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1.  Understanding and Use of Nicotine Replacement Therapy and Nonpharmacologic Smoking Cessation Strategies Among Chinese and Vietnamese Smokers and Their Families 
Introduction
Population-based studies have reported high rates of smoking prevalence among Chinese and Vietnamese American men. Although nicotine replacement therapy (NRT) is effective, recommended, and accessible without prescription, these populations underuse NRT for smoking cessation. The aim of this study was to assess understanding and use of NRT and nonpharmacologic treatments among Chinese and Vietnamese American male smokers and their families.
Methods
In-depth qualitative interviews were conducted with 13 smoker–family pairs, followed by individual interviews with each participant. A total of 39 interviews were conducted in Vietnamese or Chinese, recorded, translated, and transcribed into English for analysis.
Results
Four themes were identified: use and understanding of NRT, nonpharmacologic strategies, familial and religious approaches, and willpower. Both smokers and their family members believed strongly in willpower and a sense of personal responsibility as the primary drivers for stopping smoking. Lack of these 2 qualities keeps many Chinese and Vietnamese men from using NRT to quit smoking. Those who do use NRT often use it incorrectly, following their own preferences rather than product instructions.
Conclusion
Our findings indicate the importance of culturally appropriate patient education about NRT. It may be necessary to teach smokers and their families at an individual level about NRT as a complementary approach that can strengthen their resolve to quit smoking. At a community level, public health education on the indication and appropriate use of evidence-based smoking cessation resources, such as NRT, would be an important component of effective tobacco control.
doi:10.5888/pcd11.130299
PMCID: PMC3938957  PMID: 24556252
2.  Cancer, Cancer Risk Factors, and Community-Based Cancer Control Trials in Vietnamese Americans 
Objectives
The purpose of this paper is to describe the epidemiology of cancer in Vietnamese Americans and reviews some of the successful intervention strategies that have been accomplished in Northern California.
Findings
Preventable cancers are among the leading causes of death in Vietnamese Americans, who have higher than average rates of smoking and lower than average rates for breast and cervical cancer screening, and lower rates of hepatitis B vaccination. Community-based intervention trials have shown good success in reducing these risk factors.
Conclusions
Despite successes, more work needs to be done. Continuing research and dissemination of successful intervention strategies will help improve the health of Vietnamese Americans, one of the fastest growing populations in the U.S.
PMCID: PMC2140278  PMID: 11567508
3.  Effectiveness of a Controlled Trial to Promote Colorectal Cancer Screening in Vietnamese Americans 
American journal of public health  2010;100(5):870-876.
Objectives
We conducted a controlled trial of a public education and provider intervention to increase colorectal cancer (CRC) screening rates among Vietnamese Americans, who typically have lower rates than non-Hispanic Whites.
Methods
The public education intervention included a Vietnamese-language CRC screening media campaign, distribution of health educational material, and a hotline. The provider intervention consisted of continuing medical education seminars, newsletters, and DVDs. Vietnamese in Alameda and Santa Clara Counties, California, received the intervention from 2004 to 2006; Vietnamese in Harris County, Texas, were controls and received no intervention. A quasi-experimental study design with pre- and postintervention surveys of the same 533 participants was used to evaluate the combined intervention.
Results
The postintervention-to-preintervention odds ratio for having ever had a sigmoidoscopy or colonoscopy was 1.4 times greater in the intervention community than in the control community. Knowledge and attitudes mediated the effect of the intervention on CRC screening behavior. Media exposure mediated the effect of the intervention on knowledge.
Conclusions
Improving CRC knowledge through the media contributed to the effectiveness of the intervention.
doi:10.2105/AJPH.2009.166231
PMCID: PMC2853624  PMID: 20299659
4.  Highlights/Best Practices of San Francisco’s Asian American Network for Cancer Awareness, Research, and Training (AANCART) 
Cancer  2005;104(12 Suppl):2920-2925.
The Asian American Network for Cancer Awareness, Research, and Training in San Francisco (AANCART-SF) consists of two distinct entities, working in cooperation to advance cancer awareness, research, and training among Asian Americans: a university-based group with expertise in the Vietnamese community and a community-based health plan with expertise in the Chinese community. In addition to the goals shared with other AANCART sites, AANCART-SF is a unique effort in capacity building in that it aims to expand and export community-academic research expertise from one Asian population, the Vietnamese, to other Asian populations. It also aims to build the research capability of those serving the Chinese community through a health plan.
doi:10.1002/cncr.21506
PMCID: PMC1704074  PMID: 16270324
AANCART; cancer; Asian; community outreach; cancer awareness
5.  Individual and Family Factors Associated with Intention to Quit among Male Vietnamese American Smokers: Implications for Intervention Development 
Addictive behaviors  2010;36(4):294-301.
Smoking prevalence among Vietnamese American males remains higher than the U.S. general population. This study examined the associations of individual and family factors with quit intention among Vietnamese male smokers in California to guide intervention development to reduce their smoking prevalence. Data for Vietnamese male current smokers (n = 234) in the 2008 California Vietnamese Adult Tobacco Use Survey (N=1,101 males) were analyzed to describe quit intention and previous quit attempts. One-third of Vietnamese male smokers (33%) had no intention to quit at any time, 36% intended to quit soon (in the next 30 days), and 31% intended to quit later (beyond the next 30 days). Half (51.7%) of the sample was in “precontemplation,” indicating no intention to quit within 6 months. Many (71%) had made a serious quit attempt in the past year, but 68% of those who tried to quit used no cessation assistance. Multivariate logistic regression adjusting for age, depression, smoking intensity, nicotine dependence, health knowledge, children in the household and home smoking ban revealed that having smoking-related family conflicts and a quit attempt in the past year with or without assistance were independently associated with an intention to quit either in the next 30 days or later. Higher education was associated with no intention to quit. Findings underscore the importance of designing strategic interventions that meet the needs of smokers at both individual and family levels to promote quit intention and to facilitate successful quitting in this population.
doi:10.1016/j.addbeh.2010.11.009
PMCID: PMC3056150  PMID: 21177041
tobacco use; smoking cessation; intention to quit; Asian Americans; Vietnamese Americans
6.  Letter from the Abbey 
Western Journal of Medicine  2001;174(1):73-75.
PMCID: PMC1071243  PMID: 11154681
7.  Effectiveness of Continuing Medical Education in Increasing Colorectal Cancer Screening Knowledge among Vietnamese American Physicians 
Colorectal cancer (CRC) screening rates are lower in Vietnamese Americans than in non-Hispanic Whites. Most Vietnamese Americans have ethnically concordant physicians and are willing to have CRC screening if their physicians recommend it. We conducted two continuing medical education (CME) seminars with participants recruited from the Vietnamese Physician Association of Northern California to increase their CRC screening knowledge. We used pre- and post-CME surveys to evaluate the CMEs and per-item McNemar’s tests to assess changes in knowledge. Correct responses increased significantly from pre- to post-CME for all 5 items on CRC burden and 4 of 11 items on screening guidelines and practices at the first CME and for 5 of 7 items on screening guidelines and practices at the second CME. CME seminars were effective in increasing CRC screening knowledge among Vietnamese American physicians. This increase may lead to physicians’ recommending and their patients’ completing CRC screening tests.
doi:10.1353/hpu.0.0290
PMCID: PMC3090290  PMID: 20453357
CME; colorectal cancer screening; Vietnamese Americans; health disparities
8.  Factors Associated with Hepatitis B Testing Among Vietnamese Americans 
BACKGROUND
Chronic hepatitis B and hepatitis B-associated liver cancer is a major health disparity among Vietnamese Americans, who have a chronic hepatitis B prevalence rate of 7–14% and an incidence rate for liver cancer six times that of non-Latino whites.
OBJECTIVE
Describe factors associated with hepatitis B testing among Vietnamese Americans.
DESIGN
A population-based telephone survey conducted in 2007–2008.
PARTICIPANTS
Vietnamese Americans age 18–64 and living in the Northern California and Washington, DC areas (N = 1,704).
MAIN MEASURES
Variables included self-reports of sociodemographics, health care factors, and hepatitis B-related behaviors, knowledge, beliefs, and communication with others. The main outcome variable was self-reported receipt of hepatitis B testing.
KEY RESULTS
The cooperation rate was 63.1% and the response rate was 27.4%. Only 62% of respondents reported having received a hepatitis B test and 26%, hepatitis B vaccination. Only 54% knew that hepatitis B could be transmitted by sexual intercourse. In multivariable analyses, factors negatively associated with testing included: age 30–49 years, US residence for >10 years, less Vietnamese fluency, lower income, and believing that hepatitis B can be deadly. Factors positively associated with testing included: Northern California residence, having had hepatitis B vaccination, having discussed hepatitis B with family/friends, and employer requested testing. Physician recommendation of hepatitis B testing (OR 4.46, 95% CI 3.36, 5.93) and respondent's request for hepatitis B testing (OR 8.37, 95% CI 5.95, 11.78) were strongly associated with test receipt.
CONCLUSION
Self-reports of hepatitis B testing among Vietnamese Americans remain unacceptably low. Physician recommendation and patient request were the factors most strongly associated with test receipt. A comprehensive effort is needed to promote hepatitis B testing in this population, including culturally-targeted community outreach, increased access to testing, and physician education.
doi:10.1007/s11606-010-1285-1
PMCID: PMC2881980  PMID: 20306150
hepatitis B; Vietnamese Americans; testing
9.  CERVICAL CANCER CONTROL RESEARCH IN VIETNAMESE AMERICAN COMMUNITIES 
Census data show that the US Vietnamese population now exceeds 1,250,000. Cervical cancer among Vietnamese American women has been identified as an important health disparity. Available data indicate the cervical cancer disparity may be due to low Pap testing rates rather than variations in HPV infection rates and/or types. The cervical cancer incidence rates among Vietnamese and non-Latina white women in California during 2000–2002 were 14.0 and 7.3 per 100,000, respectively. Only 70% of Vietnamese women who participated in the 2003 California Health Interview Survey reported a recent Pap smear, compared to 84% of non-Latina white women. Higher levels of cervical cancer screening participation among Vietnamese women are strongly associated with current/previous marriage, having a usual source of care/doctor, and previous physician recommendation. Vietnamese language media campaigns and lay health worker intervention programs have been effective in increasing Pap smear use in Vietnamese American communities. Cervical cancer control programs for Vietnamese women should address knowledge deficits; enable women who are without a usual source of care to find a primary care doctor; and improve patient-provider communication by encouraging health care providers to recommend Pap testing, as well as by empowering women to ask for testing.
doi:10.1158/1055-9965.EPI-08-0386
PMCID: PMC2665877  PMID: 18990732
Cervical cancer; Pap testing; Vietnamese Americans
10.  Cardiovascular Risk Factors and Knowledge of Symptoms Among Vietnamese Americans 
BACKGROUND
There are few population-based studies of cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans.
OBJECTIVE
To describe cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans and compare the results to non-Hispanic whites.
DESIGN
Comparison of data from two population-based, cross-sectional telephone surveys.
PARTICIPANTS
Vietnamese Americans in Santa Clara County, California, and non-Hispanic whites in California, aged 18 and older.
MEASUREMENTS
Survey measures included sociodemographics, diagnoses, body mass index, fruit and vegetable intake, exercise, and tobacco use. Knowledge of symptoms of heart attack and stroke was collected for Vietnamese Americans.
MAIN RESULTS
Compared to non-Hispanic whites (n = 19,324), Vietnamese Americans (n = 4,254) reported lower prevalences of obesity, diabetes mellitus, coronary heart disease, and hypertension, and similar prevalences of stroke and hypercholesterolemia. Fewer Vietnamese Americans consumed fruits and vegetables five or more times daily (27.8% vs 16.3%, p < 0.05), and more reported no moderate or vigorous physical activity (12.1% vs 40.1%, p < 0.05). More Vietnamese men than non-Hispanic White men were current smokers (29.8% vs 19.0%, p < 0.05). Vietnamese Americans who spoke Vietnamese were more likely than those who spoke English to eat fruits and vegetables less frequently, engage in no moderate or vigorous physical activity, and, among men, be current smokers. Only 59% of Vietnamese Americans knew that chest pain was a symptom of heart attack.
CONCLUSIONS
There are significant disparities in risk factors and knowledge of symptoms of cardiovascular diseases among Vietnamese Americans. Culturally appropriate studies and interventions are needed to understand and to reduce these disparities.
doi:10.1007/s11606-008-0889-1
PMCID: PMC2628984  PMID: 19089498
Vietnamese; Asian; cardiovascular disease; epidemiology; disparities
11.  Using focus groups to develop interventions to promote colorectal cancer screening among Vietnamese Americans 
Background
Colorectal cancer is the third most common cancer in Vietnamese Americans. Their colorectal screening rates are lower than the rates of whites.
Methods
Four focus groups were conducted to identify Vietnamese American sources and credibility of health information, media utilization, and intervention approaches.
Results
Vietnamese Americans trusted doctors and patient testimonials, and had access to, and received most of their health information from, Vietnamese-language print and electronic media. Recommended intervention approaches include promoting doctors' recommendation of screening and using Vietnamese-language mass media, print materials, and oral presentations.
Conclusions
Focus groups are useful in determining communication channels and intervention approaches.
doi:10.1207/s15430154jce2102_8
PMCID: PMC2523264  PMID: 17020518
12.  Interactive “Video Doctor” Counseling Reduces Drug and Sexual Risk Behaviors among HIV-Positive Patients in Diverse Outpatient Settings 
PLoS ONE  2008;3(4):e1988.
Background
Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide “prevention with positives” in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors.
Methodology and Findings
We conducted a parallel groups randomized controlled trial (December 2003–September 2006) at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults) completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476) were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a “Video Doctor” via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months) and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months). Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months) than did controls, and had fewer casual sex partners at (−2.3 vs. −1.4, p = 0.461, at 3 months; and −2.7 vs. −0.6, p = 0.042, at 6 months).
Conclusions
The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level, and modest individual-level reductions in days of ongoing drug use and number of casual sex partners compared with the control group. Positive Choice, including Video Doctor counseling, is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient settings, and holds promise as a public health HIV intervention.
Trial Registration
Clinicaltrials.gov NCT00447707
doi:10.1371/journal.pone.0001988
PMCID: PMC2292251  PMID: 18431475
13.  Factors Influencing Physicians’ Screening Behavior for Liver Cancer Among High-risk Patients 
BACKGROUND
Little is known about physicians’ screening patterns for liver cancer despite its rising incidence.
OBJECTIVE
Describe physician factors associated with liver cancer screening.
DESIGN
Mailed survey.
PARTICIPANTS
Physicians practicing in family practice, internal medicine, gastroenterology, or nephrology in 3 northern California counties in 2004.
MEASUREMENTS
Sociodemographic and practice measures, liver cancer knowledge, attitudes, and self-reported screening behaviors.
RESULTS
The response rate was 61.8% (N = 459). Gastroenterologists (100%) were more likely than Internists (88.4%), family practitioners (84.2%), or nephrologists (75.0%) to screen for liver cancer in high-risk patients (p = 0.016). In multivariate analysis, screeners were more likely than nonscreeners to think that screening for liver cancer reduced mortality (odds ratio [OR] 1.60, CI 1.09–2.34) and that not screening was a malpractice risk (OR 1.88, CI 1.29–2.75). Screeners were more likely than nonscreeners to order any screening test if it was a quality of care measure (OR 4.39, CI 1.79–10.81).
CONCLUSIONS
Despite debate about screening efficacy, many physicians screen for liver cancer. Their screening behavior is influenced by malpractice and quality control concerns. More research is needed to develop better screening tests for liver cancer, to evaluate their effectiveness, and to understand how physicians behave when there is insufficient evidence.
doi:10.1007/s11606-007-0128-1
PMCID: PMC1829432  PMID: 17372804
liver cancer; screening; prevention
14.  Applying the Quit & Win contest model in the Vietnamese community in Santa Clara County 
Tobacco control  2000;9(Suppl 2):II56-II59.
Objective
To evaluate the effectiveness of modifying and applying a Quit & Win contest model to Vietnamese Americans.
Design
Uncontrolled trial, multicomponent program, including two Quit & Win incentive contests, smoking cessation classes, videotape broadcasts, and newspaper articles.
Subjects and setting
Vietnamese smokers living in Santa Clara County, California.
Main outcome measures
Contest participation rates and quit rates at six month follow up; saliva cotinine validation of quitting.
Results
There were 57 eligible contest entrants to the 1995 contest, approximately 0.9% of the potential pool of smokers, and 32 entrants to the 1996 contest, approximately 0.5% of the potential pool. Overall, 48 of 49 (98%) individuals who said that they had quit smoking had validation of that fact by saliva cotinine testing. At six months, telephone follow up of 76 individuals revealed a self reported continued abstinence rate of 84.2%.
Conclusion
Modification and application of the Quit & Win contest model for Vietnamese resulted not only in reasonable participation by Vietnamese male smokers, but also good success in initial quitting and an unexpectedly high abstinence rate at six month follow up.
doi:10.1136/tc.9.suppl_2.ii56
PMCID: PMC1766279  PMID: 10841592
cessation; intervention; Vietnamese Americans
15.  The Effect of Access and Satisfaction on Regular Mammogram and Papanicolaou Test Screening in a Multiethnic Population 
Medical care  2004;42(9):914-926.
Background
Access and satisfaction are determinants of preventive service use, but few studies have evaluated their role in breast and cervical cancer screening in multiethnic populations.
Objectives
We sought to investigate the relationship between race/ethnicity, access, satisfaction, and regular mammogram and Papanicolaou test receipt in 5 racial/ethnic groups.
Research Design
We conducted a telephone survey in 4 languages.
Subjects
Our subjects were black, Chinese, Filipino, Latino, or white women aged 40 to 74 residing in Alameda County, California.
Measures
Outcome: regular mammograms (last test within 15 months and another within 2 years prior) and Papanicolaou tests (36 months and 3 years, respectively). Independent: race/ethnicity, sociodemographic variables, access (health insurance, usual site of care, regular doctor, check-up within 12 months, knowing where to go, copayment for tests), and satisfaction (overall satisfaction scale, waiting times, test-related pain and embarrassment, test satisfaction).
Results
Among women who had ever had a mammogram or Papanicolaou test, 54% and 77%, respectively, received regular screening. In multivariate analyses, regular mammography was positively associated with increased age (odds ratio [OR] 1.05 per year), private insurance (OR 1.7), check-up in the past year (OR 2.3), knowing where to go for mammography (OR 3.0), and greater satisfaction with processes of care (OR 1.04 per unit), and negatively with not knowing copayment amount (OR 0.4), too many forms to fill out (OR 0.5), embarrassment at the last mammogram (OR 0.6), and Filipino race/ethnicity. Similar results were found for regular Papanicolaou tests.
Conclusions
Access and satisfaction are important predictors of screening but do little to explain racial/ethnic variation. Tailored interventions to improve regular mammography and Papanicolaou test screening in multiethnic populations are needed.
PMCID: PMC1618783  PMID: 15319618
access to care; mammography; race and ethnicity; cancer screening; patient satisfaction
16.  Economic Analysis of Promotion of Hepatitis B Vaccinations Among Vietnamese-American Children and Adolescents in Houston and Dallas 
Pediatrics  2003;111(6 Pt 1):1289-1296.
Objective
To ascertain the cost-effectiveness and benefit-cost ratios of 2 public health campaigns conducted in Dallas and Houston in 1998–2000 for “catch-up” hepatitis B vaccination of Vietnamese-Americans born 1984–1993.
Design
Program evaluation.
Setting
Houston and Dallas, Texas.
Participants
A total of 14 349 Vietnamese-American children and adolescents.
Interventions
Media-led information and education campaign in Houston, and community mobilization strategy in Dallas. Outcomes were compared with a control site: Washington, DC.
Main outcome measures
Receipt of 1, 2, or 3 doses of hepatitis B vaccine before and after the interventions, costs of interventions, cost-effectiveness ratios for intermediate outcomes, intervention cost per discounted year of life saved, and benefit-cost ratio of the interventions.
Results
The number of children who completed the series of 3 hepatitis B vaccine doses increased by 1176 at a total cost of $313 904 for media intervention, and by 390 and at $169 561 for community mobilization. Costs per child receiving any dose, per dose, and per completed series were $363, $101, and $267 for media intervention and $387, $136, and $434 for community mobilization, respectively. For media intervention, the intervention cost per discounted year of life saved was $9954 and 131 years of life were saved; for community mobilization, estimates were $11 759 and 60 years of life. The benefit-cost ratio was 5.26:1 for media intervention and 4.47:1 for community mobilization.
Conclusion
Although the increases in the number of children who completed series of 3 doses were modest for both the Houston and Dallas areas, both media education and, to a lesser degree, community mobilization interventions proved cost-effective and cost-beneficial.
doi:10.1542/peds.111.6.1289
PMCID: PMC1617035  PMID: 12777543
cost-effectiveness analysis; benefit-cost analysis; hepatitis B vaccination; media education; community mobilization; Vietnamese-Americans; HBV, hepatitis B virus; HepB, hepatitis B vaccine; VFC, Vaccines for Children; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; API, Asian and Pacific Islander; VCHPP, Vietnamese Community Health Promotion Project; CE, cost-effectiveness
17.  Predictors of Cervical Pap Smear Screening Awareness, Intention, and Receipt Among Vietnamese-American Women 
Background
Compared with white women, Vietnamese women in the United States have a higher rate of cervical cancer and lower Papanicolau (Pap) test utilization. We evaluated factors associated with awareness of the Pap test, intention to obtain it, and its receipt in Vietnamese-American women.
Methods
In 2000, we conducted a telephone survey of Vietnamese-American women aged ≥18 years living in Santa Clara County, California, and Harris County, Texas. We collected data on sociodemographics, healthcare system access and attitudes, as well as Pap test awareness, attitudes, intentions, and practices.
Results
Of 1566 subjects, 74% had heard of the Pap test, and 76% had had at least one. Only 42% of those who never had a Pap test had considered obtaining one. There were no significant differences between the two sites. Women aged ≥65 had the lowest rates for all three outcomes. For all women, younger age, being married, having requested a Pap test, physician recommendation, and preferring a female standby if the doctor was male were associated with Pap test intention. Being married, higher level of education, having a female doctor, having a respectful doctor, having requested the test, and physician recommendation were associated with Pap test receipt.
Conclusion
Vietnamese-American women have low rates of Pap test awareness, intention, and receipt. The patient–doctor interaction is an important determinant. Efforts to increase Pap test utilization in this population need to be directed at encouraging physicians to offer the Pap test and empowering women to ask for the test.
PMCID: PMC1592337  PMID: 12350454
cervix neoplasms; ethnology; female; health behavior; health services accessibility; mass screening; patient acceptance of health care; primary prevention; Vietnam
18.  Successful Promotion of Hepatitis B Vaccinations Among Vietnamese-American Children Ages 3 to 18: Results of a Controlled Trial 
Pediatrics  2003;111(6 Pt 1):1278-1288.
Objective
Chronic infection with the hepatitis B virus is endemic in Southeast Asian populations, including Vietnamese. Previous research has documented low rates of hepatitis B vaccine coverage among Vietnamese-American children and adolescents ages 3 to 18. To address this problem, we designed and tested in a controlled trial 2 public health outreach “catch-up” campaigns for this population.
Design
In the Houston, Texas metropolitan area, we mounted a media-led information and education campaign, and in the Dallas metropolitan area, we organized a community mobilization strategy. We evaluated the success of these interventions in a controlled trial, using the Washington, DC metropolitan area as a control site. To do so, we conducted computer-assisted telephone interviews with random samples of ~500 Vietnamese-American households in each of the 3 study sites both before and after the interventions. We assessed respondents’ awareness and knowledge of hepatitis B and asked for hepatitis B vaccination dates for a randomly selected child in each household. When possible, we validated vaccination dates through direct contact with each child’s providers.
Results
Awareness of hepatitis B increased significantly between the pre- and postintervention surveys in all 3 areas, and the increase in the media education area (+21.5 percentage points) was significantly larger than in the control area (+9.0 percentage points). At postintervention, significantly more parents knew that free vaccines were available for children in the media education (+31.9 percentage points) and community mobilization (+16.7 percentage points) areas than in the control area (+4.7 percentage points). An increase in knowledge of sexual transmission of hepatitis B virus was significant in the media education area (+14.0 percentage points) and community mobilization (+13.6 percentage points) areas compared with the control area (+5.2 percentage points). Parent- or provider-reported data (n = 783 for pre- and n = 784 for postintervention surveys) suggest that receipt of 3 hepatitis B vaccinations increased significantly in the community mobilization area (from 26.6% at pre- to 38.8% at postintervention) and in the media intervention area (28.5% at pre- and 39.4% at postintervention), but declined slightly in the control community (37.8% at pre- and 33.5% at postintervention). Multiple logistic regression analyses estimated that the odds of receiving 3 hepatitis B vaccine doses were significantly greater for both community mobilization (odds ratio 2.15, 95% confidence interval 1.16–3.97) and media campaign (odds ratio 3.02, 95% confidence interval 1.62–5.64) interventions compared with the control area. The odds of being vaccinated were significantly greater for children who had had at least 1 diphtheria-tetanuspertussis shot, and whose parents were married, knew someone with liver disease, had heard of hepatitis B, and had greater knowledge about hepatitis B. The odds of being vaccinated were significantly lower for older children.
Conclusions
Both community mobilization and media campaigns significantly increased the knowledge of Vietnamese-American parents about hepatitis B vaccination, and the receipt of “catch-up” vaccinations among their children.
doi:10.1542/peds.111.6.1278
PMCID: PMC1592334  PMID: 12777542
hepatitis B vaccination; catch-up; Vietnamese-Americans; HBV, hepatitis B virus; HepB, hepatitis B vaccine; CDC, Centers for Disease Control and Prevention; DTP, diphtheria, tetanus toxoid and pertussis; VFC, Vaccines for Children; EDCC, East Dallas Counseling Center; OR, odds ratio; CI, confidence interval
19.  Hepatitis B Immunization Coverage Among Vietnamese-American Children 3 to 18 Years Old 
Pediatrics  2000;106(6):E78.
Objective
Persons with chronic hepatitis B virus (HBV) infection are at increased risk of chronic hepatitis, cirrhosis, and liver cancer. Although HBV infection is relatively uncommon in the United States, the disease is endemic in persons born in Southeast Asia, including Vietnamese-Americans. Current US infant immunization recommendations and state-mandated school-entry programs have left many nontargeted age-cohorts unvaccinated and at risk of infection. To assess the need for catch-up hepatitis B immunizations, this study reports the hepatitis B immunization rates of Vietnamese-American children 3 to 18 years old living in the metropolitan areas of Houston and Dallas, Texas, and the Washington, DC, area.
Design
We conducted 1508 telephone interviews with random samples of Vietnamese households in each of the 3 study sites. We asked for hepatitis B immunization dates for a randomly selected child in each household. Attempts were made to verify immunization dates through direct contact with each child’s providers. Low and high estimates of coverage were calculated using reports from providers when reached (n = 720) and for the entire sample (n = 1508).
Results
Rates of having 3 hepatitis B vaccinations ranged from 13.6% (entire sample) to 24.1% (provider reports, Dallas), 10.3% to 26.4% (Houston), and 18.1% to 37.8% (Washington, DC). Children living in the Texas sites, older children, children whose families had lived in the United States for a longer time, and children whose provider was Vietnamese or who had an institutional provider were less likely to have been immunized. The odds of being immunized were greater, however, for children who had had at least 1 diphtheria, tetanus toxoid, and pertussis shot, and whose parents had heard about HBV infection, and were married.
Conclusions
The low rates of hepatitis B vaccine coverage among children and adolescents portend a generation which, too old to benefit from infant programs and school entry laws, will grow into adulthood without the protection of immunization. Increased efforts are needed
doi:10.1542/peds.106.6.e78
PMCID: PMC1618772  PMID: 11099621
HBV, hepatitis B virus; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; DTP, diphtheria, tetanus toxoid, and pertussis; VFC, Vaccines for Children
20.  Factors Influencing Physicians’ Screening Behavior for Liver Cancer Among High-risk Patients 
BACKGROUND
Little is known about physicians’ screening patterns for liver cancer despite its rising incidence.
OBJECTIVE
Describe physician factors associated with liver cancer screening.
DESIGN
Mailed survey.
PARTICIPANTS
Physicians practicing in family practice, internal medicine, gastroenterology, or nephrology in 3 northern California counties in 2004.
MEASUREMENTS
Sociodemographic and practice measures, liver cancer knowledge, attitudes, and self-reported screening behaviors.
RESULTS
The response rate was 61.8% (N = 459). Gastroenterologists (100%) were more likely than Internists (88.4%), family practitioners (84.2%), or nephrologists (75.0%) to screen for liver cancer in high-risk patients (p = 0.016). In multivariate analysis, screeners were more likely than nonscreeners to think that screening for liver cancer reduced mortality (odds ratio [OR] 1.60, CI 1.09–2.34) and that not screening was a malpractice risk (OR 1.88, CI 1.29–2.75). Screeners were more likely than nonscreeners to order any screening test if it was a quality of care measure (OR 4.39, CI 1.79–10.81).
CONCLUSIONS
Despite debate about screening efficacy, many physicians screen for liver cancer. Their screening behavior is influenced by malpractice and quality control concerns. More research is needed to develop better screening tests for liver cancer, to evaluate their effectiveness, and to understand how physicians behave when there is insufficient evidence.
doi:10.1007/s11606-007-0128-1
PMCID: PMC1829432  PMID: 17372804
liver cancer; screening; prevention
21.  The Costs of an Outreach Intervention for Low-Income Women With Abnormal Pap Smears 
Preventing Chronic Disease  2006;4(1):A11.
Introduction
Follow-up among women who have had an abnormal Papanicolaou (Pap) smear is often poor in public hospitals that serve women at increased risk for cervical cancer. This randomized controlled trial evaluated and compared the total cost and cost per follow-up of a tailored outreach intervention plus usual care with the total cost and cost per follow-up of usual care alone.
Methods
Women with an abnormal Pap smear (n = 348) receiving care at Alameda County Medical Center (Alameda County, California) were randomized to intervention or usual care. The intervention used trained community health advisors to complement the clinic's protocol for usual care. We assessed the costs of the intervention and the cost per follow-up within 6 months of the abnormal Pap smear test result.
Results
The intervention increased the rate of 6-month follow-up by 29 percentage points, and the incremental cost per follow-up was $959 (2005 dollars). The cost per follow-up varied by the severity of the abnormality. The cost per follow-up for the most severe abnormality (high-grade squamous intraepithelial lesion) was $681, while the cost per follow-up for less severe abnormalities was higher.
Conclusion
In a health care system in which many women fail to get follow-up care for an abnormal Pap smear, outreach workers were more effective than usual care (mail or telephone reminders) at increasing follow-up rates. The results suggest that outreach workers should manage their effort based on the degree of abnormality; most effort should be placed on women with the most severe abnormality (high-grade squamous intraepithelial lesion).
PMCID: PMC1832136  PMID: 17173719
22.  Barriers to Colorectal Cancer Screening in Latino and Vietnamese Americans 
OBJECTIVE
To identify current colorectal cancer (CRC) screening practices and barriers to screening in the Latino, Vietnamese, and non-Latino white populations.
METHODS
We conducted a telephone survey of Latino, non-Latino white, and Vietnamese individuals living in San Jose, California. We asked about demographics, CRC screening practices, intentions to be screened, and barriers and facilitators to screening.
RESULTS
Seven hundred and seventy-five individuals (40% white, 29.2% Latino, and 30.8% Vietnamese) completed the survey (Response Rate 50%). Overall, 23% of respondents reported receipt of fecal occult blood test (FOBT) in the past year, 28% reported sigmoidoscopy (SIG) in the past 5 years, and 27% reported colonoscopy (COL) in the past 10 years. Screening rates were generally lower in Latinos and Vietnamese. Vietnamese were less likely than whites to have had SIG in the past 5 years (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.09 to 0.72), but ethnicity was not an independent predictor of FOBT or COL. Only 22% of Vietnamese would find endoscopic tests uncomfortable compared with 79% of whites (P < .05). While 21% of Latinos would find performing an FOBT embarrassing, only 8% of whites and 3% of Vietnamese felt this way (P < .05). Vietnamese were more likely than whites to plan to have SIG in the next 5 years (OR, 2.24; 95% CI, 1.15 to 4.38), but ethnicity was not associated with planning to have FOBT or COL.
CONCLUSIONS
Rates of CRC screening are lower in ethnic minority populations than in whites. Differences in attitudes and perceived barriers suggest that culturally tailored interventions to increase CRC screening will be useful in these populations
doi:10.1111/j.1525-1497.2004.30263.x
PMCID: PMC1492137  PMID: 15009795
colorectal cancer; screening; prevention
23.  Encouraging Vietnamese-American Women to Obtain Pap Tests Through Lay Health Worker Outreach and Media Education 
BACKGROUND
Five times more Vietnamese-American women develop cervical cancer than white women. Few studies have examined whether community-based participatory research can effectively address Asian immigrants' health problems. This article reports the preliminary evaluation of 1 such project.
METHODS
A coalition of 11 organizations in Santa Clara County, California worked with university researchers to design and simultaneously implement a media education (ME) campaign and a lay health worker outreach (LHWO) program to increase Vietnamese-American women's cervical cancer awareness, knowledge, and screening. Two agencies each recruited 10 lay health workers (LHWs), who, in turn, each recruited 20 women who were then randomized into 2 groups: 10 to LHWO+ME (n = 200) and 10 to ME alone (n = 200). LHWs organized meetings with women to increase their knowledge and to motivate them to obtain Pap tests. Participants completed pre- and post-intervention questionnaires.
RESULTS
At post-intervention, significantly more LHWO+ME women understood that human papillomavirus and smoking cause cervical cancer. The number of women who had obtained a Pap test increased significantly among women in both LHWO+ME and ME groups, but substantially more in the LHWO+ME group. Significantly more LHWO+ME women said they intended to have a Pap test.
CONCLUSIONS
Media education campaigns can increase Vietnamese women's awareness of the importance of Pap tests, but lay health workers are more effective at encouraging women to actually obtain the tests. Lay health workers are effective because they use their cultural knowledge and social networks to create change. Researchers, community members, and community-based organizations can share expert knowledge and skills, and build one another's capacities.
doi:10.1046/j.1525-1497.2003.21043.x
PMCID: PMC1494888  PMID: 12848834
cervical cancer; screening; vietnamese; lay health worker; media
24.  Patient-provider Communication in Cancer Screening 
doi:10.1046/j.1525-1497.2003.30346.x
PMCID: PMC1494864  PMID: 12795740
25.  Doctoring to Heal 
Western Journal of Medicine  2001;174(1):66-69.
PMCID: PMC1157069  PMID: 11154679

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