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Zhang X, Kaholokula JK, Kahn-John M, Walters K, Ma G, Thao C, Lepule JT, Stinson N. Elevating Voice and Visibility: Health Research for American Indian and Alaska Native, Asian American, and Native Hawaiian and Pacific Islander Populations in the United States. Am J Public Health 2024; 114:S25-S28. [PMID: 38207264 PMCID: PMC10785185 DOI: 10.2105/ajph.2023.307494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Xinzhi Zhang
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Joseph Keaweʻaimoku Kaholokula
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Michelle Kahn-John
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Karina Walters
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Grace Ma
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Chia Thao
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Jonathon Tana Lepule
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
| | - Nathan Stinson
- Xinzhi Zhang is with the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, MD. Joseph Keawe'aimoku Kaholokula is with the John A. Burns School of Medicine at the University of Hawai'i at Mānoa. Michelle Kahn-John is with the Johns Hopkins School of Nursing, Baltimore, MD. Karina L. Walters is with the Tribal Health Research Office, NIH, Bethesda. Grace Ma is with the Center for Asian Health, Laura H. Carnell Professor at Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Chia Thao is with the California State University of Bakersfield. Jonathan (Tana) Lepule is with the Pacific Islander Collective San Diego, CA. Nathan Stinson is with the Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, Bethesda
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Xiong S, Kasouaher MY, Vue B, Culhane-Pera KA, Pergament SL, Desai J, Torres MB, Lee HY. "We will do whatever it takes": Understanding Socioecological Level Influences on Hmong-American Adolescents and Parents' Perceptions of the Human Papillomavirus Vaccine. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1893-1901. [PMID: 34164765 PMCID: PMC8221556 DOI: 10.1007/s13187-021-02057-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 05/05/2023]
Abstract
Human papillomavirus (HPV) vaccination completion rates in Asian-American populations are substantially lower than most White Americans. Our objective was to identify the knowledge, perceptions, and decision-making processes about HPV vaccinations in the Hmong population, an Asian-American group with increased risks of HPV-related cancers. We conducted eight focus groups with Hmong adolescents (n = 12) and parents (n = 13) to learn about barriers, facilitators, and decision-making processes regarding general vaccinations and the HPV vaccine. The focus group results were analyzed using thematic analysis, informed by the socioecological model and asset lens. Findings showed that at the individual level, Hmong adolescents and parents had low HPV and HPV vaccine awareness levels (barrier) and strong desires to learn about HPV and the HPV vaccine (facilitator). Community-level barriers included salient narratives about traumatic experiences with vaccines and vaccine research, while facilitators included strong community connections. At the institutional level, barriers included structural constraints in health care settings, while facilitators included ease of obtaining vaccines at school-based clinics and provider authoritative decision-making. Additionally, a range of decision-making processes between parents, adolescents, and providers were present, with parents expressing a strong appeal to engage in more shared decision-making with providers. A linguistically and culturally specific HPV educational program for Hmong adolescents and parents could address the barriers and build on facilitators and assets to promote HPV vaccine uptake in this growing Asian-American community.
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Affiliation(s)
- Serena Xiong
- School of Public Health, University of Minnesota, 1300 S 2nd Suite 300, Minneapolis, MN, 55454, USA.
- Somali, Latino, and Hmong Partnership for Health and Wellness (SoLaHmo), Community-University Health Care Center (CUHCC), 2001 Bloomington Ave, Minneapolis, MN, 55404, USA.
| | - Maiyia Y Kasouaher
- Somali, Latino, and Hmong Partnership for Health and Wellness (SoLaHmo), Community-University Health Care Center (CUHCC), 2001 Bloomington Ave, Minneapolis, MN, 55404, USA
| | - Bai Vue
- Somali, Latino, and Hmong Partnership for Health and Wellness (SoLaHmo), Community-University Health Care Center (CUHCC), 2001 Bloomington Ave, Minneapolis, MN, 55404, USA
| | | | - Shannon L Pergament
- Somali, Latino, and Hmong Partnership for Health and Wellness (SoLaHmo), Community-University Health Care Center (CUHCC), 2001 Bloomington Ave, Minneapolis, MN, 55404, USA
| | - Jay Desai
- Minnesota Department of Health, Health Promotion and Chronic Disease Division, P.O. Box 64975, St. Paul, MN, 55164, USA
- HealthPartners Institute, P.O. Box 1524, Bloomington, MN, 55440-1524, USA
| | - M Beatriz Torres
- Public Health Department, Mercyhurst University, 501 East 38th Street, Erie, PA, 16546, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, 1022 Little Hall, Box 870314, Tuscaloosa, AL, 35487, USA
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Kue J, Szalacha LA, Rechenberg K, Nolan TS, Menon U. Communication Among Southeast Asian Mothers and Daughters About Cervical Cancer Prevention. Nurs Res 2021; 70:S73-S83. [PMID: 34173374 PMCID: PMC8527390 DOI: 10.1097/nnr.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Southeast Asian women have high rates of cervical cancer and yet are among the least likely to be screened. There is sparse literature on communication patterns among Southeast Asian women, specifically related to cervical cancer and Pap test uptake. Little is known about the influence of Southeast Asian mothers and daughters on each other's cervical cancer beliefs and screening behaviors. OBJECTIVES We examined the perceptions of and barriers to cervical cancer screening among Cambodian and Lao mothers and daughters and explored how they converse about women's health issues, specifically cervical cancer and Pap testing. METHODS We conducted in-depth interviews with Cambodian and Lao mother-daughter dyads, aged 18 years and older, living in a large Midwestern city between February and September of 2015. Descriptive statistics were calculated to summarize the sample demographic characteristics. Bivariate tests (contingency table analyses, independent t-tests, and Pearson correlations) were conducted to test for differences between the mothers and daughters in demographic characteristics and measures of health status and beliefs. Qualitative data were analyzed using content analysis. RESULTS In-depth interviews were conducted with three Cambodian and eight Lao mother-daughter dyads. The daughters were significantly more acculturated to English, had greater education, and were mostly employed full time. The mothers and daughters evaluated their health status much the same, their medical mistrust equally, and all of the mothers and nine of the daughters were Buddhist. Themes in mother-daughter communication included what mothers and daughters do and do not talk about with regard to sexual health, refugee experiences, what hinders mother-daughter communication, and relationship dynamics. The mothers were embarrassed and uncomfortable discussing cervical cancer, Pap testing, and other women's health issues with their daughters. Although mothers did not influence women's health promotion or cervical cancer prevention with their daughters, daughters did influence their mothers' health and healthcare decisions. Daughters were critical in navigating healthcare systems, engaging with providers, and making medical decisions on behalf of their mothers. DISCUSSION By leveraging the unique and dynamic intergenerational bond that mothers and daughters who identify as Southeast Asian have, we can develop strategies to influence the cultural dialogue related to cervical cancer and early detection.
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Lee H, Kim D, Kiang PNC, Cooley ME, Shi L, Thiem L, Kan P, Chea P, Allison J, Kim M. Awareness, knowledge, social norms, and vaccination intentions among Khmer mother-daughter pairs. ETHNICITY & HEALTH 2021; 26:379-391. [PMID: 30141338 DOI: 10.1080/13557858.2018.1514455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
Cervical cancer is caused by human papillomavirus (HPV) infection, which can be prevented by vaccination. Mothers play an important role in promoting vaccination and health education. However, Cambodian American mothers reported to have challenges to play a role as primary health educators due to lack of health knowledge and language and cultural gaps. Therefore, this study aims to understand the Cambodian American daughters' and mothers' awareness, knowledge and social norms of HPV vaccination and their health communication and vaccination decision-making. We conducted a pilot randomized clinical trial to promote HPV vaccination. In this study, we have only reported findings from baseline data examining individual, interpersonal and social determinants of HPV vaccination behavior among 19 dyads of Cambodian American mothers and daughters. Both mothers and daughters demonstrated low levels of awareness and knowledge. A significant relationship was found between the daughters' HPV vaccine decisions and their perception of their mothers' intention on HPV vaccination for them. Culturally and linguistically appropriate communication strategies such as storytelling or visual presentation approaches may be more effective than the current practice of using information-based written materials to promote HPV vaccination and health education among Cambodian Americans.
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Affiliation(s)
- Haeok Lee
- College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Deogwoon Kim
- College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Peter Nien-Chu Kiang
- Asian American Studies Program, School for Global Inclusion and Social Development, University of Massachusetts Boston, Boston, MA, USA
| | - Mary E Cooley
- Nursing and Patient Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ling Shi
- College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Linda Thiem
- Asian American Studies Program, School for Global Inclusion and Social Development, University of Massachusetts Boston, Boston, MA, USA
| | - PenhSamnang Kan
- Asian American Studies Program, School for Global Inclusion and Social Development, University of Massachusetts Boston, Boston, MA, USA
| | - Phala Chea
- Support of English Language Learners & Families/McKinney-Vento Education Liaison, Lowell Public Schools, Lowell, MA, USA
| | - Jeroan Allison
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Minjin Kim
- Division of Preventive and Behavioral Medicine, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Ali AH, Kang MS, Kaur K, Al Adhami S, Yuvienco CR. Review of Hmong-Related Health Problems: A Quick Guide for Healthcare Providers. Cureus 2020; 12:e9808. [PMID: 32953320 PMCID: PMC7494405 DOI: 10.7759/cureus.9808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 02/04/2023] Open
Abstract
The people of Hmong descent are one of the largest resettled communities in the United States (US). The Central Valley of California is well known to be the home to the largest Hmong population in the US. However, despite the presence of such a large Hmong community in the Central Valley, our knowledge of their cultural perceptions of medicine is limited. Based on local Central Valley health providers' experiences and observations, the Hmong people have a number of health-related challenges that differ from those of the general population, and this should be considered when dealing with their healthcare needs. In this report, we present a quick guide about the Hmong community and their health-related issues. We hope this will help clinicians and researchers better understand the Hmong community, which in turn would help provide a better quality of healthcare to the Hmong people and stimulate intellectual curiosity among healthcare providers towards this unique Asian ethnicity.
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Affiliation(s)
- Ali H Ali
- Internal Medicine, University of California San Francisco-Fresno, Fresno, USA
| | - Mandip S Kang
- Internal Medicine, University of California San Francisco-Fresno, Fresno, USA
| | - Kamalmeet Kaur
- Internal Medicine, University of California San Francisco-Fresno, Fresno, USA
| | - Saja Al Adhami
- Internal Medicine, Community Regional Medical Center, Fresno, USA
| | - Candice R Yuvienco
- Internal Medicine/Rheumatology, University of California San Francisco-Fresno, Fresno, USA
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Ko M, Ton H. The Not Underrepresented Minorities: Asian Americans, Diversity, and Admissions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:184-189. [PMID: 31577586 DOI: 10.1097/acm.0000000000003019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Several lawsuits have recently been filed against U.S. universities; the plaintiffs contend that considerations of race and ethnicity in admissions decisions discriminate against Asian Americans. In prior cases brought by non-Latino whites, the U.S. Supreme Court has upheld these considerations, arguing that they are crucial to a compelling interest to increase diversity. The dissenting opinion, however, concerns the possibility that such policies disadvantage Asian Americans, who are considered overrepresented in higher education. Here, the authors explain how a decision favoring the plaintiffs would affect U.S. medical schools. First, eliminating race and ethnicity in holistic review would undermine efforts to diversify the physician workforce. Second, the restrictions on considering race/ethnicity in admissions decisions would not remedy potential discrimination against Asian Americans that arise from implicit biases. Third, such restrictions would exacerbate the difficulty of addressing the diversity of experiences within Asian American subgroups, including recognizing those who are underrepresented in medicine. The authors propose that medical schools engage Asian Americans in diversity and inclusion efforts and recommend the following strategies: incorporate health equity into the institutional mission and admissions policies, disaggregate data to identify underrepresented Asian subgroups, include Asian Americans in diversity committees and support faculty who make diversity work part of their academic portfolio, and enhance the Asian American faculty pipeline through support and mentorship of students. Asian Americans will soon comprise one-fifth of the U.S. physician workforce and should be welcomed as part of the solution to advancing diversity and inclusion in medicine, not cast as the problem.
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Affiliation(s)
- Michelle Ko
- M. Ko is assistant professor, Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, California; ORCID: https://orcid.org/0000-0001-8859-0022. H. Ton is interim associate vice chancellor, Diversity, Equity and Inclusion, associate dean, Faculty Development and Diversity, and professor, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California
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Ly MYN, Kim KK, Stewart SL. Assessing the performance of the Asian/Pacific islander identification algorithm to infer Hmong ethnicity from electronic health records in California. BMJ Open 2019; 9:e031646. [PMID: 31831538 PMCID: PMC6924723 DOI: 10.1136/bmjopen-2019-031646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study assesses the performance of the North American Association of Central Cancer Registries Asian/Pacific Islander Identification Algorithm (NAPIIA) to infer Hmong ethnicity. DESIGN AND SETTING Analyses of electronic health records (EHRs) from 1 January 2011 to 1 October 2015. The NAPIIA was applied to the EHR data, and self-reported Hmong ethnicity from a questionnaire was used as the gold standard. Sensitivity, specificity, positive (PPV) and negative predictive values (NPVs) were calculated comparing the source data ethnicity inferred by the algorithm with the self-reported ethnicity from the questionnaire. PARTICIPANTS EHRs indicating Hmong, Chinese, Vietnamese and Korean ethnicity who met the original study inclusion criteria were analysed. RESULTS The NAPIIA had a sensitivity of 78%, a specificity of 99.9%, a PPV of 96% and an NPV of 99%. The prevalence of Hmong population in the sample was 3.9%. CONCLUSION The high sensitivity of the NAPIIA indicates its effectiveness in detecting Hmong ethnicity. The applicability of the NAPIIA to a multitude of Asian subgroups can advance Asian health disparity research by enabling researchers to disaggregate Asian data and unmask health challenges of different Asian subgroups.
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Affiliation(s)
- May Ying N Ly
- Metropolitan Studies, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California Davis, Davis, California, USA
| | - Susan L Stewart
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, California, USA
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Adunlin G, Cyrus JW, Asare M, Sabik LM. Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States. J Immigr Minor Health 2019; 21:606-658. [PMID: 30117005 DOI: 10.1007/s10903-018-0794-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.
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Affiliation(s)
- Georges Adunlin
- McWhorter School of Pharmacy, Samford University, 2100 Lakeshore Dr, Homewood, AL, 35229, USA.
| | - John W Cyrus
- Tompkins-McCaw Library, Virginia Commonwealth University, 509 N 12th St, Richmond, VA, 23298-0430, USA
| | - Matthew Asare
- Department of Public Health, Baylor University, One Bear Place #97313, Waco, TX, 76798-7313, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto St., Pittsburgh, PA, 15261, USA
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Lor M. Systematic Review: Health Promotion and Disease Prevention Among Hmong Adults in the USA. J Racial Ethn Health Disparities 2018; 5:638-661. [PMID: 28795343 PMCID: PMC5807234 DOI: 10.1007/s40615-017-0410-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/14/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
Although disparities in the burden of disease and illness experienced across major racial and ethnic groups in the USA is well known, little is known about subgroups, including the Hmong population. This review sought to determine the current state of health disparities related to health promotion and disease prevention among Hmong adults from 1975 to 2015. Seventy-one descriptive (qualitative, mixed methods, and quantitative) studies were reviewed. Most focused on two areas: (1) health status (mainly breast and cervical cancers) and (2) health-related behaviors. This literature review confirms the existence of health disparities related to health promotion and disease prevention in the Hmong adult population. Effective intervention relies on identifying these disparities. A possible explanation for these disparities is the lack of health data collected on subgroup populations, which include the Hmong adult population. More research and more comprehensive health policies at the organizational level are needed to allow data to be collected on subgroup populations in order to better understand the social determinants that place the Hmong people at risk.
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Affiliation(s)
- Maichou Lor
- School of Nursing, Columbia University , Mailbox 6, 630 W 168th Street, New York City, New York, 10032, USA.
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Lee H, Kim M, Cooley ME, Kiang PNC, Kim D, Tang S, Shi L, Thiem L, Kan P, Peou S, Touch C, Chea P, Allison J. Using narrative intervention for HPV vaccine behavior change among Khmer mothers and daughters: A pilot RCT to examine feasibility, acceptability, and preliminary effectiveness. Appl Nurs Res 2018; 40:51-60. [DOI: 10.1016/j.apnr.2017.12.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 11/30/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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Beltran R, Simms T, Lee HY, Kwon M. HPV Literacy and Associated Factors Among Hmong American Immigrants: Implications for Reducing Cervical Cancer Disparity. J Community Health 2018; 41:603-11. [PMID: 26696118 DOI: 10.1007/s10900-015-0135-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous studies show that certain minority and ethnic communities experience low human papillomavirus (HPV) vaccination rates despite a higher cervical cancer burden. HPV is known to be responsible for almost all cervical cancer cases. Hmong Americans, a growing Asian American population, appear to be at increased risk. The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites. Despite such alarming statistics, there is limited research focusing on HPV literacy and its associated factors in the Hmong American community. This study's objectives are to investigate: (1) the level of HPV knowledge among Hmong Americans; (2) HPV vaccination initiation and completion rates of Hmong Americans; and (3) factors associated with HPV literacy in the Hmong American community. Andersen's Behavioral Model of Health Services Use was used as the study's theoretical framework. A self-administered paper and online health survey was completed by192 Hmong Americans living in a major metropolitan area in Minnesota. Results revealed a mean score of 4.76 (SD 1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate was 46.3 % (n = 56), with 32.7 % completing the recommended three doses. Multiple regression analysis found that participants' level of education, number of doctor visits, and cervical cancer screening literacy were significantly associated with HPV knowledge. This study's results indicate the important role of health providers in educating Hmong Americans patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population.
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Affiliation(s)
- Raiza Beltran
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA.
| | - Tina Simms
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA
| | - Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA
| | - Melissa Kwon
- Asian American Studies, University of Minnesota, Twin Cities, 778 Social Sciences Building 267 - 19th Avenue South, Minneapolis, MN, 55455, USA
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Kim M, Lee H, Kiang P, Kim D. Human Papillomavirus: A Qualitative Study of Korean American Female College Students' Attitudes Toward Vaccination
. Clin J Oncol Nurs 2017; 21:E239-E247. [PMID: 28945722 DOI: 10.1188/17.cjon.e239-e247] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines have the potential to reduce Korean American women's high burden of cervical cancer, but information is limited about their awareness of HPV and its vaccine.
. OBJECTIVES This study aimed to explore Korean American female college students' awareness of and attitudes toward HPV vaccination.
. METHODS A qualitative descriptive study was used. Five focus group interviews were conducted with 20 Korean American female college students aged 18-26 years from Massachusetts. Data were analyzed using inductive content analysis.
. FINDINGS Major themes were awareness, misunderstandings, attitudes, social influences, and cultural influence. A critical need exists to develop and implement culturally and linguistically appropriate HPV prevention education programs to promote HPV vaccination in this population.
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Affiliation(s)
- Minjin Kim
- University of Massachusetts Medical School
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Khuu BP, Lee HY, Zhou AQ. Health Literacy and Associated Factors Among Hmong American Immigrants: Addressing the Health Disparities. J Community Health 2017; 43:11-18. [PMID: 28528527 DOI: 10.1007/s10900-017-0381-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hmong Americans face a disproportionate health burden ranging from the high prevalence of diabetes to depressive disorders. Little research attention has been paid toward exploring contributing factors to this disparity. As such, the present study seeks to fill the gap in the literature by examining the health literacy levels in Hmong Americans and its associated factors. The present study employed Andersen's behavioral model of health service as the theoretical framework. A cross-sectional survey research design was used and information was gathered from 168 Hmong American immigrants. Participants were recruited using a purposive sampling strategy. A multiple regression analysis was conducted to identify the factors linked to health literacy. Approximately half of the participants had low health literacy and reported that they did not understand health information well. Health literacy levels were found to differ significantly based on the number of years participants have lived in the U.S., their social or religious group attendance, health status, and whether they had difficulties with activities of daily living. Our exploratory findings could be used prompt more research to help inform the development of interventions aiming to improve health literacy levels and address the health disparities in Hmong American Population.
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Affiliation(s)
- Belle P Khuu
- School of Social Work, University of Minnesota, Twin Cities, MN, USA.
| | - Hee Y Lee
- School of Social Work, University of Minnesota, Twin Cities, MN, USA
| | - Anne Q Zhou
- Department of Psychology, University of Minnesota, Twin Cities, MN, USA
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Stewart SL, Kwong SL, Bowlus CL, Nguyen TT, Maxwell AE, Bastani R, Chak EW, Chen Jr MS. Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012. World J Gastroenterol 2016; 22:8584-8595. [PMID: 27784971 PMCID: PMC5064040 DOI: 10.3748/wjg.v22.i38.8584] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/16/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a population-based cancer registry.
METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White (White, n = 12710), Hispanic (n = 8500), Chinese (n = 2723), non-Hispanic Black (Black, n = 2609), Vietnamese (n = 2063), Filipino (n = 1479), Korean (n = 1099), Japanese (n = 658), American Indian/Alaskan Native (AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian (n = 233), South Asian (n = 190), Hawai`ian/Pacific Islander (n = 172), Thai (n = 95), and Other Asian (n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.
RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio (OR) = 0.30, 95%CI: 0.17-0.53], Cambodian (OR = 0.65, 95%CI: 0.45-0.96), AIAN (OR = 0.66, 95%CI: 0.46-0.93), Black (OR = 0.76, 95%CI: 0.67-0.86), and Hispanic (OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese (OR = 1.58, 95%CI: 1.42-1.77), Koreans (OR = 1.45, 95%CI: 1.24-1.70), Japanese (OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese (OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio (HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians (HR = 1.35, 95%CI: 1.16-1.58), and Blacks (HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese (HR = 0.82, 95%CI: 0.77-0.86), Filipinos (HR = 0.84, 95%CI: 0.78-0.90), Vietnamese (HR = 0.85, 95%CI: 0.80-0.90), Koreans (HR = 0.90, 95%CI: 0.83-0.97), and Hispanics (HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.
CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.
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Lee H, Kim M, Kiang P, Shi L, Tan K, Chea P, Peou S, Grigg-Saito DC. Factors Associated with HPV Vaccination among Cambodian American Teenagers. Public Health Nurs 2016; 33:493-501. [PMID: 27723191 DOI: 10.1111/phn.12294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Parents have general influence over their children's health and health behavior. However, given the dearth of specific literature regarding knowledge level and social and cultural factors influencing HPV vaccination behaviors among Cambodian American (CA) parent, it is difficult to develop an effective, evidence-based public health HPV vaccination program. Therefore, the objectives of this study were to determine the HPV vaccine uptakes among CA teenagers and to examine factors influencing HPV vaccine uptakes. DESIGN AND SAMPLE A descriptive, cross-sectional survey design and a combination of network and targeted sampling methods were used. RESULTS CA mothers (n = 130) completed a health survey through face-to-face interviews in either English or Khmer language. Girls vaccination rates were 29% while that of boys was 16%. Awareness and knowledge of HPV among CA mothers was very low, and many believed that their daughters, who speak English and were educated in the U.S., had more knowledge about health than they did. Logistic regression analysis showed that CA girls had significantly higher odds of vaccination when their mothers possessed a higher level of English reading ability and had greater awareness and knowledge of HPV. CONCLUSIONS The strikingly low rates of HPV vaccination among CA girls and boys underscore the need to improve vaccination outreach, education, and uptake. The findings can be used to develop targeted public health HPV vaccination programs for CAs, which will reduce cervical cancer disparities.
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Affiliation(s)
- Haeok Lee
- Department of Nursing, College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Minjin Kim
- Department of Nursing, College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Peter Kiang
- Asian American Studies Program, School for Global Inclusion and Social Development, University of Massachusetts Boston, Boston, Massachusetts
| | - Ling Shi
- Department of Nursing, College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Kevin Tan
- Cambodian Mutual Assistance Association, Lowell, Massachusetts
| | - Phala Chea
- English Language Education Program in Support of English Language Learners & Families/McKinney Vento Education Liaison, Lowell Public Schools, Lowell, Massachusetts
| | - Sonith Peou
- Metta Health Center of Lowell Community Health Center, Lowell, Massachusetts
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Abstract
This chapter takes the reader on a step-by-step journey through the process of conducting a qualitative research study using research conducted with Traditional Healers (THs) in Malaysia and how they diagnose and treat cancer. Upwards of 80% of Malaysians consult traditional healers before seeing a medical doctor, resulting in late-stage diagnoses and thus higher mortality rates. However, prior to our research, little was known about the role of healers and their willingness to work with, rather than outside, the Western medical system. Within this context, the theoretical framework, the specific research problem and the research questions were identified. Next, the author discusses purposive sampling and data collection strategies, which included interviews, documents, and observations. She then presents a data analysis exhibit showing how they captured specific data from the interviews to address the research questions. Finally, the author discusses writing and publishing the results of the research.
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Kue J, Thorburn S, Keon KL. Research challenges and lessons learned from conducting community-based research with the Hmong community. Health Promot Pract 2014; 16:411-8. [PMID: 25445983 DOI: 10.1177/1524839914561515] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conducting research with underserved communities with little exposure to research presents a number of challenges and opportunities. Our study used a community-based approach to better understand factors that influence breast and cervical cancer screening among Hmong women. OBJECTIVE This article shares lessons learned during the process of developing and conducting qualitative research with a Hmong community with limited experience with research. METHOD We conducted 17 key informant and 84 in-depth interviews with Hmong women and men. Research team discussions, insights from Hmong research team members, input from our Community Advisory Committee, and project documents were sources of information about the process of conducting research in this community. RESULTS Lessons learned concern including a cultural insider as an investigator; building community partnerships and support; establishing and working with a community advisory committee; hiring and training bilingual, bicultural staff; and using culturally appropriate materials and methods in a small, kinship-based community. We used multiple strategies to ensure that this study was conducted in a culturally appropriate manner. CONCLUSION The lessons learned from our experiences can provide guidance to researchers on methodological and practical issues in conducting research with the Hmong and can inform future research with the Hmong and other similar underserved populations.
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Kue J, Zukoski A, Keon KL, Thorburn S. Breast and cervical cancer screening: exploring perceptions and barriers with Hmong women and men in Oregon. ETHNICITY & HEALTH 2014; 19:311-27. [PMID: 23477387 PMCID: PMC3711956 DOI: 10.1080/13557858.2013.776013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Hmong women are reported to have very low rates of breast and cervical cancer screening compared to other Asian and White women in the USA. Reasons for low cancer screening rates among this population are not well understood. METHODS This qualitative study (n=83) explored Hmong women and men's perceptions of breast and cervical cancer and cancer screening, women's experiences with breast and cervical cancer screening, and health care system barriers to screening. RESULTS Hmong women and men perceived breast cancer to be more severe than other types of cancers. Participants believed that breast cancer is curable if detected early. Cervical cancer was not well understood and was of greater concern than breast cancer because of its location within the body and its consequences for reproduction. In general, few participants had personal experiences with breast and/or cervical cancer. Overall, women and men had positive things to say about screenings for breast and cervical cancer, expressing that screenings offered a 'proof of illness.' The majority of women did not report any concerns with the exams themselves, although some discussed embarrassment, pain, and discomfort. Barriers to screening included lack of health insurance, making co-payments, language, and issues related to scheduling appointments. Barriers differed for younger and older women. CONCLUSION Results of this study provide new insight into perceptions, experiences, and barriers to breast and cervical cancer screening among Hmong women and men. These findings have implications for developing culturally appropriate interventions to increase breast and cervical cancer screening in this population.
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Affiliation(s)
- Jennifer Kue
- College of Nursing, The Ohio State University, 1585 Neil Ave., Columbus, OH 43210
| | - Ann Zukoski
- Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408
| | - Karen Levy Keon
- Formerly with the College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR 97331
| | - Sheryl Thorburn
- College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR 97331
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Lor M, Bowers B. Evaluating teaching techniques in the Hmong breast and cervical cancer health awareness project. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:358-365. [PMID: 24488558 PMCID: PMC4278583 DOI: 10.1007/s13187-014-0615-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cancer health disparities are a reality for Hmong women who are often diagnosed at a later stage and have low literacy and experienced care that are not culturally appropriate. Lack of attention to cultural appropriateness and literacy levels of cancer screening materials may contribute to disproportionately low levels of cancer screening among Hmong women. The purposes of this study were to evaluate the Hmong Health Awareness Project (HHAP), a program designed to create awareness and acceptance of breast and cervical cancer screening, and to examine participants' perceptions of the utility of the content of the workshops. Hmong researchers partnered with three Midwestern Hmong community centers to implement six workshops. Three teaching techniques: pictographs, videos, and hands-on activities were utilized to teach Hmong participants about cancer screening. Participants included 150 Hmong (male participants = 30 and female participants = 120). Teach-back method was used to assess the participants' understanding of cancer screening throughout the workshops. Qualitative data were collected in focus groups to assess the feasibility of teaching methods and participants' perceptions of the utility of the content of the workshops. Directed content analysis was used to analyze participants' responses. The three teaching techniques were helpful in increasing the Hmong people's understanding about breast and cervical cancer screening. Nearly, all participants perceived an increased in their understanding, greater acceptance of cancer screening, and increased willingness to be screened. Men expressed support for screening after the workshops. Findings can guide future interventions to improve health communications and screening and reduce diagnostic disparities among Hmong and immigrant populations.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53715, Phone: 608-262-3057, Fax #: 608-263-5296
| | - Barbara Bowers
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53715, (608) 262-8146
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Merriam S, Muhamad M. Roles traditional healers play in cancer treatment in Malaysia: implications for health promotion and education. Asian Pac J Cancer Prev 2014; 14:3593-601. [PMID: 23886151 DOI: 10.7314/apjcp.2013.14.6.3593] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For a number of reasons from cultural compatibility, to accessibility, to cost, traditional healers are a major source of health care in developing countries. In Malaysia, 'en estimated that upwards of 80% of the population consult traditional healers even if simultaneously seeking treatment from the Western medical system. Partially as a result of the widespread practice of visiting traditional healers, cancer diagnosis and treatment in Malaysia is often delayed or interrupted resulting in late presentation, advanced stage diagnosis, and a higher mortality rate than in Western countries. However, there is very little research on the role of traditional healers in cancer treatment in Malaysia. MATERIALS AND METHODS This qualitative study was designed to identify the roles traditional healers play in cancer diagnosis and treatment, with an eye to alleviating the cancer burden through educational responses with four publics in mind-policy makers, Western medical personnel, traditional healers, and the general public. In-depth interviews were conducted with 14 Malay traditional healers, 13 cancer survivors who had seen both traditional healers and Western doctors, and 12 cancer medical specialists. RESULTS Analysis of the data from these 39 participants revealed four roles traditional healers play in cancer treatment-medicinal healer, emotional comforter, spiritual guide, and palliative caregiver. CONCLUSIONS Three roles (emotional, spiritual, palliative) can be seen as complementary to the allopathic system. Emotional and spiritual roles may augment the effectiveness of biomedical treatment. Cancer awareness and education programs need to position traditional healers as complementary, rather than an alternative to Western medical treatment; Validating the roles Traditional Healers can play in cancer treatment in MY through health promotion and education will contribute to alleviating the nation's cancer burden.
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Thorburn S, Kue J, Keon KL, Zukoski A. "We don't talk about it" and other interpersonal influences on Hmong women's breast and cervical cancer screening decisions. HEALTH EDUCATION RESEARCH 2013; 28:760-71. [PMID: 23221592 PMCID: PMC3772328 DOI: 10.1093/her/cys115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 10/25/2012] [Indexed: 06/01/2023]
Abstract
Hmong women in the United States have low rates of breast and cervical cancer screening, and the factors that influence screening in this population are not well understood. This qualitative study explored family and clan influences on Hmong women's breast and cervical cancer screening attitudes and behavior. We conducted in-depth interviews with Hmong women and men living in Oregon. Interviews were audio-recorded and transcribed. Transcripts of 83 interviews were analysed using content analysis. We identified four key themes. First, Hmong women make decisions about breast and cervical cancer screening independently. Second, Hmong families do not discuss breast and cervical cancer screening. For some, not talking about breast and cervical cancer screening was seen as a way that family and clan influence attitudes. Third, Hmong families can provide encouragement and support for screening. Although women make their own decisions, about one-half of participants reported that family encouraged or supported them or women in their family to get screened. Fourth, some family members, especially elders, may actively discourage screening. This study contributes to knowledge about potential barriers and facilitators to breast and cervical cancer screening for Hmong women. Findings expand our understanding of clan and male family member's influence over Hmong women's screening behavior.
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Affiliation(s)
- Sheryl Thorburn
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, Formerly with College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA, Independent Consultant, Corvallis, OR, USA and Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408, USA
| | - Jennifer Kue
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, Formerly with College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA, Independent Consultant, Corvallis, OR, USA and Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408, USA
| | - Karen Levy Keon
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, Formerly with College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA, Independent Consultant, Corvallis, OR, USA and Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408, USA
| | - Ann Zukoski
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, Formerly with College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA, Independent Consultant, Corvallis, OR, USA and Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408, USA
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Chen MS, Fang DM, Stewart SL, Ly MY, Lee S, Dang JHT, Nguyen TT, Maxwell AE, Bowlus CL, Bastani R, Nguyen TT. Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study. Cancer Epidemiol Biomarkers Prev 2013; 38:546-53. [PMID: 23613027 DOI: 10.1007/s10900-012-9649-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk. METHODS Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. RESULTS Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation. CONCLUSIONS LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. IMPACT LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued.
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Affiliation(s)
- Moon S Chen
- University of California Davis Comprehensive Cancer Center, 4800 2nd Avenue, Suite 2200, Sacramento, CA 95817, USA.
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Chen MS, Fang DM, Stewart SL, Ly MY, Lee S, Dang JHT, Nguyen TT, Maxwell AE, Bowlus CL, Bastani R, Nguyen TT. Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study. Cancer Epidemiol Biomarkers Prev 2013; 22:782-91. [PMID: 23613027 DOI: 10.1158/1055-9965.epi-12-1399] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk. METHODS Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. RESULTS Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation. CONCLUSIONS LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. IMPACT LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued.
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Affiliation(s)
- Moon S Chen
- University of California Davis Comprehensive Cancer Center, 4800 2nd Avenue, Suite 2200, Sacramento, CA 95817, USA.
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Al-Naggar RA, Bobryshev YV, Abdulghani MAMM, Rammohan S, Al-Jashamy K. Knowledge and perceptions of cancer and cancer prevention among Malaysian traditional healers: a qualitative study. Asian Pac J Cancer Prev 2013; 13:3841-50. [PMID: 23098481 DOI: 10.7314/apjcp.2012.13.8.3841] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore the knowledge and perceptions of Malaysian tradition healers towards cancer and cancer prevention. METHODOLOGY A total of 25 participants agreed to participate in this qualitative study during the period from 20th July 2011 until 24th of September 2011. The proposal of this study was approved by the Ethics Committee of Management and Science University (MSU). Once the participant agreed to be interviewed, date, time and place of the interviews were determined. Consent form was obtained from participants before the interview began. Participants were briefed about the study and its purpose, and after asking their permission, their replies were recorded. The data was organized into themes and analyzed manually. RESULTS Twenty-five Malaysian traditional healers participated in this qualitative study. The age of participants ranged between 26 to 78 years old. The majority were in the age group of 31-60 years old, male, Chinese, degree holders with a monthly income ranging from 1,000-5,000 Ringgit Malaysia (RM) and were married (56%, 80%, 48%, 52%, 68%, 84% respectively). The majority defined cancer as having high cholesterol or abscess accumulation. A few of them defined cancer as a type of cell growth. The majority mentioned that food and unhealthy lifestyles are the primary causes of cancer. Surprisingly some of them mentioned that cancer is caused by interference by ghosts. Regarding the diagnosis of cancer, the majority mentioned that they refer their patients to modern physicians' medical report when it comes to diagnosing or treating patients with cancer. The most common cancers that many patients came to seek treatment were breast cancers, followed by colon cancers, liver and lung cancers. CONCLUSION Despite good knowledge about the causes of cancer among traditional healers, misconceptions still exist. Insufficient knowledge about the definition of cancer was noted among the traditional healers. This urges immediate action by the Ministry of Health of Malaysia to set up a strict regulation and regular monitoring of the traditional healers nationally. Traditional and Complementary Medicine may be integrated into the healthcare system and need to have sustained cooperation for the benefit of patients since about 80% of patients use traditional medicines.
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Affiliation(s)
- Redhwan A Al-Naggar
- Community Medicine Department, International Medical School, Management and Science University, Malaysia.
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Lor M, Khang PY, Xiong P, Moua KF, Lauver D. Understanding Hmong women's beliefs, feelings, norms, and external conditions about breast and cervical cancer screening. Public Health Nurs 2013; 30:420-8. [PMID: 24000914 DOI: 10.1111/phn.12043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the beliefs, feelings, norms, and external conditions regarding breast and cervical cancer screening in a sample of Hmong women. DESIGN AND SAMPLE In a descriptive design, female Hmong researchers recruited 16 Hmong women (ages 24-73) at a community center. Guided by the Theory of Care Seeking Behavior (TCSB), researchers asked participants semi-structured questions about their beliefs, feelings, norms, and external conditions in a group setting. Researchers documented responses in writing and audio recordings. Guided by theory, we used directed content analysis to categorize responses. RESULTS Participants' beliefs' about screening included uncertainty about causes of breast and cervical cancer, uncertainty about Western forms of treatments, and terminal illness as outcomes of such cancer. Many felt embarrassed about breast and cervical cancer screening. Their cultural norms about undressing for an exam and listening to authority figures were different from Western norms. External conditions that influenced participants' for screenings included difficulties in communicating with interpreters and clinicians. CONCLUSIONS Consistent with the TCSB, Hmong women's beliefs, affect, cultural norms and external conditions helped to understand their use of breast and cervical screening. Findings could guide nursing and public health interventions to improve culturally sensitive, cancer screening for Hmong women.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin-Madison, Clinical Science Center, School of Nursing, Madison, Wisconsin 53792, USA.
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Abstract
The incidence of cervical cancer is high among Southeast Asian American women, but their participation in preventive cervical cancer screening is alarmingly low. This paper reviews the literature on factors associated with participation in cervical cancer screening among women of Vietnamese, Cambodian and Hmong descent in the United States. These factors include acculturation, age, marital status, knowledge about cervical cancer, apprehension about cervical cancer screening, financial concerns, access to health care, and physician characteristics and recommendation. Suggestions for future research include the need to investigate the role of physicians treating Southeast Asian American women, the need for more extensive up-to-date studies on the current generation of young Southeast Asian American women, and the use of more advanced assessments of acculturation. Overall, much more work is needed in order to deepen our understanding of the various ways to improve the rate of cervical cancer screening among Southeast Asian American women.
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Schroepfer TA, Waltz A, Noh H, Matloub J, Kue V. Seeking to bridge two cultures: the Wisconsin Hmong cancer experience. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2010; 25:609-616. [PMID: 20300916 DOI: 10.1007/s13187-010-0102-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 02/18/2010] [Indexed: 05/29/2023]
Abstract
Compared to white non-Hispanics, Hmong report higher incidence rates of certain cancers and present at an advanced stage. Using a community-based participatory research approach, Hmong leaders partnered with academic researchers to assess the Wisconsin Hmong population's readiness to address cancer. Using the Colorado Tri-Ethnic Center's Community Readiness Assessment, face-to-face interviews were conducted with eight Hmong leaders. The stage of readiness to address cancer was "Vague Awareness". Six thematic areas provided insight into this stage and recommendations for effective intervention. Results emphasize the need for a bridge between Hmong and mainstream communities to provide basic, culturally appropriate education on the US healthcare system and cancer.
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Affiliation(s)
- Tracy A Schroepfer
- School of Social Work, University of Wisconsin-Madison, Madison, WI 53706, USA.
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Kwong SL, Stewart SL, Aoki CA, Chen MS. Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007. Cancer Epidemiol Biomarkers Prev 2010; 19:2747-57. [PMID: 20823106 PMCID: PMC3016919 DOI: 10.1158/1055-9965.epi-10-0477] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) represents a significant health disparity affecting Asian Americans, a population comprised of distinct ethnic groups. The purpose of this article is to analyze Californians of Asian ancestry with HCC with respect to socioeconomic status, demographic factors, stage of disease, treatment received, and survival. METHODS To investigate ethnic differences in survival, we analyzed ethnically disaggregated data from 6,068 Californians of Asian ancestry with HCC diagnosed in 1988 to 2007 and reported to the California Cancer Registry. RESULTS Compared with the average of all ethnic groups, cause-specific mortality was significantly higher among Laotian/Hmong [hazard ratio, 2.08; 95% confidence interval (95% CI), 1.78-2.44] and Cambodian patients (hazard ratio, 1.26; 95% CI, 1.06-1.51), groups with higher proportions of their populations at low levels of socioeconomic status; in addition, Laotian/Hmong patients disproportionately presented at later stages of disease, with only 3% receiving local surgical treatment, resection, or liver transplantation. After adjustment for time of diagnosis, age at diagnosis, gender, geographic region, stage at diagnosis, type of surgery, and socioeconomic status, survival disparities remained for both groups (Laotian/Hmong hazard ratio, 1.51; 95% CI, 1.28-1.79; Cambodian hazard ratio, 1.24; 95% CI, 1.03-1.48). CONCLUSIONS Our hypothesis that survival outcomes would differ by ethnicity was verified. IMPACT Research is needed not only to develop more effective treatments for HCC but also to develop community-based interventions to recruit Asian Americans, particularly Laotian/Hmong and Cambodians, for hepatitis B screening and into medical management to prevent or detect this tumor at an early stage.
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Affiliation(s)
- Sandy L Kwong
- Cancer Surveillance Research Unit, Cancer Surveillance and Research Branch, California Department of Public Health, San Francisco, CA, USA
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Baker DL, Melnikow J, Ying Ly M, Shoultz J, Niederhauser V, Diaz-Escamilla R. Translation of Health Surveys Using Mixed Methods. J Nurs Scholarsh 2010; 42:430-8. [DOI: 10.1111/j.1547-5069.2010.01368.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fang DM, Lee S, Stewart S, Ly MY, Chen MS. Factors associated with pap testing among Hmong women. J Health Care Poor Underserved 2010; 21:839-50. [PMID: 20693730 DOI: 10.1353/hpu.0.0338] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This paper reports the baseline data on the proportion of Hmong women (n=402), ages 18-65, in Sacramento, California who reported that they had a Pap test for the early detection of cervical cancer. We assessed the association between sociodemographic characteristics and Pap test receipt using chi-squared and multiple logistic regression analyses. Only 74% had ever had a Pap test, with 61% tested in the previous three years, compared with 91% and 86%, respectively, of California women overall. Women were more likely to have had a recent Pap test if they were age 21-30 (OR=3.0 vs. age 51-65, 95% CI 1.4-6.7) or 31-40 (OR=3.0, 95% CI 1.4-6.4), and less likely if they were single (OR=0.4 vs. married/partnered, 95% CI 0.2-1.0) or born in the U.S. (OR=0.3 vs. <10 years in U.S., 95% CI 0.1-0.8).
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Affiliation(s)
- Dao Moua Fang
- Hmong Women's Heritage Association, Sacramento, Calif 95822, USA
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Yu TC, Chou CF, Johnson PJ, Ward A. Persistent disparities in pap test use: assessments and predictions for Asian women in the U.S., 1982-2010. J Immigr Minor Health 2010; 12:445-53. [PMID: 19415491 PMCID: PMC2888862 DOI: 10.1007/s10903-009-9255-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Disparities in cancer screening among U.S. women are well documented. However, little is known about Pap test use by Asian women living in the U.S. Data for women, ages 18 and older, living in the U.S. were obtained from National Health Interview Survey (NHIS) files from 1982 to 2005. Outcomes were ever having a Pap test and having a Pap test within the preceding 3 years. Pap test prevalence trends were estimated by race and ethnicity and for Asian subgroups. Fractional logit models were used to predict Pap test use in 2010. Although the rate of having a Pap test within the preceding 3 years increased slightly from 1982 to 2005 for all U.S. women, Asian women continue to have the lowest rate. Pap test use also varied within Asian subpopulations living in the U.S. None of the races and ethnicities are predicted to reach the Pap test targets of Healthy People 2010. To reduce or eliminate continuing disparities in Pap test use requires targeted policy interventions.
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Affiliation(s)
- Tzy-Chyi Yu
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 2221 University Avenue SE, Minneapolis, MN 55414, USA.
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Lee HY, Vang S. Barriers to cancer screening in Hmong Americans: the influence of health care accessibility, culture, and cancer literacy. J Community Health 2010; 35:302-14. [PMID: 20140486 DOI: 10.1007/s10900-010-9228-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Hmong Americans face high cancer mortality rates even in comparison to their Asian American counterparts, and report low utilization of cancer screenings. To date, no study has been conducted on the cultural barriers this population faces in undergoing cancer screenings. A systematic review of the literature was conducted to examine the existing knowledge regarding the barriers to cancer screening for Hmong Americans. Potential barriers were identified from this examination to include: health access factors (type of health insurance, ethnicity of provider, low English proficiency, and years spent in the U.S.); cultural factors (belief in the spiritual etiology of diseases, patriarchal values, modesty, and mistrust of the western medical system); and cancer literacy factors (cancer and prevention illiteracy). Based on this review, potential cultural and ethnic group-specific prevention strategies and cancer health policies are discussed to address these barriers and enhance screening behavior among the Hmong.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, Saint Paul, MN 55108, USA.
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Baker DL, Dang MT, Ly MY, Diaz R. Perception of barriers to immunization among parents of Hmong origin in California. Am J Public Health 2010; 100:839-45. [PMID: 20299651 DOI: 10.2105/ajph.2009.175935] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored factors associated with perception of barriers to immunization among parents of Hmong origin in California, whose children experience persistent immunization inequities even with health insurance. METHODS A partnership of academic researchers and members of the Hmong community conducted a community-based participatory research project. We collected data in naturalistic settings with a standardized instrument. We analyzed responses from 417 parents and caregivers and created a structural equation model to determine factors that contributed to perceived barriers. RESULTS Of 3 potential contributing factors to perceived barriers-nativity, socioeconomic position, and use of traditional Hmong health care (i.e., consulting shamans and herbalists)-the latter 2 significantly predicted higher perceived barriers to immunization. Nativity, indicated by years in the United States, age of arrival in the United States, and English language fluency, did not predict perceived barriers. CONCLUSIONS Interventions aimed at reducing immunization inequities should consider distinct sociocultural factors that affect immunization rates among different refugee and immigrant groups.
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Affiliation(s)
- Dian L Baker
- California State University, Sacramento, Division of Nursing, 6000 J St, Sacramento, CA 95819, USA.
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Patterns of Mortality in California Hmong, 1988–2002. J Immigr Minor Health 2009; 12:754-60. [DOI: 10.1007/s10903-009-9230-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 01/23/2009] [Indexed: 11/25/2022]
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Bates JH, Hofer BM, Parikh-Patel A. Cervical cancer incidence, mortality, and survival among Asian subgroups in California, 1990-2004. Cancer 2008; 113:2955-63. [PMID: 18980279 DOI: 10.1002/cncr.23752] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Aggregated cancer statistics for Asians mask important differences in cancer burden among Asian subgroups. The purpose of this study was to describe the relative patterns of cervical cancer incidence, mortality, and survival among Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese women in California, using data from the California Cancer Registry. METHODS All cervical cancer cases diagnosed among the 6 subgroups and non-Hispanic whites (NHW) from 1990 to 2004 were identified and used to calculate incidence and mortality rates and trends. The Kaplan-Meier method was used to calculate 5- and 10-year survival probabilities by subgroup, and Cox proportional hazards methodology was used to calculate survival differences adjusted for race and ethnicity, age, stage at diagnosis, socioeconomic status, and treatment factors. RESULTS Vietnamese and Korean women experienced greater cervical cancer incidence and mortality than NHW women, whereas rates among Chinese, Japanese, and South Asians were comparable or lower. Five-year unadjusted survival probabilities were greatest for South Asians (86%) and Koreans (86%), followed by Vietnamese (82%), Chinese (79%), and Filipinos (79%), as compared with NHW (78%) and Japanese (72%). The adjusted risk of cervical cancer death was significantly lower for South Asians, Koreans, Vietnamese, and Filipinos than for NHW women, but not for Chinese and Japanese. CONCLUSIONS Cervical cancer incidence rates vary substantially across the major Asian subgroups. Despite higher incidence and mortality rates compared with NHW women, Vietnamese, Koreans, and Filipinos have better survival outcomes. Further studies are needed to examine the factors behind these survival differences.
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Affiliation(s)
- Janet H Bates
- Public Health Institute, California Cancer Registry, Sacramento, California 95825, USA.
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Taylor VM, Nguyen TT, Jackson JC, McPhee SJ. Cervical cancer control research in Vietnamese American communities. Cancer Epidemiol Biomarkers Prev 2008; 17:2924-30. [PMID: 18990732 PMCID: PMC2665877 DOI: 10.1158/1055-9965.epi-08-0386] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Census data show that the U.S. 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 Papanicolaou (Pap) testing rates rather than variations in human papillomavirus infection rates and/or types. The cervical cancer incidence rates among Vietnamese and non-Latina White women in California during 2000 to 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 with 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.
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Affiliation(s)
- Victoria M Taylor
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center (M3-B232), 1100 Fairview Avenue North, Seattle, WA 98109, USA.
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O'Malley CD, Shema SJ, Clarke LS, Clarke CA, Perkins CI. Medicaid status and stage at diagnosis of cervical cancer. Am J Public Health 2006; 96:2179-85. [PMID: 17077390 PMCID: PMC1698154 DOI: 10.2105/ajph.2005.072553] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether Medicaid beneficiaries are more likely to be diagnosed with late-stage cervical cancer than women not enrolled in Medicaid. METHODS Using the California Cancer Registry-Medicaid linked file, we identified 4682 women diagnosed during 1996-1999 with invasive cervical cancer. Multivariate logistic regression was used to evaluate the association between late-stage diagnosis and prediagnosis Medicaid status. RESULTS Late-stage disease was diagnosed in 51% of Medicaid and 42% of non-Medicaid women. Relative to women without Medicaid coverage, adjusted odds ratios for late-stage diagnosis were 2.8 times higher among women enrolled in Medicaid at the time of their diagnosis and 1.3 times higher among those intermittently enrolled before being diagnosed. Vietnamese women were less likely than White women to have advanced disease; the adjusted odds for women in other racial/ethnic groups did not differ from those among Whites. Women of low socioeconomic status and older women were at increased risk. CONCLUSIONS Women intermittently enrolled in Medicaid or not enrolled until their diagnosis were at greatest risk of a late-stage diagnosis, suggesting that more outreach to at-risk women is needed to ensure access to screening services.
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Abstract
The Hmong represent a unique new Southeast Asian immigrant group to the U.S. Approximately 169,000 Hmong reside in the U.S., primarily in California, Minnesota, and Wisconsin. Previous studies of cancer in this population have indicated that Hmong experience an elevated risk of gastric, hepatic, cervical, and nasopharyngeal cancers and experience a reduced risk of breast, prostate, lung, and colorectal cancers. Approximately 65,000 Hmong live in California, where there has been a population-based cancer registry since 1988, and the authors used these data to calculate age-adjusted cancer incidence rates and to examine disease stage and tumor grade at diagnosis. Changes in rates during the period studied also were evaluated. These rates and proportions were compared with rates among the non-Hispanic white (NHW) and Asian/Pacific Islander (API) populations of California. Between 1988 and 2000, a total of 749 Hmong in California were diagnosed with invasive cancer, and the age-adjusted rate of cancer for the Hmong was 284 per 100,000 population, compared with 362.6 and 478 per 100,000 in the API and NHW populations, respectively. The age-adjusted incidence rates of cancer in the Hmong were elevated for hepatic, gastric, cervical, and nasopharyngeal cancers and for leukemia and non-Hodgkin lymphoma (NHL). Rates were lower in the Hmong for colorectal, lung, breast, and prostate cancers. For gastric cancer and lung cancer, age-adjusted rates increased between 1988 and 2000 in the Hmong, although breast cancer incidence declined. Cervical cancer incidence increased, rates of NHL were declining, and rates for colorectal cancer remained steady between 1988 and 2000. The Hmong experienced later disease stage at diagnosis than other API and generally poorer grade of disease at diagnosis. Hmong experienced lower overall invasive cancer incidence rates than API or NHW populations in California. However, they experienced higher rates of hepatic, gastric, cervical, and nasopharyngeal cancers; and, for most types of cancer, they were diagnosed in a later disease stage.
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Affiliation(s)
- Paul K Mills
- Cancer Registry of Central California, Fresno, CA 93710, USA.
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Abstract
Asian Americans are the nation's fastest growing racial group in terms of percentages, and they constitute a very heterogeneous population. The author reviewed the literature and proposed an agenda to reduce cancer health disparities based on this review and the accomplishments and aspirations of the National Cancer Institute-funded Asian American Network for Cancer Awareness, Research, and Training. The Asian American cancer burden is unique, unusual, and, to a certain extent, unnecessary. The Asian American cancer burden is unique, because Asians are the only racial/ethnic population to experience cancer as the leading cause of death. The unusual aspects of the cancer burden among Asian Americans include experiencing proportionally more cancers of infectious origin, such as human papillomavirus-induced cervical cancer, hepatitis B virus-induced liver cancer, and stomach cancer, than any other racial/ethnic population and, at the same time, experiencing an increasing numbers of cancers associated with "Westernization." To a certain extent, the cancer burden for Asian Americans is unnecessary if barriers to cancer screening, overcoming resistance to physician visits, and culturally competent interventions to reduce smoking, unhealthy diet, and increasing proper exercise can be instituted. Reducing cancer health disparities among Asian Americans will involve research into their unique, unusual, and unnecessary cancer burden.
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Affiliation(s)
- Moon S Chen
- Department of Public Health Sciences, School of Medicine, University of California Davis, Sacramento, California 95817, USA.
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Dodge JL, Mills PK, Yang RC. Nasopharyngeal cancer in the California Hmong, 1988-2000. Oral Oncol 2005; 41:596-601. [PMID: 15975522 DOI: 10.1016/j.oraloncology.2005.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 01/26/2005] [Indexed: 10/25/2022]
Abstract
Although previous studies document elevated nasopharyngeal cancer incidence in the American Hmong, a descriptive analysis is lacking. The present case-series aims to identify important features of head and neck cancers in the California Hmong, specifically nasopharyngeal cancer. We assessed incident head and neck cancers identified by the California Cancer Registry from 1988-2000 for incidence, mortality and descriptive comparisons between the Hmong, non-Hispanic Whites (NHW) and Asian/Pacific Islanders (API). Nasopharyngeal cancer was the most frequent Hmong cancer (39 of 51 cases) with incidence 23 times greater than in NHW. Nasopharyngeal cancer mortality rates for Hmong, NHW and API were 10.4, 0.2 and 1.7/100,000 respectively. Hmong were more likely to be diagnosed with remote tumors and less likely to receive treatment. A public health disparity clearly exists regarding nasopharyngeal cancer in the Hmong. Education on culturally appropriate healthcare and efforts to encourage diagnosis and treatment are necessary to reduce this disparity.
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Affiliation(s)
- Jennifer L Dodge
- Cancer Registry of Central California, 1320 E. Shaw Ave., Suite 160, Fresno, CA 93710, USA
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