(2):259-270.
It has been reported that Asian ethnicity confers a survival benefit in colorectal cancer (CRC) compared with other ethnicities, but it is not known if this is limited to specific Asian subsets. In the current study, the authors attempted to determine differences using data from the large, population-based California Cancer Registry (CCR).
The authors conducted a case-only analysis of CCR data (1994–2003), including descriptive analysis of relevant clinical variables. Overall survival univariate analyses were conducted using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazards ratios (HR).
The 61,494 incident cases of colon and 24,350 incident cases of rectal cancer analyzed included 1905 Chinese, 1162 Filipino, 414 Vietnamese, 391 Korean, 1091 Japanese, 148 Asian Indian, and 77,554 Caucasians. After adjustment for age, sex, grade, histology, site within the colon, stage of disease, insurance status, socioeconomic status (SES), and therapy, Filipino (colon: HR, 0.85; 95% confidence interval [95% CI], 0.76–0.95) (rectum: HR, 0.82; 95% CI, 0.71–0.94) and Chinese ethnicity (colon: HR, 0.90; 95% CI, 0.92–0.98) had significantly decreased risk of death compared with Caucasians. Sigmoid lesions were independently associated with improved survival among all cases (HR, 0.92; 95% CI, 0.88–0.95) (referent group were proximal and transverse lesions), and among Asian-only cases in separate analysis (HR, 0.78; 95% CI, 0.70–0.87).
Although survival after CRC diagnosis is improved for Asians in general, significant survival differences are observed only in specific Asian subsets. Data from the current study suggest that survival among Asians is less affected by SES or treatment disparities, and may be because of biologic factors.
PMCID: PMC4042844  PMID: 19109815
Asian; colorectal cancer; ethnicity; race; survival
17.  Asian Subgroups and Cancer Incidence and Mortality Rates in California 
Cancer  2005;104(12 Suppl):2975-2981.
The objective of this study was to characterize better the cancer burden among Asian subgroups in California. Nearly 3.7 million Asians reside in California, and no other state has as many Asians. Cancer statistics for Asians often are combined with statistics for Pacific Islanders, and rates for subgroups are not often examined, because most states do not have a large enough population. Asians are affected disproportionately by certain cancers, such as stomach and liver cancers. The California Cancer Registry, a population-based cancer registry, has collected data, including race/ethnicity data, since 1988. The 5-year, average, annual, age-adjusted cancer incidence and mortality rates from 1997 through 2001 were calculated for 5 Asian subgroups: Chinese, Filipino, Japanese, Korean, and Vietnamese. Cancer incidence and mortality varied greatly. Incidence rates for all sites combined among males varied from a low of 318.6 per 100,000 for Chinese to a high of 366.0 per 100,000 among Japanese. For females, rates ranged from 236.6 per 100,000 among Koreans to 302.4 per 100,000 among Japanese. Mortality rates also varied by Asian subgroup. Presenting one statistic for Asian/Pacific Islanders did not provide an accurate depiction of the cancer burden among the different Asian subgroups. Acculturation will continue to affect the patterns of cancer incidence among Asian subgroups in California.
PMCID: PMC1810966  PMID: 16247792
Asian American Network for Cancer Awareness, Research, and Training; cancer surveillance; Chinese; incidence; mortality; Filipino; Japanese; Korean; Vietnamese; California
18.  Breast cancer incidence patterns among California Hispanic women: Differences by nativity and residence in an enclave 
Breast cancer incidence is higher in US-born Hispanic women than foreign-born Hispanics, but no studies have examined how these rates have changed over time. To better inform cancer control efforts, we examined incidence trends by nativity and incidence patterns by neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants).
Information regarding all Hispanic women diagnosed with invasive breast cancer between 1988 and 2004 were obtained from the California Cancer Registry. Nativity was imputed from Social Security number for the 27% of cases with missing birthplace information. Neighborhood variables were developed from Census data.
From 1988 to 2004, incidence rates for US-born Hispanics were parallel, but lower than, those of non-Hispanic whites, showing an annual 6% decline from 2002 to 2004. Foreign-born Hispanics had an annual 4% increase in incidence rates from 1995 to 1998 and a 1.4% decline thereafter. Rates were 38% higher for US- than foreign-born Hispanics, with elevations more pronounced for localized than regional/distant disease, and for women > 50 years of age. Residence in higher SES and lower Hispanic enclave neighborhoods were independently associated with higher incidence, with Hispanic enclave having a stronger association than SES.
Compared to foreign-born, US-born Hispanic women in California had higher prevalence of breast cancer risk factors, suggesting that incidence patterns largely reflects these differences in risk factors.
Further research is needed to separate the effects of individual- and neighborhood-level factors that impact incidence in this large and growing population.
PMCID: PMC2895619  PMID: 20447917
19.  Trends in Colorectal Cancer Screening Utilization among Ethnic Groups in California: Are We Closing the Gap? 
Given the low prevalence of and racial/ethnic disparities in colorectal cancer (CRC) screening, it is important to monitor whether prevalence and disparities are increasing or decreasing over time.
We estimated the prevalence of CRC screening by year (2001, 2003 and 2005), modality (endoscopy, fecal occult blood test, either) and recency (ever had, up-to-date) for the California population as a whole, major racial/ethnic groups (White, Black, Latino, Asian), and selected Asian subgroups (Chinese, Filipino, Japanese, Korean, Vietnamese) using data from the California Health Interview Survey. All prevalence estimates were age- and gender-standardized.
Between 2001 and 2005, prevalence of up-to-date screening increased significantly among Whites and Latinos but not among Blacks and Asian Americans. Screening prevalence varied substantially among Asian subgroups, with Korean, Filipino and Vietnamese Americans having the lowest prevalence. Korean Americans were the only group in the analysis with a significant decline in screening prevalence between 2001 and 2005. The gap between the highest and lowest up-to-date screening prevalence using any screening modality, exhibited by Japanese and Korean Americans, increased from 18% in 2001 to 30% in 2005.
Findings suggest that we need to intensify efforts to increase colorectal cancer screening, especially among Korean Americans but also among Filipinos, Vietnamese and Latinos.
PMCID: PMC2745842  PMID: 19273482
colorectal cancer screening; ethnic disparities; Asian subgroups; California Health Interview Survey
20.  Menstrual and reproductive factors and risk of breast cancer in Asian-Americans. 
British Journal of Cancer  1996;73(5):680-686.
We conducted a population-based case-control study of breast cancer among Chinese-, Japanese- and Filipino-American women in Los Angeles County Metropolitan Statistical Area (MSA), San Francisco-Oakland MSA and Oahu, Hawaii. One objective of the study was to quantify breast cancer risks in relation to menstrual and reproductive histories in migrant and US-born Asian-Americans and to establish whether the gradient of risk in Asian-Americans can be explained by these factors. Using a common study design and questionnaire in the three study areas, we successfully conducted in-person interviews with 597 Asian-American women diagnosed with incident, primary breast cancer during the period 1983-87 (70% of those eligible) and 966 population-based controls (75% of those eligible). Controls were matched to cases on age, ethnicity and area of residence. In the present analysis, which included 492 cases and 768 controls, we observed a statistically non-significant 4% reduction in risk of breast cancer with each year delay in onset of menstruation. Independent of age at menarche risk of breast cancer was lower (odds ratio; OR=0.77) among women with menstrual cycles greater than 29 days. Parous Asian-American women showed a significantly lower risk of breast cancer then nulliparous women (OR=0.54). An increasing number of livebirths and a decreasing age at first livebirth were both associated with a lower risk of breast cancer, although the effect of number of livebirths was no longer significant after adjustment for age at first livebirth. Women with a pregnancy (spontaneous or induced abortions) but no livebirth had a statistically non-significant increased risk (OR=1.84), but there was no evidence that one type of abortion was particularly harmful. A positive history of breastfeeding was associated with non-significantly lower risk of breast cancer (OR=.78). There are several notable differences in the menstrual and reproductive factors between Asian-Americans in this study and published data on US whites. US-born Asian Americans had an average age at menarche of 12.12 years-no older than has been found in comparable studies of US whites, but 1.4 years earlier than Asian women who migrated to the US. Asian-American women, particularly those born in the US and those who migrated before age 36, also had a later age at first birth and fewer livebirths than US whites. A slightly higher proportion of Asian-American women breastfed, compared with US whites. The duration of breastfeeding was similar in US-born Asians and US whites, but was longer in Asian migrants, especially those who migrated at a later age. Menstrual and reproductive factors in Asian-American women are consistent with their breast cancer rates being at least as high as in US whites, and they are. However, the effects of these menstrual and reproductive factors were small and the ORs for migration variables changed only slightly after adjustment for these menstrual and reproductive factors. These results suggest that the lower rates of breast cancer in Asians must be largely as a result of other environmental/lifestyle factors.
PMCID: PMC2074339  PMID: 8605107
21.  Cardiovascular risk factors in ethnic populations within Canada: results from national cross-sectional surveys  
Open Medicine  2010;4(3):e143-e153.
Differences in the prevalence of cardiovascular disease and associated risk factors have been noted across ethnic groups both within and between countries. The Canadian population is becoming increasingly diverse because of immigration. Understanding ethnic differences in cardiovascular risk factors is critically important in planning appropriate prevention strategies for the country’s rapidly changing population. We sought to examine the prevalence of cardiovascular risk factors in various Canadian ethnic groups.
We analyzed 3 cross-sectional cycles (for 2000, 2003 and 2005) of the Canadian Community Health Survey of people aged 12 years and older. The surveys were conducted by means of self-reported questionnaires. We used stratified analysis to evaluate the relation between risk factors and ethnicity. The effect of participants’ ethnicity on the prevalence of risk factors was estimated by means of logistic regression, with adjustment for differences in age, sex, marital status, education, household income, language spoken, immigration status, residency type (urban or rural), household size, region (province or territory) and chronic diseases (heart disease, stroke, cancer, bronchitis, chronic obstructive pulmonary disease, bowel disease, arthritis, epilepsy, ulcers, thyroid disease and diabetes mellitus).
We included 371 154 individuals in the analysis. Compared with white people, people from visible minorities (i.e., neither white nor Aboriginal) had a lower prevalence of diabetes mellitus (4.5% v. 4.0%), hypertension (14.7% v. 10.8%), smoking (20.4% v. 9.7%) and obesity (defined as body mass index ≥ 30; 14.8% v. 9.7%) but a higher prevalence of physical inactivity (50.3% v. 58.1%). More specifically, after adjustment for sociodemographic characteristics, people from most visible minorities, in comparison with the white population, were less likely to smoke; were more likely to be physically inactive, with the exception of people of Korean, Japanese and Latin ethnicity; and were less likely to be obese, with the exception of people of black, Latin, Arab or West Asian ethnicity. However, relative to white people, hypertension was more prevalent among those of Filipino or South East Asian background (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.23–1.93) and those of black ancestry (OR 1.69, 95% CI 1.43–2.00).
Cardiovascular risk factors vary dramatically by ethnic group. Health professionals should increase their promotion of physical activity among visible minorities and should prioritize the detection and control of diabetes and hypertension during routine contact with patients of visible minorities, particularly those of South Asian, Filipino and black ethnicity.
PMCID: PMC3090103  PMID: 21687334
22.  The Promise of Prevention: The Effects of Four Preventable Risk Factors on National Life Expectancy and Life Expectancy Disparities by Race and County in the United States 
PLoS Medicine  2010;7(3):e1000248.
Majid Ezzati and colleagues examine the contribution of a set of risk factors (smoking, high blood pressure, elevated blood glucose, and adiposity) to socioeconomic disparities in life expectancy in the US population.
There has been substantial research on psychosocial and health care determinants of health disparities in the United States (US) but less on the role of modifiable risk factors. We estimated the effects of smoking, high blood pressure, elevated blood glucose, and adiposity on national life expectancy and on disparities in life expectancy and disease-specific mortality among eight subgroups of the US population (the “Eight Americas”) defined on the basis of race and the location and socioeconomic characteristics of county of residence, in 2005.
Methods and Findings
We combined data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to estimate unbiased risk factor levels for the Eight Americas. We used data from the National Center for Health Statistics to estimate age–sex–disease-specific number of deaths in 2005. We used systematic reviews and meta-analyses of epidemiologic studies to obtain risk factor effect sizes for disease-specific mortality. We used epidemiologic methods for multiple risk factors to estimate the effects of current exposure to these risk factors on death rates, and life table methods to estimate effects on life expectancy. Asians had the lowest mean body mass index, fasting plasma glucose, and smoking; whites had the lowest systolic blood pressure (SBP). SBP was highest in blacks, especially in the rural South—5–7 mmHg higher than whites. The other three risk factors were highest in Western Native Americans, Southern low-income rural blacks, and/or low-income whites in Appalachia and the Mississippi Valley. Nationally, these four risk factors reduced life expectancy at birth in 2005 by an estimated 4.9 y in men and 4.1 y in women. Life expectancy effects were smallest in Asians (M, 4.1 y; F, 3.6 y) and largest in Southern rural blacks (M, 6.7 y; F, 5.7 y). Standard deviation of life expectancies in the Eight Americas would decline by 0.50 y (18%) in men and 0.45 y (21%) in women if these risks had been reduced to optimal levels. Disparities in the probabilities of dying from cardiovascular diseases and diabetes at different ages would decline by 69%–80%; the corresponding reduction for probabilities of dying from cancers would be 29%–50%. Individually, smoking and high blood pressure had the largest effect on life expectancy disparities.
Disparities in smoking, blood pressure, blood glucose, and adiposity explain a significant proportion of disparities in mortality from cardiovascular diseases and cancers, and some of the life expectancy disparities in the US.
Please see later in the article for the Editors' Summary
Editors' Summary
Life expectancy (a measure of longevity and premature death) and overall health have increased steadily in the United States over recent years. New drugs, new medical technologies, and better disease prevention have all helped Americans to lead longer, healthier lives. However, even now, some Americans live much longer and much healthier lives than others. Health disparities—differences in how often certain diseases occur and cause death in groups of people classified according to their ethnicity, geographical location, sex, or age—are extremely large and persistent in the US. On average, black men and women in the US live 6.3 and 4.5 years less, respectively, than their white counterparts; the gap between life expectancy in the US counties with the lowest and highest life expectancies is 18.4 years for men and 14.3 years for women. Disparities in deaths (mortality) from chronic diseases such as cardiovascular diseases (for example, heart attacks and stroke), cancers, and diabetes are known to be the main determinants of these life expectancy disparities.
Why Was This Study Done?
Preventable risk factors such as smoking, high blood pressure, excessive body fat (adiposity), and high blood sugar are responsible for many thousands of deaths from chronic diseases. Exposure to these risk factors varies widely by race, state of residence, and socioeconomic status. However, the effects of these observed disparities in exposure to modifiable risk factors on US life expectancy disparities have only been examined in selected groups of people and it is not known how multiple modifiable risk factors affect US health disparities. A better knowledge about how disparities in risk factor exposure contribute to health disparities is needed to ensure that prevention programs not only improve the average health status but also reduce health disparities. In this study, the researchers estimate the effects of smoking, high blood pressure, high blood sugar, and adiposity on US life expectancy and on disparities in life expectancy and disease-specific deaths among the “Eight Americas,” population groups defined by race and by the location and socioeconomic characteristics of their county of residence.
What Did the Researchers Do and Find?
The researchers extracted data on exposure to these risk factors from US national health surveys, information on deaths from different diseases in 2005 from the US National Center for Health Statistics, and estimates of how much each risk factor increases the risk of death from each disease from published studies. They then used modeling methods to estimate the effects of risk factor exposure on death rates and life expectancy. The Asian subgroup had the lowest adiposity, blood sugar, and smoking rates, they report, and the three white subgroups had the lowest blood pressure. Blood pressure was highest in the three black subgroups, whereas the other three risk factors were highest in Western Native Americans, Southern rural blacks, and whites living in Appalachia and the Mississippi Valley. The effects on life expectancy of these factors were smallest in Asians and largest in Southern rural blacks but, overall, these risk factors reduced the life expectancy for men and women born in 2005 by 4.9 and 4.1 years, respectively. Other calculations indicate that if these four risk factors were reduced to optimal levels, disparities among the subgroups in deaths from cardiovascular diseases and diabetes and from cancers would be reduced by up to 80% and 50%, respectively.
What Do These Findings Mean?
These findings suggest that disparities in smoking, blood pressure, blood sugar, and adiposity among US racial and geographical subgroups explain a substantial proportion of the disparities in deaths from cardiovascular diseases, diabetes, and cancers among these subgroups. The disparities in risk factor exposure also explain some of the disparities in life expectancy. The remaining disparities in deaths and life expectancy could be the result of preventable risk factors not included in this study—one of its limitations is that it does not consider the effect of dietary fat, alcohol use, and dietary salt, which are major contributors to different diseases. Thus, suggest the researchers, reduced exposure to preventable risk factors through the implementation of relevant policies and programs should reduce life expectancy and mortality disparities in the US and yield health benefits at a national scale.
Additional Information
Please access these Web sites via the online version of this summary at
The US Centers for Disease Control and Prevention, the US Office of Minority Health, and the US National Center on Minority Health and Health Disparities all provide information on health disparities in the US
MedlinePlus provides links to information on health disparities and on healthy living (in English and Spanish)
The US Centers for Disease Control and Prevention provides information on all aspects of healthy living
The American Heart Association and the American Cancer Society provide information on modifiable risk factors for patients and caregivers
Healthy People 2010 is a national framework designed to improve the health of people living in the US
The US National Health and Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS) collect information on risk factor exposures in the US
PMCID: PMC2843596  PMID: 20351772
23.  Prostate Cancer Risk Profiles in Asian Americans: Disentangling the Effects of Immigration Status and Race/Ethnicity 
The Journal of urology  2013;191(4):952-956.
Asian-American men with prostate cancer have been reported to present with higher grade and later stage disease than White Americans. However, Asian Americans comprise a heterogeneous population with distinct health outcomes. We compared prostate cancer risk profiles among the diverse racial and ethnic groups in California.
Materials and Methods
We used data from the California Cancer Registry for 90,845 Non-Hispanic White, Non-Hispanic Black, and Asian-American men diagnosed with prostate cancer between 2004 and 2010. Patients were categorized into low, intermediate, or high-risk groups based on clinical stage, Gleason score, and PSA value at diagnosis. Using polytomous logistic regression, we estimated adjusted odds ratios for the association of race/ethnicity and nativity with risk group.
In addition to Non-Hispanic Blacks, six Asian-American groups (US-born Chinese, foreign-born Chinese, US-born Japanese, foreign-born Japanese, foreign-born Filipino, and foreign-born Vietnamese) were more likely to have an unfavorable risk profile compared to Non-Hispanic Whites. The odds ratios for high vs. intermediate-risk disease ranged from 1.23 (95% CI, 1.02–1.49) for US-born Japanese to 1.45 (95% CI, 1.31–1.60) for foreign-born Filipinos. These associations appeared to be driven by higher grade and PSA values, rather than advanced clinical stage at diagnosis.
In this large, ethnically diverse population-based cohort, we found that Asian-American men were more likely to have unfavorable risk profiles at diagnosis. This association varied by racial/ethnic group and nativity, and was not attributable to later stage at diagnosis, suggesting that Asian men may have biological differences that predispose to the development of more severe disease.
PMCID: PMC4051432  PMID: 24513166
Asian Americans; prostatic neoplasms; epidemiology; SEER Program
24.  Lymphoid malignancies in US Asians: incidence rate differences by birthplace and acculturation 
Malignancies of the lymphoid cells, including non-Hodgkin lymphomas (NHLs), Hodgkin lymphoma (HL) and multiple myeloma (MM), occur at much lower rates in Asians than other racial/ethnic groups in the United States (US). It remains unclear whether these deficits are explained by genetic or environmental factors. To better understand environmental contributions, we examined incidence patterns of lymphoid malignancies among populations characterized by ethnicity, birthplace, and residential neighborhood socioeconomic status (SES) and ethnic enclave status.
We obtained data regarding all Asian patients diagnosed with lymphoid malignancies between 1988 and 2004 from the California Cancer Registry and neighborhood characteristics from US Census data.
While incidence rates of most lymphoid malignancies were lower among Asian than white populations, only follicular lymphoma (FL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and nodular sclerosis (NS) HL rates were statistically significantly lower among foreign-born than US-born Asians, with incidence rate ratios ranging from 0.34 to 0.87. Rates of CLL/SLL and NS HL were also lower among Asian women living in ethnic enclaves or lower-SES neighborhoods than those living elsewhere. Conclusions: These observations support strong roles of environmental factors in the causation of FL, CLL/SLL, and NS HL.
Studying specific lymphoid malignancies in US Asians may provide valuable insight towards understanding their environmental causes.
PMCID: PMC3111874  PMID: 21493873
lymphoid malignancies; Asians; immigration; environmental causes
25.  Explaining disparities in colorectal cancer screening among five Asian ethnic groups: A population-based study in California 
BMC Cancer  2010;10:214.
Data from the California Health Interview Survey (CHIS) indicate that levels and temporal trends in colorectal cancer (CRC) screening prevalence vary among Asian American groups; however, the reasons for these differences have not been fully investigated.
Using CHIS 2001, 2003 and 2005 data, we conducted hierarchical regression analyses progressively controlling for demographic characteristics, English proficiency and access to care in an attempt to identify factors explaining differences in screening prevalence and trends among Chinese, Filipino, Vietnamese, Korean and Japanese Americans (N = 4,188).
After controlling for differences in gender and age, all Asian subgroups had significantly lower odds of having ever received screening in 2001 than the reference group of Japanese Americans. In addition, Korean Americans were the only subgroup that had a statistically significant decline in screening prevalence from 2001 to 2005 compared to the trend among Japanese Americans. After controlling for differences in education, marital status, employment status and federal poverty level, Korean Americans were the only group that had significantly lower screening prevalence than Japanese Americans in 2001, and their trend to 2005 remained significantly depressed. After controlling for differences in English proficiency and access to care, screening prevalences in 2001 were no longer significantly different among the Asian subgroups, but the trend among Korean Americans from 2001 to 2005 remained significantly depressed. Korean and Vietnamese Americans were less likely than other groups to report a recent doctor recommendation for screening and more likely to cite a lack of health problems as a reason for not obtaining screening.
Differences in CRC screening trends among Asian ethnic groups are not entirely explained by differences in demographic characteristics, English proficiency and access to care. A better understanding of mutable factors such as rates of doctor recommendation and health beliefs will be crucial for designing culturally appropriate interventions to promote CRC screening.
PMCID: PMC2888788  PMID: 20482868

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