Pathways of cervical cancer screening among Chinese women.

BACKGROUND: The purpose of this community-based study was to develop a structural equation model for factors contributing to cervical cancer screening among Chinese American women. METHODS: A cross-sectional design included a sample of 573 Chinese American women aged 18 years and older. The initial step involved use of confirmatory factor analysis, that included the following variables: access to and satisfaction with health care, and enabling and predisposing cultural and health beliefs. Structural equation model analyses were conducted on factors related to cervical cancer screening. RESULTS: Age, marital status, employment, household income, and having health insurance, but not educational level, were significantly related to cervical screening status. Predisposing and enabling factors were positively associated with cervical cancer screening. The cultural factor was significantly related to the enabling factor or the satisfaction with health care factor. CONCLUSION: This model highlights the significance of sociocultural factors in relation to cervical cancer screening. These factors were significant, with cultural, predisposing, enabling, and health belief factors and access to and satisfaction with health care reinforcing the need to assist Chinese American women with poor English fluency in translation and awareness of the importance of cervical cancer screening. Community organizations may play a role in assisting Chinese American women, which could enhance cervical cancer screening rates.

Social influences on Cigarette Smoking Among Mainland Chinese and Chinese Americans: A Comparative Study.

The purpose of this cross-national study was to determine the leading social influences on smoking among Chinese Americans and mainland Chinese adults with the aim of improving prevention and intervention strategies to reduce smoking rates. A comparative cross-sectional design was used and a stratified-cluster sampling technique was employed in identifying the study sample. An 80-item questionnaire was administered in Chinese to 1222 participants, 812 in China and 410 in the U.S. Data were analyzed using descriptive and inferential statistical tests. Results contain comparative data on social influences of smoking among Chinese Americans and mainland Chinese, as well as factors influencing smoking behavior which include cultural beliefs, gender roles, and family relationship dynamics. Grandparents were influential and significantly correlated with current smokers in China. Findings indicate differential effects of social influences on smoking behavior. Similarities and differences provide a basis for improving and/or developing smoking intervention programs of mutual benefit to China and the U.S..

Role of sociocultural factors in hepatitis B screening among Asian Americans.

OBJECTIVE: To apply the proposed Sociocultural Health Behavior Model to determine association of factors related to hepatitis B virus (HBV) screening among Asian Americans. METHODS: A cross-sectional design of 1312 Asian men and women 18 years and older. The frequency distribution analysis and chi square analysis were used for the initial screening of the following variables: access/satisfaction with health care, enabling, predisposing, cultural, and health belief factors. Univariate and multivariate analyses were conducted on factors for HBV screening using logistic regression analysis. RESULTS: Correlates to HBV screening included demographics, cultural factors, enabling factors, and family/social support factors. Enabling factors were more likely to be associated with HBV screening. CONCLUSION: The model highlights the role sociocultural factors play in HBV screening. Findings reinforce the need for HBV screening programs and indicate programs could be more effective if they included these components and were sensitive to ethnic and cultural factors.

Community-based colorectal cancer intervention in underserved Korean Americans.

BACKGROUND: Despite evidence of a decline in both incidence and prevalence of colorectal cancer nationwide, it remains the second most commonly diagnosed cancer and the third highest cause of mortality among Asian Americans, including Korean Americans. This community-based and theoretically guided study evaluated a culturally appropriate intervention program that included a bilingual cancer educational program among Korean Americans including information on CRC risks, counseling to address psychosocial and access barriers, and patient navigation assistance. METHODS: A two-group quasi-experimental design with baseline and post-intervention assessment and a 12-month follow-up on screening was used in the study. Korean Americans (N=167) were enrolled from six Korean churches. The intervention group received culturally appropriate intervention program addressing accessibility and psychosocial barriers, and navigation assistance for screening. The control group received general health education that included cancer-related health issues and screening. RESULTS: There was a significant difference (p<0.05) between the post-intervention and control groups in awareness of CRC risk factors. There was also a significant improvement in the pre-post across HBM measures in the intervention group for perceived susceptibility (p<0.05) and benefits and barriers to screening (p<0.001). At baseline, 13% of participants in the intervention group and 10% in control group reported having had a CRC cancer screening test in the previous year. At the 12-month post-intervention follow-up, 77.4% of participants in the intervention group had obtained screening compared to 10.8% in the control group. CONCLUSION: While health disparities result from numerous factors, a culturally appropriate and church-based intervention can be highly effective in increasing knowledge of and access to, and in reducing barriers to CRC screening among underserved Koreans.

Factors associated with cervical cancer screening compliance and noncompliance among Chinese, Korean, Vietnamese, and Cambodian women.

OBJECTIVE: The purpose of this study was to determine factors associated with cervical cancer screening compliance and noncompliance among Chinese, Korean, Vietnamese, and Cambodian women aged 18 years and older. METHODS: A cross-sectional design was used. The sample consisted of 1049 women aged 18 or older, of whom 37.94% reported never having been screened for cervical cancer, 23.55% reported noncompliance, and 38.51% were in compliance with screening guidelines. The sample was comprised of Chinese, 50.58%; Koreans, 17.50%; Vietnamese, 16.15%; and Cambodians, 15.77%. RESULTS: Education was significantly associated with never having been screened for cervical cancer for Cambodians. Low income (<$10000) was significantly associated with never having been screened for Cambodian and Chinese women. Not having health insurance was significantly correlated with not getting screened for all ethnic groups. Age and living in the United States less than 15 years were significantly correlated with never having been screened for Vietnamese, Korean, and Chinese women. Marital status was significantly correlated with not getting screened for Korean and Chinese women. English fluency was significantly associated with screening for Cambodians, Koreans, and Chinese. Barriers associated with women who were never screened compared to those barriers for women who were screened and were compliant included lack of knowledge, psychosocial, no insurance, language, transportation, and lack of time, but these barriers were different among the 4 ethnic groups. CONCLUSION: Compliance with cervical cancer screening guidelines among Asian American women can be enhanced significantly by providing culturally and linguistically appropriate educational and early intervention programs.

Diffusion of Philadelphia's No-Smoking Policy to Chinese Businesses.

The study assessed the extent that Philadelphia's smoking ordinance diffused to Chinatown businesses and identified attitudinal and other barriers to implementation. Guided by constructs from Diffusion of Innovations and Theory of Planned Behavior, a cross-sectional study was conducted. The majority of business owners and employees lacked in-depth knowledge of relevant details of the policy, suggesting that the extent of its diffusion was limited. Retail businesses were more likely to witness smoking post-enactment than restaurants and had more difficulty with implementation. A multi-faceted diffusion strategy through communication channels familiar to the Chinatown community is needed to improve implementation and compliance.

Knowledge, attitudes, and behaviors of Chinese hepatitis B screening and vaccination.

OBJECTIVE: To measure the knowledge, attitudes, and behaviors of Hepatitis B (HBV) screening and vaccination in the Chinese American population. METHODS: A cross-sectional study was conducted among 429 Chinese in New York City. Participants were recruited from Chinese community-based organizations. Descriptive statistics and chi-square tests of independence were conducted. RESULTS: Knowledge level of HBV risk factors and screening and vaccination rates are low. There were significant differences in screening and vaccination by marital and health insurance status, language, gender, education, and income. CONCLUSIONS: Findings suggested that interventions for Chinese Americans and health care providers can substantially increase screening and vaccination rates.

Asian Tobacco Education and Cancer Awareness Research Special Population Network. A model for reducing Asian American cancer health disparities.

Asian Americans are the fastest growing and the second largest foreign-born ethnic group in the United States. Cancer is a leading cause of death among Asian Americans. The Asian Tobacco Education and Cancer Awareness Research (ATECAR) Special Population Network, Center for Asian Health, aimed to reduce or eliminate cancer health disparities in these diverse, underserved populations in Pennsylvania, New Jersey, Delaware, and New York. The ATECAR logic model was adapted from a variety of conceptual frameworks to develop and implement the network's multifaceted cancer health disparities research, training, awareness, and outreach programs. The model was the basis for the developmental phases of the network that included (1) needs assessment, infrastructure, and partnership building; (2) intervention research, training, and mentorship; and (3) evaluation, dissemination, and diffusion. Community involvement occurred at every operational level to ensure program and network sustainability. Between 2000 and 2005, the ATECAR network consisted of 88 partners, representing a cross-section of Asian communities, academia, cancer centers, and health service agencies, ensuring a viable infrastructure for the network's multidimensional cancer health disparities programs. ATECAR's research covered tobacco control, cancer prevention and intervention, and clinical trials. More than 22 research projects were conducted and their results disseminated in peer-reviewed journals. ATECAR also trained 76 junior researchers and special population investigators and 1014 community professionals in disparity issues. ATECAR's multimedia cancer awareness education program reached over 116,000 Asians. The ATECAR network's achievements have had a profound impact on Asian Americans and established a trend toward reducing cancer health disparities, especially among underserved Asian Americans. Cancer 2006. (c) 2006 American Cancer Society.

Knowledge, attitudes and behavior regarding secondhand smoke among Asian Americans.

BACKGROUND: This study seeks to measure exposure to secondhand smoke and to evaluate potential differences in knowledge, attitudes, and tolerance of secondhand smoke among subgroups of Asian Americans in the Delaware Valley region of Pennsylvania and New Jersey. METHODS: A cross-sectional study was conducted among 1374 Asian Americans, which included Chinese, Koreans, Vietnamese, and Cambodians. The sample was selected by using a stratified-cluster proportional sampling technique. Study measures included demographic variables, smoking status, exposure to secondhand smoke, and knowledge, attitudes, and behavior regarding secondhand smoke. Data were analyzed using SPSS. RESULTS: Involuntary exposure to secondhand smoke remains a common public health hazard among Asian Americans, with 38.3% reporting exposure at home and 40.3% at the worksite. Knowledge and tolerance differed significantly by ethnic groups, gender, education, and smoking status. Knowledge level had a significant effect on tolerance behavior. CONCLUSIONS: Findings indicate an urgent need for a smoke-free policy at home, in the work place, and in public areas. Tobacco prevention/intervention and cessation programs for Asian Americans should emphasize the adverse health effects of secondhand smoke and promote a smoke-free environment. Further studies are needed to explore the unexplained differences in tolerance levels regarding secondhand smoke across ethnic groups.

Tobacco use, secondhand smoke exposure and their related knowledge, attitudes and behaviors among Asian Americans.

The present study examined tobacco use, secondhand smoke exposure and related knowledge, attitudes and behaviors among Asian Americans in the Delaware Valley of Pennsylvania and New Jersey, and the relationship between acculturation and smoking, social influence patterns on smoking, and stages of change of smoking among Asian subgroups. Study sample was 1174 Chinese, Koreans, Vietnamese, Cambodians, and other Asians. Findings revealed mean age of initiation to be 18.3, 40% ever and 30% current users. Significant differences were reflected in smoking by gender, ethnicity, educational level, marital and employment status. While knowledge and attitudes about smoking and secondhand smoke were associated with these variables, ethnic pride and smoking status played significant roles. Fathers and brothers had greater social influence on young male smoking behavior; smoking friends had influence on both genders. Stages of change of smoking and acculturation impact on smoking varied with gender, age, and time living in the U.S. Findings provide comprehensive insights into tobacco use and related KAB among Asian Americans that reflect the need for developing culturally appropriate programs for this underserved population.

ATECAR: An Asian American community-based participatory research model on tobacco and cancer control.

In the past few decades, community-based participatory research, which underscores the indispensable role of the community in all phases of the research process, has been recognized as a viable approach to working constructively with communities to achieve mutually beneficial goals. This article presents a history of the Asian Tobacco Education, Cancer Awareness and Research's pioneering efforts in conducting community-based participatory research among Asian Americans in the Delaware Valley region of Pennsylvania and New Jersey. Information about project background, target populations, and the rationale for the conduct of community-based participatory research in American communities is provided. It also delineates the manner in which the principles of community-based participatory research were applied as guides for the development of partnership infrastructures, research programs, and the challenges and barriers that were encountered. Facilitating factors in partnership building, and implications of employing this model in this ethnically and racially diverse population, are further discussed.

Acculturation and smoking behavior in Asian-American populations.

The relationship between acculturation and smoking behavior was examined in four Asian-American groups that included recent immigrants and US-born Koreans, Chinese, Vietnamese and Cambodians residing in the Delaware Valley of Pennsylvania and New Jersey. The study was part of a community-based, comprehensive cross-sectional study designed to assess a broad array of knowledge, attitudes and behaviors on tobacco use and tobacco-related cancer issues in the target multi-ethnic and multi-lingual Asian-American community. The sample of 1374 respondents was selected using a stratified-cluster proportional sampling technique, with a response rate of 83%. Findings indicated that acculturation had a variable effect on smoking behavior: more acculturated youth and less acculturated male adults had higher smoking rates than the less acculturated youth and the more acculturated male adults. Smoking rates for all females were generally lower than those of males regardless of acculturation status; however, acculturated adult females had a higher smoking rate than the less acculturated.