Determinants of suboptimal hepatitis B vaccine uptake among men in the Republic of Korea: where should our efforts be focused: results from cross-sectional study.

BACKGROUND: Liver cancer is the second most-frequent cause of cancer death in Korea. Hepatitis B virus (HBV) infection is a major cause of liver cancer, and this disease is effectively prevented by HBV vaccination. This study was conducted to investigate factors associated with the lack of HBV vaccine uptake in the general adult male population in Korea. METHODS: Data of men who participated in a nationwide cross-sectional interview survey were analyzed. A total of 2,174 men 40 years of age and older were interviewed between 2006 and 2008. None of the participants was infected with HBV or was experiencing sequelae of an HBV infection. RESULTS: Only half (50.4%) of the men received one or more dose of the three-dose series of HBV vaccinations, and 32.5% received all three doses. Compared with men who had completed the vaccination regimen, non-vaccinated men were more likely to lack supplemental medical insurance for cancer (odds ratio = 0.66, 95% confidence interval: 0.52-0.84), have lower incomes (p-trend = 0.010), and be less educated (p-trend = 0.021). Lower education was also more prevalent in the non-vaccinated group compared with the incompletely vaccinated group. Those who had completed the vaccination regimen were likely to be more educated than those in the incompletely vaccinated group (p-trend = 0.044). The most commonly cited reason for not obtaining the HBV vaccine was lack of knowledge regarding the need for the vaccination. The number of men who cited this reason decreased as a function of education. CONCLUSIONS: It is important to develop strategic interventions targeted at less-educated men to increase uptake of a complete three-dose series of HBV vaccinations as a primary approach to preventing liver cancer.

What types of cancer screening information are needed?

OBJECTIVE: Seeking information about cancer is an important means by which individuals acquire cancer-related knowledge and know whether they should be screened for cancer. This study was performed to identify the desired types of cancer screening information and to describe patterns of information-seeking behavior. METHODS: In August 2006, a questionnaire was administered to a population of South Korean adults who ranged in age from 40 to 70 years (n = 1,676). The chi-square test, linear regression, and logistic regression were used for data analysis. RESULTS: Only 7.8% of the study population reported seeking information about cancer within the previous 12 months. Respondents were more likely to seek information about cancer if they were younger than 49 years, had a post-high school education, were insured through Medicaid, perceived their health status to be fair or poor/very poor and had received prior cancer screening. The most desired information included methods of cancer screening, followed by procedures, benefits and necessity, and limits and side effects. Factors associated with the need for information were age (i.e., less than 49 years), residence (i.e., non-metropolitan), perceived health status (i.e., fair or poor/very poor), cancer family history, and prior cancer screening. CONCLUSION: It is important to understand the characteristics of information seekers and non-seekers and to deliver cancer screening information based on individuals' needs to promote higher rates of cancer screening.

Comparison of breast cancer screening rates between Korean women in America versus Korea.

BACKGROUND: Breast cancer is the most commonly diagnosed cancer among Korean American women and among Korean women in Korea. However, many Asian women are not aware of the importance of screening mammography. This study compares breast cancer screening in Korean women in California and in Korea. METHODS: The 2005 California Health Interview Survey (CHIS) and 2005 Korean National Cancer Screening Survey (KNCSS) were used to examine breast cancer screening and related factors. The sample included 252 Korean American women in California and 889 Korean women aged > or = 40 years. Logistic regression was used to predict the odds of having had a screening mammography in the past 2 years. For CHIS data, SUDAAN software (Research Triangle Institute, Research Triangle Park, NC) was used to take into account the design of the complex and multistage samples. RESULTS: Korean women reported a lower rate than Korean American women of ever having had a screening mammography (50.8% vs. 77.8%). Korean women also had lower rates of having had a screening mammography in the past 2 years than Korean American women (39.5% vs. 57.2%). Korean Americans were less likely to undergo screening mammography if they were older. Korean women were less likely to undergo screening mammography if they were older, unemployed, lacked private cancer insurance, lacked health checkups, did not exercise, had poor health status, or currently smoked. CONCLUSIONS: We found significant differences in cancer screening behavior in Korean women depending on where they lived. These differences may indicate an important influence of social factors on preventive health behavior.

Hepatitis B vaccinations among Koreans: Results from 2005 Korea National Cancer Screening Survey.

BACKGROUND: Liver cancer is one of most commonly diagnosed cancers among Koreans. Chronic hepatitis B virus (HBV) infection is a major risk factor for liver cancer. HBV infection can be prevented by effective screening and vaccination programs. The purpose of this study is to examine the status of HBV infection and the predictors associated with HBV vaccination. METHODS: The study population was derived from the 2005 Korea National Cancer Screening Survey (KNCSS). The KNCSS is an annual cross-sectional survey that uses a nationally-representative random sampling to investigate cancer screening rates. A total of 1,786 Koreans over 40 years of age participated in this study. RESULTS: Of all the participants, 5.9% reported HBV positive (HBsAg+, HBsAb-), 41.8% were HBV negative but protected (HBsAg-, HBsAb+), and 52.3% were unprotected (HBsAg-, HBsAb-). Among unprotected individuals (n = 934), 23.1% reported to have received the vaccination. About half of those who had vaccinations completed the 3-shot vaccine series. In multiple analyses, education, having private cancer insurance, alcohol use, having regular check-up, and doing regular exercise were associated with completed HBV vaccination. CONCLUSION: This study result suggests that we need a liver cancer education program to increase HBV awareness and to increase the liver cancer prevention message among low educated populations.

Predicting the stages of adoption of cervical cancer screening among Korean women.

OBJECTIVE: We examined the Transtheoretical Model (TTM) of behavioral change based on cervical cancer screening among Korean women. We assessed the stages of Pap smear adoption, positive and negative attitudes toward Pap smear, and contributory factors. METHOD: This study was based on the 2007 Korean National Cancer Screening Survey, which included a total of 1224 women > or =30 years. Multiple logistic analyses were conducted to determine the factors that influenced the women's stages of adoption. RESULTS: Fifty-seven percent of the women reported on-schedule screening while 43% did not. Those subjects who were 50-64 years old, had higher incomes, married, lived in a rural area, exercised regularly, and had regular checkups were more likely to be in maintenance than in precontemplation. However, the con scores were negatively associated with a transition from precontemplation to maintenance. Further, a high con score was associated with being in relapse risk or relapse rather than in maintenance while the pro scores were not significant across the stages of adoption. CONCLUSION: Our results confirm the applicability of the TTM to Pap smear screening in an Asian context. Age, income, marital status, residency, regular exercise, health checkups, and con scores were significantly associated with the stage of adoption.

Screening for gastric cancer in Korea: population-based preferences for endoscopy versus upper gastrointestinal series.

This study assessed the screening rates for gastric cancer by two different screening methods, upper gastrointestinal (UGI) series and endoscopy; intentions to undergo future gastric cancer screening; and the preferred method of screening. The study population was derived from the 2006 Korean National Cancer Screening Survey. The Korean National Cancer Screening Survey is an annual cross-sectional survey that uses nationally representative random sampling to investigate cancer screening rates. A total of 1,625 Koreans over 40 years of age participated in this study. Logistic regression was used to identify the factors associated with undergoing gastric cancer screening, having an intention to be screened, and preferring one of the two screening tests. Among the 1,625 subjects, 15.1% had received a UGI, 33.2% had received an endoscopy, and 43.1% had undergone either or both of the tests in the previous 2 years. About 52% of people reported the intention to be screened within the next 2 years. The odds ratio for intending to be screened was 11.8 and 6.2 higher among those who had undergone a prior UGI test and an endoscopy test within the previous 2 years, respectively, than for those who had never been screened. Among the 1,625 individuals, 67% chose endoscopy and 33% UGI for their preferred future screening method. Collectively, our results highlight the preference for endoscopy testing as a gastric cancer screening method. Providers' assessments of individuals' screening preferences in combination with intervention strategies to promote performance of the preferred test may increase patient compliance with gastric cancer screening recommendations.

Comparison of satisfaction with cancer screening at mobile van and static sites: National Cancer Screening Program in Korea.

OBJECTIVES: Our objectives were to evaluate participant satisfaction in the National Cancer Screening Program (NCSP) and to examine differences in satisfaction between mobile vans and static sites. METHODS: A total of 243 967 participants who were screened by NCSP between January and May 2007 were eligible for the study. Of these, 3416 samples were randomly chosen and stratified by the type of cancer screened and screening unit. A telephone survey was conducted in July 2007, and 1672 participants (48.9%) were responded. The questionnaire included participant satisfaction with screening, screening service use and demographic data. Five multiple regression models were used to determine the relation between screening location (mobile van or static site) and each of five satisfaction measures (information transfer, staff interpersonal skills, privacy protection, physical surroundings and general satisfaction). RESULTS: Of the participants, 764 (45.7%) were screened at a mobile van and 908 (54.3%) at a static site. Relatively high scores were reported for all satisfaction measures, but satisfaction with screening at a mobile van was lower than that at a static site. Even after adjusting for potential confounders, screening at a mobile van was significantly associated with lower satisfaction for information transfer (P = 0.005), staff interpersonal skills (P = 0.025), privacy protection (P = 0.019), physical surroundings (P < 0.001) and general satisfaction (P < 0.001). CONCLUSIONS: Improving the satisfaction with and quality of mobile screening services is important to increase compliance and achieve the aims of the NCSP. Therefore, further efforts such as quality assurance or continuous monitoring are required.

Perceived risk for gastric cancer among the general Korean population: a population-based survey.

OBJECTIVE: We measured the perceived risk for developing gastric cancer and investigated how a range of socio-demographic, lifestyle, health, and psychological factors were associated with risk perception in a population-based sample in Korea. METHODS: This study was based on the 2006 Korean National Cancer Screening Survey conducted by the National Cancer Center, in which trained interviewers met face-to-face with participants selected by a nationally representative random sampling. The participants included 1673 adults, aged 40 years or older, who had not previously been diagnosed with cancer. Simple and multiple ordinal regression were used to determine the associations between perceived risk and socio-demographic, lifestyle, health, and psychological factors. RESULTS: Almost half of the subjects (48.3%) thought their chance of developing gastric cancer was lower than that of other men or women of the same age. A higher level of worry concerning gastric cancer was strongly associated with a higher perceived risk for gastric cancer development. Those who drink alcohol two or more days per week, and who are unmarried all perceived their risk as being higher. However, those without a previous gastric cancer screening, a personal history of gastric disease, or a good overall health status had a lower perceived risk for gastric cancer development. CONCLUSION: This study found comparative optimism about the risk for developing gastric cancer in a Korean population. It is necessary to increase people's ability to accurately perceive their risk for cancer.

Personal background and cognitive factors as predictors of the intention to be screened for stomach cancer.

Although stomach cancer screening is effective for reducing mortality, it is underutilized in Korea. By applying an extended theory of planned behavior model, our objective was to determine how personal background factors influence a patient's inclination to be screened for stomach cancer. The study population was derived from the 2006 Korean National Cancer Screening Survey, which was done to investigate the participation of the general population in cancer screening. In total, 1,509 Koreans who were 40 to 70 years old participated in this study. Path analysis was used to test a conceptual model in which (a) factors considered as precursors to be screened (components in theory of planned behavior model) directly predicted the intention to be screened and (b) personal background factors, including sociodemographic factors, previous screening experience, economic status, and perceived risk, indirectly influenced the intention to be screened through their effects on cognitive components such as attitude and subjective norm in the theory of planned behavior model. Most of the personal background factors did not directly influence intention but instead influenced cognitive elements in the theory of planned behavior model. Attitude and perceived behavioral control were well correlated with a patient's intention, regardless of the screening cost.

[Factors influencing the intention to have stomach cancer screening].

OBJECTIVES: The purpose of this study was to identify the factors influencing the intention to have stomach cancer screening using the theory of planned behavior (TPB) in Korea. METHODS: For this population-based study, 1,535 adult respondents (aged 40 to 70 years) were recruited using multi-stratified random sampling and a face-to-face administered questionnaire. This study was based on Ajzen's theory of planned behavior. Intentions were divided into three scenarios for fee payment in the next two years: (1) free of charge, (2) co-payment, and (3) full charge. Multiple linear regression was used to identify the factors influencing the intention to have stomach cancer screening. RESULTS: Perceived behavioral control and attitude toward stomach cancer screening were significant predictors of the intention to have stomach cancer screening. However, subjective norm only influenced the intention to have stomach cancer screening with full charge in the next two years. CONCLUSIONS: The results suggest that attitude and perceived behavioral control are likely to contribute toward increasing the intention to have stomach cancer screening. Especially, perceived behavioral control is a good predictor. Because the study subjects were nation wide residents, the study results can be generalized.

[Women's willingness to pay for cancer screening].

OBJECTIVES: The goal of this study is to measure women's willingness to pay for cancer screening and to identify those factors associated with this willingness to pay METHODS: A population-based telephone survey was performed on 1,562 women (aged 30 years or over) for 2 weeks (9-23th, July, 2004). Data about sociodemographic characteristics, health behaviors, the intention of the cancer screenings and willingness to pay for cancer screening were collected. 1,400 respondents were included in the analysis. The women's willingness to pay for cancer screening and the factors associated with this willingness to pay were evaluated. RESULTS: The results show that 76% of all respondents have a willingness to pay for cancer screening. Among those who are willing to pay, the average and median amount of money for which the respondents are willing to pay are 126,636 (s.d.: 58,414) and 120,000 won, respectively. As the status of education & the income are higher, the average amount that women are willing to pay becomes much more. The amount of money women are willing to pay is the highest during the 'contemplation' stage. Being willing to pay or not is associated with a change of behavior (transtheoretical model), the income, the concern about the cancer risk, the family cancer history, the marital status, the general health exam, age and the place of residence. Income is associated with a greater willingness to pay. Old age was associated with a lower willingness to pay. CONCLUSIONS: According to the two-part model, income and TTM are the most important variables associated with the willingness to pay for cancer screening. The cancer screening participation rate is low compared with the willingness to pay for cancer screening. It is thought that we have to consider the participants' behavior that's associated with cancer screening and their willingness to pay in order to organize and manage cancer screening program.

[Factors associated with cancer screening participation, Korea].

OBJECTIVES: We wanted to identify those factors associated with stomach, colon, breast and cervix cancer screening. METHODS: A population-based telephone survey was conducted for 2 weeks (the 9th-23th of July, 2004) by trained interviewers with using a questionnaire. 2,598 respondents (females aged 30 years or over, and the males aged 40 years or over) were selected by random-digit dialing that was based on the 2000 Population and Housing Census. The data on socio-demographic, health behavior and enabling factors were collected. 2,571 respondents were included in analysis. The cancer screening rate was classified into 2 categories: the life time screening rate and the screening rate with recommendations. RESULTS: For the 2,571 respondents, the life time screening rate was as follows: 52.0% (Stomach), 25.3% (Colon), 55.9% (Breast) and 76.8% (Cervix). The screening rate with recommendation was as follows: 39.2% (Stomach), 20.6% (Colon), 42.5% (Breast) and 58.3% (Cervix). On a multiple logistic regression analysis of the life time screening, statistically significant relationships were observed for the screening intention, the health exam, the disease history, the age of the patients and the cancer screening rates. On a multiple logistic regression analysis of the screening with recommendation, statistically significant relationships were observed for the screening intention, the health exam, the age of the patients, the concern about the risk of cancer, the voluntary health insurance for cancer and the cancer screening rates. CONCLUSIONS: The results of this study suggest that the cancer screening intention, the health exam and the age of the patients are the most important factors to participate in life time cancer screening and also screening with recommendations. A positive association was also observed for the concern about the risk of cancer, the voluntary health insurance for cancer. It is hoped that this study will be a base line data for suggesting the representative cancer screening rate in Korea.