Public Health Model for Prevention of Liver Cancer Among Asian Americans

Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 704, Baltimore, MD 21205, USA.
Journal of Community Health (Impact Factor: 1.28). 09/2008; 33(4):199-205. DOI: 10.1007/s10900-008-9091-y
Source: PubMed


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.

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Available from: Hee-Soon Juon, Dec 12, 2013
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    • "Some US-based programs were promoted and supported by faith-based organizations [36, 39, 40], and some were offered by clinical groups offering education and testing at community events [30, 43, 45]; while some screened all participants (in Miami, FL and Houston, TX) [43, 44], others based testing decision on risk factors (Colorado) [30]. "
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    ABSTRACT: Introduction Chronic hepatitis B (CHB) affects over 350 million people worldwide and can lead to life-threatening complications, including liver failure and hepatocellular cancer (HCC). Modern antiviral therapies could stem the rising tide of hepatitis B-related HCC, provided that individuals and populations at risk can be reliably identified through hepatitis B screening and appropriately linked to care. Opportunistic disease screening cannot deliver population-level outcomes, given the large number of undiagnosed people, but they may be achievable through well-organized and targeted community-based screening interventions. Material and methods This review summarizes the experience with community-based CHB screening programs published in the English-language literature over the last 30 years. Results They include experiences from Taiwan, the USA, The Netherlands, New Zealand, and Australia. Despite great variability in program setting and design, successful programs shared common features, including effective community engagement incorporating the target population’s cultural values and the ability to provide low-cost or free access to care, including antiviral treatment. Conclusion While many questions still remain about the best funding mechanisms to ensure program sustainability and what the most effective strategies are to ensure program reach, linkage to care, and access to treatment, the evidence suggests scope for cautious optimism. A number of successful, large-scale initiatives in the USA, Asia–Pacific, and Europe demonstrated the feasibility of community-based interventions in effectively screening large numbers of people with CHB. By providing an effective mechanism for community outreach, scaling up these interventions could deliver population-level outcomes in liver cancer prevention relevant for many countries with a large burden of disease.
    Full-text · Article · Oct 2014 · Hepatology International
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    • "thus reduce the disparity in liver cancer rates (Chen, 2005; Coronado et al., 2007; Hu, 2008; Juon et al., 2008; Kreps & Sparks, 2008; Ma, Shive, et al., 2007; Ma et al., 2008; T. T. Nguyen et al., 2010; Wu et al., 2007). A photonovel might be a culturally appropriate educational material to promote liver cancer prevention among Asian Americans because it is an educational storybook that incorporates culturally appropriate components, such as photos of faces familiar to the community featured as main characters of the story, daily dialogues used by the community people, and storylines drawn from common life experiences in the community. "
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    ABSTRACT: Asian Americans have disproportionately high prevalence of chronic hepatitis B virus infection in the United States and yet have low hepatitis B screening and vaccination rates. We developed three photonovels specifically designed for Chinese, Korean, and Vietnamese Americans and evaluated their cultural relevance and effectiveness in increasing self-efficacy and intention to have a hepatitis B screening. Photonovels' storylines were drawn from focus group themes, and lay people from each community played actors/actresses in community settings. Photonovels were pilot tested, revised, and distributed in a hepatitis B intervention. A two-page process evaluation questionnaire was mailed to 441 participants after one month. Descriptive analysis and multiple logistic regressions were conducted to assess the overall evaluation of the photonovel and to assess factors associated with self-efficacy and intention to have hepatitis B screening. Eighty-four percent of participants responded to the process evaluation. The majority of participants either strongly agreed or agreed that the cancer information in the photonovel was helpful, the story was written by someone who knows the community, and the information was easy to understand. Overall, more than 80% of them thought this photonovel was a good teaching tool. Favorable evaluation of the photonovel was associated with both having intention and self-efficacy to have a hepatitis B screening in the next 5 months. When stratified by level of education and income, the associations were stronger among the lower income and education groups. Culturally appropriate photonovels are useful tools to promote hepatitis B screening among Asian Americans, especially among those of lower socioeconomic status.
    Full-text · Article · Jan 2013 · Health Education & Behavior
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    • "We took this opportunity to describe and report our findings of this survey. Our paper adds to the limited literature on faith-based health initiatives among Asian American populations (Juon et al., 2008; Ma et al., 2009; Teng and Friedman 2009; Jo et al., 2010; Kang and Romo 2010). We report interest in health promotion programs that could be offered at Korean American churches and preferences with respect to content and format of these programs among English and Korean-speaking retreat attendees. "
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    ABSTRACT: Little is known about interest in faith-based health promotion programs among Asian American populations. Among the Christian denominations, the Seventh-day Adventist (SDA) church is known to place a strong doctrinal emphasis on health. To understand appropriate ways to develop and implement health promotion programs and to conduct research among Korean American SDAs. We collaborated with the North American Division of Korean SDA Churches which sponsors annual week-long religious retreats for their church members. We developed and administered a 10-page questionnaire at their 2009 retreat in order to assess socio-demographic and church characteristics, religiosity, perceived relationship between health and religion, and interest and preferences for church-based health promotion programs. Overall, 223 participants completed our survey (123 in Korean and 100 in English). The sample consisted of regular churchgoers who were involved in a variety of helping activities, and many holding leadership positions in their home churches. The vast majority was interested in receiving health information at church (80%) in the form of seminars, cooking classes and workshops (50-60%). Fewer respondents were interested in support groups (27%). Some interests and preferences differed between English and Korean language groups. Korean American SDA church retreat participants from a large geographic area are very interested in receiving health information and promoting health at their churches and can potentially serve as "agents of influence" in their respective communities.
    Full-text · Article · Jun 2012 · Asian Pacific journal of cancer prevention: APJCP
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