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1.  Results of a randomized controlled trial testing the efficacy of a culturally-targeted and a generic video on mammography screening among Chinese-American immigrants 
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.
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.
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.
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.
The results of this study provide empirical evidence on the efficacy of cultural targeting for minority immigrants.
PMCID: PMC3542829  PMID: 22971901
Cultural targeting; Video intervention; Mammography screening; Chinese Americans; Randomized controlled trial
2.  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.
PMCID: PMC3337423  PMID: 22327806
3.  Physical Distress and Cancer Care Experiences Among Chinese-American and Non-Hispanic White Breast Cancer Survivors 
Gynecologic Oncology  2011;124(3):383-388.
The number of Chinese-American breast cancer survivors (BCS) is increasing as a result of increasing incidence rates. There has been little research on Chinese BCS’ follow-up cancer care. This qualitative study aims to understand how Chinese-American BCS experience and cope with physical distress relative to non-Hispanic White (NHW) survivors.
Seventy-one BCS (37 Chinese immigrant, 7 US-born Chinese, 27 NHW) were recruited from the Greater Bay Area Cancer Registry to participate in focus group discussions or one-on-one interviews about their survivorship experiences. All BCS were diagnosed with breast cancer at stage 0-IIA between 2006-2009, and had survived for 1-4 years without recurrence. Interviews were conducted in Cantonese, Mandarin, or English. Data analyses followed established qualitative methods of content analysis.
BCS experienced pain and side effects from radiation, surgery, and hormonal therapy. Physical distress subsequently caused emotional concerns about recurrence or metastasis. Most BCS consulted physicians about their physical distress. Chinese immigrant BCS were less likely to have their issues resolved compared to NHW and US-born Chinese who were more likely to question physicians, ask for referrals, and make repeat attempts if their problems were not resolved. Some Chinese immigrant BCS turned to Traditional Chinese Medicine for relief or accepted the idea that physical distress was part of survivorship.
Chinese immigrant BCS may be at risk for greater distress compared with US-born Chinese and NHW BCS because of cultural norms that make them less inclined to express their needs to physicians or challenge physicians when their needs are not met. Furthermore, they may express symptoms in culturally unique ways (e.g., hot-cold imbalances). Further research is needed to determine how to best improve survivorship care experiences in this understudied population, with the goal of decreasing BCS’ physical distress and improving quality of life.
PMCID: PMC3298543  PMID: 22115854
4.  Cultural Views, Language Ability, and Mammography Use in Chinese American Women 
Mammography screening rates among Chinese American women have been reported to be low. This study examines whether and how culture views and language ability influence mammography adherence in this mostly immigrant population. Asymptomatic Chinese American women (n = 466) aged 50 and older, recruited from the Washington, D.C. area, completed a telephone interview. Regular mammography was defined as having two mammograms at age-appropriate recommended intervals. Cultural views were assessed by 30 items, and language ability measured women’s ability in reading, writing, speaking, and listening to English. After controlling for risk perception, worry, physician recommendation, family encouragement, and access barriers, women holding a more Chinese/Eastern cultural view were significantly less likely to have had regular mammograms than those having a Western cultural view. English ability was positively associated with mammography adherence. The authors’ results imply that culturally sensitive and language-appropriate educational interventions are likely to improve mammography adherence in this population.
PMCID: PMC3577419  PMID: 19233947
breast cancer screening; culture; minority health
5.  Pharmacological blockade of the cold receptor TRPM8 attenuates autonomic and behavioral cold defenses and decreases deep body temperature 
We studied M8-B, a selective and potent antagonist of the transient receptor potential melastatin-8 (TRPM8) channel. In vitro, M8-B blocked cold-induced and TRPM8-agonist-induced activation of rat, human, and murine TRPM8 channels, including those on primary sensory neurons. In vivo, M8-B decreased deep body temperature (Tb) in Trpm8+/+ mice and rats, but not in Trpm8−/− mice, thus suggesting an on-target action. The intravenous administration of M8-B was more effective in decreasing Tb in rats than the intrathecal or intracerebroventricular administration, indicating a peripheral action. M8-B attenuated cold-induced c-Fos expression in the lateral parabrachial nucleus, thus indicating a site of action within the cutaneous cooling neural pathway to thermoeffectors, presumably on sensory neurons. A low intravenous dose of M8-B did not affect Tb at either a constantly high or a constantly low ambient temperature (Ta), but the same dose readily decreased Tb if rats were kept at a high Ta during the M8-B infusion and transferred to a low Ta immediately thereafter. These data suggest that both a successful delivery of M8-B to the skin (high cutaneous perfusion) and the activation of cutaneous TRPM8 channels (by cold) are required for the hypothermic action of M8-B. At tail skin temperatures < 23°C, the magnitude of the M8-B-induced decrease in Tb was inversely related to skin temperature, thus suggesting that M8-B blocks thermal (cold) activation of TRPM8. M8-B affected all thermoeffectors studied (thermopreferendum, tail skin vasoconstriction, and brown fat thermogenesis), thus suggesting that TRPM8 is a universal cold receptor in the thermoregulation system.
PMCID: PMC3566779  PMID: 22323721
thermoregulation; cold sensors; thermopreferendum; hypothermia; melastatin; TRPM8 antagonist; lateral parabrachial nucleus
6.  The Influence of Culture and Cancer Worry on Colon Cancer Screening Among Older Chinese-American Women 
Ethnicity & disease  2006;16(2):404-411.
This study investigated the hypothesis that adherence to colon cancer screening guidelines among Chinese women was associated with Eastern cultural views and anxiety about developing colon cancer.
Cross-sectional data from a community-based longitudinal study were used to examine the hypothesis of this study. Measures of sociodemographics, medical access factors, cultural views of health care, cancer worry, and practices of colon cancer screening were administered by a computer assisted telephone interview.
Four hundred and thirty-three Chinese-American women from Metropolitan Washington, DC age 50 years and older and without a history of colon cancer completed the telephone interview.
Main Outcome Measure
Adherence to utilization of either fecal occult blood test (FOBT) within a year, sigmoidoscopy within five years, or colonoscopy within 10 years was used to define two outcome categories: current screeners and noncurrent screeners.
Controlling for covariates, this study found that: 1) women with more Eastern cultural views were less likely to be current screeners; 2) women who thought about the chance of getting colon cancer had approximately three-fold greater odds of being current screeners than women who never thought about colon cancer; and 3) women receiving physician recommendation for colon cancer screening had more than three-fold increased odds of being current screeners than those who had not received a recommendation.
In addition to the lack of physician recommendation, older Chinese women face cultural and psychological barriers to obtaining timely colon cancer screening. These barriers may be reduced through culturally sensitive intervention studies.
PMCID: PMC3528348  PMID: 17682242
Cancer Worry; Chinese-American Women; Colon Cancer Screening; Colonoscopy; Cultural Views of Health Care; FOBT; Physician Recommendation; Sigmoidoscopy
7.  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.
PMCID: PMC2990797  PMID: 20720095
small-group/video intervention; mammography screening; Chinese American women
8.  Effects of sildenafil and/or muscle derived stem cells on myocardial infarction 
Previous studies have shown that long-term oral daily PDE 5 inhibitors (PDE5i) counteract fibrosis, cell loss, and the resulting dysfunction in tissues of various rat organs and that implantation of skeletal muscle-derived stem cells (MDSC) exerts some of these effects. PDE5i and stem cells in combination were found to be more effective in non-MI cardiac repair than each treatment separately. We have now investigated whether sildenafil at lower doses and MDSC, alone or in combination are effective to attenuate LV remodeling after MI in rats.
MI was induced in rats by ligature of the left anterior descending coronary artery. Treatment groups were: “Series A”: 1) untreated; 2) oral sildenafil 3 mg/kg/day from day 1; and “Series B”: intracardiac injection at day 7 of: 3) saline; 4) rat MDSC (106 cells); 5) as #4, with sildenafil as in #2. Before surgery, and at 1 and 4 weeks, the left ventricle ejection fraction (LVEF) was measured. LV sections were stained for collagen, myofibroblasts, apoptosis, cardiomyocytes, and iNOS, followed by quantitative image analysis. Western blots estimated angiogenesis and myofibroblast accumulation, as well as potential sildenafil tachyphylaxis by PDE 5 expression. Zymography estimated MMPs 2 and 9 in serum.
As compared to untreated MI rats, sildenafil improved LVEF, reduced collagen, myofibroblasts, and circulating MMPs, and increased cardiac troponin T. MDSC replicated most of these effects and stimulated cardiac angiogenesis. Concurrent MDSC/sildenafil counteracted cardiomyocyte and endothelial cells loss, but did not improve LVEF or angiogenesis, and upregulated PDE 5.
Long-term oral sildenafil, or MDSC given separately, reduce the MI fibrotic scar and improve left ventricular function in this rat model. The failure of the treatment combination may be due to inducing overexpression of PDE5.
PMCID: PMC3476974  PMID: 22871104
Stem cells; Myocardial infarction; Heart failure; PDE5 inhibitors; Fibrosis
9.  Elevated Serum Gastrin Is Associated With a History of Advanced Neoplasia in Barrett’s Esophagus 
Proton pump inhibitors (PPIs) are frequently prescribed to patients with Barrett’ s esophagus (BE), but in a subset, they can induce significant hypergastrinemia. Elevated levels of gastrin have been associated with tumorigenic effects in a number of gastrointestinal cancers. We decided to investigate the association between serum gastrin levels and dysplasia in BE.
We performed a cross-sectional study and enrolled patients with BE without dysplasia, low-grade dysplasia (LGD), high-grade dysplasia (HGD), or adenocarcinoma (AC), as well as gastroesophageal reflux disease controls, all chronically taking PPIs. Fasting serum gastrin was measured, and data were collected on patient characteristics, medication use, and the highest degree of BE neoplasia.
A total of 95 patients were enrolled. The mean age was 64.7 (±10.0) years, and 70.5 % were male. The median serum gastrin level was 40 pM. There was no significant difference in gastrin levels with increased degrees of BE neoplasia (overall P = 0.68). In multivariable analysis, the highest quartile of gastrin was associated with significantly increased odds of advanced neoplasia (HGD or AC) (odds ratio (OR): 5.46, 95 % confidence interval (CI): 1.20–24.8).
In BE patients taking PPIs, an elevated serum gastrin is associated with a history of HGD or AC. Prospective studies are needed to determine whether patients with nondysplastic BE and elevated serum gastrin are at increased risk for neoplastic progression.
PMCID: PMC3139948  PMID: 19904251
10.  Knowledge, Cultural, and Attitudinal Barriers to Mammography Screening among Non-Adherent Immigrant Chinese Women: Ever versus Never Screened Status 
Cancer  2009;115(20):4828-4838.
Chinese-American women have much lower mammography screening rates than the general population. This study examined the collective impact of knowledge, cultural views, and health beliefs on intentions to obtain mammography among Chinese women who had not had a mammogram in the previous year.
Five-hundred, sixty-six immigrant Chinese women from the Washington, DC and New York metropolitan areas completed baseline assessments for a longitudinal intervention study. Validated surveys were used to measure variables of interest. The outcomes were 1) past mammography use (ever versus never) and 2) future screening intention.
Only 35% of the participants reported intentions to obtain mammograms, with approximately 19% of the never users reporting intentions (vs. 44% ever users). Ever users had higher knowledge (OR 1.13, 95% CI 1.03–1.25), less Eastern cultural views (OR 0.78, 95% CI 0.70–0.87), and perceived fewer barriers (OR 0.78, 95% CI 0.70–0.87) than never users, controlling for covariates. Never users were more likely to be recent immigrants, have low income and English ability, and lack regular sources of care than ever users (all p<.001). Multivariate models showed that ever users who were employed, received physician recommendations, had less Eastern views, and perceived higher susceptibility were more likely to have intentions. Among never users, only being ages 40–49 and perceiving fewer barriers led to increased intention.
Understanding cultural patterns and health beliefs in Chinese women is critical to changing their screening behaviors. Interventions that address their common beliefs and specific group barriers are optimal for promoting mammography adherence.
PMCID: PMC2761518  PMID: 19645031
Mammography adherence; Chinese-American women; Cultural views; Health Belief Model
11.  Language Use and the Receipt of Cancer Screening Recommendations by Immigrant Chinese American Women 
Journal of Women's Health  2009;18(2):201-207.
Cancer screening rates are low among Chinese American women, a mostly immigrant minority population. This is possibly because they do not receive cancer screening recommendations from their physicians. The objective of this study was to determine if the rate at which physicians recommend cancer screening to older Chinese American women differs according to the language used during visits.
Data for the cross-sectional study were collected from a telephone survey of older Chinese American women residing in the Washington, DC, area. A total of 507 asymptomatic Chinese American women aged ≥50 who had a regular physician participated in this study. The main outcome was women's self-reported perception of having received a recommendation from their physician for mammography, Pap tests, or colorectal cancer screening in the past 2 years. The main independent variable was the language used during visits (English vs. Chinese). Patient age, educational level, employment status, cultural views, physician specialty, physician gender, and length of relationship with the physician were included in the multiple logistic regression analyses.
Chinese women who communicated with their physicians in English were 1.71 (95% CI 1.00-2.96) and 1.73 (95% CI 1.00-3.00) times more likely to report having received mammography and colorectal cancer screening recommendations, respectively (p < 0.05). Physicians in family medicine or general practice were 2.11 (95% CI 1.31-3.40) and 1.70 (95% CI 1.06-2.48) times more likely to recommend cancer screening than those in other specialties.
Chinese American women who conversed with their physicians in Chinese were less likely to perceive receiving cancer screening recommendations. Future research is needed to identify physician-specific knowledge, attitude, and cultural barriers to recommending cancer screening.
PMCID: PMC2945721  PMID: 19183091
12.  Are Health-care Relationships Important for Mammography Adherence in Latinas? 
Journal of General Internal Medicine  2008;23(12):2024-2030.
Latinas are the fastest growing racial ethnic group in the United States and have an incidence of breast cancer that is rising three times faster than that of non-Latino white women, yet their mammography use is lower than that of non-Latino women.
We explored factors that predict satisfaction with health-care relationships and examined the effect of satisfaction with health-care relationships on mammography adherence in Latinas.
Design and Setting
We conducted a cross-sectional survey of 166 Latinas who were ≥40 years old. Women were recruited from Latino-serving clinics and a Latino health radio program.
Mammography adherence was based on self-reported receipt of a mammogram within the past 2 years. The main independent variable was overall satisfaction with one’s health-care relationship. Other variables included: self report of patient-provider communication, level of trust in providers, primary language, country of origin, discrimination experiences, and perceptions of racism.
Forty-three percent of women reported very high satisfaction in their health-care relationships. Women with high trust in providers and those who did not experience discrimination were more satisfied with their health-care relationships compared to women with lower trust and who experienced discrimination (p < .01). Satisfaction with the health-care relationship was, in turn, significantly associated with mammography adherence (OR: 3.34, 95% CI: 1.47–7.58), controlling for other factors.
Understanding the factors that impact Latinas’ mammography adherence may inform intervention strategies. Efforts to improve Latina’s satisfaction with physicians by building trust may lead to increased use of necessary mammography.
PMCID: PMC2596511  PMID: 18839258
Latinas; immigrants; mammograms; satisfaction; adherence
13.  microRNA-mediated control of cell fate in megakaryocyte-erythrocyte progenitors 
Developmental cell  2008;14(6):843-853.
Lineage specification is a critical issue in developmental and regenerative biology. We hypothesized that microRNAs (miRNAs) are important participants in that process and used the poorly-understood regulation of megakaryocyte-erythrocyte progenitors (MEPs) in hematopoiesis as a model system. We report here that miR-150 modulates lineage fate in MEPs. Using a novel methodology capable of profiling miRNA expression in limiting numbers of primary cells, we identify miR-150 as preferentially expressed in the megakaryocytic lineage. Through gain- and loss-of-function experiments, we demonstrate that miR-150 drives MEP differentiation toward megakaryocytes at the expense of erythroid cells in vitro and in vivo. Moreover, we identify the transcription factor MYB as a critical target of miR-150 in this regulation. These experiments show that miR-150 regulates MEP fate, and thus establish a role for miRNAs in lineage specification of mammalian multi-potent cells.
PMCID: PMC2688789  PMID: 18539114
14.  Designing a tobacco counter-marketing campaign for African American youth 
The objectives of this qualitative study were to: a) identify common marketing themes and tactics used by the tobacco industry to entice African Americans (AA's) and youth to initiate and maintain smoking behavior, especially smoking mentholated brands of cigarettes, and b) determine AA youths' knowledge, attitudes, intentions, and beliefs about smoking and the tobacco industry. Together, these activities could aid in the development of effective tobacco counter-marketing campaigns for AA youth. Using publicly available tobacco industry documents, computerized searches using standardized keywords were run and results were cataloged and analyzed thematically. Subsequently, 5 focus groups were conducted with n = 28 AA middle school-aged youth. Results suggest that the tobacco industry consistently recruited new AA smokers through a variety of means, including social and behavioral marketing studies and targeted media and promotional campaigns in predominantly AA, urban, and low income areas. AA youth interviewed in this study were largely unaware of these tactics, and reacted negatively against the industry upon learning of them. Youth tended to externalize control over tobacco, especially within the AA community. In designing a counter-marketing campaign for this population, partnering knowledge of tobacco industry practices with youth needs and community resources will likely increase their effectiveness.
PMCID: PMC2556031  PMID: 18822164
15.  Taci Is a Traf-Interacting Receptor for Tall-1, a Tumor Necrosis Factor Family Member Involved in B Cell Regulation 
We and others recently reported tumor necrosis factor (TNF) and apoptosis ligand–related leukocyte-expressed ligand 1 (TALL-1) as a novel member of the TNF ligand family that is functionally involved in B cell proliferation. Transgenic mice overexpressing TALL-1 have severe B cell hyperplasia and lupus-like autoimmune disease. Here, we describe expression cloning of a cell surface receptor for TALL-1 from a human Burkitt's lymphoma RAJI cell library. The cloned receptor is identical to the previously reported TNF receptor (TNFR) homologue transmembrane activator and calcium modulator and cyclophilin ligand (CAML) interactor (TACI). Murine TACI was subsequently isolated from the mouse B lymphoma A20 cells. Human and murine TACI share 54% identity overall. Human TACI exhibits high binding affinities to both human and murine TALL-1. Soluble TACI extracellular domain protein specifically blocks TALL-1–mediated B cell proliferation without affecting CD40- or lipopolysaccharide-mediated B cell proliferation in vitro. In addition, when injected into mice, soluble TACI inhibits antibody production to both T cell–dependent and –independent antigens. By yeast two-hybrid screening of a B cell library with TACI intracellular domain, we identified that, like many other TNFR family members, TACI intracellular domain interacts with TNFR-associated factor (TRAF)2, 5, and 6. Correspondingly, TACI activation in a B cell line results in nuclear factor κB and c-Jun NH2-terminal kinase activation. The identification and characterization of the receptor for TALL-1 provides useful information for the development of a treatment for B cell–mediated autoimmune diseases such as systemic lupus erythematosus.
PMCID: PMC1887716  PMID: 10880535
TACI; TNFR family; TALL-1; B cell stimulation; autoimmune disease

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