Health Care Access and Sociodemographic Factors Associated with Hepatitis B Testing in Vietnamese American Men

The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review

A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.

Sero-prevalence of hepatitis B virus and compliance with hepatitis B vaccination schedules among outpatient clinic attendees in Nairobi

BACKGROUND

Hepatitis B is becoming a growing public health problem in Kenya. To combat the threat, HBV vaccination should be recommended, particularly for individuals who are not covered by the national immunization program. Vaccination provides sero-protection rates approaching 95% among healthy adults after completing the three-dose vaccination course, but decreases to 87% among those who receive only two doses, emphasizing the importance of completing the three-dose vaccination course. However, data on adult adherence to HBV multi-dose vaccines in Sub-Saharan Africa are limited, despite the fact that this information is critical for prevention. As a result, more research on HBV vaccine dose completion is required. The purpose of this study is to estimate the prevalence of hepatitis B virus infection among out-patient clinic attendees in Nairobi, Kenya, as well as to identify beneficiaries of free vaccination and barriers to completing the recommended vaccine doses.

METHODS

Between July 30th and September 30th, 2015, 2644 outpatient clinic attendees aged ≥ 4 were recruited from three hospitals in Nairobi County, Kenya: Mama Lucy, Riruta, and Loco. Self-administered questionnaires were used to collect socio-demographic information, and blood samples were tested for hepatitis B surface antigen (HBsAg) using the KEMRI HEPCELL Rapid® (Hepatitis B Detection kit) test kit. Individuals who tested negative for HBsAg were given a free course of three doses of HBV vaccine. The vaccination register provided information on the number of doses administered.

RESULTS

The average age of the study population was 31.4 years (range: 4-66), with females accounting for 59.2%. 1.82% (48/2644) of the participants tested positive for HBsAg. Among the 2596 individuals eligible for vaccination, 66% (1720/2596) received at least one dose, and 51.8% (1345/2596) received all three doses. Vaccination acceptance increased with age, with older patients more likely to return for subsequent dose (OR>1 for second and third dose). Unavailability and failure to contact client were cited as significant (p<0.0001) barrier to vaccination completion by 53.7% (666/1226, 95% CI 0.5-0.6) and 37% (454/1226, 95% CI 0.3-0.4) of respondents respectively.

CONCLUSION

The prevalence of HBV infection among outpatient clinic attendees highlights the importance of expanding HBV immunization programs in Kenya. However, given the low vaccination completion rate, there is a need for public awareness of the vaccine's importance in preventing HBV and HBV-related complications.

Ethnic Minorities and Low Socioeconomic Status Patients With Chronic Liver Disease Are at Greatest Risk of Being Uninsured

Background

Chronic liver disease (CLD) predominantly affects ethnic minorities and socially vulnerable populations, who have high prevalence of risk factors (e.g., suboptimal insurance coverage) predisposing to healthcare disparities. We evaluate prevalence and predictors of uninsured status among CLD adults, and secondarily, how this affects documented immunity or vaccination for hepatitis A virus (HAV) and hepatitis B virus (HBV).

Methods

Using 2011 - 2018 National Health and Nutrition Examination Survey data, self-reported insurance status was determined among adults with CLD. Prevalence of uninsured status was stratified by patient characteristics and evaluated using multivariable logistic regression models. Prevalence of self-reported completion of vaccination as well as laboratory value-based documented immunity to HAV and HBV was stratified by insurance status.

Results

Overall, 19.0% of adults with CLD reported having no insurance, which was highest among individuals of Hispanic ethnicity (33.5%), less than high school education (33.7%), and below poverty status (35.3%). On multivariable analyses, significantly lower odds of having any insurance coverage was observed in men, Hispanics, and individuals with lower education and lower household income. Prevalence of documented immunity or vaccination for HAV was low across all insurance categories, ranging from 46.5% to 54.0%. Prevalence of documented immunity or vaccination for HBV was similarly low across all insurance categories, ranging from 24.3% to 40.8%.

Conclusion

Prevalence of uninsured status among CLD was more than twice the US adult population, and lack of insurance particularly impacted Hispanics and individuals with low education and low household income. Low prevalence of documented immunity or vaccination for HAV and HBV across all insurance categories is concerning.

Hepatitis B Testing Among Vietnamese in Metropolitan Atlanta: The Role of Healthcare-Related and Acculturation-Related Factors

BACKGROUND

Compared to other racial/ethnic groups, U.S. Vietnamese have higher Hepatitis B infection prevalence, which is a major liver cancer risk factor. Increased testing could reduce this disparity. It is critical to understand subgroups of U.S. Vietnamese least likely to have been tested for Hepatitis B and design appropriate interventions. We examined healthcare- and acculturation-related factors influencing Hepatitis B testing among U.S. Vietnamese.

METHODS

Survey data of 100 U.S. Vietnamese attending health fairs/programs hosted by community-based organizations (2017-2018) were analyzed. Healthcare-related predictors included insurance and past 2-year checkup. Acculturation-related predictors included Vancouver Acculturation Index, percentage of lifetime in the U.S., and Vietnamese and English fluency. We conducted a multiple logistic regression controlling for age, sex, education, and household income.

RESULTS

The sample was an average 37.5 years old and 61.6% female. Insurance coverage was reported by 83.0%. Average percentage of lifetime in the U.S. was 56.8%. Seventy percent reported having received Hepatitis B testing. Hepatitis B testing was associated with health insurance (aOR = 2.61, 95% CI = [1.05-6.47], p = .04) but not any acculturation-related predictors CONCLUSION: Improving insurance coverage and options can be a strategy to increase Hepatitis B testing among U.S. Vietnamese. More education regarding Hepatitis B (e.g., via community-based, culturally-appropriate, lay health worker-led programs) is needed to ensure that individuals are aware of their testing status and pursue appropriate healthcare decisions.

Sociocultural barriers to hepatitis B health literacy in an immigrant population: a focus group study in Korean Americans

BACKGROUND

Chronic hepatitis B (CHB) is a major global health issue disproportionately affecting Asian Americans and other immigrant populations in the United States. Despite the high risk of morbid complications from CHB, the majority of individuals with CHB do not access healthcare due to a complex of barriers. These barriers influence health literacy which may affect behaviors linked to hepatitis B care. We aimed to identify and evaluate various sociocultural factors and how they interact with health literacy to impact CHB care and health seeking in a Korean American population.

METHODS

A total of 28 Korean American individuals with CHB were divided into 5 different focus discussion groups. This study investigated the participants' sociocultural backgrounds as well as their awareness and utilization of the healthcare system that could influence their health literacy and behaviors in accessing care.

RESULTS

Our analysis identified and concentrated on three themes that emerged from these discussions: low risk perception and knowledge of CHB and its complications; language, immigrant status, and stigma; and financial and institutional barriers. The participants' overall awareness of the disease and prevention methods demonstrated poor understanding of important characteristics and potential outcomes of the disease. Additionally, differences in cultural expectations and a lack of understanding and utilization of healthcare systems affected health literacy in further limiting participants' motivation to seek care.

CONCLUSIONS

The present study suggests that there are culture-specific barriers to health literacy governing individuals' health behavior in accessing hepatitis B care. These findings may inform strategies for developing culturally tailored resources and programs and for facilitating the implementation of community-wide hepatitis B education and screening initiatives in immigrant communities.

Knowledge, Attitudes, and Behaviors of Viral Hepatitis Among Recent African Immigrants in the United States: A Community Based Participatory Research Qualitative Study

Background: In the United States, hepatocellular carcinoma is the ninth leading cause of cancer mortality. Hepatocellular carcinoma disproportionately affects individuals of African ancestry with the rates being higher amongst individuals of foreign-born African ancestry. This study explored knowledge, attitudes, and behaviors toward viral hepatitis transmission, screening, and vaccination among recent African immigrants in Minnesota and identify ways to improve early detection and screening methods. Methods: A community based participatory research (CBPR) team with minority researchers and community members sought to gain insight on persons of African Ancestry knowledge, attitudes, and behaviors related to viral hepatitis by conducting a qualitative research study. The CBPR team developed a focus group moderator's guide with semi-structured questions related to transmission, screening, and vaccination of viral hepatitis. We conducted seven focus groups using bilingual, bicultural moderators with participants from local Ethiopian, Liberian and Kenyan communities from August 10th, 2014 to October 11th, 2014. Focus groups were audio recorded and transcribed. The CBPR team categorized the data into themes and subthemes with consensus using traditional content analysis. Results: Community partners recruited 63 participants with a majority identifying as male (51%). Participants lacked knowledge of viral hepatitis screening, vaccination, and treatment. Participants were aware of some behaviors that increased risk of acquisition of hepatitis. Participants endorsed a strategy of developing and delivering educational materials for African immigrants. Moreover, access to care and cultural awareness were mentioned as pivotal for prevention and treatment of viral hepatitis. Conclusions: Findings from this pilot study provide insight on areas of research focus. Having a research team consisting of members from the community helped to increase trust and foster an understanding of shared community values. Information from this study provides evidence to support the development culturally appropriate strategies to address disparities in viral hepatitis in these communities.

Insight into hepatitis B prevalence and risk factors among Vietnamese Americans: a cross-sectional analysis of data from a community-based screening program

OBJECTIVES

The aims of our study were to describe current hepatitis B prevalence among Vietnamese Americans and to examine predictors of hepatitis B risk in this specific ethnic community.

DESIGN

Cross-sectional analysis of data from a community-based screening program.

SETTING

This analysis was based on hepatitis screening community events in Southern California.

PARTICIPANTS

2508 Vietnamese Americans in Southern California.

OUTCOME MEASURES

Serological tests for hepatitis B surface antigen, hepatitis B surface antibody, and total hepatitis B core antibody were used to classify participants as one of four hepatitis B infection statuses: currently infected, previously infected, susceptible, or immune due to a previous hepatitis B vaccination.

RESULTS

Across 2508 participants, 9.0% were currently infected with hepatitis B and 17.7% were at risk for hepatitis B. Females and those reporting a previous hepatitis B vaccination were at significant decreased risk of hepatitis B (OR=0.48, 95% CI 0.33 to 0.69 and OR=0.53, 95% CI 0.31 to 0.93, respectively) whereas those born outside of the USA and with a family history of the disease showed substantial increased risk (OR=13.36, 95% CI 1.62 to 110.05 and OR=4.68, 95% CI 2.66 to 8.22, respectively). Among those who reported a previous hepatitis B vaccination, less than half (42.9%) possessed the protective antibodies that result from a hepatitis B vaccination.

CONCLUSIONS

Vietnamese Americans remain disproportionately burdened by hepatitis B. Public health efforts that focus on improving hepatitis B awareness and vaccination knowledge and that are tailored to specific high-risk subgroups, such as immigrants and those with infected family members, could help in addressing the disease's burden in this high-prevalence population.

Seroprevalence of Hepatitis B Infection Among Immigrants in a Primary Care Clinic: A Case for Granular Ethnicity and Language Data Collection

Chronic hepatitis B virus (HBV) infection is highly prevalent worldwide and is most often diagnosed through screening efforts. In order to identify the specific ethnic groups at greatest risk, it is necessary to go beyond traditional categories. We conducted a retrospective case series in a primary care clinic serving non-English speaking immigrants to determine the prevalence of HBV among patients of various primary spoken languages (used as a proxy for ethnicity). Among the 1378 patients, the overall prevalence of current infection was 8%. HBV infection was markedly higher among Somali, Oromo and Khmer speakerscompared to other groups. This study illustrates the use of granular language data in describing the serologic profiles of HBV infection among non-English speaking patients in primary care setting. The variations in prevalence by language have implications for public health HBV screening efforts, in addition to suggesting potential risk factors for transmission.

Social Norm, Family Communication, and HBV Screening among Asian Americans

Individuals' behaviors are influenced by those of others in their social environment (i.e., descriptive norms), as well as by how individuals perceive they should behave in that environment (e.g., injunctive norms). Although social norms are thought to play an important role in hepatitis B virus (HBV) screening, limited theoretical or empirical guidance exists on how the underlying process works. In addition, norms are social phenomena that are spread through family discussion about the importance of getting HBV screening. Using the theory of normative social behavior (TNSB), this study examined the roles of injunctive norms (IN), descriptive norms (DN), and family discussion in HBV screening behavior among Asian Americans. Data from a survey of Asian Americans in the Baltimore Washington metropolitan area (N = 877) were used to test underlying theoretical propositions. DN and family discussion emerged as key factors in HBV screening behavior among all Asian Americans. IN were associated with HBV screening among Chinese and Korean Americans, but not for Vietnamese Americans. Family discussion moderated the influence of DN on behavior among Chinese and Vietnamese Americans. However, the main effect of DN on screening behavior was not modified by IN (no interactions between DN and IN). The results indicate that family discussion and social norms are integral in enabling Asian Americans to undergo HBV screening and warrant sensitivity in the design and implementation of a liver cancer prevention program in this high-risk group of Asian Americans.

Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial

Background

This study aimed to evaluate the effect of a lay health worker (LHW) telephone intervention on completing a series of hepatitis B virus (HBV) vaccinations among foreign-born Asian Americans in the Baltimore-Washington Metropolitan area.

Methods

During the period of April 2013 and March 2014, we recruited Asian Americans who were 18 years of age and older in the community-based organizations. Of the 645 eligible participants, 600 (201 Chinese, 198 Korean, 201 Vietnamese) completed a pretest survey and received hepatitis B screening. Based on the screening results, we conducted a randomized controlled trial among those unprotected (HBsAg-/HBsAB-) by assigning them either to an intervention group (n = 124) or control group (n = 108). The intervention group received a list of resources by mails for where to get free vaccinations as well as reminder calls for vaccinations from trained LHWs, while the control group received only list of resources by mail. Seven months after mailing the HBV screening results, trained LHWs followed up with all participants by phone to ask how many of the recommended series of 3 vaccinations they had received: none, 1 or 2, or all 3 (complete). Their self-reported vaccinations were verified with the medical records. Multinomial logistic regressions were used to examine the effect of the LHW intervention. Process evaluation was conducted by asking study participants in the intervention group to evaluate the performance of the LHWs.

Results

After seven months, those in the intervention group were more likely to have 1 or more vaccines than the control group, compared to the no vaccination group (OR = 3.04, 95% CI, 1.16, 8.00). Also, those in the intervention group were more likely to complete a series of vaccinations than the control group, compared to the no vaccination group (OR = 7.29, 95% CI 3.39, 15.67). The most important barrier preventing them from seeking hepatitis B vaccinations was lack of time to get the vaccination. The most important promoters to getting vaccinations, among those who had vaccinations (n = 89), were our intervention program (70.8%) and self-motivation (49.4%). The majority of participants in the intervention group received the phone calls from LHWs (93%) and almost all of them got the reminder to receive vaccines (98%).

Conclusion

The LHW intervention was successful at increasing HBV vaccinations rates among foreign-born Asian Americans. This study suggests that this culturally integrated intervention program may be useful for reducing liver cancer disparities from chronic HBV infection in high risk Asian Americans.

Trial Registration

ClinicalTrials.gov NCT02760537

Utilization of health-care services among immigrants recruited through non-profit organizations in southern Italy

OBJECTIVES

The study aims were focused on acquiring information about access to health-care services and to investigate the potential barriers affecting full access to health-care services.

METHODS

The study population consisted of immigrants and refugees aged 18 or more living in Italy for at least 12 months recruited through non-profit organizations.

RESULTS

961 immigrants took part in the study, with a response rate of 98.9 %. Of the participants, 85 % had access to a general practitioner (GP) at least once, and 46.6 and 22.4 % mentioned a minimum one emergency visit and hospital stay, respectively. Diagnostic procedures and/or drug prescriptions (49.7 %), chronic disease control (15.8 %), and preventive interventions (13 %) were the most reported reasons for GP access.

CONCLUSIONS

This study yielded current and broader insight into the model of health-care utilization among immigrants. The findings adds to our understanding of the third-sector organizations' role in facilitating immigrants' access to services offered by the Italian National Health Service, contributing to the extensive discussion on how to best manage migrant health care in Italy.

State of viral hepatitis knowledge and testing uptake in Brazil: Findings from the National Survey of Knowledge, Attitudes and Practices (PCAP-2013)

Background

Data were obtained from the third National Survey of Knowledge, Attitudes and Practices of HIV and other Sexually Transmitted Infections (STI) (PCAP-2013) and used to describe the current state of viral hepatitis (VH) knowledge and screening as well as the prevalence of viral hepatitis B (HBV) vaccination in Brazil and to assess the factors associated with testing uptake.

Methods

A probability sample survey of 12,000 individuals (50 % men) aged between 15 and 64 years was conducted between October and December of 2013. The participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interviews. We analysed data related to self-reported knowledge of VH routes and screening uptake after weighting the variables to account for unequal selection probabilities and correct for differences in sex, age and region according to 2010 census figures.

Results

The levels of correct knowledge regarding HBV and HCV transmission through unprotected sex were 33.1 and 34.3 %, respectively. The levels of correct knowledge regarding HBV and HCV transmission through tattooing/piercing were 26.4 and 24.5 %, respectively. Overall, 29 % of the respondents reported having underwent VH screening and 73.9 % reported prior HBV vaccination. VH screening was associated with the following factors: age between 25 and 49 years (adjusted male odds ratio (OR): 2.29, [95 % confidence interval (CI): 1.83–2.87]; female OR: 1.36, [95 % CI: 1.10-1.67]); age between 50 and 64 years (male OR: 1.52, [CI: 1.13–2.03]; female OR: 1.29, [CI: 1.02–1.63]); initial sexual intercourse before the age of 15 years in men (OR: 1.32, [CI: 1.10–1.57]); higher socioeconomic statuses of group A (male OR: 2.38, [CI: 1.81–3.13]; female OR: 2.10, [CI: 1.66–2.68]) and B (female OR: 1.56, [CI: 1.27–1.93]); and having ever been tested for HIV (male OR: 7.50, [CI: 5.82–8.53]; female OR: 7.13, [CI: 5.97–8.54]).

Conclusions

This study revealed low levels of knowledge regarding VH transmission and screening practices in the general Brazilian population, especially among younger individuals and those with lower socioeconomic status. Efforts to enhance awareness campaigns and expand testing sites are needed to remove barriers to testing.

A cross-sectional serosurvey on hepatitis B vaccination uptake among adult patients from GP practices in a region of South-West Poland

BACKGROUND

Hepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. Therefore, HBV vaccination is widely recommended for those not covered by the national immunisation program.

OBJECTIVE

To assess the coverage and influencing determinants of HBV vaccination among adult patients attending GP clinics as well as to establish serological status in terms of HBV infection.

METHODS

Patients who were seen consecutively in March 2013 at four randomly selected GP practices located in Zgorzelec county, in south-western part of Poland, were invited to participate and complete questionnaires on socio-demographic data and other factors related to vaccination. A pilot study was done in one urban GP practice in the city of Gryfino (Gryfino county), the results have been included in the study. Patients' immunisation status was assessed basing on vaccination cards and anti-HBs titer with the use of third-generation testing methods. In addition, serum samples were assayed for anti-HBc total.

RESULTS

Response rate: 99.3 %. Of 410 participants (66.1 % females, median age 56 years), 55.4 % (95%CI:50.5-60.1 %) were previously vaccinated; in those 11.5 % took 2 doses, 66.1 % - 3 doses,18.1 % - 4 doses. Elective surgery was the main reason (57.7 %) for HBV immunization, 4.8 % - were vaccinated due to recommendations by GPs. The multivariable logistic regression model revealed that living in a city (OR 2.11), and having a surgery in the past (OR 2.73) were each associated with greater odds of being vaccinated. Anti-HBc total prevalence among those unvaccinated was 13.6 % (95%CI:9.3 %-19,5 %), and 7.2 % (95%CI:4.4-11.8 %) among those vaccinated.

CONCLUSIONS

Low HBV immunization coverage among adult patients from GP clinics and the presence of serological markers of HBV infection among both - those unvaccinated and vaccinated call for comprehensive preventative measures against infection, including greater involvement of family doctors. Although interventions should cover the whole population, inhabitants living in the rural areas should be a group of special interest. Preoperative immunization for HBV seems to be an efficient public health tool to increase the vaccination uptake.

Prevalence and presentation of hepatitis B and C virus (HBV and HCV) infection in Vietnamese Americans via serial community serologic testing

The prevalence of hepatitis B virus (HBV) infection is reportedly high in Vietnamese Americans (VAs), but most previous studies did not assess full HBV serology, and not the prevalence of HBV and hepatitis C virus (HCV) infection simultaneously. The aim of the study is to assess the prevalence of different HBV serologies and HCV infection in VAs. This study was based on the data collected by testing for Hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibody (HBcAb IgG), anti-HBs antibody (HBsAb), and anti-HCV antibody (anti-HCV) in a series of community screening in VAs in Orange County, California. In 1,405 VA participants, the mean age was 51 (17-87) years, 45.1% were males; 68.2%, married; 97.2%, born in Vietnam. Most of the participants were non-US born with their primary language being non-English and with limited access to health care. Of the 1,405 cases, 124 (8.8%) were confirmed HBV infection by HBsAg+; 81 (5.8%), HCV infection by anti-HCV+; including four (0.3%) with HBV/HCV coinfection. Twelve percent of the participants with confirmed HBV infection thought they were previously tested negative, while 29.7% of the participants with confirmed HCV infection thought they were previously tested negative. In this cohort, 15.4% were HBsAg-/HBsAb-/HBcAb IgG-, i.e. being susceptible to HBV infection. In HCV infected participants, 65.4% were born between 1945 and 1965. This large serial survey and screening in the Vietnamese American community confirmed the rates of HBV and HCV infection to be as high as 8.8% and 5.8%, respectively. We have also identified factors related to HBV and HCV infection in this high-risk population.

Hepatitis B testing and access to care among racial and ethnic minorities in selected communities across the United States, 2009-2010

Hepatitis B virus (HBV) infection is widely prevalent among racial and ethnic minorities in the United States; however, few data have been available regarding HBV testing and referral to care for these populations. Using survey data collected in 2009-2010 from the Racial and Ethnic Approaches to Community Health (REACH) across the U.S., we assessed rates and determinants of hepatitis B testing and access to care in 28 minority communities in the U.S. Of 53,896 respondents, 21,129 (39.2%) reported having been tested for hepatitis B. Of the 1,235 who reported testing positive, 411 (33.3%) reported currently receiving specialty care. After controlling for demographic and socioeconomic characteristics, the likelihood of having been tested for hepatitis B and receiving care if infected was higher among males, non-English speaking persons, and those having health insurance compared to their counterparts. Compared to college graduates, respondents without a college education were less likely to get tested for hepatitis B.

CONCLUSION

These data indicate that more than half of racial/ethnic minority persons in these communities had not been tested for hepatitis B, and only about one-half of those who tested positive had ever received treatment. More state and federal efforts are needed to screen racial/ethnic minorities, especially foreign-born persons, for HBV and link those with infection to care.

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.

Electronic messages increase hepatitis B screening in at-risk Asian American patients: a randomized, controlled trial

BACKGROUND

Hepatitis B (HBV) induced hepatocellular carcinoma is the greatest cancer health disparity affecting Asian Americans, but the prevalence of screening to detect HBV is suboptimal.

AIMS

Our aims were to determine the effectiveness of electronic health record (EHR) prompts to increase ordering of HBV tests among primary care providers (PCPs) within an academic health system.

METHODS

We conducted a randomized, controlled trial between April and June 2011 among 76 PCPs caring for 175 outpatient adults with Chinese or Vietnamese surnames, with appointments with providers and no history of HBV testing. Providers were randomized to either receive an EHR prompt for HBV testing prior to patients' appointments or usual care. Primary outcomes were the proportion of patients (1) whose physician ordered a HBsAg test and (2) who completed testing. Secondary outcomes were (A) test results and (B) whether the physicians followed-up on the results.

RESULTS

HBsAg tests were ordered for 36/88 (40.9 %) of the intervention patients and 1/87 (1.1 %) of the control patients [χ (2) (df = 1) = 41.48, p < 0.001]. Thirty intervention patients (34.1 %) and no control patients completed the HBsAg test [χ (2) (df = 1) = 35.80, p < 0.001]. Four (13.3 %) of the completed tests were HBsAg-positive, 14 (46.7 %) were immune, and 12 (40 %) were unprotected from HBV. Two HBsAg-positive patients were referred to specialists, and 3 unprotected patients were vaccinated for HBV.

CONCLUSIONS

EHR-based provider prompts significantly increased HBV testing in Chinese and Vietnamese patients when compared to "usual care." EHR prompts are a promising intervention that could significantly increase screening for HBV.

Electronic messages increase hepatitis B screening in at-risk Asian American patients: a randomized, controlled trial

BACKGROUND

Hepatitis B (HBV) induced hepatocellular carcinoma is the greatest cancer health disparity affecting Asian Americans, but the prevalence of screening to detect HBV is suboptimal.

AIMS

Our aims were to determine the effectiveness of electronic health record (EHR) prompts to increase ordering of HBV tests among primary care providers (PCPs) within an academic health system.

METHODS

We conducted a randomized, controlled trial between April and June 2011 among 76 PCPs caring for 175 outpatient adults with Chinese or Vietnamese surnames, with appointments with providers and no history of HBV testing. Providers were randomized to either receive an EHR prompt for HBV testing prior to patients' appointments or usual care. Primary outcomes were the proportion of patients (1) whose physician ordered a HBsAg test and (2) who completed testing. Secondary outcomes were (A) test results and (B) whether the physicians followed-up on the results.

RESULTS

HBsAg tests were ordered for 36/88 (40.9 %) of the intervention patients and 1/87 (1.1 %) of the control patients [χ (2) (df = 1) = 41.48, p < 0.001]. Thirty intervention patients (34.1 %) and no control patients completed the HBsAg test [χ (2) (df = 1) = 35.80, p < 0.001]. Four (13.3 %) of the completed tests were HBsAg-positive, 14 (46.7 %) were immune, and 12 (40 %) were unprotected from HBV. Two HBsAg-positive patients were referred to specialists, and 3 unprotected patients were vaccinated for HBV.

CONCLUSIONS

EHR-based provider prompts significantly increased HBV testing in Chinese and Vietnamese patients when compared to "usual care." EHR prompts are a promising intervention that could significantly increase screening for HBV.

Hepatitis B and liver cancer among three Asian American sub-groups: a focus group inquiry

Prevalence of hepatitis B among Asian Americans is higher than for any other ethnic group in the United States. Since more than 50% of liver cancer is hepatitis B related, the burden of morbidity and mortality is extremely high among Asian Americans, highlighting the need for culturally appropriate interventions. We conducted focus groups (n = 8) with a total of 58 Korean, Vietnamese, and Chinese immigrants in Maryland to explore knowledge, awareness and perceived barriers toward hepatitis B screening and vaccinations. Thematic analysis uncovered generally low levels of knowledge and awareness of hepatitis B risks, screening, and vaccination; inter-generational differences; and barriers to prevention. Some differences arose across ethnic groups, particularly toward perceived orientation to preventive activities and the role of religious groups. High rates of hepatitis B infection among Asian Americans highlight the need for tailored interventions. These findings may assist policy strategists in implementing interventions that will facilitate the integration and scale-up of hepatitis B education, screening, and vaccination campaigns.

Theoretically informed correlates of hepatitis B knowledge among four Asian groups: the health behavior framework

BACKGROUND

Few studies have examined theoretically informed constructs related to hepatitis B (HBV) testing, and comparisons across studies are challenging due to lack of uniformity in constructs assessed. The present analysis examined relationships among Health Behavior Framework factors across four Asian American groups to advance the development of theory-based interventions for HBV testing in at-risk populations.

METHODS

Data were collected from 2007-2010 as part of baseline surveys during four intervention trials promoting HBV testing among Vietnamese-, Hmong-, Korean- and Cambodian-Americans (n = 1,735). Health Behavior Framework constructs assessed included: awareness of HBV, knowledge of transmission routes, perceived susceptibility, perceived severity, doctor recommendation, stigma of HBV infection, and perceived efficacy of testing. Within each group we assessed associations between our intermediate outcome of knowledge of HBV transmission and other constructs, to assess the concurrent validity of our model and instruments.

RESULTS

While the absolute levels for Health Behavior Framework factors varied across groups, relationships between knowledge and other factors were generally consistent. This suggests similarities rather than differences with respect to posited drivers of HBV-related behavior.

DISCUSSION

Our findings indicate that Health Behavior Framework constructs are applicable to diverse ethnic groups and provide preliminary evidence for the construct validity of the Health Behavior Framework.

Ethnic differences in prevalence and barriers of HBV screening and vaccination among Asian Americans

Our study identifies the prevalence of HBV virus (HBV) screening and vaccination among Asian Americans, and ethnic differences for factors associated with screening and vaccination behaviors. In 2009-2010 we recruited 877 Korean, Chinese, and Vietnamese Americans 18 years of age and above through several community organizations, churches and local ethnic businesses in Maryland for a health education intervention and a self-administered survey. Prevalence of HBV screening, screening result and vaccinations were compared by each ethnic group. We used logistic regression analysis to understand how sociodemographics, familial factors, patient-, provider-, and resource-related barriers are associated with screening and vaccination behaviors, using the total sample and separate analysis for each ethnic group. Forty-seven percent of participants reported that they had received HBV screening and 38% had received vaccinations. Among the three groups, the Chinese participants had the highest screening prevalence, but lowest self-reported infection rate; Vietnamese has the lowest screening and vaccination prevalence. In multivariate analysis, having better knowledge of HBV, and family and physician recommendations was significantly associated with screening and vaccination behaviors. Immigrants who had lived in the US for more than a quarter of their lifetime were less likely to report ever having been screened (OR = 0.39, 95% CI: 0.28-0.55) or vaccinated (OR = 0.62, 95% CI: 0.44-0.88). In ethnic-specific analysis, having a regular physician (OR = 4.46, 95% CI: 1.62-12.25) and doctor's recommendation (OR = 2.11, 95% CI: 1.05-4.22) are significantly associated with Korean's vaccination behaviors. Health insurance was associated with vaccination behaviors only among Vietnamese (OR = 2.66, 95% CI: 1.21–5.83), but not among others.

Hepatocellular carcinoma screening in a hepatitis B virus-infected Korean population

BACKGROUND

Hepatocellular carcinoma (HCC) screening has been recommended for hepatitis B virus (HBV)-infected individuals in an effort to detect HCC at a sufficiently early stage to provide potentially curative treatments. The study reported here is the first to address the rate of HCC screening use in an HBV endemic area.

METHODS

Data were collected from 11,147 adults aged ≥40 years who participated in the 2007-2009 Korea National Health and Nutrition Examination Survey and had a valid HBV surface antigen test. Current HCC screening was defined as either receiving an ultrasonography or an α-fetoprotein measurement in the past year. Prevalence estimates were weighted.

RESULTS

The response rate was 78.4 %, and 436 cases of HBV infection were identified. The overall seroprevalence of the HBV surface antigen was 4.1 % [95 % confidence interval (CI) 3.9-4.4 %]. Of the 436 HBV-infected subjects, only 23.2 % (95 % CI 19.5 -27.4 %) were aware that they had been infected, and approximately 27 % (27.1 %; 95 %CI 23.2-to 31.5 %) were up to date with their HCC screening tests; more than half (52.9 %, 95 % CI 48.2-57.5) had never been screened. In a multivariate analysis that included various sociodemographic variables, only self-reported awareness of HBV infection was significantly associated with current HCC screening tests (odds ratio 2.82; 95 % CI 1.64-4.84).

CONCLUSIONS

Adoption of HCC screening as a standard practice among HBV-infected Korean adults aged ≥40 years is suboptimal. Evidence-based programs in communities and education for both healthcare providers and HBV-infected persons are needed to improve the implementation of HCC screening in clinical practice.

Socioeconomic inequalities in completion of hepatitis B vaccine series among Korean women: results from a nationwide interview survey

BACKGROUND

Hepatitis B virus (HBV) infection and its sequelae are major global health problems. This study was conducted to investigate the association between factors related to socioeconomic status and HBV vaccination in the general population of women in Korea.

METHODS

Data from annual nationwide cross-sectional interview surveys conducted between 2005 and 2008 were reviewed. These surveys included representative samples of cancer-free people and 4350 women interviewed within the study period were included in the present report. Polychotomous logistic regression was used in the analysis.

RESULTS

The complete HBV coverage rate was 39.8%. Older age, lower household income and lower education level showed significant unfavorable influences on the completion of the HBV vaccine series (P-trend <0.001 for all three variables). Lack of private insurance and having a routine and manual job were also associated with a lower complete vaccination rate (OR: 0.69, 95% CI: 0.57-0.84; OR: 0.56, 95% CI: 0.38-0.82, respectively), whereas living in an urban area was related to a higher rate (OR: 1.18, 95% CI: 1.02-1.37). Older age, lower education level, and not having private insurance were associated with incomplete vaccination compared with unvaccination (P-trend 0.001, <0.001, OR: 0.68, 95% CI: 0.53-0.78, respectively). Among women of reproductive age, similar results were seen for education level, household income, and occupation. Significant disparities in vaccination status according to socioeconomic status, as indicated by the combination of household income and education level, were seen (P-trend <0.001). The most common reason for unvaccination was lack of knowledge about the necessity for HBV vaccination.

CONCLUSION

Considering that vertical transmission is the most common source of HBV infection, vaccination of women is important to prevent HBV transmission to newborn infants. Therefore governmental strategies to reduce socioeconomic inequalities related to the completion of the HBV vaccine series among women should be implemented.

Knowledge, Awareness and Medical Practice of Asian Americans/Pacific Islanders on Chronic Hepatitis B Infection: Review of Current Psychosocial Evidence

The purpose of this review is to conduct a concise review of the literature to evaluate the knowledge, awareness, and medical practice of Asian Americans/Pacific Islanders (API) supporting the relationship of chronic hepatitis B infection. Liver cancer is the fifth most common cause of cancer death in men and the ninth most common cause of death in women in the United States. On average, Asian Americans are three times more likely to die from liver cancer than other racial/ethnic groups, with Chinese Americans at six times, Koreans eight times and Vietnamese 13 times higher than non-Hispanic Whites. In the United States, about 80% of liver cancer is etiologically associated with hepatitis B virus (HBV) infection. Asian Americans and Pacific Islanders (API) account for over half of the 1.3 million chronic hepatitis B cases and for over half of the deaths resulting from chronic hepatitis B infection. Relevant studies were identified in PubMed (Medline) using the following search structure: (Hepatitis B or synonyms) AND (liver cancer or synonyms) AND (Asian Americans or synonyms). Further studies were identified by citations in retrieved papers and by consultation with experts. Twenty publications were included in this review. Compared to other racial/ethnic groups, Asians, especially those born in China or Southeast Asia, have significantly poorer knowledge regarding hepatitis B and liver cancer. Knowledge, awareness and medical practice among Asian Americans regarding HBV infection were dependent upon age, gender, race/ethnicity, immigrant status and length of residency. Despite increased risk for chronic hepatitis B and liver cancer, many Asian Americans are uninformed, untested, and unprotected against the disease.

Development of a culturally tailored Internet intervention promoting hepatitis B screening in the Turkish community in the Netherlands

Hepatitis B virus infections are an important health problem in the Turkish community in the Netherlands. Screening for hepatitis B should be promoted through public health interventions, which take into account the socio-cultural and behavioural determinants that influence screening. The Intervention Mapping protocol was used to develop a culturally tailored Internet intervention for first-generation Turkish immigrants in Rotterdam, aged 16-40 year. Behavioural factors and cultural motivators and barriers, identified in the first steps of the protocol, were incorporated in the intervention. To ensure participation, members of the target population were involved in all steps of programme development. A theory- and evidence-based culturally tailored intervention was developed. Both surface structure and deep structure elements were used; surface structure tailoring resulting in different Internet skins and peer-stories for subgroups, such as young women. Deep structure elements comprised cultural motivators such as the religiously inspired feelings of responsibility and strong family values, and perceived community rules regarding health and disease. Cultural barriers that were addressed were the satisfaction and trust in Dutch health care, and the association of hepatitis B screening with sexual behaviour. Intervention Mapping provided a useful framework for the systematic development of our theory- and evidence-based intervention to promote hepatitis B screening in the Turkish community in the Netherlands.

Cost-effectiveness of universal hepatitis B virus screening in patients beginning chemotherapy for solid tumors

PURPOSE

Universal screening for chronic hepatitis B virus (HBV) infection before chemotherapy has been recommended. We evaluated the cost-effectiveness of HBV screening before chemotherapy given for nonhematopoietic solid tumors (STs).

METHODS

A decision-analytic model was used to compare the cost-effectiveness of universal screening conducted per professional guidelines versus no screening in hypothetical patient cohorts beginning adjuvant chemotherapy for early breast cancer or palliative chemotherapy for advanced non-small-cell lung cancer. Survival times were extrapolated using Markov models. Probabilities were derived from published studies and costs estimated from the perspective of the Australian health care system. One-way and probabilistic sensitivity analyses were performed, including with the application of an alternative HBV screening strategy.

RESULTS

Using an incremental cost-effectiveness ratio threshold of $50,000 (Australian dollars) per life-year (LY) saved, universal HBV screening was not cost-effective for adjuvant patients ($88,224/LY, 13% probability of being cost-effective), palliative patients ($1,344,251/LY, 0%), or pooled (all) patients ($149,857/LY, 1%). Sensitivity analyses found that screening approached cost-effectiveness among adjuvant patients with the highest reported rates of undiagnosed chronic HBV (65%, $59,445/LY) or HBV reactivation with chemotherapy (41%, $56,537/LY). Cost- effectiveness was also significantly influenced by HBV population prevalence. An alternative screening strategy using hepatitis B surface antigen testing only produced the most economically favorable results, with $30,126/LY (80% probability) for adjuvant patients and $51,201/LY (43%) for the pooled cohort.

CONCLUSION

Universal HBV screening conducted per current guidelines is not cost-effective in patients with STs. Screening may be economically favorable in selected patient subpopulations and/or with simplification of the screening strategy.

Vietnamese community screening for hepatitis B virus and hepatitis C virus

Asian Americans represent an important cohort at high risk for viral hepatitis. To determine the prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection and HBV vaccination in a Vietnamese community, a total of 322 Vietnamese subjects from a local doctor's office and annual Vietnamese Health Fair were included in this study. Demographic and clinical data were collected. 2.2% of the screened cohort tested positive for anti-HCV and 9.3% tested positive for HBsAg. Unlike HBV-positive subjects, HCV-positive subjects had significantly higher liver enzymes (P = 0.0045 and P = 0.0332, respectively). The HBV-positive group was more likely to report jaundice (P = 0.0138) and a family history of HBV (P = 0.0115) compared to HBV-negative subjects. Forty-eight patients (15.5%) reported a family history of liver disease (HBV, HCV, HCC, cirrhosis, other). Of this 48, 68.8% reported no personal history of HBV vaccination and 77.1% reported no family history of vaccination for HBV. Among the 183 subjects without a family history of liver disease, 156 (85.2%) reported no personal history of vaccination and 168 (91.8%) reported no family history of vaccination. HBV vaccination rates in those reporting a family history of liver disease were significantly higher (P =0.020). There was a high prevalence of HBV infection in this community screening. Nevertheless, the rate for HBV vaccination was low. The low prevalence of abnormal liver enzymes in HBV-positive subjects emphasizes the need for screening to be triggered by risk factors and not by abnormal liver enzymes.

Hepatitis B vaccination prevalence and its predictors among Asian, Pacific Islander, Native American, and multiracial adults in the National Health and Nutrition Examination Survey

Hepatitis B Virus (HBV) vaccination prevalence and its predictors were estimated among Asian, Pacific Islander, Native American, and Multiracial (A-PI-NA-M) adults. Using 2005 National Health and Nutrition Examination Survey data, estimates of HBV vaccination among A-PI-NA-M adults (N = 233) were compared with all other racial/ethnic groups. Multivariable logistic regression was used to estimate predictors of vaccination. Among A-PI-NA-M adults 42% (95%CI 34, 50) were HBV immunized, higher than all other racial/ethnic groups. Some college was associated with a 31% (95%CI 7, 55); a college degree with a 28% (95%CI 8, 49) increased probability of HBV vaccination relative to less education. Each 10-year increase in age was associated with an 11% (95%CI -18, -4) lower probability of HBV vaccination. Access to medical care and immigrant status were not associated with vaccination. Interventions to increase HBV vaccination should target less-educated and older A-PI-NA-M adults, as well as develop strategies so that access to care may increase vaccination.

Awareness, knowledge and self-reported test rates regarding Hepatitis B in Turkish-Dutch: a survey

Background

Hepatitis B virus infection is an important health problem in the Turkish community in the Netherlands. To prevent transmission and progression of the disease in this community, increased screening is necessary. This study aimed to determine 1) the levels of awareness and knowledge regarding hepatitis B, comparing these in tested and non-tested Turkish-Dutch in Rotterdam; 2) the self-reported hepatitis B test status in this population, and how this is related to demographic characteristics, knowledge and awareness.

Methods

We conducted a postal survey amongst first and second generation migrants, aged 16 - 40 years.

Results

The response rate was 30.2% (n = 355 respondents). Levels of awareness and knowledge regarding hepatitis B were low, as the majority of respondents (73%) never thought about the disease and 58% of the respondents scored 5 or less out of ten knowledge items. Weighted analysis of self-reports showed a test rate of 15%, and a vaccination rate of 3%. Regression analysis showed that having been tested for hepatitis B was related to being married and higher levels of awareness and knowledge.

Conclusions

This study shows low levels of hepatitis B awareness and knowledge in the Turkish community in Rotterdam. Self-reported test rates are lower in people who are not currently married, and in those who have low levels of awareness and knowledge. Especially, knowledge about the consequences of hepatitis B, such as liver cancer, was lacking. Therefore, a health promotion intervention should foremost raise awareness, and increase knowledge on the seriousness of this disease.

What made a successful hepatitis B program for reducing liver cancer disparities: an examination of baseline characteristics and educational intervention, infection status, and missing responses of at-risk Asian Americans

Asian Americans, compared with other racial/ethnic groups, are disproportionately affected by Hepatitis B disease. The literature suggests that knowledge and awareness of prevention strategies such as receiving hepatitis B screening and vaccination are potential factors associated with occurrence of hepatitis B and liver cancer, while it is unclear how baseline characteristics relate to these effective hepatitis B prevention strategies. In the study, five Asian-American groups in the state of Maryland completed self-administered pre- and post-test after receiving lectures on hepatitis B prevention, and participated in blood screening for Hepatitis B. T-test and one-way ANOVA were used to explore the differences of baseline characteristics among these participants. Logistic regression was employed to study the baseline factors and association with completion of tests. All groups were significantly different in socioeconomic characteristics except for gender and immunization status, and only marginally different in infection status (P = 0.089). The mean pre- and post-test scores were different by group (P < 0.01). All groups had significantly improved knowledge of prevention (F = 7.65, P < 0.01). Age and race were positively related to immunization status, with older participants are more likely to get vaccinated (OR = 1.02, CI = 1.00-1.03). Chinese, Korean and Vietnamese were more likely to receive vaccination. For infection, only gender was correlated with infection status, with odds of being HBV carriers for females being 74% less than that for males (OR = 0.26, CI = 0.07-0.90). Participants who had only high school or lower education, retired, self-employed, higher income level, and married were less likely to complete surveys. The study found correlations of gender, infection status, age and race with immunization status. Males are more likely to be HBV carriers. It reveals new findings on the relationship between baseline characteristics and the completion of pre- and post-tests and missing responses. The information may provide potential directions for improve preventive program for at-risk communities.

Constructing a theoretically based set of measures for liver cancer control research studies

OBJECTIVE

Measurement tools such as surveys assessing knowledge, attitudes, and behaviors need to be theoretically consistent with interventions. The purpose of this article is to describe the first steps in the process of constructing a theoretically based set of measures that is currently used in three trials to reduce liver cancer disparities.

METHODS

Guided by a common theoretical formulation-the Health Behavior Framework-we identified constructs relevant for liver cancer control research, compiled items from previous studies and constructed new items, and translated and pilot tested items in collaboration with members of the Vietnamese, Korean, and Hmong communities.

RESULTS

We constructed three questionnaires in Vietnamese, Hmong, and Korean languages that are slightly different due to cultural and language nuances but contain a core set of measures assessing identical constructs of the Health Behavior Framework. Initial research demonstrates that items are easily understood and that they are generally related to hepatitis B screening as expected.

CONCLUSIONS

Researchers are encouraged to follow a similar process for creating theory-based assessment tools. Measuring common theoretical constructs can advance liver cancer control and other health research by facilitating a more systematic comparison of findings across different populations and intervention strategies.

Barriers to health care access in 13 Asian American communities

OBJECTIVE

To obtain and discuss in-depth information on health care use in Asian Americans (AAs).

METHODS

Nineteen focus groups were conducted in 174 adults from 13 AA communities in Montgomery County, Maryland. MAX QDA software was used to analyze qualitative data.

RESULTS

Financial, physical, communication, and cultural attitudes were 4 major barriers to accessing health care. Underrepresented communities reported unique additional barriers, such as lack of screening opportunities and interpretation services due to lack of resources in the communities.

CONCLUSIONS

Future studies, public health policy, and funding resources should consider including underrepresented AA subgroups and reflect their needs.

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.

Hepatitis B screening in the Turkish-Dutch population in Rotterdam, the Netherlands; qualitative assessment of socio-cultural determinants

Background

Hepatitis B is an important health problem in the Turkish community in the Netherlands. Increased voluntary screening is necessary in this community, to detect individuals eligible for treatment and to prevent further transmission of the disease.

Methods

We investigated socio-cultural determinants associated with hepatitis B screening in male and female, first and second generation Turkish migrants, by means of Focus Group Discussions.

Results

Socio-cultural themes related to hepatitis B screening were identified; these were social norm, social support, sensitivity regarding sexuality, reputation, responsiveness to authority, religious responsibility, cleanliness and religious doctrine regarding health and disease, and the perceived efficacy of Dutch health care services. Motivating factors were the (religious) responsibility for one's health, the perceived obligation when being invited for screening, and social support to get tested for hepatitis B. Perceived barriers were the association of hepatitis B screening with STDs or sexual activity, the perception of low control over one's health, and the perceived low efficacy of the Dutch health care services. Reputation could act as either a motivator or barrier.

Conclusion

This study identified relevant socio-cultural themes related to hepatitis B screening, which may serve to customize interventions aimed at the promotion of voluntary hepatitis B screening in the Turkish-Dutch population in the Netherlands.

Hepatitis B testing and vaccination among Vietnamese- and Cambodian-Americans

We determined hepatitis B virus (HBV) testing and vaccination levels and factors associated with testing and vaccination among Vietnamese- and Cambodian-Americans. We also examined factors associated with healthcare professional (HCP)-patient discussions about HBV. We analyzed 2006 Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey data from four US communities. We used logistic regression to identify variables associated with HBV vaccination, testing, and HCP-patient discussions about HBV. Of the 2,049 Vietnamese- and Cambodian-American respondents, 60% reported being tested for HBV, 35% reported being vaccinated against hepatitis B, and 36% indicated that they had discussed HBV with a HCP. Cambodian-Americans were less likely than Vietnamese-Americans to have been tested for HBV, while respondents with at least a high school diploma were more likely to have been tested for HBV. Respondents born in the US, younger individuals, and respondents with at least some college education were more likely to have been vaccinated against hepatitis B. HBV testing and vaccination remain suboptimal among members of these populations. Culturally sensitive efforts that target Vietnamese- and Cambodian-Americans for HBV testing and vaccination are needed to identify chronic carriers of HBV, prevent new infections, and provide appropriate medical management. HCPs that serve these populations should be encouraged to discuss HBV with their patients.

Psychometric testing of the Immigrant Barriers to Health Care Scale: Hispanic Version

Barriers to care contribute to health inequities for immigrant populations. Although inadequate health insurance is a known barrier, other factors impact the issue. Few instruments exist to specifically measure these other barriers. The purpose of this study was to test the Immigrant Barriers to Health Care Scale - Hispanic Version. It was first pilot-tested in southern California with a Mexican population. After refinement, the instrument was tested in a north-eastern sample of diverse Hispanic adults. The data were analyzed using exploratory factor analysis. Factor loadings and communalities were used to assess the adequacy of the scale's items. Six items were deleted due to ambiguous factor loadings. The final 11 items loaded onto four factors and explained 54.58% of the variance. The coefficient alpha was 0.81 for the instrument. The Immigrant Barriers to Health Care Scale is a reliable and valid tool. Its further use and reporting with other socially and economically disadvantaged groups is advised.

Recommendations for identification and public health management of persons with chronic hepatitis B virus infection

Early identification of persons with chronic HBV infection enables infected persons to receive necessary care to prevent or delay onset of liver disease, and enables the identification and vaccination of susceptible household contacts and sex partners, interrupting ongoing transmission. Testing has been recommended previously to enable primary prevention of HBV infection among close contacts for pregnant women, household contacts and sex partners of HBV-infected persons, persons born in countries with hepatitis B surface antigen (HBsAg) prevalence of more than 8%, persons who are the source of blood or body fluid exposures that might warrant postexposure prophylaxis (e.g., needlestick injury to a healthcare worker or sexual assault), and to enable appropriate treatment for infants born to HBsAg-positive mothers and persons infected with human immunodeficiency virus. Recently, with the increasing availability of efficacious hepatitis B treatment, the Centers for Disease Control and Prevention published new recommendations for public health evaluation and management for chronically infected persons and their contacts and extended testing recommendations to include persons born in geographic regions with HBsAg prevalence of greater than 2%, men who have sex with men, and injection drug users. Patient and provider education, developing partnerships between health departments and community organizations, and other resources will be needed to assure appropriate populations are tested and care provided for persons newly identified as HBsAg-positive.

Public health model for prevention of liver cancer among Asian Americans

Asian Americans and Pacific Islanders (AAPIs) account for over half of the 1.3 million chronic hepatitis B cases and for over half of the deaths resulting from chronic hepatitis B infection in United States. There are very few studies published about hepatitis B virus (HBV) data in the Baltimore-Washington metropolitan area. In 2003, the Hepatitis B Initiative-DC (HBI-DC) worked closely with a large Korean church, located in Vienna, Virginia. Their partnership included a pilot-test of a faith-based HBV program, which educates, screens and vaccinates for the HBV. This pilot program was later expanded to include a total of nine Korean and Chinese American churches in this region, plus a Pastor's Conference targeting Asian American pastors from around the United States. During 2003-2006, a total of 1,775 persons were tested for HBV infection through the HBI-DC program. Of all the participants, 2% (n=35) were tested HBV positive (HbsAg+, HbsAb-), 37% (n=651) were HBV negative but protected (HbsAg-, HbsAb+), and 61% (n=1089) were unprotected (HbsAg-, HbsAb-). Most of these unprotected individuals (n=924) received the first vaccination. The proportion of the second vaccination was 88.8% (n=824). About 79% completed 3-shot vaccine series. Our study contributes to the literature by providing an overview of the hepatitis B unprotected rate among Asian American adults. It indicates that culturally integrated liver cancer prevention program will reduce cancer health disparities in high risk immigrant populations.

Influenza and pneumococcal vaccination rates among Vietnamese, Asian, and non-Hispanic white Americans

BACKGROUND

Vaccination data for Asian Americans are comparable to those for whites, possibly because they are reported in aggregate rather than for subgroups. We compared influenza and pneumococcal vaccination rates among eligible Asian Americans and white Americans, and for Vietnamese Americans as a subgroup, and assessed factors associated with these vaccinations.

METHODS

Cross-sectional study of data collected from three ethnic groups over 4 years by telephone survey. Data were weighted for selection probability and population estimates and analyzed by multivariate logistic regression.

RESULTS

Vietnamese Americans had a higher rate of influenza vaccination (61%) than Asian Americans (45%) and white Americans (52%), and lower rate of pneumococcal vaccination (41%) than Asian Americans (56%), both lower than white Americans (67%).

CONCLUSION

When analyzed as a subgroup, Vietnamese Americans had a higher influenza vaccination rate, but a lower pneumococcal vaccination rate, compared to Asian Americans and white Americans, which may indicate that health behaviors and outcomes can differ widely among Asian subgroups. Analyses of preventive care measures in Asian Americans should focus on subgroups to ensure accuracy and quality of assessments.

Hepatitis B virus (HBV) infection in Asian and Pacific Islander Americans (APIAs): how can we do better for this special population?

Hepatitis B virus(HBV) infection is one of the major global public health problems. Based on the second National Health and Nutrition Examination Survey (NHANES II), it is estimated that 1.25 million people are HBV infected in the United States. However, Asian and Pacific Islander Americans (APIAs) were underrepresented in this survey, and studies on the community HBV screening reported 6-15% of HBV infection in this special population. This article systematically reviews recent research advances in the possible barriers of hepatitis B care in APIAs that can be classified into three major categories, i.e., provider-, patient-, and resource-related barriers. The article also provides an overview of multiple approaches to effectively reduce these barriers so that we can evolve better strategy and deliver appropriate care to this special population and eventually reduce health disparity of CHB in APIAs.

Sources of health information among Vietnamese American men

Vietnamese American men face multiple health disparities compared to white men. Our study objective was to determine the sources of health information used by Vietnamese men in the United States. A population-based, in-person survey was conducted among Vietnamese men in Seattle during 2002. Our survey was completed by 509 Vietnamese men (79% response rate). The most commonly reported sources of health information included Vietnamese newspapers/magazines (73%), Vietnamese and English language television (64% and 67%, respectively), Vietnamese radio (51%), and friends and family members (51% and 63%, respectively). We found that sources of health information varied significantly among sociodemographic subgroups of the Vietnamese male population. Sources of health information among Vietnamese American men differ considerably from other racial/ethnic groups. Research findings should be used to guide the development of health education interventions for Vietnamese men and subgroups within the Vietnamese male population.