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Background: Little is known about how to best communicate with older adults about dietary behaviors and related factors in complex chronic disease care. Photo‐based communication could promote efficient information exchange and activate patients to effectively communicate their lived experiences. We conducted a pilot study to assess the feasibility and acceptability of a photo‐based patient‐clinician communication intervention to promote dietary discussions in geriatric primary care. Methods: Older adult patients with 2+ concurrent chronic conditions received in‐person training on photo‐taking with a smartphone before taking photos in response to the prompt, "What aspects of your everyday life affect what you eat and how much you have to eat?" Patients then shared photos and their narratives with their primary care clinician during a clinic visit. Patients and clinicians completed separate audio‐recorded post‐visit interviews to assess perspectives on the intervention. Interview transcripts were analyzed using a thematic analysis approach. Results: Fourteen patient‐clinician dyads completed the study. All except one patient‐clinician dyad (93%) completed the intervention as trained. 93% of patients and 86% of clinicians reported that they would "definitely" or "probably" be willing to engage in a future visit with photo‐sharing. Patients and clinicians shared similar perspectives on how sharing of photos during the visit enhanced communication and information exchange about dietary practices and other health‐related factors, influenced clinical recommendations made during the visits, and strengthened the patient‐clinician relationship. Conclusion: Incorporation of a photo‐based patient‐clinician communication intervention to promote discussions regarding diet and other health‐related factors could be a patient‐centered strategy to help deliver comprehensive geriatric primary care. [ABSTRACT FROM AUTHOR]

Background: Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans.Methods: A cluster randomized controlled trial was conducted among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by an LHE. The control group received education regarding nutrition and physical activity delivered by a health educator. The outcomes were changes in self-reported ever-screening and up-to-date CRC screening after 6 months.Results: All 329 participants were foreign-born with mostly no formal education, limited English proficiency, and no employment. The majority of the participants were insured and had a regular source of health care. The intervention group experienced greater changes after the intervention than the control group for ever-screening (P = .068) and being up-to-date with screening (P<.0001). In multivariable regression analyses, the intervention group demonstrated a greater increase than the control group in reporting ever-screening (adjusted odds ratio, 1.73; 95% confidence interval, 1.07-2.79) and being up-to-date with screening (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32). Individuals who had health insurance were found to have >4 times the odds of receiving screening, both ever-screening and up-to-date screening. A higher CRC knowledge score mediated the intervention effect for both screening outcomes.Conclusions: A culturally and linguistically appropriate educational intervention delivered by trained LHEs was found to increase CRC screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Cancer 2017;98-106. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the efficacy of an in-language intervention of 2 lectures plus printed materials versus printed materials alone on knowledge and adherence to nutrition and physical activity guidelines among older Chinese Americans in San Francisco, California. Methods. From August 2010 to September 2013, we randomized 756 Chinese Americans aged 50 to 75 years to either lectures plus print (n = 361) or print (n = 357). Clusters were the participants recruited by each lay health worker. Intervention outcomes were changes in knowledge of recommended vegetable intake, fruit intake, and physical activity level and adherence to those recommendations from pre- to 6 months postintervention. Results. The retention rate was 99%. At baseline, knowledge and adherence to recommendations were low. Print yielded increases in knowledge of recommended vegetable intake and physical activity level and adherence to fruit intake and physical activity recommendations. Lectures plus print had significant increases in all 6 outcomes. In multivariable models, lectures plus print was superior to print for knowledge of vegetable (adjusted odds ratio [AOR] = 12.61; 95% confidence interval [CI] = 6.50, 24.45) and fruit (AOR = 16.16; 95% CI = 5.61, 46.51) intake recommendations and adherence to vegetable intake recommendations (AOR = 5.53; 95%CI = 1.96, 15.58). Conclusions. In-language print materials, alone and combined with lectures, increased nutrition and physical activity knowledge and behaviors among older Chinese Americans. [ABSTRACT FROM AUTHOR]

The goal of this project was to explore family communication dynamics and their implications for smoking cessation. We conducted 39 in-depth dyadic and individual qualitative interviews with 13 immigrant smoker-family member pairs of Vietnamese (n = 9 dyads, 18 individuals) and Chinese (n = 4 dyads, 8 individuals) descent, including seven current and six former smokers and 13 family members. All 13 dyadic and 26 individual interviews were analyzed using a collaborative crystallization process as well as grounded theory methods. We identified three interrelated pathways by which tobacco use in immigrant Vietnamese and Chinese families impacts family processes and communication dynamics. Using a two-dimensional model, we illustrate how the shared consequences of these pathways can contribute to a dynamic of avoidance and noncommunication, resulting in individual family members "suffering in silence" and ultimately smoking being reinforced. We discuss the implications of these findings for development of smoking cessation interventions. [ABSTRACT FROM AUTHOR]

Objectives. We conducted a cluster randomized controlled study of a lay health worker (LHW) intervention to increase colorectal cancer (CRC) screening rates among Vietnamese Americans, who typically have lower rates than do non-Hispanic Whites. Methods. We randomized 64 LHWs to 2 arms. Each LHW recruited 10 male or female participants who had never had CRC screening (fecal occult blood test, sigmoidoscopy, or colonoscopy). Intervention LHWs led 2 educational sessions on CRC screening. Control LHWs led 2 sessions on healthy eating and physical activity. The main outcome was self-reported receipt of any CRC screening at 6 months after the intervention. We conducted the study from 2008 to 2013 in Santa Clara County, California. Results. A greater proportion of intervention participants (56%) than control participants (19%) reported receiving CRC screening (P<.001). When controlling for demographic characteristics, the intervention odds ratio was 5.45 (95% confidence interval = 3.02, 9.82). There was no difference in intervention effect by participant gender. Conclusions. LHW outreach was effective in increasing CRC screening in Vietnamese Americans. Randomized controlled trials are needed to test the effectiveness of LHW outreach for other populations and other health outcomes. [ABSTRACT FROM AUTHOR]

Background: Vietnamese-American women underutilize breast cancer screening. Design: An RCT was conducted comparing the effect of lay health workers (LHWs) and media education (ME) to ME alone on breast cancer screening among these women. Setting/participants: Conducted in California from 2004 to 2007, the study included 1100 Vietnamese-American women aged ≥40 years who were recruited through LHW social networks. Data were analyzed from 2007 to 2009. Intervention: Both groups received targeted ME. The intervention group received two LHW educational sessions and two telephone calls. Main outcome measures: Change in self-reported receipt of mammography ever, mammography within 2 years, clinical breast examination (CBE) ever, or CBE within 2 years. Results: The LHW+ME group increased receipt of mammography ever and mammography in the past 2 years (84.1% to 91.6% and 64.7% to 82.1%, p<0.001) while the ME group did not. Both ME (73.1% to 79.0%, p<0.001) and LHW+ME (68.1% to 85.5%, p<0.001) groups increased receipt of CBE ever, but the LHW+ME group had a significantly greater increase. The results were similar for CBE within 2 years. In multivariate analyses, LHW+ME was significantly more effective than ME for all four outcomes, with ORs of 3.62 (95% CI=1.35, 9.76) for mammography ever; 3.14 (95% CI=1.98, 5.01) for mammography within 2 years; 2.94 (95% CI=1.63, 5.30) for CBE ever; and 3.04 (95% CI=2.11, 4.37) for CBE within 2 years. Conclusions: Increased breast cancer screening by LHWs among Vietnamese-American women. Future research should focus on how LHWs work and whether LHW outreach can be disseminated to other ethnic groups. [Copyright &y& Elsevier]

Background: There are few population-based studies of cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans.Objective: To describe cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans and compare the results to non-Hispanic whites.Design: Comparison of data from two population-based, cross-sectional telephone surveys.Participants: Vietnamese Americans in Santa Clara County, California, and non-Hispanic whites in California, aged 18 and older.Measurements: Survey measures included sociodemographics, diagnoses, body mass index, fruit and vegetable intake, exercise, and tobacco use. Knowledge of symptoms of heart attack and stroke was collected for Vietnamese Americans.Main Results: Compared to non-Hispanic whites (n = 19,324), Vietnamese Americans (n = 4,254) reported lower prevalences of obesity, diabetes mellitus, coronary heart disease, and hypertension, and similar prevalences of stroke and hypercholesterolemia. Fewer Vietnamese Americans consumed fruits and vegetables five or more times daily (27.8% vs 16.3%, p < 0.05), and more reported no moderate or vigorous physical activity (12.1% vs 40.1%, p < 0.05). More Vietnamese men than non-Hispanic White men were current smokers (29.8% vs 19.0%, p < 0.05). Vietnamese Americans who spoke Vietnamese were more likely than those who spoke English to eat fruits and vegetables less frequently, engage in no moderate or vigorous physical activity, and, among men, be current smokers. Only 59% of Vietnamese Americans knew that chest pain was a symptom of heart attack.Conclusions: There are significant disparities in risk factors and knowledge of symptoms of cardiovascular diseases among Vietnamese Americans. Culturally appropriate studies and interventions are needed to understand and to reduce these disparities. [ABSTRACT FROM AUTHOR]

This article reports on a study seeking to promote cervical cancer screening among Vietnamese American women in Santa Clara County, California. Vietnamese American women have the highest incidence of cervical cancer of any racial or ethnic group in the U.S. at a rate five times higher than that of non-Hispanic Whites. This disparity is entirely preventable. Persistent infection with human papillomavirus (HPV) is accepted as a major cause of the cancer and active and passive smoking are also risk factors. Two groups of women were recruited and one was given health worker outreach and media-based health education while the other group had the media-based education only. The combined intervention motivated more women to get their first Papanicolaou (Pap) smear.

Background: Compared with white women, Vietnamese women in the United States have a higher rate of cervical cancer and lower Papanicolau (Pap) test utilization. We evaluated factors associated with awareness of the Pap test, intention to obtain it, and its receipt in Vietnamese-American women.Methods: In 2000, we conducted a telephone survey of Vietnamese-American women aged >or=18 years living in Santa Clara County, California, and Harris County, Texas. We collected data on sociodemographics, healthcare system access and attitudes, as well as Pap test awareness, attitudes, intentions, and practices.Results: Of 1566 subjects, 74% had heard of the Pap test, and 76% had had at least one. Only 42% of those who never had a Pap test had considered obtaining one. There were no significant differences between the two sites. Women aged >or=65 had the lowest rates for all three outcomes. For all women, younger age, being married, having requested a Pap test, physician recommendation, and preferring a female standby if the doctor was male were associated with Pap test intention. Being married, higher level of education, having a female doctor, having a respectful doctor, having requested the test, and physician recommendation were associated with Pap test receipt.Conclusion: Vietnamese-American women have low rates of Pap test awareness, intention, and receipt. The patient-doctor interaction is an important determinant. Efforts to increase Pap test utilization in this population need to be directed at encouraging physicians to offer the Pap test and empowering women to ask for the test. [ABSTRACT FROM AUTHOR]

Introduction: Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans.Design: Cluster randomized comparative trial.Setting/participants: From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin.Intervention: Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls.Main Outcome Measures: Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015.Results: This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%-88.3%, p<0.0001; Print, 72.3%-79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%-78.1%, p<0.0001; Print, 58.1%-64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date.Conclusions: Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants.Trial Registration: This study is registered at www.clinicaltrials.gov NCT00947206. [ABSTRACT FROM AUTHOR]

Asian Americans have low prevalence of overweight/obesity based on standard BMI cut points yet have higher rates of diabetes. We examined the prevalence of overweight/obesity, using lower BMI cut points recommended by the World Health Organization (WHO) for Asians, and diabetes in Asian American subgroups in California. Method Secondary analysis of the 2009 adult California Health Interview Survey (n=45,946) of non-Hispanic Whites (NHW), African Americans, Hispanics and Asians (Vietnamese, Chinese, Korean, Filipino, South Asian and Japanese). WHO Asian BMI cut points (overweight=23-27.5kg/m2; obese≥27.5kg/m2) were used for Asian subgroups. Standard BMI cut points (overweight=25-29.9kg/m2; obese≥30kg/m2) were applied for other groups. Results Among Asian subgroups, overweight/obesity was highest among Filipinos (78.6%), which was higher than NHWs (p<0.001) but similar to African Americans and Hispanics. Compared to NHW, diabetes prevalence was higher for Vietnamese, Koreans, Filipinos and South Asians with BMI=23-24.9kg/m2 and Koreans, Filipinos and Japanese with BMI=27.5-29.9kg/m2, the ranges WHO recommends as overweight or obese for Asians but not for other groups. Conclusions Filipinos should be a priority population for overweight/obesity screening. Filipinos, Vietnamese, Korean, South Asians and Japanese have higher diabetes prevalence at lower BMI cut points. WHO Asian BMI cut points may have clinical utility to identify at-risk Asian Americans. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors have declared that no competing interests exist.

Introduction: Americans have low levels of knowledge of and adherence to recommendations for healthy eating of fruits and vegetables and for physical activity (HEPA). We conducted a cluster randomized controlled trial of a lay health worker intervention to increase HEPA among Vietnamese Americans., Methods: We randomized 64 lay health workers to 2 intervention arms. Each lay health worker recruited 10 participants aged 50 to 74. From 2008 to 2013, using flip charts, lay health workers led 2 educational sessions on HEPA (intervention) or colorectal cancer (comparison). We assessed HEPA knowledge and self-reported behaviors by preintervention and postintervention surveys 6 months apart., Results: Of the 640 participants, 50.0% were female, 38.4% had lived in the United States for 10 years or fewer, and 71.4% reported limited English proficiency. Knowledge of the recommended intake of fruits and vegetables (≥5 servings daily) increased from 2.6% to 60.5% in the intervention group (n = 311) and from 2.9% to 6.7% in the comparison group (n = 316) (intervention vs comparison change, P < .001). Knowledge of the physical activity recommendation (≥150 minutes weekly) increased from 2.6% to 62.4% among intervention participants and from 1.0% to 2.5% among comparison participants (P < .001). Consumption of 5 or more daily servings of fruits and vegetables increased more in the intervention group (8.4% to 62.1%) than in the comparison group (5.1% to 12.7%) (P < .001). Participants reporting 150 minutes or more of physical activity weekly increased from 28.9% to 54.0% in the intervention group and from 38.0% to 46.8% in the comparison group (intervention vs comparison change, P = .001)., Conclusion: A lay health worker intervention increased both healthy eating and physical activity knowledge and self-reported behaviors among older Vietnamese Americans.

Prior studies have supported the effectiveness of the use of Lay Health Workers (LHWs) as an intervention model for managing chronic health conditions, yet few have documented the mechanisms that underlie the effectiveness of the interventions. This study provides a first look into how LHWs delivered a family-based intervention and the challenges encountered. We utilize observation data from LHW-led educational sessions delivered as part of a randomized controlled trial (RCT) designed to test a LHW outreach family-based intervention to promote smoking cessation among Vietnamese American smokers. The RCT included experimental (smoking cessation) and control (healthy living) arms. Vietnamese LHWs were trained to provide health information in Vietnamese to groups of family dyads (smoker and family member). Bilingual, bicultural research team members conducted unobtrusive observations in a subset of LHW educational sessions and described the setting, process and activities in structured fieldnotes. Two team members coded each fieldnote following a grounded theory approach. We utilized Atlas.ti qualitative software to organize coding and facilitate combined analysis. Findings offer a detailed look at the 'black box' of how LHWs work with their participants to deliver health messages. LHWs utilized multiple relational strategies, including preparing an environment that enables relationship building, using recognized teaching methods to engage learners and co-learners as well as using humor and employing culturally specific strategies such as hierarchical forms of address to create trust. Future research will assess the effectiveness of LHW techniques, thus enhancing the potential of LHW interventions to promote health among underserved populations., (© The Author (2018). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Direct acting antiviral (DAA) treatments may reduce the elevated α fetoprotein (AFP), but data on how these treatments affect elevated AFP in patients with chronic hepatitis C (CHC) remain insufficient. In the present study, the frequency of baseline AFP elevations and their related factors, AFP dynamics during and after DAA treatment, and factors associated with AFP reduction was assessed. This retrospective study included 141 patients with CHC without hepatocellular carcinoma who received DAA and achieved sustained virological response. The details are as follows: mean post-treatment follow-up was 99 weeks (12-213); mean age, 57.8 years old; 52%, males; 79%, genotype (GT) 1; and 47%, cirrhosis. Pre-treatment AFP elevation (> 5.5 ng/mL) was seen in 48.2% patients. On multivariate analysis, baseline AFP > 5.5 was associated with the presence of cirrhosis (P =0.001), coexisting non-alcoholic steatohepatitis (NASH) (P = 0.035), and GT 1 (P = 0.029). AFP normalization was seen in 28.2% patients at treatment week 2, in 52% at the end of treatment, and in 73.4% at the end of follow-up. Post-treatment week 24 AFP normalization was associated with the absence of cirrhosis (P = 0.003), Child-Pugh score < 6 (P = 0.015), and baseline AFP < 10 (P = 0.015). AFP elevation is common in patients with CHC and independently associated with NASH, cirrhosis, and GT 1. DAA treatment resulted in AFP normalization as early as treatment week 2. Post-treatment week 24 AFP normalization is independently associated with the absence of cirrhosis, Child-Pugh score < 6, and baseline AFP < 10.

Aim: To describe racial/ethnic differences in treatment and survival among liver cancer patients in a population-based cancer registry., Methods: Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White (White, n = 12710), Hispanic ( n = 8500), Chinese ( n = 2723), non-Hispanic Black (Black, n = 2609), Vietnamese ( n = 2063), Filipino ( n = 1479), Korean ( n = 1099), Japanese ( n = 658), American Indian/Alaskan Native (AIAN, n = 281), Laotian/Hmong ( n = 244), Cambodian ( n = 233), South Asian ( n = 190), Hawai`ian/Pacific Islander ( n = 172), Thai ( n = 95), and Other Asian ( n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality., Results: After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio (OR) = 0.30, 95%CI: 0.17-0.53], Cambodian (OR = 0.65, 95%CI: 0.45-0.96), AIAN (OR = 0.66, 95%CI: 0.46-0.93), Black (OR = 0.76, 95%CI: 0.67-0.86), and Hispanic (OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese (OR = 1.58, 95%CI: 1.42-1.77), Koreans (OR = 1.45, 95%CI: 1.24-1.70), Japanese (OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese (OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio (HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians (HR = 1.35, 95%CI: 1.16-1.58), and Blacks (HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese (HR = 0.82, 95%CI: 0.77-0.86), Filipinos (HR = 0.84, 95%CI: 0.78-0.90), Vietnamese (HR = 0.85, 95%CI: 0.80-0.90), Koreans (HR = 0.90, 95%CI: 0.83-0.97), and Hispanics (HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality., Conclusion: Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities., Competing Interests: Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Objectives: To determine the effectiveness of a statewide telephone service in identifying low-income women at risk for hereditary breast and ovarian cancer and referring them to free genetic counseling., Methods: From June 2010 through August 2011, eligible callers to California's toll-free breast and cervical cancer telephone service were screened for their family histories of breast and ovarian cancer. High-risk women were identified and called for a baseline survey and randomization to an immediate offer of genetic counseling or a mailed brochure on how to obtain counseling. Clinic records were used to assess receipt of genetic counseling after 2 months., Results: Among 1212 eligible callers, 709 (58.5%) agreed to answer family history questions; 102 (14%) were at high risk (25% Hispanic, 46% White, 10% Black, 16% Asian, 3% of other racial/ethnic backgrounds). Of the high-risk women offered an immediate appointment, 39% received counseling during the intervention period, as compared with 4.5% of those receiving the brochure., Conclusions: A public health approach to the rare but serious risk of hereditary breast and ovarian cancer can be successful when integrated into the efforts of existing safety net organizations.

Background: Enrollment of minorities in clinical trials remains low. Through a California population-based study of men with early stage prostate cancer, we examined the relationships between race/ethnicity and 1) attitudes, 2) knowledge and 3) willingness to participate in clinical trials., Methods: From November 2011-November 2012, we identified all incident cases of prostate cancer in African American, Latino, and Asian American men ages 18-75 years, and a random sample of white men diagnosed in 2008, through the California Cancer Registry, living within 60 miles of a site offering ≥ 1 clinical trial. Participants completed a 30-min telephone interview in English, Spanish, or Chinese. In this cross-sectional population-based study, multivariable logistic regression was used to estimate associations between race/ethnicity and 1) attitudes, 2) knowledge and 3) willingness to participate., Results: Of 855 participants, 52% were ≥ 65 years, 42% were white, 24% Latino, 19% African American and 15% Asian American. The majority (81%) had medium-to-high health literacy. Compared to non-Latino white men, African American men were less likely to have above average knowledge of clinical trials (OR=0.55; CI=0.35-0.86), as were Asian American (OR=0.55; CI=0.33-0.93) and Latino men (OR=0.30; CI=0.18-0.48). There were no racial/ethnic differences in willingness to participate. The attitude that "researchers are the main beneficiaries" was negatively associated with willingness (OR=0.63; CI=0.43-0.93); the attitude that "patients are the main beneficiaries" was positively associated with willingness to participate (OR=1.57; CI=1.07-2.29)., Conclusions: Men with early stage prostate cancer are willing to take part in clinical trials and this willingness does not vary by race/ethnicity., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Hepatitis B (HBV) represents a significant health disparity among medically underserved Asian and Hawaiian/Pacific Islander (API) populations. Studies evaluating adherence to HBV screening and vaccination guidelines in this population are limited., Objective: The purpose of this study was to evaluate HBV screening and vaccination practices using both provider self-report and patient records., Design: Medical records for 20,574 API adults were reviewed retrospectively and primary care providers were surveyed to evaluate rates and adherence to HBV screening and vaccination guidelines., Participants: The study included primary care providers and their adult API patients in the San Francisco safety-net healthcare system., Main Measures: Patient, practice, and provider factors, as well as HBV screening and vaccination practices, were assessed using provider survey constructs and patient laboratory and clinical data. Generalized linear mixed models and multivariate logistic regression analyses were used to identify factors associated with recommended HBV screening and vaccination., Key Results: The mean age of patients was 52 years, and 63.4 % of patients were female. Only 61.5 % underwent HBV testing, and 47.4 % of HBV-susceptible patients were vaccinated. Of 148 (44.8 %) responding providers, most were knowledgeable and had a favorable attitude towards screening, but 43.2 % were unfamiliar with HBV guidelines. HBV screening was positively associated with favorable provider attitude score (OR per unit 1.80, 95 % CI 1.18-2.74) and negatively associated with female patient sex (OR 0.82, 95 % CI 0.73-0.92), a higher number of clinic patients per week (OR per 20 patients 0.46, 95 % CI 0.28-0.76), and provider barrier score (OR per unit 0.45, 95 % CI 0.24-0.87). HBV vaccination was negatively associated with provider barrier score (OR per unit 0.48, 95 % CI 0.25-0.91)., Conclusions: Rates of HBV screening and vaccination of API patients in this safety-net system are suboptimal, and provider factors play a significant role. Efforts to cultivate positive attitudes among providers and expand healthcare system resources to reduce provider barriers to HBV care are warranted.

Hepatitis B disproportionately affects Asian Americans. Because outreach to promote testing and vaccination can be intensive and costly, we assessed the feasibility of an efficient strategy to identify Asian Americans at risk. Prior research with California's statewide toll-free phone service where low-income women call for free cancer screening found 50% of English-and Spanish-speaking callers were willing to participate in a study on health topics other than cancer screening. The current study ascertained whether Asian Americans could be recruited. Among 200 eligible callers, 50% agreed to take part (95% confidence interval 43%-57%), a rate comparable to our previous study. Subsequent qualitative interviews revealed that receptivity to recruitment was due to trust in the phone service and women's need for health services and information. This was a relatively low-intensity intervention in that, on average, only five minutes additional call time was required to identify women at risk and provide a brief educational message. Underserved women from diverse backgrounds may be reached in large numbers through existing communication channels.

Smoking prevalence among Vietnamese American males remains higher than the U.S. general population. This study examined the associations of individual and family factors with quit intention among Vietnamese male smokers in California to guide intervention development to reduce their smoking prevalence. Data for Vietnamese male current smokers (n=234) in the 2008 California Vietnamese Adult Tobacco Use Survey (N=1101 males) were analyzed to describe quit intention and previous quit attempts. One-third of Vietnamese male smokers (33%) had no intention to quit at any time, 36% intended to quit soon (in the next 30 days), and 31% intended to quit later (beyond the next 30 days). Half (51.7%) of the sample was in "precontemplation," indicating no intention to quit within 6 months. Many (71%) had made a serious quit attempt in the past year, but 68% of those who tried to quit used no cessation assistance. Multivariate logistic regression adjusting for age, depression, smoking intensity, nicotine dependence, health knowledge, children in the household and home smoking ban revealed that having smoking-related family conflicts and a quit attempt in the past year with or without assistance were independently associated with an intention to quit either in the next 30 days or later. Higher education was associated with no intention to quit. Findings underscore the importance of designing strategic interventions that meet the needs of smokers at both individual and family levels to promote quit intention and to facilitate successful quitting in this population., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

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.

Objectives: We examined trends in smoking prevalence from 2002 through 2006 in 4 Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) intervention., Methods: Annual survey data from 2002 through 2006 were gathered in 4 REACH Asian communities. Trends in the age-standardized prevalence of current smoking for men in 2 Vietnamese communities, 1 Cambodian community, and 1 Asian American/Pacific Islander (API) community were examined and compared with nationwide US and state-specific data from the Behavioral Risk Factor Surveillance System., Results: Prevalence of current smoking decreased dramatically among men in REACH communities. The reduction rate was significantly greater than that observed in the general US or API male population, and it was greater than reduction rates observed in the states in which REACH communities were located. There was little change in the quit ratio of men at the state and national levels, but there was a significant increase in quit ratios in the REACH communities, indicating increases in the proportions of smokers who had quit smoking., Conclusions: Smoking prevalence decreased in Asian communities served by the REACH project, and these decreases were larger than nationwide decreases in smoking prevalence observed for the same period. However, disparities in smoking prevalence remain a concern among Cambodian men and non-English-speaking Vietnamese men; these subgroups continue to smoke at a higher rate than do men nationwide.

Mitigating the unequal burden of cancer often involves conducting community-based trials to develop effective intervention strategies to promote cancer-related health behaviors. However, this is challenging due to the simultaneous influence of numerous factors, at multiple levels in the socio-ecological context, on health behavior. A sound conceptual framework can bring order to this complex environment and provide a roadmap for systematically addressing the multiple determinants of the behavior in question. This paper describes the application of The Health Behavior Framework, an integrative conceptual model, in an ongoing Program Project, "Liver Cancer Control Interventions for Asian-Americans." The Framework has been integral to shaping all aspects of the three component research trials from selection of the study designs to development of the interventions and data collection instruments. We advocate universal adoption of theory into community-based intervention research as a way to accelerate our ability to develop effective interventions and facilitate synthesis of study results across populations and behavioral outcomes: critical steps in advancing the field of health disparities research., (Copyright 2009 The Institute For Cancer Prevention. Published by Elsevier Inc. All rights reserved.)

Introduction: Asian Americans, along with other ethnic minorities, have been described to be more likely than Whites to be light and intermittent smokers. Characterizing Asian American smoking behavior accurately on a population level requires oversampling groups of different national origin and including non-English-speaking participants., Methods: We analyzed the California Health Interview Survey to compare moderate/heavy (> or =10 cigarettes/day), light (0-9 cigarettes/day), and intermittent (not daily) smoking patterns in Asian Americans with those of Whites. We also examined whether social and demographic factors that had been associated with Asian American smoking prevalence also were associated with light and intermittent smoking patterns in each of the national origin groups., Results: Most Asian American smokers were more likely to be light and intermittent smokers (range = 36.6%-61.5% for men and 29.9%-81.5% for women) compared with Whites, with lower mean cigarette consumption. Asian American light and intermittent smokers were more likely than moderate/heavy smokers to be women (odds ratio [OR] = 2.12, 95% CI = 1.14-3.94), highly educated (OR = 3.16, 95% CI = 1.21-8.28), not Korean (compared with Chinese; OR = 0.32, 95% CI = 0.13-0.79), and bilingual speakers with high English language proficiency compared with English-only speakers (OR = 2.83, 95% CI = 1.21-6.84). Asian American intermittent smokers were more likely than daily smokers to be women (OR = 2.25, 95% CI = 1.08-4.72) and to have lower household income., Discussion: The predominance of Asian American light and intermittent smoking patterns has important implications for developing effective tobacco control outreach. Further studies are needed to elaborate the relationship between biological, psychosocial, and cultural factors influencing Asian American smoking intensity.

Background: Higher acculturation is associated with Asian-American smoking prevalence decreasing in men and increasing in women. Asian immigrants in California are significantly more likely than their counterparts in Asia to have quit smoking. Smoke-free environments may mediate this acculturation effect because such environments are not widespread in Asia., Methods: In 2006, Asian-American current and former smokers were analyzed using the 2003 California Health Interview Survey. A multivariate logistic regression analysis examined how the interaction between having a smoke-free-home rule and immigrating to the U.S. is associated with status as a former smoker and lighter smoking., Results: For recent Asian immigrants (<10 years in the U.S.) and longer-term residents (born/>or=10 years in the U.S.), having a smoke-free-home rule was associated with status as a former smoker (OR 14.19, 95% CI=4.46, 45.12; OR 3.25, 95% CI=1.79, 5.90, respectively). This association was stronger for recent immigrants (p=0.02). Having a smoke-free-home rule was associated with lighter smoking only for longer-term residents (OR 5.37, 95% CI=2.79, 10.31)., Conclusions: For Asian Americans, smoke-free-home rules are associated with status as a former smoker, particularly among recent immigrants, and lighter smoking in long-term residents. Interventions encouraging Asian Americans to adopt smoke-free-home rules should be evaluated.

The use of tobacco remains a significant public health concern among Asian American (AA) adolescents. Understanding the factors that affect smoking progression among Chinese and Vietnamese adolescents in particular, may help in illuminating potential interventions that can be implemented to maximize scarce programming and resources. This study is a longitudinal cohort study with data collected in California via telephone over a two-year period. 1,270 Chinese and Vietnamese American adolescents were recruited via telephone listings from one southern and four northern California counties. Main outcomes were smoking susceptibility and change in smoking status. Examination of these adolescents indicated that in both groups: boys were more likely than girls to become susceptible to smoking, risk behaviors were associated with becoming smokers, having been susceptible at baseline was associated with susceptibility and smoking at follow-up, and the influence of friends was a predictor of susceptibility and smoking.

In California, 641 Chinese and 629 Vietnamese age 12-17 participated in a longitudinal telephone study from 1999 to 2001. Four attitude scales were constructed: acceptance of smokers, addictive nature of smoking, psychosocial reasons to smoke, and gender roles and smoking. Vietnamese American adolescents had more pro-smoking attitudes than Chinese American adolescents. Male gender, having friends who smoked, and baseline smoking were associated with smoking susceptibility at follow-up. Those factors, U.S. birthplace, and the acceptance and psychosocial scales were associated with smoking. Smoking prevention efforts targeting Chinese and Vietnamese American adolescents should focus on gender, birthplace, peer smoking, and attitudes.

Among Asian Americans, colorectal cancer (CRC) is the second most commonly diagnosed cancer, and it is the third highest cause of cancer-related mortality. The 2001 California Health Interview Survey (CHIS 2001) was used to examine 1) CRC screening rates between different Asian-American ethnic groups compared with non-Latino whites and 2) factors related to CRC screening. The CHIS 2001 was a population-based telephone survey that was conducted in California. Responses about CRC screening were analyzed from 1771 Asian Americans age 50 years and older (Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese). The authors examined two CRC screening outcomes: individuals who ever had CRC screening and individuals who were up to date for CRC screening. For CRC screening, fecal occult blood test (FOBT), sigmoidoscopy/colonoscopy, and any other form of screening were examined. CRC screening of any kind was low in all populations, and Koreans had the lowest rate (49%). Multivariate analysis revealed that, compared with non-Latino whites, Koreans were less likely to undergo FOBT (odds ratio [OR], 0.40; 95% confidence interval [95% CI], 0.25-0.62), and Filipinos were the least likely to undergo sigmoidoscopy/colonoscopy (OR, 0.62; 95% CI, 0.44-0.88) or to be up to date with screening (OR, 0.68; 95% CI, 0.48-0.97). Asian Americans were less likely to undergo screening if they were older, male, less educated, recent immigrants, living with >or= 3 individuals, poor, or uninsured. Asian-American populations, especially Koreans and Filipinos, are under-screened for CRC. Outreach efforts could be more focused on helping Asian Americans to understand the importance of CRC screening, providing accurate information in different Asian languages. Other strategies for increasing CRC screening may include using a more family-centered approach and using qualified translators., (Cancer 2005. (c) 2005 American Cancer Society.)

Purpose: To examine the prevalence of unhealthy behaviors among a cohort of Vietnamese adolescents in California; to examine the relationship between these behaviors and school-related variables (school performance, educational risk behaviors, higher-education aspirations, and participation in extracurricular activities); and to assess the differences that may exist between males and females with regard to these factors., Methods: We conducted telephone interviews with 783 Vietnamese adolescents, aged 12-17 years, recruited through telephone listings from four California counties where large Vietnamese populations reside: San Francisco, Santa Clara, Los Angeles, and Orange. Of the 783 completed interviews, 60.8% were conducted in English and 39.2% in Vietnamese. The main outcome measure is a health risk behavior scale that includes adolescents' reports of ever smoking a cigarette, sedentary vs. active lifestyle, consumption of fruits and vegetables, consumption of foods high in fat, ever drinking alcohol, and ever engaging in sexual behavior. Multiple regression analyses were employed to estimate the association among the demographic variables, acculturation, school performance, aspirations, extracurricular activities, and the overall health risk., Results: Females were significantly more sedentary than males. Over one-quarter (29%) of the females reported not having participated in vigorous physical activity on 3 or more days per week, compared with just 18% of the males. Most adolescents reported they had never tried cigarettes (84%), never used alcohol (77%), and never had sex (97%). Males were more likely than females to report a higher frequency of experimentation with smoking and drinking. Overall, school performance and participation in extracurricular activities were significantly related to the health risk behavior scale. Adolescents who demonstrated at least one educational risk (ever skipped school or ever sent out of the classroom) were more likely to engage in other risky behaviors. Also, older and more acculturated adolescents were at increased risk of engaging in health-compromising behaviors. Analysis by gender revealed that the variables age, educational risk, and chance of attending college were all related to health risk behavior for both males and females. Among the boys, those who reported achieving an average grade of B or better had a decreased risk of engaging in health-compromising behaviors; however, neither extracurricular activities nor acculturation was related to health-compromising behaviors in boys. Among the girls, the reverse was true: lack of participation in extracurricular activities was related to health-compromising behaviors, whereas grades were not a significant risk factor., Conclusions: Among sampled Vietnamese adolescents in California, health risk behaviors are common and inversely related to some school performance indicators. Using these indicators to identify high-risk groups could allow targeted educational programs or interventions for the mitigation of health-compromising behaviors.

Background: Screening mammogram and Pap smear rates are lower for women in underserved racial and ethnic groups, yet may be overestimated due to reliance on patients' self-reports. The purpose of this study was to determine accuracy of self-reports of mammograms and Pap smears in a multiethnic, multilingual population of African American, Latina, Chinese, Filipina, and White women residing in low-income census tracts of Alameda County, California., Methods: Following a baseline telephone survey of 1,464 women regarding receipt of mammograms and Pap smears, we examined computerized and written medical records to validate the dates and locations of tests reported by women., Results: Of 1,464 subjects, 94.9% reported having had a Pap smear, and 87% reported having had a mammogram. For Pap smears, in a subsample of 448 cases, we validated only 69.4% of the women's self-reports, and for mammography, in a subsample of 846 women, we validated only 75.4% of the self-reports. Validation rates differed significantly by ethnicity and site of care for both Pap smears and mammograms., Conclusions: Population estimates of breast and cervical cancer screening rates based upon patient self-reports need to be adjusted downward, by as much as one-quarter to one-third, for low-income, ethnic women.

The authors provided psychiatric consultation to medical personnel in charge of a Vietnamese refugee camp in California. Although the emergency measures that supplied clothing, food, shelter, and medical care to nearly 60,000 refugees were immensely successful, consultation was requested to assist with selected mental health problems. The recommendations of the consulting team were related to the stage of camp development: early recommendations concerned easing adaptation to the camp setting; later efforts included creating a psychiatric crisis clinic and carrying out a mental health survey on a random sample of refugees. The results of this survey helped camp directors to understand how refugees responded to the camp experience.