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1.  The Use of Sociocultural Constructs in Cancer Screening Research Among African Americans 
Background
Studies are increasingly examining the role of sociocultural values, beliefs, and attitudes in cancer prevention. However, these studies vary widely in how sociocultural constructs are defined and measured, how they are conceived as affecting cancer beliefs, behaviors, and screening, and how they are applied in interventions.
Methods
To characterize the current state of this research literature, we conducted a critical review of studies published between 1990 and 2006 to describe the current use of sociocultural constructs in cancer screening research among African Americans. We included quantitative and qualitative studies with cancer as a primary focus that included African American participants, assessed screening behaviors, reported race-specific analyses, and considered one or more sociocultural factors. Studies were evaluated for type of cancer and screening analyzed, study population, methodology, sociocultural constructs considered, definitions of constructs, provision of psychometric data for measures, and journal characteristics.
Results
Of 94 studies identified for review, 35 met the inclusion criteria and were evaluated. Most focused on breast cancer screening, and thus African American women. Sociocultural constructs were seldom clearly defined, and the sources and psychometric properties of sociocultural measures were rarely reported.
Conclusions
A multidisciplinary approach to developing a common language and a standardized set of measures for sociocultural constructs will advance research in this area. Specific recommendations are made for future research.
PMCID: PMC3614350  PMID: 19556966
2.  Prostate Cancer Screening Among Chinese American Men: A Structural Model 
Objective
To test the Sociocultural Health Behavior Model in relation to the health behavior of prostate cancer (PCa) screening among Chinese American men.
Methods
Confirmatory factor analysis and structural equation model analyses were conducted among Chinese American men.
Results
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.
Conclusions
The model highlights the significance that sociocultural factors play in relation to PCa screening.
doi:10.5993/AJHB.36.4.6
PMCID: PMC3325499  PMID: 22488399
digital rectal exam; prostate specific antigen (PSA) blood test; prostate cancer screening; structural equation model
3.  Health seeking behavioral analysis associated with breast cancer screening among Asian American women 
Objective
The purpose of this community-based study was to apply a Sociocultural Health Behavior Model to determine the association of factors proposed in the model with breast cancer screening behaviors among Asian American women.
Methods
A cross-sectional design included a sample of 682 Chinese, Korean, and Vietnamese women aged 40 years and older. The frequency distribution analysis and Chi-square analysis were used for the initial screening of the following variables: sociodemographic, cultural, enabling, environmental, and social support. Univariate and multivariate analyses were conducted on factors for breast cancer screening using multinomial logistic regression analysis.
Results
Correlates to positive breast cancer screening included demographics (ethnicity), cultural factors (living in the United States for 15 years or more, speaking English well), enabling factors (having a regular physician to visit, health insurance covering the screening), and family/social support factors (those who had a family/friend receiving a mammogram).
Conclusions
The results of this study suggest that breast cancer screening programs will be more effective if they include the cultural and health beliefs, enabling, and social support factors associated with breast cancer screening. The use of community organizations may play a role in helping to increase breast cancer screening rates among Asian American women.
doi:10.2147/IJWH.S30738
PMCID: PMC3379860  PMID: 22723730
breast cancer screening; Vietnamese; Korean; Chinese; breast cancer; Asian American
4.  A Socio-cultural Perspective on Cancer Control Issues for Asian Americans 
Purpose
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.
Methods
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.
Findings
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.
Conclusions
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
5.  Hepatitis B and Liver Cancer Among Three Asian American Sub-Groups: A Focus Group Inquiry 
Prevalence of hepatitis B among Asian Americans is higher than for any other ethnic group in the United States. Since more than 50% of liver cancer is hepatitis B related, the burden of morbidity and mortality is extremely high among Asian Americans, highlighting the need for culturally appropriate interventions. We conducted focus groups (n = 8) with a total of 58 Korean, Vietnamese, and Chinese immigrants in Maryland to explore knowledge, awareness and perceived barriers toward hepatitis B screening and vaccinations. Thematic analysis uncovered generally low levels of knowledge and awareness of hepatitis B risks, screening, and vaccination; inter-generational differences; and barriers to prevention. Some differences arose across ethnic groups, particularly toward perceived orientation to preventive activities and the role of religious groups. High rates of hepatitis B infection among Asian Americans highlight the need for tailored interventions. These findings may assist policy strategists in implementing interventions that will facilitate the integration and scale-up of hepatitis B education, screening, and vaccination campaigns.
doi:10.1007/s10903-011-9523-0
PMCID: PMC3804298  PMID: 21901445
Hepatitis B risk; HBV screening and vaccinations; Asian Americans; Qualitative; Immigrant health
6.  The Influence of Sociocultural Factors on Colonoscopy and FOBT Screening Adherence among Low-income Hispanics 
Few studies have examined barriers and facilitators to colorectal cancer (CRC) screening among Hispanics, particularly sociocultural factors that may be relevant. This paper examines the influence of sociocultural factors on adherence to fecal occult blood testing (FOBT) and colonoscopy. A survey was conducted among a sample of 400 low-income Hispanics in East Harlem, New York. Fatalism and health literacy were both significantly associated with colonoscopy screening adherence in bivariate models, though fatalism became non-significant and health literacy became less significant in multivariable models. With respect to adherence to colonoscopy or FOBT, both fatalism and health literacy were associated in bivariate models, though only fatalism remained significant in multivariable models (p=.03; OR: .94; 95% CI: .881–.992). These findings suggest fatalism and health literacy may play a role in shaping CRC screening adherence among low-income Hispanics. Researchers should continue investigating how sociocultural factors influence screening adherence among Hispanics, using larger and more geographically diverse samples.
doi:10.1353/hpu.2011.0074
PMCID: PMC3635094  PMID: 21841288
Hispanics/Latinos; colorectal cancer screening; fatalism; health literacy; cancer screening
7.  Prevalence and Correlates of Lifetime Suicidal Ideation and Attempts among Latino Subgroups in the United States 
Objective
Limited data is available to understand the prevalence and correlates of suicidal behavior among U.S. Latino subgroups. This paper compares the prevalence of lifetime suicide ideation and suicide attempts among major U.S. Latino ethnic subgroups and identifies psycho-sociocultural factors associated with suicidal behaviors.
Method
The National Latino and Asian American Study (NLAAS) includes Spanish and English speaking Mexicans, Puerto Ricans, Cubans and other Latinos. Descriptive statistics and logistic models were used to determine demographic, clinical, cultural and social correlates of lifetime suicide ideation and attempts.
Results
The lifetime prevalence of suicidal ideation and attempts among Latinos was 10.2% and 4.4%, respectively. Puerto Ricans were more likely to report ideation as compared to other Latino subgroups but this difference was eliminated after adjustments for psychiatric and sociocultural factors. Most lifetime suicidal attempts described by Latinos were reported as occurring when they were under the age of 18 years. Any lifetime DSM-IV diagnoses, including dual diagnoses, were associated with an increased risk of lifetime suicidal ideation and attempts among Latinos. In addition, female gender, acculturation (born in U.S. and English speaking) and high levels of family conflict were independently and positively correlated with suicide attempts among Latinos, even among those without any psychiatric disorder.
Conclusions
These findings reinforce the importance of understanding the process of acculturation, the role of family and sociocultural context for suicide risk among Latinos. These should be considered in addition to psychiatric diagnoses and symptoms in Latino suicide research, treatment and prevention, especially among young individuals.
PMCID: PMC2774123  PMID: 17474813
8.  Hepatitis B and Hepatocellular Carcinoma Screening Among Asian Americans: Survey of Safety Net Healthcare Providers 
Digestive Diseases and Sciences  2010;56(5):1516-1523.
Background
Physician patterns of screening for hepatitis B (HBV) and hepatocellular carcinoma (HCC) among Asian Americans are not well described.
Aims
To describe HBV and HCC screening practices among providers with large Asian American populations.
Methods
Providers within San Francisco’s safety net system were surveyed with respect to HBV and HCC screening practices as well as knowledge, attitudes, and barriers to HCC screening.
Results
Among the 109 respondents (response rate = 72%), 62% were aged >40, 65% female, 24% Asian, 87% primary care providers, and 48% had >25% Asian patients. Only 76% had screened >50% of their Asian patients for HBV and 43% had vaccinated >50% of eligible patients against HBV. Although 94% knew Asians were disproportionately affected by HCC, only 79% had screened for HCC in >50% of their Asian patients with chronic hepatitis B (CHB). A majority believed that HCC screening in CHB reduces HCC mortality (70%) and is cost-effective (57%). The most common HCC screening modality was AFP with abdominal ultrasound every 6–12 months (63%). Factors associated with HBV screening were familiarity with AASLD guidelines (OR 6.4, 95% CI 1.3–30.1, p = 0.02) and having vaccinated >50% of eligible patients against HBV (OR 2.2, 95% CI 1.1–4.5, p = 0.03). Factors associated with HCC screening using abdominal ultrasound every 6–12 months were having >25% Asian patients (OR = 4.5, 95% CI 1.3–15.3, p = 0.02) and higher HCC knowledge score (OR = 1.9 per item, 95% CI 1.01–3.6, p = 0.045).
Conclusions
HBV and HCC screening rates and HBV vaccination among Asians from physician report is suboptimal. HCC screening is associated with having more Asian patients and higher provider knowledge. Provider education is essential in increasing rates of HBV and HCC screening among Asian Americans.
doi:10.1007/s10620-010-1439-3
PMCID: PMC3082048  PMID: 21046247
Hepatocellular carcinoma surveillance; Hepatitis B screening; Asian American; Provider practices
9.  Pathways of Breast Cancer Screening Among Chinese American Women 
Objective
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.4172/2161-0711.1000209
PMCID: PMC3762685  PMID: 24013711
Mammograms; Breast cancer screening; Chinese women
10.  Cancer Screening Practices of Asian American Physicians in New York City 
Cancer screening rates are lower among Asian Americans than the general USA population. While prior studies examined characteristics of Asian American patients as predictors of cancer screening, few investigated their health care providers. Asian American primary care physicians practicing in New York City were surveyed by questionnaire regarding their demographics, practice characteristics, and cancer screening of their Asian American patients. Of the 117 eligible respondents, 96% recommended mammograms to their Asian patients 50+ years of age and 70% to patients 40–49-year-old. Only 30% of respondents use both age and onset of sexual activity to determine when to recommend Pap smears. For colorectal cancer screening, the rates of performing fecal occult blood testing or recommending colonoscopy or sigmoidoscopy were 77% and 74%. About 70% recommend screening for hepatitis B. Gender and ethnicity of the physician were found to be significant predictors for cancer screening practice.
doi:10.1007/s10903-007-9077-3
PMCID: PMC3314289  PMID: 17653863
Asian; Asian American; Cancer; Prevention; Screening; Physician
11.  Race/Ethnic Differences in Desired Body Mass Index and Dieting Practices Among Young Women Attending College in Hawai‘i 
Hawaii Medical Journal  2011;70(7 suppl 1):32-36.
In accordance with the sociocultural model, race/ethnicity is considered a major influence on factors associated with body image and body dissatisfaction, and eating disorders are often characterized as problems that are primarily limited to young White women from Western cultures. The purpose of this study was to determine whether there are differences that exist by race in desired body weight; the importance placed on those ideals; and dieting strategies among White, Asian American, Native Hawaiian/Pacific Islanders, and other mixed-race young women in Hawai‘i. A total of 144 female college students 18–20 years of age were surveyed about body weight as well as eating and exercise habits. Results demonstrated that all the young women wanted to lose weight. However, there were no differences in desired body weight or desired weight change by race after controlling for body mass index suggesting that current weight rather than race/ethnicity is the predominant influence on weight-related concerns. Young White women placed the greatest level of importance on achieving a lower body weight, which corresponded with a greater likelihood to be attempting weight loss (dieting) and greater endorsement of behaviors consistent with weight loss compared to their counterparts. Findings imply that, for young women, race/ethnicity may not have as significant an impact on factors associated with body weight ideals as previously believed. Rather, differences in the value placed on achieving a desired body weight, as it relates to disordered eating, should be further explored among race/ethnic groups.
PMCID: PMC3158449  PMID: 21886291
12.  Descriptive cross sectional study on prevalence, perceptions, predisposing factors and health seeking behaviour of women with stress urinary incontinence 
BMC Women's Health  2014;14:78.
Background
Stress urinary incontinence (SUI) leads to considerable physical and psychological morbidity. The highest prevalence reported was found in Caucasian Americans (range 23% -67%) and the lowest in Singaporean females (4.8%). The study assessed the prevalence, perceptions, predisposing factors and health seeking behaviour of women with SUI in an Asian setting which may have different sociocultural implications.
Methods
400 consecutive women >20 years of age attending the outpatient department of a tertiary care hospital in Sri Lanka, for non-urinary conditions were studied over a 3 week period using an interviewer administered questionnaire. SUI was diagnosed on clinical history alone when leakage of urine occurred either with coughing, sneezing, walking or lifting heavy objects. The severity was graded using the Finnish Gynaecological Society’s Urinary Incontinence Severity Score (UISS). Data were analysed using SPSS version 20. Odds ratios were calculated using univariate and multivariate analysis.
Results
Ninety three (23.33%) had SUI and only 12 (12.9%) had sought treatment. The prevalence among women >50 years of age was 34.71% ( n = 121) compared to 18.28% (n = 279) in those ≤50 years. 25 (26.88%) had mild SUI, 66 (70.97%) moderate and 2 (2.15%) severe as per UISS. SUI was perceived as an illness by 210 (52.5%). SUI was significantly associated with pregnancy, parity, vaginal delivery, complicated labour, diabetes mellitus, chronic cough, constipation and faecal incontinence (p < 0.05).
Among those affected main reasons for not seeking medical advice included; being embarrassed (n = 27, 33.33%), not knowing that it is remediable (n = 23, 28.40%), perceiving SUI to be a normal consequence of childbirth (n = 19, 23.46%) and having to attend to needs of the family (n = 12, 14.81%). None who had been pregnant (n = 313) had received advice on postnatal pelvic floor exercises. SUI interfered with social activities (71;76.34%), sexual function (21; 22.58%) and resulted in despair (67; 72.09%). It was associated with clinically diagnosed candidiasis (50; 53.76%) and soreness in the perineal region (49; 52.69%).
Conclusions
SUI is a common and neglected gynaecological problem with poor healthcare seeking behaviour. Community based education may help to minimize the occurrence and improve the quality of life of those affected.
doi:10.1186/1472-6874-14-78
PMCID: PMC4094634  PMID: 24985068
Stress urinary incontinence; Prevalence; Risk factors; Health seeking behaviour
13.  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
14.  Sociocultural Differences and Colorectal Cancer Screening Among African American Men and Women 
Oncology Nursing Forum  2012;39(1):100-107.
Purpose/Objectives
To examine sociocultural factors that influence an informed decision about colorectal cancer (CRC) screening among African American men and women.
Design
Descriptive, cross-sectional.
Setting
A medical center, a National Cancer Institute-designated comprehensive cancer center, and various social organizations and barbershops in a midwestern city of the United States.
Sample
A purposive sample of African American women (n = 65) and African American men (n = 64) aged 50 years and older.
Methods
Participants completed a self-administered survey.
Main Research Variables
Cultural identity, CRC beliefs, family support, and informed decision.
Findings
Family support was positively related to CRC beliefs among participants, and CRC beliefs were positively related to an informed decision. However, among men, family support positively related to an informed decision about CRC screening. In addition, t-test results indicated that the men and women were significantly different. Family support predicted CRC beliefs among men (p < 0.01) and women (p < 0.01). CRC beliefs predicted CRC screening informed decisions among men (p < 0.01) and women (p < 0.05). However, the accounted variance was dissimilar, suggesting a difference in the impact of the predictors among the men and women.
Conclusions
Family support has a significant impact on CRC beliefs about CRC screening among African Americans. However, how men and women relate to the variables differs.
Implications for Nursing
To improve CRC screening rates, informed decision-making interventions for African Americans should differ for men and women and address family support, CRC beliefs, and elements of cultural identity.
doi:10.1188/12.ONF.100-107
PMCID: PMC3354616  PMID: 22201660
15.  Areca nut and betel quid chewing among South Asian immigrants to Western countries and its implications for oral cancer screening 
Rural and remote health  2009;9(2):1118.
The South Asian community is the largest and one of the fastest growing minority groups in Canada, according to the 2006 census. These immigrants bring to Canada talents and skills that can promote Canada’s economy and cultural diversity, but they also bring lifestyle habits that may lead to serious health issues. Chewing areca nut and betel quid (paan, with and without tobacco) is a known risk factor for oral cancer. This habit is common in the Indo-Canadian population, as evidenced by its sales in local Indian markets and restaurants. In this article, we present an overview of the sociocultural beliefs, knowledge and practices regarding betel quid/areca nut chewing, and discuss its implications for oral cancer screening among this immigrant population.
PMCID: PMC2726113  PMID: 19445556
betel quid/areca nut chewing; cancer screening; oral health; rural immigrants
16.  An Ethnomedical Analysis of Hypertension Among Detroit Afro-Americans 
To analyze Afro-American ethnomedical beliefs and practices concerning disease and health care, the author investigated the health-care-seeking behavior among 285 Afro-Americans and 178 Euro-Americans in the Detroit metropolitan area with respect to hypertension. Hypertension was chosen because more than 60 million individuals in the United States have elevated blood pressure (140/90 mmHg or greater).
Quantitative and qualitative data revealed five themes associated with hypertension: (1) degree of activity and responsibility, (2) individual and familial moral strength, (3) naturalistic causation, (4) family, folk, or personal care, and (5) physical and spiritual balance. In addition to these ethnohealth and ethnocaring modes, the decisive sociocultural factors in the utilization of the health screening were (1) the health beliefs of the extended lay network, (2) the type of health facility, (3) the lifestyle and behavioral patterns of Detroiters from 1910 to the present, and (4) the adherence to traditional Afro-American cultural beliefs. Once health care professionals recognize the multitude of factors that affect health-care-seeking behavior among Afro-Americans, many health care issues can be resolved.
PMCID: PMC2625881  PMID: 3249315
17.  Intrapersonal and interpersonal dimensions of cancer perception: a confirmatory factor analysis of the cancer experience and efficacy scale (CEES) 
Supportive Care in Cancer  2009;18(5):561-571.
Purpose
Sociocultural factors influence psychological adjustment to cancer in Asian patients in two major ways: prioritization of relationships over individual orientations and belief in the efficacy of interpersonal cooperation. We derived and validated among Chinese colorectal cancer (CRC) patients an instrument assessing cancer perceptions to enable the study of the sociocultural processes.
Patients and methods
Qualitative interviews (n = 16) derived 15 items addressing interpersonal experience in Chinese CRC patients’ adjustment. These 15 items and 18 corresponding self-referent items were administered to 166 Chinese CRC survivors and subjected to exploratory factor analysis (EFA) to establish the initial scale structure and reliability. The final 29 items, together with other psychometric measures, were administered to a second cohort of 215 CRC patients and subjected to confirmatory factor analysis (CFA).
Results
EFA (63.35% of the total variance) extracted six factors: personal strain, socioeconomic strain, emotional strain, personal efficacy, collective efficacy, and proxy efficacy. CFA confirmed the psychometric structure [χ2(df) = 702.91(368); Comparative Fit Index = 0.95; Nonnormed Fit Index = 0.94; Incremental Fit Index = 0.95; standardized root mean square residual = 0.08] of the six factors by using a model with two latent factors: experience and efficacy. All subscales were reliable (α = 0.76–0.92). Appropriate correlations with adjustment outcomes (symptom distress, psychological morbidity, and subjective well-being), optimistic personalities, and social relational quality indicated its convergent and divergent validity. Known group comparisons (i.e., age, active treatment, and colostomy) showed its clinical utility.
Conclusion
The cancer experience and efficacy scale is a valid multidimensional instrument for assessing intrapersonal and interpersonal dimensions of cancer experience in Asian patients, potentiating existing patient-reported outcome measures.
doi:10.1007/s00520-009-0687-2
PMCID: PMC2946548  PMID: 19588170
Asians; Colorectal cancer; Interpersonal cancer perceptions; Psychometric evaluations; Sociocultural differences
18.  Genetic Ancestry, Social Classification, and Racial Inequalities in Blood Pressure in Southeastern Puerto Rico 
PLoS ONE  2009;4(9):e6821.
Background
The role of race in human genetics and biomedical research is among the most contested issues in science. Much debate centers on the relative importance of genetic versus sociocultural factors in explaining racial inequalities in health. However, few studies integrate genetic and sociocultural data to test competing explanations directly.
Methodology/Principal Findings
We draw on ethnographic, epidemiologic, and genetic data collected in southeastern Puerto Rico to isolate two distinct variables for which race is often used as a proxy: genetic ancestry versus social classification. We show that color, an aspect of social classification based on the culturally defined meaning of race in Puerto Rico, better predicts blood pressure than does a genetic-based estimate of continental ancestry. We also find that incorporating sociocultural variables reveals a new and significant association between a candidate gene polymorphism for hypertension (α2C adrenergic receptor deletion) and blood pressure.
Conclusions/Significance
This study addresses the recognized need to measure both genetic and sociocultural factors in research on racial inequalities in health. Our preliminary results provide the most direct evidence to date that previously reported associations between genetic ancestry and health may be attributable to sociocultural factors related to race and racism, rather than to functional genetic differences between racially defined groups. Our results also imply that including sociocultural variables in future research may improve our ability to detect significant allele-phenotype associations. Thus, measuring sociocultural factors related to race may both empower future genetic association studies and help to clarify the biological consequences of social inequalities.
doi:10.1371/journal.pone.0006821
PMCID: PMC2731885  PMID: 19742303
19.  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.
doi:10.1002/cncr.21521
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
20.  Primary Care Physicians’ Cancer Screening Recommendation Practices and Perceptions of Cancer Risk of Asian Americans 
Asian Americans experience disproportionate incidence and mortality rates of certain cancers, compared to other racial/ethnic groups. Primary care physicians are a critical source for cancer screening recommendations and play a significant role in increasing cancer screening of their patients. This study assessed primary care physicians’ perceptions of cancer risk in Asians and screening recommendation practices. Primary care physicians practicing in New Jersey and New York City (n=100) completed a 30-question survey on medical practice characteristics, Asian patient communication, cancer screening guidelines, and Asian cancer risk. Liver cancer and stomach cancer were perceived as higher cancer risks among Asian Americans than among the general population, and breast and prostate cancer were perceived as lower risks. Physicians are integral public health liaisons who can be both influential and resourceful toward educating Asian Americans about specific cancer awareness and screening information.
PMCID: PMC3800694  PMID: 23679307
Asian Americans; cancer; primary care physician; health disparities
21.  Score reliability and factor similarity of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) among four ethnic groups 
Background
This study evaluated the score reliability and equivalence of factor structure of the Sociocultural Attitudes towards Appearance Questionnaire-3 (SATAQ-3) [1] in a sample of female college students from the four largest ethnic groups in the USA.
Methods
Participants were 1245 women who self-identified as European American/White (n = 543), African American/Black (n = 137), Asian American (n = 317), or Latina/Hispanic (n = 248). All completed the SATAQ-3 and a demographic questionnaire. To test the factor similarity and score reliability across groups, we used exploratory factor analysis and calculated Cronbach’s alphas (respectively).
Results
Score reliability was high for all groups. Tests of factor equivalence suggested that the four pre-established factors of the SATAQ-3 (i.e., knowledge, perceived pressure, thin-ideal internalization, athletic-ideal internalization) were similar for women of all ethnic groups. Only two items (20 and 27) did not consistently load on the previously identified scale across all four groups. When scored, African Americans reported significantly less perceived pressure and internalization than all other groups.
Conclusions
Results support the use of the SATAQ-3 in female college students of these four ethnicities.
doi:10.1186/2050-2974-1-14
PMCID: PMC4081787
Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3); Media pressure; Thin-ideal internalization; Ethnicity; Psychometric equivalence
22.  Sociocultural differences in patients' expectations at consultations for upper respiratory tract infection 
Among 214 patients consulting their general practitioner with upper respiratory tract infection, differences in expectation were apparent between Whites, Afro-Caribbeans and Asians. Significantly more Asians (84%) wanted prescriptions for antibiotics and/or other medication than did Afro-Caribbeans (72%) or Whites (47%) (P
PMCID: PMC1710800  PMID: 3694587
BACKGROUND
Physicians can play a significant role in helping to decrease the hepatitis B virus (HBV) burden among Asian Americans. Few studies have described knowledge and practice patterns in the medical community among different provider types regarding HBV and liver cancer.
OBJECTIVE
Our study explores the HBV beliefs, attitudes and practice patterns of medical providers serving Asian American communities.
DESIGN
We conducted three focus groups with primary care providers, liver specialists, and other providers predominantly serving Asian American community. We asked about practices and barriers to appropriate medical care and outreach.
PARTICIPANTS
We moderated three focus groups with 23 participants, 18 of whom completed and returned demographic surveys. Twelve were of Asian ethnicity and 13 spoke English as a second language. Only eight screened at least half of their patients, most (72%) using the hepatitis B surface antigen test.
APPROACH
We used grounded theory methods to analyze focus group transcripts.
RESULTS
Participants frequently discussed cultural and financial barriers to hepatitis care. They admitted reluctance to screen for HBV because patients might be unwilling or unable to afford treatment. Cultural differences were discussed most by primary care providers; best methods of outreach were discussed most by liver specialists; and alternative medicine was discussed most by acupuncturists and other providers.
CONCLUSIONS
More resources are needed to lower financial barriers complicating HBV care and encourage providing guideline-recommended screenings. Other providers can help promote HBV screening and increase community and cultural awareness.
doi:10.1007/s11606-009-1204-5
PMCID: PMC2839343  PMID: 20049549
provider attitudes; Hepatitis B; Asian Americans; qualitative research; focus groups
Gut and Liver  2013;7(4):450-457.
Background/Aims
Screening for hepatitis B virus (HBV) is recommended in populations with anticipated prevalence ≥2%. This study surveyed HBV screening and vaccination practices of Asian American primary care providers (PCPs).
Methods
Approximately 15,000 PCPs with Asian surnames in the New York, Los Angeles, San Francisco, Houston, and Chicago areas were invited to participate in a web-based survey. Asian American PCPs with ≥25% Asian patients in their practice were eligible.
Results
Of 430 (2.9%) survey respondents, 217 completed the survey. Greater than 50% followed ≥200 Asian patients. Although 95% of PCPs claimed to have screened patients for HBV, 41% estimated that ≤25% of their adult Asian patients had ever been screened, and 50% did not routinely screen all Asian patients. In a multivariable analysis, the proportion of Asian patients in the practice, provider geographic origin and the number of liver cancers diagnosed in the preceding 12 months were significantly associated with a higher likelihood of screening for HBV. Over 80% of respondents reported that ≤50% of their adult Asian patients had received the HBV vaccine.
Conclusions
Screening and vaccination for HBV in Asian American patients is inadequate. Measures to improve HBV knowledge and care by primary-care physicians are critically needed.
doi:10.5009/gnl.2013.7.4.450
PMCID: PMC3724034  PMID: 23898386
Hepatitis B virus; Chronic hepatitis B
Journal of Viral Hepatitis  2012;19(8):594-600.
Asians Americans have a high burden of hepatitis B (HBV) associated hepatocellular carcinoma (HCC). HCC screening practices in this population are unknown. We aimed to investigate predictors and patterns of HCC screening and its impact on survival in HBV-infected Asian Americans. Clinical data were obtained from a retrospective cohort of 1870 HBsAg-positive Asians in San Francisco’s safety net clinics. In 824 patients at-risk for HCC, screening (≥1 imaging and/or AFP per year) decreased from 67% to 47% to 24% from the first to second to tenth year after HBV diagnosis, respectively. AFP, imaging, and imaging plus AFP were used in 37%, 14%, and 49% during the first year after diagnosis, and imaging plus AFP increased to 64% by the tenth year. Among 1431 patients followed in 2007, age 40-64 years, female gender, cirrhosis, hepatologist evaluation, HBV diagnosis after 2003, and testing for HBeAg were associated with HCC screening. Of the 51 patients with HCC, more cirrhotics received screening and were diagnosed with early stage disease. Median survival following HCC diagnosis was higher in screened patients (1624 vs.111 days, p=0.02). MELD score at HCC diagnosis (HR 1.2, 95%CI: 1.1-1.3) and receipt of curative therapy (HR 0.3, 95%CI: 0.08-0.94) were associated with survival. Screening rates in at-risk Asian Americans, particularly among non-cirrhotics, were suboptimal and decreased over time. Among patients with HCC, receipt of prior screening improved survival, and this survival benefit was related to better liver function at HCC diagnosis and receipt of curative therapy.
doi:10.1111/j.1365-2893.2011.01577.x
PMCID: PMC3390753  PMID: 22762144
liver cancer; hepatitis B; safety net healthcare system; cirrhosis; mortality

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