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1.  A bi-national comparative study of health behaviors of Koreans in South Korea and Korean Americans in California 
Background
Few studies have compared health behaviors of Koreans in their home country and Korean Americans.
Methods
Using 2009 data from the Community Health Survey (South Korea) and the California Health Interview Survey (USA), we compared native Koreans and Korean Americans, grouped by level of acculturation, on prevalence of specific health behaviors and self-rated health, and conducted multiple logistic regression comparing the odds of these behaviors among the groups adjusted for demographic variables.
Results
While Korean Americans exhibit healthier behaviors than Koreans in some areas (e.g., reduced smoking and binge drinking in men, increased utilization of flu vaccinations), we also identified problem behaviors (e.g., increased body weight in Korean American men, uptake of alcohol drinking and smoking among Korean American women).
Discussion
Findings support the critical need for health promotion programs addressing these health behaviors to prevent future health problems among Korean Americans.
doi:10.1007/s10903-012-9706-3
PMCID: PMC3530654  PMID: 22918692
California Health Interview Survey; South Korea Community Health Survey; body mass index; smoking; alcohol intake; self-reported health; acculturation
2.  Results of a Community-based Randomized Trial to Increase Colorectal Cancer Screening among Filipino Americans 
American journal of public health  2010;100(11):2228-2234.
Objectives
Low CRC screening rates among Asian Americans are contributing to late stage at diagnosis and poor survival outcomes compared to Non-Hispanic whites. We conducted one of the first community-based trials to increase CRC screening in an Asian American population.
Methods
Filipino Americans (N=548) non-adherent to CRC screening guidelines were randomized into two multi-component intervention arms that included a small-group CRC education session with or without distribution of free FOBT kits or a control condition (small-group education promoting physical activity).
Results
Based on intent-to-treat analysis, self-reported CRC screening rates during the 6 month follow-up period were 30%, 25% and 9% for participants assigned to intervention with FOBT kit, intervention without FOBT kit, and the control condition, respectively. Participants randomized to either of the two intervention arms were significantly more likely to report screening at follow-up than control group assignees (odds ratios 4.9 and 3.7 compared to control, both p<.001).
Conclusions
A multi-component intervention that includes an educational group session in a community setting can significantly increase CRC screening in Filipino Americans, even when no free FOBT kits are distributed.
doi:10.2105/AJPH.2009.176230
PMCID: PMC2951922  PMID: 20864724
3.  Developing Theoretically Based and Culturally Appropriate Interventions to Promote Hepatitis B Testing in 4 Asian American Populations, 2006–2011 
Introduction
Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community.
Methods
Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities.
Results
Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs.
Conclusions
The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors.
doi:10.5888/pcd11.130245
PMCID: PMC4008952  PMID: 24784908
4.  Promotion and Provision of Colorectal Cancer Screening: A Comparison of Colorectal Cancer Control Program Grantees and Nongrantees, 2011–2012 
Introduction
Since 2009, the Centers for Disease Control and Prevention (CDC) has awarded nearly $95 million to 29 states and tribes through the Colorectal Cancer Control Program (CRCCP) to fund 2 program components: 1) providing colorectal cancer (CRC) screening to uninsured and underinsured low-income adults and 2) promoting population-wide CRC screening through evidence-based interventions identified in the Guide to Community Preventive Services (Community Guide). CRCCP is a new model for disseminating and promoting use of evidence-based interventions. If the program proves successful, CDC may adopt the model for future cancer control programs. The objective of our study was to compare the colorectal cancer screening practices of recipients of CRCCP funding (grantees) with those of nonrecipients (nongrantees).
Methods
We conducted parallel Web-based surveys in 2012 with CRCCP grantees (N = 29) and nongrantees (N = 24) to assess promotion and provision of CRC screening, including the use of evidence-based interventions.
Results
CRCCP grantees were significantly more likely than nongrantees to use Community Guide-recommended evidence-based interventions (mean, 3.14 interventions vs 1.25 interventions, P < .001) and to use patient navigation services (eg, transportion or language translation services) (72% vs 17%, P < .001) for promoting CRC screening. Both groups were equally likely to use other strategies. CRCCP grantees were significantly more likely to provide CRC screening than were nongrantees (100% versus 50%, P < .001).
Conclusion
Results suggest that CRCCP funding and support increases use of evidence-based interventions to promote CRC screening, indicating the program’s potential to increase population-wide CRC screening rates.
doi:10.5888/pcd11.140183
PMCID: PMC4184085  PMID: 25275807
5.  Social determinants of health in the Mixtec and Zapotec community in Ventura County, California 
Introduction
There are an estimated 165,000 indigenous Mexicans living in California, including Mixtec and Zapotec immigrant farm workers. Because many of these immigrants speak only their native non-written languages, there is little information about the needs of this community. An academic-community partnership research team developed a survey to assess basic needs that are known to be social determinants of health in the Mixtec and Zapotec community in Ventura County.
Methods
In summer 2013, Spanish-Mixteco and Spanish-Zapoteco bilingual promotoras conducted surveys in Spanish, Mixteco and Zapoteco in the greater Oxnard area in Ventura County, California to assess the following basic needs: ability of adults and children to obtain health services; household needs regarding work opportunities, food, housing, transportation, safety and education; and discrimination. Independent variables included respondent characteristics such as age, gender, marital status, living part of the year in another city, and household characteristics such as Spanish spoken in the household, number of household members and number of health care providers/agencies used. Several sets of analyses examined the relationship between basic needs and independent variables.
Results
Respondents (N = 989) reported insufficient employment opportunities (74%), food for the family (59%) or housing (48%), lack of transportation (59%), and discrimination or bullying (34%). Most reported access to medical care for children (90%), but only 57% of respondents were able to get health care for themselves.
Conclusions
Many basic needs in the Mixtec and Zapotec community in Ventura County are unmet. It will require many different resources and services to address the needs of this community and to overcome longstanding inequities that are experienced by immigrant farm workers. Our findings will guide the development of future health programs and will serve as a baseline to evaluate the impact of services to improve the health conditions in this community.
doi:10.1186/s12939-015-0148-0
PMCID: PMC4320817  PMID: 25643835
Household survey; Indigenous farm workers; Community-engaged research; Promotoras; Social determinants of health
6.  Assessment of training and technical assistance needs of Colorectal Cancer Control Program Grantees in the U.S. 
BMC Public Health  2015;15:49.
Background
Practitioners often require training and technical assistance to build their capacity to select, adapt, and implement evidence-based interventions (EBIs). The CDC Colorectal Cancer Control Program (CRCCP) aims to promote CRC screening to increase population-level screening. This study identified the training and technical assistance (TA) needs and preferences for training related to the implementation of EBIs among CRCCP grantees.
Methods
Twenty-nine CRCCP grantees completed an online survey about their screening activities, training and technical assistance in 2012. They rated desire for training on various evidence-based strategies to increase cancer screening, evidence-based competencies, and program management topics. They also reported preferences for training formats and facilitators and barriers to trainings.
Results
Many CRCCP grantees expressed the need for training with regards to specific EBIs, especially system-level and provider-directed EBIs to promote CRC screening. Grantees rated these EBIs as more difficult to implement than client-oriented EBIs. Grantees also reported a moderate need for training regarding finding EBIs, assessing organizational capacity, implementing selected EBIs, and conducting process and outcome evaluations. Other desired training topics reported with higher frequency were partnership development and data collection/evaluation. Grantees preferred training formats that were interactive such as on-site trainings, webinars or expert consultants.
Conclusions
Public health organizations need greater supports for adopting evidence-based interventions, working with organizational-level change, partnership development and data management. Future capacity building efforts for the adoption of EBIs should focus on systems or provider level interventions and key processes for health promotion and should be delivered in a variety of ways to assist local organizations in cancer prevention and control.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-015-1386-1) contains supplementary material, which is available to authorized users.
doi:10.1186/s12889-015-1386-1
PMCID: PMC4318175  PMID: 25636329
Colorectal neoplasms; Early detection and screening; Technical assistance; Training; Evidence-based interventions; Cancer screening
7.  Evaluating the Training of Filipino American Community Health Advisors to Disseminate Colorectal Cancer Screening 
Journal of community health  2012;37(6):1218-1225.
Community health advisor-led interventions are associated with improved health promotion behaviors, such as cancer screening, but the process of training community health advisors is rarely described and evaluated. We trained 91 Filipino Americans from 19 organizations to conduct small-group sessions with members of their organizations to promote colorectal cancer screening. Community health advisors completed brief pre- and post-training surveys that included knowledge of colorectal cancer screening guidelines (4 items), perceived self-efficacy of performing specific tasks (15-item scale, Cronbach’s alpha >.90) and satisfaction with the training itself (5 items). Community health advisors had high levels of knowledge and self-efficacy at pre-training, but levels increased significantly immediately after the 6-hour training (percent of knowledge items answered correctly: 63% to 94%; self-efficacy: 8.2 to 8.9 on a 10 point scale, both p<.001). Correlates of self-efficacy at pre- and post-test were high educational attainment, health care background, high level of participation in the organization, being perceived by others as a leader, and frequent participation in research activities in the past. Consistent evaluation measuring similar constructs across studies may help to standardize the quality of the training, and may improve the implementation of community health advisor-led programs.
doi:10.1007/s10900-012-9557-9
PMCID: PMC3383892  PMID: 22430865
lay health educator; community health educator; evaluation of training; self-efficacy; knowledge; satisfaction
8.  Health Risk Behaviors among Five Asian American Subgroups in California: Identifying Intervention Priorities 
This analysis assessed the prevalence of excess body weight, physical inactivity and alcohol and tobacco use in Asian American subgroups. Using 2005 California Health Interview Survey data, we estimated the prevalence of body mass index (BMI) categories using both standard and World Health Organization-proposed Asian-specific categories, physical inactivity, and alcohol and tobacco use for Chinese (n=1285), Japanese (n=421), Korean (n=620), Filipino (n=659) and Vietnamese (n=480) Americans in California. About 80% of Japanese and Filipino American men and 70% of Korean American men were “increased/high risk” by Asian-specific BMI categories. Most Asian American subgroups were more likely to walk for transportation than non-Hispanic whites, but less likely to report other physical activities. Highest smoking and binge drinking prevalences were among Korean, Vietnamese and Filipino American men and Japanese and Korean American women. These results suggest risk profiles for each Asian American subgroup to consider when setting priorities for health promotion programs.
doi:10.1007/s10903-011-9552-8
PMCID: PMC3298627  PMID: 22089979
Asian American subgroups; California Health Interview Survey; Body Mass Index; Health risk behaviors
9.  What factors explain disparities in mammography rates among Asian American immigrant women? A population-based study in California 
BACKGROUND
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.
METHODS
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.
FINDINGS
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.
CONCLUSIONS
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.
doi:10.1016/j.whi.2013.08.005
PMCID: PMC3833860  PMID: 24183415
10.  Alternative approaches to assessing intervention effectiveness in randomized trials: Application in a colorectal cancer screening study 
Cancer causes & control : CCC  2011;22(9):1233-1241.
BACKGROUND
Previous analysis of a randomized community-based trial of a multi-component intervention to increase colorectal cancer (CRC) screening among Filipino Americans (n=548) found significantly higher screening rates in the two intervention groups compared to the control group, when using intent-to-treat analysis and self-reported screening as the outcome. This report describes more nuanced findings obtained from alternative approaches to assessing intervention effectiveness to inform future intervention implementation.
METHODS
The effect of the intervention on CRC screening receipt during follow-up was estimated using methods that adjusted for biases due to missing data and self-report, and for different combinations of intervention components. Adjustment for self-report used data from a validation substudy. Effectiveness within demographic subgroups was also examined.
RESULTS
Analyses accounting for self-report bias and missing data supported the effectiveness of the intervention. The intervention was also broadly effective across the demographic characteristics of the sample. Estimates of the intervention effect were highest among participants whose providers received a letter as part of the intervention.
CONCLUSIONS
The findings increase confidence that the intervention could be broadly effective at increasing CRC screening in this population. Subgroup analyses and attempts to deconstruct multi-component interventions can provide important information for future intervention development, implementation and dissemination.
doi:10.1007/s10552-011-9793-9
PMCID: PMC3148350  PMID: 21678032
colorectal cancer; cancer screening; immigrants; validation of self-report; subgroup analysis
11.  Behavioral mediators of colorectal cancer screening in a randomized controlled intervention trial 
Preventive medicine  2010;52(2):167-173.
Background
Understanding mediators for behavioral change is important for the optimization of intervention strategies. This report examines mediators of change in the context of a randomized controlled intervention trial (Los Angeles, 2004–2009) that successfully increased colorectal cancer (CRC) screening among Filipino Americans.
Methods
The intervention, based on the Health Behavior Framework, targeted knowledge/awareness of CRC screening, communication with health care provider, health beliefs, social support and barriers to CRC screening. Health Behavior Framework variables were assessed at baseline and 6 month follow-up (N=432). Variables targeted for change were tested as potential mediators of the primary outcome, self-reported receipt of CRC screening during the follow-up period, which was previously found to have increased significantly among intervention participants.
Results
Consistent with the Health Behavior Framework, knowledge/awareness of CRC screening and patient-provider communication mediated receipt of screening. Increase in knowledge/awareness of CRC screening accounted for 13% (95% confidence interval 2%–24%) of the total intervention effect size while patient-provider communication accounted for 20% (5%–36%). Combined, these two variables accounted for 28% (10%–46%) of the total effect size.
Conclusion
Examining the roles of potential mediators in intervention trials may help identify constructs to target in order to enhance the effectiveness of interventions to increase screening.
doi:10.1016/j.ypmed.2010.11.007
PMCID: PMC3075444  PMID: 21111754
colorectal cancer; cancer screening; immigrants; intervention trial; mediation
12.  Constructing a Theoretically-Based Set of Measures for Liver Cancer Control Research Studies 
Preventive medicine  2009;50(1-2):68.
Objective
Measurement tools such as surveys assessing knowledge, attitudes and behaviors need to be theoretically consistent with interventions. The purpose of this paper is to describe the first steps in the process of constructing a theoretically-based set of measures that is currently used in three trials to reduce liver cancer disparities.
Methods
Guided by a common theoretical formulation - the Health Behavior Framework - we identified constructs relevant for liver cancer control research, compiled items from previous studies and constructed new items, and translated and pilot tested items in collaboration with members of the Vietnamese, Korean, and Hmong communities.
Results
We constructed three questionnaires in Vietnamese, Hmong and Korean language that are slightly different due to cultural and language nuances, but contain a core set of measures assessing identical constructs of the Health Behavior Framework. Initial research demonstrates that items are easily understood and that they are generally related to hepatitis B screening as expected.
Conclusions
Researchers are encouraged to follow a similar process for creating theory-based assessment tools. Measuring common theoretical constructs can advance liver cancer control and other health research by facilitating a more systematic comparison of findings across different populations and intervention strategies.
doi:10.1016/j.ypmed.2009.10.015
PMCID: PMC2813918  PMID: 19883680
hepatitis B virus; theory-based assessment instruments; cancer prevention; community-based research
13.  An Experimental Test of the Effect of Incentives on Recruitment of Ethnically Diverse Colorectal Cancer Cases and Their First-Degree Relatives into a Research Study 
Background
Optimizing participant response rates is important for obtaining representative samples and the timely completion of studies. It is a common practice to use participant incentives to boost response rates, but few studies have systematically examined their effectiveness, particularly among minority groups.
Methods
We experimentally tested three incentive strategies for their effectiveness in improving response rates among colorectal cancer cases (N=3,816) and their relatives (N=2,353). A 2×2×2 factorial design compared (1) registered versus first class mail, (2) $5 cash with the initial mailing (yes/no), and (3) $20promise (yes/no) upon completion of the information form (for cases) or $10 promise (yes/no) upon completion of the baseline survey (for relatives). Outcome measures were provision of contact information on first-degree relatives for cases and completion of the baseline survey for relatives.
Results
The response rate among cases was low in all ethnic groups (28 – 37%) and incentive strategies did not have an effect. Among relatives, the overall baseline survey response rate was 71%, ranging from 66% among Asians to 76% among Whites. Modest absolute increases were observed for payment schedules that included a $5 cash enclosure with the initial mailing in the total sample (OR 1.65 and 1.47) and among Latinos (OR 1.94 and 1.74) but not among Asians (OR 1.61 and 1.55) or African Americans (OR 1.19 and 1.02). Response rates were not influenced by registered versus first-class mailing.
Conclusion
The effects of incentives in this study were modest with some suggestion of differences by ethnic group and type of incentive.
doi:10.1158/1055-9965.EPI-09-0299
PMCID: PMC2759859  PMID: 19755646
randomized trial; effect of incentives; Asian American; Latino; African American
14.  Disparities in Receipt of FOBT versus Endoscopy among Filipino American Immigrants 
Background
This report examines disparities associated with the type of colorectal screening test, fecal occult blood test (FOBT) versus endoscopy, within a particular racial/ethnic group, Filipino American immigrants.
Methods
Between July 2005 and October 2006, Filipino Americans age 50-75 from 31 community organizations in Los Angeles completed a 15-minute survey in English (65%) or Filipino (35%).
Results
Of the 487 respondents included in this analysis, 257 (53%) had never received any type of colorectal cancer (CRC) screening. Among the 230 subjects who had ever received a routine screening test, 78 had FOBT only (16% of the total sample) and 152 had endoscopy with or without FOBT (31% of the total sample). After controlling for access to care and key demographic variables in a multivariate analysis, only two characteristics distinguished between respondents who had FOBT only versus those who had endoscopy: acculturation, assessed by percent lifetime in the U.S. and language of interview, and income.
Conclusions
Our data suggest a two tier system, FOBT for less acculturated Filipino Americans with lower income versus endoscopy for Filipino immigrants with higher levels of acculturation and income. The disparity persists after adjusting for access to care. Instead of treating minority groups as monolithic, differences within groups need to be examined so that interventions can be appropriately targeted.
doi:10.1158/1055-9965.EPI-07-2800
PMCID: PMC2852182  PMID: 18708385
colorectal cancer screening; fecal occult blood test; endoscopy; Filipino American immigrants
15.  Trends in Colorectal Cancer Screening Utilization among Ethnic Groups in California: Are We Closing the Gap? 
Background
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.
Methods
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.
Results
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.
Conclusions
Findings suggest that we need to intensify efforts to increase colorectal cancer screening, especially among Korean Americans but also among Filipinos, Vietnamese and Latinos.
doi:10.1158/1055-9965.EPI-08-0608
PMCID: PMC2745842  PMID: 19273482
colorectal cancer screening; ethnic disparities; Asian subgroups; California Health Interview Survey
16.  The Perils of Ignoring Design Effects in Experimental Studies: Lessons from a Mammography Screening Trial 
Psychology & health  2013;28(5):593-602.
Objective
Threats to external validity including pretest sensitization and the interaction of selection and an intervention are frequently overlooked by researchers despite their potential to significantly influence study outcomes. The purpose of this investigation was to conduct secondary data analyses to assess the presence of external validity threats in the setting of a randomized trial designed to promote mammography use in a high risk sample of women.
Design
During the trial, recruitment and intervention implementation took place in three cohorts (with different ethnic composition), utilizing two different designs (pretest-posttest control group design; posttest only control group design).
Results
Results reveal that the intervention produced different outcomes across cohorts, dependent upon the research design used and the characteristics of the sample.
Conclusion
These results illustrate the importance of weighing the pros and cons of potential research designs before making a selection and attending more closely to issues of external validity.
doi:10.1080/08870446.2012.756880
PMCID: PMC3630258  PMID: 23289517
external validity; research design; methodology; cancer screening; randomized controlled trial
17.  Increasing Hepatitis B Screening for Hmong adults: Results from a randomized controlled community-based study 
Background
Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9/100,000, Hmong Americans experience liver cancer at a rate that is 6–7 times greater than that of non-Hispanic Whites. Serological testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer deaths through earlier identification of those at risk.
Methods
Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation.
Results
Intervention group participants were more likely to report receiving serological testing for HBV (24% vs. 10%, p=0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, p=0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.3–9.2), improvement in knowledge score (OR 1.3 per point, 95% CI 1.02–1.7), female gender (OR 5.3, 95% CI 1.7–16.6), and having seen a doctor in the past year at baseline (OR 4.8, 95% CI 1.3–17.6). The most often cited reason for testing was a doctor’s recommendation.
Conclusions
LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors’ recommendations were pivotal. Participation of health care providers is essential to increase HBV testing.
Impact
LHWs can significantly increase HBV screening rates for Hmong, but their doctors’ recommendation is highly influential and should be pursued.
doi:10.1158/1055-9965.EPI-12-1399
PMCID: PMC3650126  PMID: 23613027
Hepatitis B; Hmong; Randomized controlled trial; community-based; liver cancer
18.  STRATEGIES TO RECRUIT AND RETAIN OLDER FILIPINO–AMERICAN IMMIGRANTS FOR A CANCER SCREENING STUDY 
Journal of community health  2005;30(3):167-179.
Recruitment and retention of subjects in cancer prevention, screening, and treatment trials is challenging, especially if subjects are low-income, from minority groups or immigrants with limited English fluency. This article describes our experiences in recruiting 530 female Filipino–American immigrants at community based organizations and churches for a randomized trial that assessed the effect of a small group educational session on breast and cervical cancer screening. We found that a personal invitation from either a female project liaison, a friend, or the Filipino project director were all successful strategies that resulted in over 80% attendance at an educational session that was offered as part of the study. Although non-attendees did not differ from attendees in demographic characteristics, they expressed significantly more barriers to participating in a health study. Attendance at the group session was a significant predictor of retention in the study. We were able to conduct telephone follow-up surveys among 88% of enrollees at 12 month follow-up and 76% at 24 month follow-up. Results and implications are discussed in the hope that they may facilitate future participation of Filipinos and other Asian immigrants in research.
doi:10.1007/s10900-004-1956-0
PMCID: PMC1810967  PMID: 15847243
recruitment and retention strategies; Filipino–American immigrants; cancer screening study
19.  Adoption of an evidence-based colorectal cancer screening promotion program by community organizations serving Filipino Americans 
BMC Public Health  2014;14:246.
Background
Filipino Americans have low rates of colorectal cancer (CRC) screening and high CRC mortality. To reduce this disparity, we conducted a dissemination trial in which we offered two levels of technical assistance to community organizations to disseminate an evidence-based CRC screening promotion program among their Filipino American members. This report describes the recruitment of organizations and adoption – the proportion and representativeness of organizations that decided to implement the program.
Methods
During the recruitment phase, we completed organizational assessments with 44 community-based organizations (previous partners in research, organizations that were referred to us, or new organizations) to assess their eligibility to participate (having ≥ 150 Filipino American members age 50+). We compared organizational characteristics of organizations that did and did not adopt our CRC screening promotion program.
Results
Twenty two of the 44 community organizations that completed the assessment adopted the CRC screening promotion program (50%). Adoption was highest among organizations that had previously partnered with us (11/14 = 79%) and among organizations that were referred to us by community partners (5/10 = 50%) and lowest among new organizations (6/20 = 30%). Few organizational differences were found between adopters and non-adopters.
Conclusions
The high rate of adoption among organizations that were referred by community partners or had partnered with us in the past underscores the importance of community resources, community-academic relationships, and partnership in the dissemination process. However, the moderate rate of adoption among new organizations and the demands of completing documentation and assessments in our trial to advance dissemination research raise questions regarding the generalizability of study findings.
doi:10.1186/1471-2458-14-246
PMCID: PMC3995646  PMID: 24618267
Lay health educator; Health promotion; Dissemination; Community organization; Churches; Adoption; Evidence-based intervention; Colorectal cancer screening
20.  Physical Activity Among Older Filipino-American Women 
Women & health  2002;36(1):67-79.
Filipino women (N = 530, mean age 63 years, predominantly low income) were recruited through various community based organizations and churches in Los Angeles County. All women were randomly invited to attend a single group session with a Filipino health educator to discuss breast and cervical cancer screening or the health benefits of exercise. At 3 months after the group session, the exercise assessment tool used in the National Health and Nutrition Examination Survey III was completed by 487 women (92 percent retention rate). This paper describes the pattern of physical activity among older Filipino-American women and a physical activity intervention specifically designed for this group.
PMCID: PMC1618778  PMID: 12215004
Filipino older women; immigrants; physical activity pattern; intervention; randomized design
21.  Results of a randomized controlled trial testing the efficacy of a culturally-targeted and a generic video on mammography screening among Chinese-American immigrants 
Background
Research comparing the effects of culturally-targeted and generic but linguistically appropriate intervention programs is limited. We conducted a randomized controlled trial comparing the efficacy of a culturally-targeted video, a generic video, and a fact sheet (control) in promoting mammography screening among Chinese-American immigrants.
Methods
We randomized 664 Chinese-American women from the Washington, DC and New York City areas who were >40 years and non-adherent to annual mammography screening guidelines to three study arms (each with ~221 women). The outcome was self-reported mammography screening six months post intervention. Measures of knowledge, Eastern cultural views, and health beliefs were administered before and after the intervention.
Results
The culturally-targeted video, the generic video, and the fact sheet increased mammography utilization by 40.3%, 38.5%, and 31.1% from baseline, respectively. A significant intervention effect was observed only in one subgroup: The culturally-targeted video significantly increased mammography screening among low-acculturated women over the fact sheet (OR=1.70, 95% CI=1.04, 2.78). Overall, women who obtained a mammogram during the follow-up period reported significantly fewer barriers to screening after intervention than those who had not obtained screening. Both of the video groups reported fewer barriers after intervention than the control group.
Conclusions
Both theoretically-guided videos increased the likelihood of mammography use to a similar extent. Cultural targeting was only effective for low-acculturated women. Both videos reduced perceived barriers to screening and consequently increased screening behavior.
Impact
The results of this study provide empirical evidence on the efficacy of cultural targeting for minority immigrants.
doi:10.1158/1055-9965.EPI-12-0821
PMCID: PMC3542829  PMID: 22971901
Cultural targeting; Video intervention; Mammography screening; Chinese Americans; Randomized controlled trial
22.  Comparing Perceived and Test-Based Knowledge of Cancer Risk and Prevention among Hispanic and African Americans: An Example of Community Participatory Research 
Ethnicity & disease  2013;23(2):210-216.
Background
Most theoretical formulations acknowledge that knowledge and awareness of cancer screening and prevention recommendations significantly influence health behaviors. This study compares perceived knowledge of cancer prevention and screening with test-based knowledge in a community sample. We also examine demographic variables and self-reported cancer screening and prevention behaviors as correlates of both knowledge scores, and consider whether cancer related knowledge can be accurately assessed using just a few, simple questions in a short and easy-to-complete survey.
Methods
We used a community-partnered participatory research approach to develop our study aims and a survey. The study sample was composed of 180 predominantly African American and Hispanic community individuals who participated in a full-day cancer prevention and screening promotion conference in South Los Angeles, California, on July 2011. Participants completed a self-administered survey in English or Spanish at the beginning of the conference.
Results
Our data indicate that perceived and test-based knowledge scores are only moderately correlated. Perceived knowledge score shows a stronger association with demographic characteristics and other cancer related variables than the test-based score. Thirteen out of twenty variables that are examined in our study showed a statistically significant correlation with the perceived knowledge score, however, only four variables demonstrated a statistically significant correlation with the test-based knowledge score.
Conclusion
Perceived knowledge of cancer prevention and screening was assessed with fewer items than test-based knowledge. Thus, using this assessment could potentially reduce respondent burden. However, our data demonstrate that perceived and test-based knowledge are separate constructs.
PMCID: PMC3747224  PMID: 23530303
Cancer; Knowledge; Minority; Prevention; Screening
23.  Drinking Patterns Among Korean Adults: Results of the 2009 Korean Community Health Survey 
Objectives
In Korea, the proportion of deaths due to alcohol is estimated at 8.9%, far exceeding the global estimate of 3.8%. Therefore, this study was performed to examine the factors associated with low-risk, moderate-risk, and high-risk drinking patterns in Korean adults and to identify target populations for prevention and control of alcohol-related diseases and deaths.
Methods
We analyzed data from 230 715 Korean adults aged 19 years and older who participated in the 2009 Korean Community Health Survey. Multinomial logistic regression analysis was used to examine associations between socio-demographic and health-related factors and patterns of alcohol use.
Results
A substantially larger proportion of men than women engaged in high risk (21.2% vs. 3.4%) and moderate-risk alcohol use (15.5% vs. 8.2%). In both sexes, moderate- and high-risk uses were associated with younger age, higher income, being currently employed, smoking, being overweight/obese, and good self-rated health.
Conclusions
Given the large proportion of the population that is engaging in moderate- and high-risk drinking and given the social norms that support this behavior, public health policies and campaigns to reduce alcohol consumption targeting the entire population are indicated.
doi:10.3961/jpmph.2013.46.4.183
PMCID: PMC3740223  PMID: 23946876
Alcohol drinking; Epidemiology; High-risk drinking; Risk factors; Republic of Korea
24.  Intervention tailoring for Chinese American women: comparing the effects of two videos on knowledge, attitudes and intentions to obtain a mammogram 
Health Education Research  2012;27(3):523-536.
This study utilized data from an ongoing randomized controlled trial to compare a culturally tailored video promoting positive attitudes toward mammography among Chinese immigrant women to a linguistically appropriate generic video and print media. Intervention development was guided by the Health Belief Model. Five hundred and ninety-two immigrant Chinese Americans from the metropolitan Washington, DC, and New York City areas completed telephone interviews before and after intervention. Changes in knowledge, Eastern views of health care (fatalism and self-care), health beliefs (perceived susceptibility, severity, benefits and barriers) and screening intentions were measured. Results showed that both videos improved screening knowledge, modified Eastern views of health care, reduced perceived barriers and increased screening intentions relative to print media (all P < 0.05). The generic video increased screening intention twice as much as the cultural video, although subgroup analysis showed the increase was only significant in women aged 50–64 years. Only Eastern views of health care were negatively associated with screening intentions after adjusting for all baseline covariates. These data suggest that a theoretically guided linguistically appropriate video that targets women from various ethnic groups is as efficacious in modifying attitudes toward mammography screening as a video that is exclusively tailored for Chinese immigrant women.
doi:10.1093/her/cys007
PMCID: PMC3337423  PMID: 22327806
25.  Pilot test of a peer-led small-group video intervention to promote mammography screening among Chinese American immigrants 
Health promotion practice  2010;12(6):887-899.
This study evaluated the feasibility, acceptability and potential effect of a small-group video intervention led by trained Chinese American lay educators who recruited Chinese American women not up to date on mammography screening. Nine lay educators conducted 14 “breast health tea time workshops” in community settings and private homes that started with watching a culturally tailored video promoting screening followed by a question and answer session and distribution of print materials. Many group attendees did not have health insurance or a regular doctor, had low levels of income and were not proficient in English. Forty-four percent of the attendees reported receipt of a mammogram within 6 months after the small-group session with higher odds of screening among women who had lived in the U.S. less than 10% of their lifetime. Four of the educators were very interested in conducting another group session in the next 6 months.
doi:10.1177/1524839909355550
PMCID: PMC2990797  PMID: 20720095
small-group/video intervention; mammography screening; Chinese American women

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