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1.  American Heart Association’s Ideal Cardiovascular Health Metrics in Under-Represented Asian Americans 
Journal of community health  2016;41(6):1282-1289.
The American Heart Association’s ideal cardiovascular health score is based on 7 cardiovascular health metrics to measure progress toward their Impact Goal of reducing cardiovascular disease by 20 % before 2020. This study applied this construct to assess cardiovascular health in a sample of Asian Americans. Convenience sampling methods were used to enroll self-identified Asian American’s over the age of 18 years who were attending community health fairs across the greater Philadelphia and urban areas of New Jersey. The heart health metrics of tobacco use, body mass index, physical activity, diet, blood pressure, and glucose were measured. In the greater sample (N = 541), 82 % were female, the mean age was 65.1 (SD = 15.5) years, 45 % were Vietnamese, 38 % were Chinese and 17 % were Korean. Prevalence of ideal heart health for the metrics of tobacco use (95 %) was high. Only 19.4 % achieved ideal levels of physical activity, 35.1 % for BMI, 28.9 % for glucose and 66 % for blood pressure. Dietary intake was ideal for 20.7 % of the sample. More years since migration and Korean race trended toward having a higher prevalence of poor health in some metrics. Most Asian Americans are not achieving ideal cardiovascular health for several of the metrics evaluated, with those residing in the United States for more than 13 years and Korean Americans being higher-risk groups. Targeted community based intervention approaches to improving and monitoring heart health in Asian American, and Asian American subgroups, are needed.
doi:10.1007/s10900-016-0217-3
PMCID: PMC5083159  PMID: 27363824
Cardiovascular health; Asian American; Migrant health; Ideal heart health; Korean American
2.  The Role of Sociocultural Factors in Hepatitis B Screening Among Asian Americans 
Southern Medical Journal  2011;104(7):466-472.
doi:10.1097/SMJ.0b013e31821f8ab0
PMCID: PMC3298880  PMID: 21886043
Hepatitis B (HBV) screening; Asian Americans; sociocultural factors
3.  Working to Eliminate Cancer Health Disparities from Tobacco: A Review of the National Cancer Institute’s Community Networks Program 
Nicotine & Tobacco Research  2015;17(8):908-923.
Introduction:
In 2005, the National Cancer Institute funded the Community Networks Program (CNP), which aimed to reduce cancer health disparities in minority racial/ethnic and underserved groups through community-based participatory research, education, and training. The purpose of this study was to describe the CNP model and their tobacco-related work in community-based research, education, and training using a tobacco disparities research framework.
Methods:
We conducted a comprehensive review of the CNP tobacco-related activities including publications, published abstracts, research activities, trainee pilot studies, policy-related activities, educational outreach, and reports produced from 2005–2009. Two authors categorized the tobacco-related activities and publications within the framework.
Results:
Although there was no mandate to address tobacco, the CNPs produced 103 tobacco-related peer-reviewed publications, which reflects the largest proportion (12%) of all CNP cancer-related publications. Selected publications and research activities were most numerous under the framework areas “Psychosocial Research,” “Surveillance,” “Epidemiology,” and “Treatment of Nicotine Addiction.” Thirteen CNPs participated in tobacco control policymaking in mainstream efforts that affected their local community and populations, and 24 CNPs conducted 1147 tobacco-related educational outreach activities. CNP activities that aimed to build research and infrastructure capacity included nine tobacco-related pilot projects representing 16% of all CNP cancer-related pilot projects, and 17 publications acknowledging leveraged partnerships with other organizations, a strategy encouraged by the CNP.
Conclusions:
The CNP is a promising academic-community model for working to eliminate tobacco-related health disparities. Future efforts may address scientific gaps, consider collaboration across groups, assess the extent of operationalizing community-based participatory research, and improve common tracking measures.
doi:10.1093/ntr/ntv069
PMCID: PMC4542844  PMID: 26180215
4.  The sociocultural health behavioral model and disparities in colorectal cancer screening among Chinese Americans 
Objective
The purpose of this study was to validate a Sociocultural Health Behavior Model using a structural equation analysis to determine the direction and magnitude of the interdependence of model components in relation to health behavior associated with colorectal cancer (CRC) screening among Chinese Americans.
Methods
A cross-sectional design included a sample of 311 Chinese American men and women age 50 and older. The initial step involved use of confirmatory factor analysis which included the following variables: access/satisfaction with health care, enabling, predisposing, cultural, and health belief factors. Structural equation modeling analyses were conducted on factors for CRC screening.
Results
Education and health insurance status were significantly related to CRC screening. Those with less than a high school education and without health insurance were more likely to be “never screened” for CRC than those having more education and health insurance. The path analysis findings also lend support for components of the Sociocultural Health Belief Model and indicated that there was a positive and significant relationship between CRC screening and the enabling factors, between cultural factors and predisposing, enabling, and access/satisfaction with health care factors and between enabling factors and access/satisfaction with health care.
Conclusions
The model highlights the significance that sociocultural factors play in relation to CRC screening and reinforced the need to assist Chinese with poor English proficiency in translation and awareness of the importance of CRC screening. The use of community organizations may play a role in assisting Chinese to enhance colorectal cancer screening rates.
doi:10.5430/jnep.v3n7p129
PMCID: PMC4214268  PMID: 25364475
Colorectal cancer; Cancer screening; Chinese Americans; Sociocultural health behavior model; Structural equation modeling
5.  Increasing Asian American participation in clinical trials by addressing community concerns 
Clinical trials (London, England)  2014;11(3):328-335.
Background
Asians Americans are underrepresented in clinical trials, but little is known about the factors that contribute to clinical trial participation in this population.
Purpose
The purpose of this study was to identify knowledge, barriers, facilitators and cultural influences on participating in clinical trials among three Asian American ethnic groups. Concurrently, we sought to identify mechanisms and messages to facilitate dissemination of information and to identify strategies to promote clinical trial participation in this population.
Methods
Eight focus groups were conducted (n=103) with Chinese (4 groups), Korean (2 groups), and Vietnamese (2 groups) Americans. Each group was conducted with a moderator and a translator using a standardized guide.
Results
Participants discuss the benefits of contributing to science, future generations and their families by being in clinical trials. Some participants think clinical trials would give hope to those with terminal illnesses. A doctor's recommendation, being sick and needing more options for treatment are motivators for Asian Americans. Having some guarantee of treatment effectiveness and lack of side effects facilitates participation. Cultural or religious beliefs are not believed to prevent clinical trial participation.
Limitations
This qualitative, two-site study included 3 Asian American ethnic groups and is not meant to establish prevalence of beliefs.
Conclusions
Asian Americans need more information about clinical trials and their benefits to science and the larger community. Healthcare providers can play pivotal roles in enhancing recruitment of Asian Americans. Basing recruitment goals on percentage representation in most US geographic areas does not provide sufficient numbers to allow for analysis of minorities like Asian American groups. The discovery of important group-specific harms and benefits depends on greater participation of racial/ethnic subgroups.
doi:10.1177/1740774514522561
PMCID: PMC4156927  PMID: 24603005
Clinical trials; Asian Americans; recruitment; cancer
6.  Social influences on Cigarette Smoking Among Mainland Chinese and Chinese Americans: A Comparative Study 
The purpose of this cross-national study was to determine the leading social influences on smoking among Chinese Americans and mainland Chinese adults with the aim of improving prevention and intervention strategies to reduce smoking rates. A comparative cross-sectional design was used and a stratified-cluster sampling technique was employed in identifying the study sample. An 80-item questionnaire was administered in Chinese to 1222 participants, 812 in China and 410 in the U.S. Data were analyzed using descriptive and inferential statistical tests. Results contain comparative data on social influences of smoking among Chinese Americans and mainland Chinese, as well as factors influencing smoking behavior which include cultural beliefs, gender roles, and family relationship dynamics. Grandparents were influential and significantly correlated with current smokers in China. Findings indicate differential effects of social influences on smoking behavior. Similarities and differences provide a basis for improving and/or developing smoking intervention programs of mutual benefit to China and the U.S..
PMCID: PMC3914219  PMID: 24511220
7.  Factors that Affect Willingness to Donate Blood for the Purpose of Biospecimen Research in the Korean American Community 
Biopreservation and Biobanking  2015;13(2):107-113.
Objective: Biorepositories have been key resources in examining genetically-linked diseases, particularly cancer. Asian Americans contribute to biorepositories at lower rates than other racial groups, but the reasons for this are unclear. We hypothesized that attitudes toward biospecimen research mediate the relationship between demographic and healthcare access factors, and willingness to donate blood for research purposes among individuals of Korean heritage.
Methods: Descriptive statistics and bivariate analyses were utilized to characterize the sample with respect to demographic, psychosocial, and behavioral variables. Structural equation modeling with 5000 re-sample bootstrapping was used to assess each component of the proposed simple mediation models.
Results: Attitudes towards biospecimen research fully mediate associations between age, income, number of years lived in the United States, and having a regular physician and willingness to donate blood for the purpose of research.
Conclusion: Participants were willing to donate blood for the purpose of research despite having neutral feelings towards biospecimen research as a whole. Participants reported higher willingness to donate blood for research purposes when they were older, had lived in the United States longer, had higher income, and had a regular doctor that they visited. Many of the significant relationships between demographic and health care access factors, attitudes towards biospecimen research, and willingness to donate blood for the purpose of research may be explained by the extent of acculturation of the participants in the United States.
doi:10.1089/bio.2014.0028
PMCID: PMC4516915  PMID: 25853387
8.  Hepatitis B screening among Chinese Americans: a structural equation modeling analysis 
BMC Infectious Diseases  2015;15:120.
Background
Hepatitis B Virus (HBV) disproportionately affects new immigrants from endemic regions such as China. Untreated infections increase health risks for liver diseases including cancer. Yet most of those infected are unaware of their disease limiting prevention and early treatment options. The purpose of this community based study was to evaluate a heuristic model identifying factors contributing to Hepatitis B (HBV) screening among Chinese Americans.
Methods
A cross-sectional design included a sample of 924 Chinese men and women 18 years of age and older of which 718 had complete data for final analysis. Confirmatory factor analysis verified conceptual indicators including access/satisfaction with health care and enabling, predisposing, cultural, and health belief factors. Structural equation modeling was used to identify direct and indirect predictors of Hepatitis B screening.
Results
Bivariate analysis revealed that Chinese respondents who were never screened for HBV were significantly more likely to be below age 40 (69.8%), male (69.2%), had less than a high school education (76.4%), with less than 6 years living in the US (72.8%) and had no health insurance (79.2%). The final model identified enabling factors (having health insurance, a primary health care provider to go to when sick and more frequent visits to a doctor in the last year) as the strongest predictor of HBV screening (coefficient = 0.470, t = 7.618, p < .001). Predisposing factors (education variables) were also significantly related to HBV screening. Cultural factors and Satisfaction with Health care were associated with HBV screening only through their significant relationships with enabling factors.
Conclusions
The tested theoretical model shows promise in predicting HBV testing among Chinese Americans. Increasing access to health care by expanding insurance options and improving culturally sensitivity in health systems are critical to reach new immigrants like Chinese for HBV screening. Yet such strategies are consistent with DHHS Action plan for the Prevention and Treatment of Viral Hepatitis. Implementing community-based strategies like partnering with relevant Community-Based Organizations are important for meeting HBV policy targets.
Electronic supplementary material
The online version of this article (doi:10.1186/s12879-015-0854-7) contains supplementary material, which is available to authorized users.
doi:10.1186/s12879-015-0854-7
PMCID: PMC4357149  PMID: 25880870
HBV; Hepatitis B; HBV screening; Chinese; Health care access
9.  Pathways of Breast Cancer Screening Among Chinese American Women 
Objective
The purpose of this community-based study was to develop a structural equation model for factors contributing to breast cancer screening among Chinese American women.
Methods
A cross-sectional design included a sample of 440 Chinese American women aged 40 years and older. The initial step involved use of confirmatory factor analysis, which included the following variables: access/satisfaction with health care, enabling, predisposing, and cultural and health belief factors. Structural equation model analyses were conducted to evaluate factors related to breast cancer screening in Chinese American women.
Results
Initial univariate analyses indicated that women without health insurance were significantly more likely to report being never-screened compared to women with health insurance. Structural equation modeling techniques were used to evaluate the utility of the Sociocultural Health Behavior model in understanding breast cancer screening among Chinese American women. Results indicated that enabling and predisposing factors were significantly and positively related to breast cancer screening. Cultural factors were significantly associated with enabling factors and satisfaction with healthcare. Overall, the proposed model explained 34% of the variance in breast cancer screening among Chinese American women.
Conclusions
The model highlights the significance of enabling and predisposing factors in understanding breast cancer screening behaviors among Chinese American women. In addition, cultural factors were associated with enabling factors, reinforcing the importance of providing translation assistance to Chinese women with poor English fluency and increasing awareness of the critical role of breast cancer screening. Partnering with community organizations may help to facilitate and enhance the screening rates.
doi:10.4172/2161-0711.1000209
PMCID: PMC3762685  PMID: 24013711
Mammograms; Breast cancer screening; Chinese women
10.  Correlates of Cervical Cancer Screening among Vietnamese American Women 
Objective. Vietnamese American women are at the greatest risk for cervical cancer but have the lowest cervical cancer screening rates. This study was to determine whether demographic and acculturation, healthcare access, and knowledge and beliefs are associated with a prior history of cervical cancer screening among Vietnamese women. Methods. Vietnamese women (n = 1450) from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey participated in the study and completed baseline assessments. Logistic regression analyses were performed. Results. Overall levels of knowledge about cervical cancer screening and human papillomavirus (HPV) are low. Factors in knowledge, attitude, and beliefs domains were significantly associated with Pap test behavior. In multivariate analyses, physician recommendation for screening and having health insurance were positively associated with prior screening. Conclusion. Understanding the factors that are associated with cervical cancer screening will inform the development of culturally appropriate intervention strategies that would potentially lead to increasing cervical cancer screening rates among Vietnamese women.
doi:10.1155/2012/617234
PMCID: PMC3449126  PMID: 23008526
11.  Factors Associated with Willingness to Participate in Biospecimen Research Among Chinese Americans 
Biopreservation and Biobanking  2014;12(2):131-138.
A paucity of information exists on the recruitment of Asian Americans for biospecimen research. Although studies show that Chinese Americans are at high risk for hepatitis B virus (HBV) infection, little is known about their willingness to participate in HBV-related biospecimen research and how knowledge, attitudes, and cultural factors impact their willingness to participate. The study was guided by Community-Based Participatory Research principles. Data were derived from an assessment study on HBV-related biospecimen research participation among Chinese Americans in the Philadelphia region. The assessment was conducted with 415 Chinese Americans recruited from eight Chinese community-based organizations. Cultural beliefs, knowledge, and attitudes toward biospecimen research were examined for associations with their willingness to participate in biospecimen banking research. Overall, 192 (46.3%) of 415 participants who completed the assessment indicated they were willing to participate if they were invited to donate blood to be frozen and stored for future HBV biospecimen studies. Cultural variables significant in bivariate analysis included collectivism, knowledge about biospecimen research, and Yin-Yang beliefs. Fatalism and individualism were not associated with participation willingness. In multivariate analysis, age, health care attitudes, and trust were significantly associated with willingness to participate in biospecimen banking research. Asian American communities have little knowledge of biospecimen banking and will benefit from educational campaigns that emphasize collective benefits and attitudes towards and trust in the health care system. Understanding cultural factors is important for improving Chinese Americans' knowledge, awareness, and intentions of participation in biospecimen research. Similar efforts need to be undertaken to develop culturally appropriate educational intervention programs to increase participation in biospecimen research among other Asian American groups.
doi:10.1089/bio.2013.0081
PMCID: PMC3995351  PMID: 24749880
12.  The Impact of a Community-Based Clinical Trial Educational Intervention Among Underrepresented Chinese Americans 
Background
Clinical trials are a critical resource for the discovery of new prevention, diagnostic and treatment methods for cancer. The most effective prevention and treatment modalities are based on previous clinical trial results. However, participation in clinical trials is underrepresented by racial/ethnic minority populations, Asian Americans in particular. Asian Americans are the least represented of any ethnic groups in clinical trials.
Objective
The purpose of this study is to develop and evaluate a culturally and linguistically appropriate community-based educational intervention to increase knowledge of and intent to participate in cancer clinical trials among underrepresented Chinese Americans.
Methods
Community-Based Participatory Research (CBPR) approach was used to guide the development, cultural tailoring, implementation and evaluation of clinical trial intervention. First, 22 Asian community representatives were recruited as community health educators (CHEs) who received 12-hour training on clinical trial education. Second, 262 members were recruited from 11 Chinese community organizations (CBOs). Of those recruited, a total of 247 eligible Chinese enrolled and participated in the clinical trial education delivered by trained CHEs. Participants completed pre-test before and post-test after the intervention.
Results
Fifteen out of 21 measures of clinical trial knowledge showed significant changes post the intervention (p<.05). Education remained the sole demographic factor increasing clinical trial knowledge in multivariate analysis.
Conclusion
Clinical trial education should emphasize both benefits to science and the larger Asian community. This community-based clinical trial intervention demonstrated promising results and has potential to enhance recruitment and participation in clinical trial research among the underrepresented Asian Americans.
doi:10.1158/1055-9965.EPI-13-0773
PMCID: PMC3951588  PMID: 24092627
clinical trial intervention; underrepresented Chinese-Americans; health disparities
13.  Culturally Appropriate Education Intervention on Biospecimen Research Participation Among Chinese Americans 
Background
Chinese Americans are at increased risk for hepatitis B virus (HBV) infection. To reduce or eliminate disparities in HBV-related infection rates, participation in scientific investigations of HBV risk and treatment, including biospecimen sampling, is important. However, Asian Americans have low rates of participation in biospecimen research, and little is known about how educational interventions affect knowledge and participation in HBV-related biospecimen research.
Methods
Eight Chinese community-based organizations participated in a quasi-experimental, two-group design with education assessments at pre- and post-workshop and a three-month follow-up. Four sites were randomly assigned to receive the intervention (n = 175) and four sites to receive general health education (control; n = 240).
Results
Participant knowledge about biospecimen research increased from pre- to post-education in the intervention but not in the control condition. Of intervention participants, 83.4% (146/175) donated one tube of blood for future HBV biospecimen research, and 50.9% (89/175) donated another tube of blood for HBV testing. In contrast, only 1.1% of participants in the control condition reported donating a blood sample at follow-up assessment.
Conclusion
The intervention program significantly increased knowledge of and participation in HBV biospecimen research among Chinese Americans. Community-based participatory research (CBPR) methods featured active support by community leaders, a culturally specific curriculum, and convenient, immediate access to blood sampling, which resulted in high donation rates.
Impact
HBV-related morbidity and mortality is an urgent problem faced by Chinese Americans. CBPR provides a model for engaging communities in early detection, vaccination, and treatment that can reduce this health threat.
doi:10.1158/1055-9965.EPI-13-0742
PMCID: PMC3955025  PMID: 24609847
biospecimen research; biobanking; Chinese Americans; Hepatitis B; cultural factors
14.  The effect of a culturally tailored smoking cessation for Chinese American smokers 
Nicotine & Tobacco Research  2009;11(12):1448-1457.
Introduction:
Tobacco use is a serious public health problem among low-income Chinese Americans with limited English proficiency. Chinese men are at high risk for smoking-related morbidity and mortality. We tested the feasibility of a culturally and linguistically sensitive smoking intervention program with combined counseling and pharmacological components for Chinese smokers in New York City; identified factors and techniques that enhance the administration and appropriateness of the intervention program; and examined the overall impact of this program on quit attempts, quit rates, and overall smoking reduction.
Methods:
We were guided by the transtheoretical model and used an adapted motivational interviewing (MI) approach. The study involved a randomized sample with pretreatment assessment and multiple follow-up measures. Eligible participants (N = 122) were randomly assigned to intervention (4 individualized counselor-led MI sessions and nicotine replacement therapy [NRT]) or control groups (4 general health education sessions, self-help materials, and NRT).
Results:
Quit rate at 6 months in the intervention group was 67% versus 32% for the control group, indicating minimal relapse and a highly successful intervention program. Increase in self-efficacy and decease in pros of smoking from baseline to 6-month follow-up were positively associated with smoking cessation. The number of cigarette smoked at baseline was inversely related to smoking cessation. Results indicate that a combined intensive behavioral counseling and pharmacological intervention can reduce smoking substantially.
Conclusion:
The results of this pilot will be used as a basis for a large-scale randomized trial of an intervention with combined culturally and linguistically sensitive MI and NRT components for Chinese and other Asian ethnic groups.
doi:10.1093/ntr/ntp159
PMCID: PMC2784492  PMID: 19915080
15.  Health Beliefs Associated with Cervical Cancer Screening Among Vietnamese Americans 
Journal of Women's Health  2013;22(3):276-288.
Abstract
Background
Vietnamese American women represent one of the ethnic subgroups at great risk for cervical cancer in the United States. The underutilization of cervical cancer screening and the vulnerability of Vietnamese American women to cervical cancer may be compounded by their health beliefs.
Objective
The objective of this study was to explore the associations between factors of the Health Belief Model (HBM) and cervical cancer screening among Vietnamese American women.
Methods
Vietnamese American women (n=1,450) were enrolled into the randomized controlled trial (RCT) study who were recruited from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey. Participants completed baseline assessments of demographic and acculturation variables, health care access factors, and constructs of the HBM, as well as health behaviors in either English or Vietnamese.
Results
The rate of those who had ever undergone cervical cancer screening was 53% (769/1450) among the participants. After adjusting for sociodemographic variables, the significant associated factors from HBM included: believing themselves at risk and more likely than average women to get cervical cancer; believing that cervical cancer changes life; believing a Pap test is important for staying healthy, not understanding what is done during a Pap test, being scared to know having cervical cancer; taking a Pap test is embarrassing; not being available by doctors at convenient times; having too much time for a test; believing no need for a Pap test when feeling well; and being confident in getting a test.
Conclusion
Understanding how health beliefs may be associated with cervical cancer screening among underserved Vietnamese American women is essential for identifying the subgroup of women who are most at risk for cervical cancer and would benefit from intervention programs to increase screening rates.
doi:10.1089/jwh.2012.3587
PMCID: PMC3601630  PMID: 23428284
16.  The National Cancer Institute’s Community Networks Program Initiative to Reduce Cancer Health Disparities: Outcomes and Lessons Learned 
Background
We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities.
Methods
Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme.
Results
Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services.
Implications
Findings demonstrate the value of government-supported, community–academic, CBPR partnerships in cancer prevention and control research.
doi:10.1353/cpr.2015.0017
PMCID: PMC4698458  PMID: 26213401
17.  Challenges and Needs of Chinese and Korean American Breast Cancer Survivors: In-Depth Interviews 
Breast cancer incidence and the number of breast cancer survivors have been rapidly increasing among Chinese and Korean women in the United States. However, few data are available regarding quality of life in Asian American breast cancer survivors. This qualitative study aims to describe Asian American women’s perceptions of quality of life and their breast cancer experiences. In-depth interviews with four Chinese and five Korean American breast cancer survivors and three oncologists were conducted in Chinese, Korean, or English. Interviews were recorded and transcripts were translated into English. Qualitative analyses were performed by two independent coders and then discussed and agreed upon by the research team. The respondents reported that the breast cancer experience had affected various domains of quality of life, but women reported having limited resources with which to cope effectively. Depression, anxiety, and stress were commonly reported, but women rarely discussed these issues with family and friends or sought professional help. As immigrants, women’s loneliness and a lack of social support and culturally relevant resources seemed to be major barriers to maintaining good quality of life. Women also expressed interest in learning more about alternative therapies and relaxation skills. These findings can be used to help inform the development of a culturally appropriate intervention for Asian American breast cancer survivors. Future programs may provide information in women’s native languages to teach skills to cope with stress and anxiety, increase women’s self-efficacy within the context of their cultural background, and enhance social support among women from the same ethnic group.
doi:10.7156/najms.2013.0601001
PMCID: PMC3766352  PMID: 24019995
breast cancer; quality of life; survivorship; Asian American; Chinese American; Korean American
18.  Pathways of cervical cancer screening among Chinese women 
Background
The purpose of this community-based study was to develop a structural equation model for factors contributing to cervical cancer screening among Chinese American women.
Methods
A cross-sectional design included a sample of 573 Chinese American women aged 18 years and older. The initial step involved use of confirmatory factor analysis, that included the following variables: access to and satisfaction with health care, and enabling and predisposing cultural and health beliefs. Structural equation model analyses were conducted on factors related to cervical cancer screening.
Results
Age, marital status, employment, household income, and having health insurance, but not educational level, were significantly related to cervical screening status. Predisposing and enabling factors were positively associated with cervical cancer screening. The cultural factor was significantly related to the enabling factor or the satisfaction with health care factor.
Conclusion
This model highlights the significance of sociocultural factors in relation to cervical cancer screening. These factors were significant, with cultural, predisposing, enabling, and health belief factors and access to and satisfaction with health care reinforcing the need to assist Chinese American women with poor English fluency in translation and awareness of the importance of cervical cancer screening. Community organizations may play a role in assisting Chinese American women, which could enhance cervical cancer screening rates.
doi:10.2147/IJWH.S45405
PMCID: PMC3702238  PMID: 23843708
Papanicolaou test; cervical cancer screening; Chinese women
19.  Factors Associated with Hepatitis C Knowledge Before and After an Educational Intervention among Vietnamese Americans 
BACKGROUND
Hepatitis C virus (HCV) is a major cause of chronic liver disease and cancer. Vietnamese Americans are at high risk of HCV infection, with men having the highest US incidence of liver cancer. This study examines an intervention to improve HCV knowledge among Vietnamese Americans.
STUDY
Seven Vietnamese community-based organizations in Pennsylvania and New Jersey recruited a total of 306 Vietnamese participants from 2010 to 2011.
RESULTS
Average knowledge scores for pretest and posttest were 3.32 and 5.88, respectively (maximum 10). After adjusting for confounding variables, age and higher education were positively associated with higher pretest scores and having a physician who spoke English or Vietnamese was negatively associated with higher pretest scores. Additionally, after adjusting for confounding variables, household income, education, and having an HCV-infected family member significantly increased knowledge scores.
CONCLUSIONS
Promotion and development of HCV educational programs can increase HCV knowledge among race and ethnic groups, such as Vietnamese Americans. Giving timely information to at-risk groups provides the opportunity to correct misconceptions, decrease HCV risk behaviors, and encourage testing that might improve timely HCV diagnosis and treatment.
doi:10.4137/CGast.S24737
PMCID: PMC4629630  PMID: 26561280
hepatitis C; liver cancer; Vietnamese
20.  What Is Lacking in Patient-Physician Communication: Perspectives from Asian American Breast Cancer Patients and Oncologists 
Journal of behavioral health  2012;1(2):10.5455/jbh.20120403024919.
Objectives
Interactions between breast cancer patients and their oncologists are important as effective patient-physician communication can facilitate the delivery of quality cancer care. However, little is known about patient-physician communication processes among Asian American breast cancer patients, who may have unique communication needs and challenges. Thus, we interviewed Asian American patients and several oncologists to explore patient-physician communication processes in breast cancer care.
Methods
We conducted in-depth interviews with nine Chinese- or Korean American breast cancer patients and three Asian American oncologists who routinely provided care for Asian American patients in the Washington DC metropolitan area in 2010. We conducted patient interviews in Chinese or Korean and then translated into English. We conducted physicians’ interviews in English. We performed qualitative analyses to identify themes.
Results
For women with limited English proficiency, language was the greatest barrier to understanding information and making treatment-related decisions. Both patients and oncologists believed that interpretation provided by patients’ family members may not be accurate, and patients may neglect to ask questions because of their worry of burdening others. We observed cultural differences regarding expectations of the doctor’s role and views of cancer recovery. As expressed by the patients and observed by oncologists, Asian American women are less likely to be assertive and are mostly reliant on physicians to make treatment decisions. However, many patients expressed a desire to be actively involved in the decision-making process.
Conclusion
Findings provide preliminary insight into patient-physician communication and identify several aspects of patient-physician communication that need to be improved for Asian American breast cancer patients. Proper patient education with linguistically and culturally appropriate information and tools may help improve communication and decision-making processes for Asian American women with breast cancer.
doi:10.5455/jbh.20120403024919
PMCID: PMC3566873  PMID: 24496377
Asian American; breast cancer; patient-physician communication; language barrier; cultural difference; treatment decision making
21.  Health seeking behavioral analysis associated with breast cancer screening among Asian American women 
Objective
The purpose of this community-based study was to apply a Sociocultural Health Behavior Model to determine the association of factors proposed in the model with breast cancer screening behaviors among Asian American women.
Methods
A cross-sectional design included a sample of 682 Chinese, Korean, and Vietnamese women aged 40 years and older. The frequency distribution analysis and Chi-square analysis were used for the initial screening of the following variables: sociodemographic, cultural, enabling, environmental, and social support. Univariate and multivariate analyses were conducted on factors for breast cancer screening using multinomial logistic regression analysis.
Results
Correlates to positive breast cancer screening included demographics (ethnicity), cultural factors (living in the United States for 15 years or more, speaking English well), enabling factors (having a regular physician to visit, health insurance covering the screening), and family/social support factors (those who had a family/friend receiving a mammogram).
Conclusions
The results of this study suggest that breast cancer screening programs will be more effective if they include the cultural and health beliefs, enabling, and social support factors associated with breast cancer screening. The use of community organizations may play a role in helping to increase breast cancer screening rates among Asian American women.
doi:10.2147/IJWH.S30738
PMCID: PMC3379860  PMID: 22723730
breast cancer screening; Vietnamese; Korean; Chinese; breast cancer; Asian American
22.  Evidence-Based Intervention to Reduce Access Barriers to Cervical Cancer Screening Among Underserved Chinese American Women 
Journal of Women's Health  2010;19(3):463-469.
Abstract
Objective
The primary objective of the present study was to evaluate the effects of a community-based pilot intervention that combined cervical cancer education with patient navigation on cervical cancer screening behaviors among Chinese American women residing in New York City.
Methods
Chinese women (n = 134) who had not had a Pap test within the previous 12 months were recruited from four Asian community-based organizations (CBOs). Women from two of the CBOs received the intervention (n = 80) consisting of education, interaction with a Chinese physician, and navigation assistance, including help in identifying and accessing free or low-cost screening services. The control group (n = 54) received education delivered by Chinese community health educators and written materials on general health and cancer screening, including cervical cancer, the Pap test, and information about sites that provided free screening. Study assessments were obtained in-person at baseline and postintervention. Screening behavior was self-reported at 12-month postintervention and verified by medical staff.
Results
In the 12-month interval following the program, screening rates were significantly higher in the intervention group (70%) compared to the control group (11.1%). Hierarchical logistic regression analyses indicated that screening behavior was associated with older age (OR = 1.08, 95% CI = 1.01–1.15, p < .05). In addition, women with poorer English language fluency (OR = 0.30, 95% CI = 0.10–0.89, p < .05) and who did not have health insurance were less likely to obtain screening (OR = 0.15, 95% CI = 0.02–0.96, p < .05). Among health beliefs, greater perceived severity of disease was positively associated with screening behavior (OR = 4.26, 95% CI = 1.01-18.04, p < .05).
Conclusions
Community-based programs that provide combined education and patient navigation may be effective in overcoming the extensive linguistic and access barriers to screening faced by Chinese American women.
doi:10.1089/jwh.2009.1422
PMCID: PMC2867551  PMID: 20156089
23.  Diffusion of Philadelphia’s No-Smoking Policy to Chinese Businesses 
The study assessed the extent that Philadelphia’s smoking ordinance diffused to Chinatown businesses and identified attitudinal and other barriers to implementation. Guided by constructs from Diffusion of Innovations and Theory of Planned Behavior, a cross-sectional study was conducted. The majority of business owners and employees lacked in-depth knowledge of relevant details of the policy, suggesting that the extent of its diffusion was limited. Retail businesses were more likely to witness smoking post-enactment than restaurants and had more difficulty with implementation. A multi-faceted diffusion strategy through communication channels familiar to the Chinatown community is needed to improve implementation and compliance.
PMCID: PMC2802338  PMID: 20057915
24.  Recruiting Chinese Americans into Cancer Screening Intervention Trials: Strategies and Outcomes 
Clinical trials (London, England)  2014;11(2):167-177.
Background
Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are under-represented in cancer research and report poor adherence to cancer screening guidelines.
Purpose
This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. Findings will inform effective strategies for promoting Asian American participation in cancer control research.
Methods
Chinese Americans who were nonadherent to annual mammography screening guidelines (Study 1 with 664 immigrant women >age 40) and to colorectal cancer screening guidelines (Study 2 with 455 immigrants >age 50) were enrolled from the greater Washington DC, New York City (NYC), and Philadelphia (PA) areas. Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent. Study 1 adopted community approaches and worked with community organizations to enroll participants. Study 2 randomly selected potential participants through 24 Chinese American primary care physician offices, and mailed letters from physicians to enroll patients, followed by telephone calls from research staff. The success of recruitment approaches was assessed by yield rates based on number of participants approached, ineligible, and consented.
Results
Most participants (70%) of Study 1 were enrolled through in-person community approaches (e.g, Chinese schools, stores, health fairs, and personal networks). The final yield of specific venues differed widely (6% to 100%) due to various proportions of ineligible subjects (2% to 64%) and refusals (0% to 92%). The Study 2 recruitment approach (physician letter followed by telephone calls) had different outcomes in two geographic areas, partially due to differences in demographic characteristics in the DC and NYC/PA areas. The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach (p<.001). Enrollment cost is provided to inform future research studies.
Limitations
Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American populations because they may vary by study protocols (e.g., length of trials), target populations (i.e., eligibility criteria), and available resources.
Conclusions
Use of multiple culturally relevant strategies (e.g., building trusting relationships through face-to-face enrollment, use of bilingual and bicultural staff, use of a physician letter, and employing linguistically appropriate materials) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical settings. Our data demonstrates that substantial effort is required for recruitment; studies need to budget for this effort to ensure the inclusion of Asian Americans in health research.
doi:10.1177/1740774513518849
PMCID: PMC3972290  PMID: 24567288
Randomized controlled trial; Chinese Americans; Minority enrollment; Community recruitment
25.  Information and communication needs of Chinese American breast cancer patients: perspectives on survivorship care planning 
Background
The existing knowledge on the survivorship experiences of Chinese American breast cancer survivors (CABCS) has arisen largely from aggregated data across multiethnic or multicancer studies that have focused on quality of life. Little is known about Chinese American perspectives and preferences for survivorship care.
Objective
To examine the experiences of CABCS to better understand their information and communication needs and their preferences for survivorship care plans (SCPs).
Methods
16 CABCS, aged 37-72 years, were recruited through community-based organizations in the Northeast United States to participate in one-on-one telephone interviews about their breast cancer survivorship experience. The semistructured interviews were conducted in Mandarin, Cantonese, or English. Two investigators transcribed and translated the audio recordings into English and analyzed the interview transcripts using established methods of qualitative content analysis.
Results
Three main themes were identified through analysis of interview transcripts: the need for evidence-based and culturally and linguistically appropriate health information; the role of language or communication barriers and culture in accessing care and communicating with providers; and preferences for SCP elements and format.
Limitations
The sample may not be representative of the entire population of CABCS.
Conclusions
The findings provide insight into the information and communication needs and SCP preferences of CABCS. Understanding the cultural nuances that underlie these needs and preferences is critical for improving CABCS's quality of life after treatment for cancer. SCPs that incorporate Chinese-language resources and address the unique cultural needs of this population should be developed and they should include information about diet and nutrition as well as traditional Chinese medicine.
doi:10.12788/jcso.0095
PMCID: PMC4370226  PMID: 25811036

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