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1.  Pathways of Breast Cancer Screening Among Chinese American Women 
The purpose of this community-based study was to develop a structural equation model for factors contributing to breast cancer screening among Chinese American women.
A cross-sectional design included a sample of 440 Chinese American women aged 40 years and older. The initial step involved use of confirmatory factor analysis, which included the following variables: access/satisfaction with health care, enabling, predisposing, and cultural and health belief factors. Structural equation model analyses were conducted to evaluate factors related to breast cancer screening in Chinese American women.
Initial univariate analyses indicated that women without health insurance were significantly more likely to report being never-screened compared to women with health insurance. Structural equation modeling techniques were used to evaluate the utility of the Sociocultural Health Behavior model in understanding breast cancer screening among Chinese American women. Results indicated that enabling and predisposing factors were significantly and positively related to breast cancer screening. Cultural factors were significantly associated with enabling factors and satisfaction with healthcare. Overall, the proposed model explained 34% of the variance in breast cancer screening among Chinese American women.
The model highlights the significance of enabling and predisposing factors in understanding breast cancer screening behaviors among Chinese American women. In addition, cultural factors were associated with enabling factors, reinforcing the importance of providing translation assistance to Chinese women with poor English fluency and increasing awareness of the critical role of breast cancer screening. Partnering with community organizations may help to facilitate and enhance the screening rates.
PMCID: PMC3762685  PMID: 24013711
Mammograms; Breast cancer screening; Chinese women
2.  Prostate Cancer Screening Among Chinese American Men: A Structural Model 
To test the Sociocultural Health Behavior Model in relation to the health behavior of prostate cancer (PCa) screening among Chinese American men.
Confirmatory factor analysis and structural equation model analyses were conducted among Chinese American men.
The path analysis supported the components of the sociocultural model and indicated a positive and significant relationship between PCa screening and the enabling factors; between cultural factors and predisposing, enabling, and access/satisfaction with health care factors; and between enabling factors and access/satisfaction with health care.
The model highlights the significance that sociocultural factors play in relation to PCa screening.
PMCID: PMC3325499  PMID: 22488399
digital rectal exam; prostate specific antigen (PSA) blood test; prostate cancer screening; structural equation model
3.  Do cultural factors predict mammography behavior among Korean immigrants? 
Journal of advanced nursing  2009;65(12):2574-2584.
This paper is a report of a study of the correlates of mammogram use among Korean American women.
Despite the increasing incidence of and mortality from breast cancer, Asian women in the United States of America report consistently low rates of mammography screening. A number of health beliefs and sociodemographic characteristics have been associated with mammogram participation among these women; however, studies systematically investigating cultural factors in relation to mammogram experience have been scarce.
We measured screening-related health beliefs, modesty and use of Eastern medicine in 100 Korean American women in 2006. Hierarchical logistic regression was used to examine the unique contribution of the study variables, after accounting for sociodemographic characteristics.
Only 51% reported past mammogram use. Korean American women who had previously had mammograms were statistically significantly older and had higher perceived benefit scores than those who had not. Perceived benefits (odds ratio=6.3, 95% confidence interval=2.12, 18.76) and breast cancer susceptibility (odds ratio=3.18, 95% confidence interval=1.06, 9.59) were statistically significant correlates of mammography experience, whereas cultural factors did not correlate. Post hoc analysis showed that for women with some or good English skills, cultural factors statistically significantly correlated with health beliefs and breast cancer knowledge (p < 0.05).
Nurses should consider the inclusion in culturally-tailored interventions of more targeted outreach and healthcare system navigation assistance for promoting mammography screening in Korean American women. Further research is needed to unravel the interplay between acculturation, cultural factors, and health beliefs related to cancer screening behaviors of Korean American women.
PMCID: PMC2786070  PMID: 19941544
breast cancer; cultural factors; mammography; ethnicity; Women’s health; Immigrants; Korea
4.  Health Beliefs Associated with Cervical Cancer Screening Among Vietnamese Americans 
Journal of Women's Health  2013;22(3):276-288.
Vietnamese American women represent one of the ethnic subgroups at great risk for cervical cancer in the United States. The underutilization of cervical cancer screening and the vulnerability of Vietnamese American women to cervical cancer may be compounded by their health beliefs.
The objective of this study was to explore the associations between factors of the Health Belief Model (HBM) and cervical cancer screening among Vietnamese American women.
Vietnamese American women (n=1,450) were enrolled into the randomized controlled trial (RCT) study who were recruited from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey. Participants completed baseline assessments of demographic and acculturation variables, health care access factors, and constructs of the HBM, as well as health behaviors in either English or Vietnamese.
The rate of those who had ever undergone cervical cancer screening was 53% (769/1450) among the participants. After adjusting for sociodemographic variables, the significant associated factors from HBM included: believing themselves at risk and more likely than average women to get cervical cancer; believing that cervical cancer changes life; believing a Pap test is important for staying healthy, not understanding what is done during a Pap test, being scared to know having cervical cancer; taking a Pap test is embarrassing; not being available by doctors at convenient times; having too much time for a test; believing no need for a Pap test when feeling well; and being confident in getting a test.
Understanding how health beliefs may be associated with cervical cancer screening among underserved Vietnamese American women is essential for identifying the subgroup of women who are most at risk for cervical cancer and would benefit from intervention programs to increase screening rates.
PMCID: PMC3601630  PMID: 23428284
5.  Korean women: breast cancer knowledge, attitudes and behaviors 
BMC Public Health  2001;1:7.
Clustered within the nomenclature of Asian American are numerous subgroups, each with their own ethnic heritage, cultural, and linguistic characteristics. An understanding of the prevailing health knowledge, attitudes, and screening behaviors of these subgroups is essential for creating population-specific health promotion programs.
Korean American women (123) completed baseline surveys of breast cancer knowledge, attitudes, and screening behaviors as part of an Asian grocery store-based breast cancer education program evaluation. Follow-up telephone surveys, initiated two weeks later, were completed by 93 women.
Low adherence to the American Cancer Society's breast cancer screening guidelines and insufficient breast cancer knowledge were reported. Participants' receptiveness to the grocery store-based breast cancer education program underscores the importance of finding ways to reach Korean women with breast cancer early detection information and repeated cues for screening. The data also suggest that the Asian grocery store-based cancer education program being tested may have been effective in motivating a proportion of the women to schedule a breast cancer screening between the baseline and follow-up surveys.
The program offers a viable strategy to reach Korean women that addresses the language, cultural, transportation, and time barriers they face in accessing breast cancer early detection information.
PMCID: PMC55345  PMID: 11553321
6.  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
7.  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
8.  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
9.  Ethnic Differences in Prevalence and Barriers of HBV Screening and Vaccination Among Asian Americans 
Journal of community health  2012;37(5):1071-1080.
Our study identifies the prevalence of HBV virus (HBV) screening and vaccination among Asian Americans, and ethnic differences for factors associated with screening and vaccination behaviors. In 2009–2010 we recruited 877 Korean, Chinese, and Vietnamese Americans 18 years of age and above through several community organizations, churches and local ethnic businesses in Maryland for a health education intervention and a self-administered survey. Prevalence of HBV screening, screening result and vaccinations were compared by each ethnic group. We used logistic regression analysis to understand how sociodemographics, familial factors, patient-, provider-, and resource-related barriers are associated with screening and vaccination behaviors, using the total sample and separate analysis for each ethnic group. Forty-seven percent of participants reported that they had received HBV screening and 38% had received vaccinations. Among the three groups, the Chinese participants had the highest screening prevalence, but lowest self-reported infection rate; Vietnamese has the lowest screening and vaccination prevalence. In multivariate analysis, having better knowledge of HBV, and family and physician recommendations was significantly associated with screening and vaccination behaviors. Immigrants who had lived in the US for more than a quarter of their lifetime were less likely to report ever having been screened (OR = 0.39, 95% CI: 0.28–0.55) or vaccinated (OR = 0.62, 95% CI: 0.44–0.88). In ethnic-specific analysis, having a regular physician (OR = 4.46, 95% CI: 1.62–12.25) and doctor's recommendation (OR = 2.11, 95% CI: 1.05–4.22) are significantly associated with Korean's vaccination behaviors. Health insurance was associated with vaccination behaviors only among Vietnamese (OR = 2.66, 95% CI: 1.21–5.83), but not among others.
PMCID: PMC3804552  PMID: 22302652
HBV infection; Asian Americans; HBV prevalence; Health care access barriers
10.  Pathways of cervical cancer screening among Chinese women 
The purpose of this community-based study was to develop a structural equation model for factors contributing to cervical cancer screening among Chinese American women.
A cross-sectional design included a sample of 573 Chinese American women aged 18 years and older. The initial step involved use of confirmatory factor analysis, that included the following variables: access to and satisfaction with health care, and enabling and predisposing cultural and health beliefs. Structural equation model analyses were conducted on factors related to cervical cancer screening.
Age, marital status, employment, household income, and having health insurance, but not educational level, were significantly related to cervical screening status. Predisposing and enabling factors were positively associated with cervical cancer screening. The cultural factor was significantly related to the enabling factor or the satisfaction with health care factor.
This model highlights the significance of sociocultural factors in relation to cervical cancer screening. These factors were significant, with cultural, predisposing, enabling, and health belief factors and access to and satisfaction with health care reinforcing the need to assist Chinese American women with poor English fluency in translation and awareness of the importance of cervical cancer screening. Community organizations may play a role in assisting Chinese American women, which could enhance cervical cancer screening rates.
PMCID: PMC3702238  PMID: 23843708
Papanicolaou test; cervical cancer screening; Chinese women
11.  Correlates of Cervical Cancer Screening among Vietnamese American Women 
Objective. Vietnamese American women are at the greatest risk for cervical cancer but have the lowest cervical cancer screening rates. This study was to determine whether demographic and acculturation, healthcare access, and knowledge and beliefs are associated with a prior history of cervical cancer screening among Vietnamese women. Methods. Vietnamese women (n = 1450) from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey participated in the study and completed baseline assessments. Logistic regression analyses were performed. Results. Overall levels of knowledge about cervical cancer screening and human papillomavirus (HPV) are low. Factors in knowledge, attitude, and beliefs domains were significantly associated with Pap test behavior. In multivariate analyses, physician recommendation for screening and having health insurance were positively associated with prior screening. Conclusion. Understanding the factors that are associated with cervical cancer screening will inform the development of culturally appropriate intervention strategies that would potentially lead to increasing cervical cancer screening rates among Vietnamese women.
PMCID: PMC3449126  PMID: 23008526
12.  Community-based breast cancer intervention program for older African American women in beauty salons. 
Public Health Reports  1995;110(2):179-183.
African American women are at high risk for morbidity and mortality from breast cancer. African American women ages 50 and older have been a difficult group to reach through conventional breast cancer intervention programs. Cultural and health beliefs that differ from mainstream society are reported to be factors contributing to the low rates of breast screening among this group. In addition to these attitudinal factors, older African American women are disproportionately represented among uninsured and under-insured Americans. As a result, cost becomes a barrier to mammography screening for many of these women. This project proposes to increase breast cancer screening awareness and provide a referral or free breast screening, or both, for African American women ages 50 and older. This information will be offered in the culturally familiar setting of local beauty salons. The culturally sensitive educational pamphlets developed by the National Cancer Institute (NCI) and video developed by the NCI-funded project, Cancer Prevention Research Unit, will be used to promote mammography, clinical breast examinations, and breast self-examination. Providers staffing a mobile mammography van provided by Dr. Anitha Mitchell of the Association of Black Women Physicians through a grant from the Breast and Cervical Cancer Control Program, funded by the Centers for Disease Control and Prevention, will perform mammograms for women on site during scheduled intervals. A followup telephone survey will be conducted.
PMCID: PMC1382099  PMID: 7630996
13.  Cancer-Related Information Seeking and Scanning Behavior of Older Vietnamese Immigrants 
Journal of health communication  2010;15(7):754-768.
Information seeking and scanning refers to active pursuit of information and passive exposure, respectively. Cancer (ca) is the leading cause of mortality for Asian Americans, yet little is known about their ca information seeking/scanning behaviors (SSB). We aimed to evaluate ca SSB among older limited English proficient (LEP) Vietnamese immigrants, compared to Whites/African Americans. 104 semi-structured interviews about breast/prostate/colon ca SSB (age 50–70) were conducted in English and Vietnamese, transcribed, and coded for frequency of source use, active/passive nature, depth of recall, and relevance to decisions. Higher SSB was associated with ca screening. In contrast to non-Vietnamese, SSB for Vietnamese was low. Median # of ca screening sources was 2 (vs. 8–9 for non-Vietnamese). They also had less seeking, lower recall, and less decision-making relevance for information on colon ca and all ca combined. Overall, Vietnamese had lower use of electronic, print, and interpersonal sources for ca SSB, but more research is needed to disentangle potential effects of ethnicity and education. This study brings to light striking potential differences between ca SSB of older LEP Vietnamese compared to Whites/African Americans. Knowledge of SSB patterns among linguistically isolated communities is essential for efficient dissemination of cancer information to these at-risk communities.
PMCID: PMC3064469  PMID: 21104504
14.  Breast cancer screening practices and correlates among American Indian and Alaska Native women in California, 2003 
Breast cancer incidence and mortality have been increasing among American Indian and Alaska Native (AI/AN) women, and their survival rate is the lowest of all racial/ethnic groups. Nevertheless, knowledge of AI/AN women’s breast cancer screening practices and their correlates is limited.
Using the 2003 California Health Interview Survey, we 1) compared the breast cancer screening practices of AI/AN women to other groups and 2) explored the association of several factors known or thought to influence AI/AN women’s breast cancer screening practices.
Compared to other races, AI/AN women had the lowest rate of mammogram screening (ever and within the past 2 years). For clinical breast exam receipt, Asian women had the lowest rate, followed by AI/AN women. Factors associated with AI/AN women’s breast cancer screening practices included older age, having a high school diploma or some college education, receipt of a Pap test within the past 3 years, and having visited a doctor within the past year.
Significant differences in breast cancer screening practices were noted between races, with AI/AN women often having significantly lower rates. Integrating these epidemiological findings into effective policy and practice requires additional applied research initiatives.
PMCID: PMC2935087  PMID: 20211430
breast cancer screening; American Indian or Alaska Native; women’s health
15.  Overcoming Barriers to Cervical Cancer Screening Among Asian American Women 
Significant disparities in cervical cancer incidence and mortality exist among ethnic minority women, and in particular, among Asian American women. These disparities have been attributed primarily to differences in screening rates across ethnic/racial groups. Asian American women have one of the lowest rates of screening compared to other ethnic/racial groups. Yet Asian Americans, who comprise one of the fastest growing populations in the United States, have received the least attention in cancer control research. Studies suggest that various factors, including lack of knowledge, psychosocial and cultural beliefs, and access barriers, are associated with cervical cancer screening behaviors among Asian American women. Indeed, the few interventions that have been developed for Asian American women demonstrate that targeting these factors can yield significant increases in screening rates. It is important to note, however, that the effectiveness of educational interventions is often attenuated if access barriers are not adequately addressed. Hence, interventions that include key essential components, such as the use of community individuals as lay health workers, culturally-tailored and linguistically-appropriate educational materials, and navigation assistance to overcome access barriers, are more likely to be successful in enhancing screening rates. As the benefits of community-based cervical cancer prevention programs become more apparent, it will be essential to identify effective approaches for disseminating such programs more broadly. In conclusion, community-based cervical cancer screening programs have demonstrated promise in addressing existing cervical cancer disparities by increasing awareness and knowledge and promoting recommended screening behaviors. These findings will be instrumental in guiding future community-based programs to reduce cervical cancer health disparities among Asian American women.
PMCID: PMC3115728  PMID: 21687826
cervical cancer; screening; Asian Americans; disparities; cancer prevention; community-based; psychosocial beliefs; access barriers
16.  Breast Cancer Screening Beliefs among Older Korean American Women 
Korean American women’s breast cancer screening rates are low, and the rates among older Korean American women are even lower. This article describes health beliefs related to older Korean American women’s screening behaviors, comparing them to beliefs of younger Korean American women. The 73 women age 65 and older had significantly different health beliefs than the 114 women between ages 40 and 64. Further, older women’s perceptions of the seriousness of the disease and benefits of and barriers to taking action to prevent the disease predated their screening behaviors. Interventions to change the health beliefs of older Korean American women are suggested.
PMCID: PMC3089419  PMID: 19715259
17.  Strategies for Piloting a Breast Health Promotion Program in the Chinese-Australian Population 
In Australia, women from non–English-speaking backgrounds participate less frequently in breast cancer screening than English-speaking women, and Chinese immigrant women are 50% less likely to participate in breast examinations than Australian-born women. Chinese-born Australians comprise 10% of the overseas-born Australian population, and the immigrant Chinese population in Australia is rapidly increasing. We report on the strategies used in a pilot breast health promotion program, Living with Healthy Breasts, aimed at Cantonese-speaking adult immigrant women in Sydney, Australia. The program consisted of a 1-day education session and a 2-hour follow-up session. We used 5 types of strategies commonly used for cultural targeting (peripheral, evidential, sociocultural, linguistic, and constituent-involving) in a framework of traditional Chinese philosophies (Confucianism, Taoism, and Buddhism) to deliver breast health messages to Chinese-Australian immigrant women. Creating the program's content and materials required careful consideration of color (pink to indicate femininity and love), symbols (peach blossoms to imply longevity), word choice (avoidance of the word death), location and timing (held in a Chinese restaurant a few months after the Chinese New Year), communication patterns (the use of metaphors and cartoons for discussing health-related matters), and concern for modesty (emphasizing that all presenters and team members were female) to maximize cultural relevance. Using these strategies may be beneficial for designing and implementing breast cancer prevention programs in Cantonese-speaking Chinese immigrant communities.
PMCID: PMC3266691  PMID: 22172170
18.  Continuity of Care and Colorectal Cancer Screening by Vietnamese American Patients 
Colorectal cancer (CRC) screening rates among Asian Americans are 30–50% lower than among Whites. Using practice management and electronic medical records data from a community health center, we examined the association of CRC screening with continuity of care and comorbidity. These variables have not previously been studied in Asian American and limited-English proficient populations.
After obtaining IRB approval, we extracted data in 2009 on age-eligible Vietnamese patients who had one or more clinic visits in the prior 24 months. Our analysis examined associations between CRC screening (per current US Preventive Services Task Force guidelines) and clinic site, demographics, insurance status, continuity of care, comorbidities, and provider characteristics.
We identified a total of 1,016 eligible patients (604 at Clinic 1 and 412 at Clinic 2). Adherence to CRC screening was lower for patients who were male; lacked insurance; had only one medical visit in the past 12 months; and had no assigned primary care provider. Our multivariable models showed higher screening rates among patients who were female; had public health insurance; and had more than one medical visit in the past 12 months, regardless of “high” or “low” continuity of care.
We found no association between higher continuity of care and CRC screening. Additional primary care systems research is needed to guide cancer screening interventions for limited-English proficient patients.
PMCID: PMC3856709  PMID: 21133636
Colorectal cancer; screening; Vietnamese Americans
19.  Breast cancer knowledge, beliefs, and screening behaviors among low-income, elderly black women. 
This cross-sectional study explored whether there are age-specific differences in breast cancer-related knowledge, beliefs, and screening behaviors among low-income, elderly black women. Data were collected at senior citizen facilities from 214 black women aged 65 and older. Differences in knowledge, beliefs, and screening practices across three age groups were assessed by chi-square tests. Logistic regression modeling was used to determine the effect of these factors on compliance with American Cancer Society (ACS) screening guidelines. Age was inversely associated with knowledge and screening practices. The youngest group (65-74) was about twice as likely as the oldest group (85 and over) to correctly recognize breast cancer risk factors. About 50% of the oldest women compared to about 20% of the youngest women believed their risk for breast cancer was nil. The oldest group was also least likely to have had a mammogram or clinical breast examination within the past year, as recommended by the ACS. Our results suggest that educating elderly women, especially those 85 and over, about breast cancer and screening may lead to higher compliance with ACS recommendations.
PMCID: PMC2594465  PMID: 14527046
20.  Factors Associated with Colorectal Cancer Screening Among Cambodians, Vietnamese, Koreans and Chinese Living in the United States 
The purpose of this community-based participatory study was to identify factors associated with colorectal cancer (CRC) screening compliance and non-compliance among Cambodians, Vietnamese, Koreans and Chinese men and women 50 years and older living in the United States. A cross-sectional design was used in the study. The completed sample included 815 Asian Americans which included Cambodians (N=215), Vietnamese (N=195), Koreans (N=94) and Chinese (N=311). A 95-item questionnaire was developed and pilot tested for content validity and reliability. An in-person data collection approach was utilized and participants were given choice in responding in English or their native language. Of the 815 participants, 79.1% (N=645) reported never-screened, 7.9% (N=64), non-compliance, and 13.0% (N=106) compliance. Education was significantly associated with never-screened for CRC for Vietnamese and Chinese; employment status for Cambodians and Koreans; lack of health insurance for Cambodians, Korean and Chinese; English fluency and years lived in the U.S. for Vietnamese, Koreans, and Chinese. Less acculturated Asian Americans were more likely to be never screened, but differentially across ethnic subgroups. Barriers to screening included lack of knowledge, language, transportation, and time. Increased culturally-targeted public awareness and education programs are needed to improve CRC screening and compliance among high risk Asian American ethnic subgroups.
PMCID: PMC3521597  PMID: 23243486
sigmoidoscopy or colonoscopy; fecal occult blood test; Vietnamese; Korean; Chinese; Cambodian; correlates of colorectal cancer screening
21.  Perceived Medical Discrimination and Cancer Screening Behaviors of Racial and Ethnic Minority Adults 
Discrimination has been shown as a major causal factor in health disparities, yet little is known about the relationship between perceived medical discrimination (vs. general discrimination outside medical settings) and cancer screening behaviors. We examined whether perceived medical discrimination is associated with lower screening rates for colorectal and breast cancers among racial and ethnic minority adult Californians.
Pooled cross-sectional data from 2003 and 2005 California Health Interview Surveys were examined for cancer screening trends among African-American, American-Indian/Alaskan-Native, Asian, and Latino adult respondents reporting perceived medical discrimination compared to those not reporting discrimination (n=11,245). Outcome measures were dichotomous screening variables for colorectal cancer among respondents, ages 50 -75; and breast cancer among women, ages 40 - 75.
Women perceiving medical discrimination were less likely to be screened for colorectal (OR = 0.66; CI = 0.64 - 0.69) or breast cancer (OR = 0.52; CI = 0.51 - 0.54) compared to women not perceiving discrimination. Although men who perceived medical discrimination were no less likely to be screened for colorectal cancer than those who did not (OR = 1.02; CI = 0.97 - 1.07), significantly lower screening rates were found among men who perceived discrimination and reported having a usual source of health care (OR = 0.30; CI = 0.28 - 0.32).
These findings of a significant association between perceived racial or ethnic-based medical discrimination and cancer screening behaviors have serious implications for cancer health disparities. Gender differences in patterns for screening and perceived medical discrimination warrant further investigation.
PMCID: PMC2526181  PMID: 18687583
Cancer screening; Racial/ethnic disparities; Perceived discrimination; Colorectal cancer; Breast cancer
22.  Development of Intervention Materials for Individuals With Limited English Proficiency 
Medical care  2008;46(9 0 1):10.1097/MLR.0b013e31817f0cde.
According to recent US census data, 52 million people reported speaking a language other than English at home, and almost 45% of this population reported limited English proficiency (LEP). Colorectal cancer (CRC) ranks among the top 3 most common cancers for several Asian ethnic groups, yet screening remains underutilized by Asian Americans.
This article describes the development of culturally and linguistically appropriate intervention materials for individuals with LEP. We discuss lessons learned from this research and implications for the translation of research into practice.
The Health Behavior Framework served as the conceptual model for this study, and qualitative findings guided the development of our intervention materials (a video and pamphlet). To recommend Western preventive behaviors, the research team bridged the gap between Western and Chinese values and beliefs by devoting particular attention to: (1) the target population's sociocul-tural values and health beliefs; and (2) unique linguistic features of the Chinese language.
Key lessons learned from this study include the importance of: (1) a conceptual framework to guide intervention development; (2) incorporating sociocultural values and health beliefs into the intervention; (3) addressing and capitalizing on complex linguistics issues; (4) using qualitative methodology in cross-cultural research; and (5) contributions from a multicultural and multilingual research team. Other lessons relate to the translation of research findings into practice. We surmise that lessons learned from this study may be pertinent to the promotion of CRC screening among other patient groups with LEP and applicable to additional cancer screening tests.
PMCID: PMC3860055  PMID: 18725834
limited English proficiency; colorectal cancer screening; culturally and linguistically appropriate materials
23.  Determinants of Breast, Cervical and Colorectal Cancer Screening Adherence in Mexican American Women 
Journal of Community Health  2012;37(2):421-433.
Despite the effectiveness of cancer screening procedures, its utilization among Latinas remains low. Guided, in part, by the Behavioral Model for Vulnerable Populations, this study examined the associations between predisposing, enabling, and need factors with self-reported breast, cervical, and colorectal cancer screening adherence. Participants were 319 Mexican American women, from a range of socioeconomic (SES) backgrounds, living near the United States-Mexico border. Women were adherent with breast cancer (BC) screening (≥42 years) if they had received at least one mammogram within the last two years, with cervical cancer (CC) screening (≥40 years) if they had received at least one Pap exam in the last three years, and with colorectal cancer (CRC) screening (≥52 years) if they had undergone one or more of the following: Fecal Occult Blood Test (FOBT) within the last year, or sigmoidoscopy in the last 5 years, or colonoscopy within the last 10 years. BC and CC screenings were higher in the current sample compared to national and state figures: 82% with mammography and 86% adherent with Pap exam screening. However, only 43% were adherent with CRC screening recommendations. Characteristics associated with mammography adherence included CC adherence and usual source of care. BC adherence was associated to CC adherence. Characteristics associated with CRC adherence included BC adherence, being premenopausal, and insurance coverage. A key correlate of cancer screening adherence was adherence to other preventive services. Results underscore the need for continued efforts to ensure that Latinas of all SES levels obtain regular and timely cancer screenings.
PMCID: PMC3296890  PMID: 21874364
Breast cancer screening; Cervical cancer screening; Colorectal cancer screening; Cancer disparities; Mexican Americans
24.  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
25.  A Socio-cultural Perspective on Cancer Control Issues for Asian Americans 
Eighty-five to ninety percent of cancer incidence is attributable to lifestyle choices, such as diet, life habits such as smoking, and environmental factors. Culture is the single force most influential on lifestyles. This paper provides a framework to understand the potential contribution of sociocultural factors to cancer control.
This literature review of culture and cancer control provides a perspective on Asian American populations. Culture is defined in a manner that enables researchers and practitioners to begin to focus on the fundamental elements of culture that directly influence health behavior.
Only four studies were found that address sociocultural factors in cancer control for Asian Americans. Each of these studies found significant variations in the response to cancer than Euro-American populations. Only mainstream researchers or practitioners, who are knowledgeable enough about Asian American cultures to be sensitive to these differences, would recognize these variations.
The widening disparities in cancer outcomes between Asian- and Euro-Americans challenges the current research and practice paradigms for cancer control. A Cultural Systems Approach would strengthen future studies. This paradigm requires multi-level analyses of individuals and populations within specific contexts in order to identify culturally based strategies to improve practice along the cancer care continuum.
PMCID: PMC1618773  PMID: 11567507

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