Factors Associated with Hepatitis B Testing Among Vietnamese Americans
Chronic hepatitis B and hepatitis B-associated liver cancer is a major health disparity among Vietnamese Americans, who have a chronic hepatitis B prevalence rate of 7–14% and an incidence rate for liver cancer six times that of non-Latino whites.
Describe factors associated with hepatitis B testing among Vietnamese Americans.
A population-based telephone survey conducted in 2007–2008.
Vietnamese Americans age 18–64 and living in the Northern California and Washington, DC areas (N = 1,704).
Variables included self-reports of sociodemographics, health care factors, and hepatitis B-related behaviors, knowledge, beliefs, and communication with others. The main outcome variable was self-reported receipt of hepatitis B testing.
The cooperation rate was 63.1% and the response rate was 27.4%. Only 62% of respondents reported having received a hepatitis B test and 26%, hepatitis B vaccination. Only 54% knew that hepatitis B could be transmitted by sexual intercourse. In multivariable analyses, factors negatively associated with testing included: age 30–49 years, US residence for >10 years, less Vietnamese fluency, lower income, and believing that hepatitis B can be deadly. Factors positively associated with testing included: Northern California residence, having had hepatitis B vaccination, having discussed hepatitis B with family/friends, and employer requested testing. Physician recommendation of hepatitis B testing (OR 4.46, 95% CI 3.36, 5.93) and respondent's request for hepatitis B testing (OR 8.37, 95% CI 5.95, 11.78) were strongly associated with test receipt.
Self-reports of hepatitis B testing among Vietnamese Americans remain unacceptably low. Physician recommendation and patient request were the factors most strongly associated with test receipt. A comprehensive effort is needed to promote hepatitis B testing in this population, including culturally-targeted community outreach, increased access to testing, and physician education.
- Weiss RA, McMichael AJ. Social and environmental risk factors in the emergence of infectious diseases. Nat Med. 2004;10(12 Suppl):S70–6. CrossRef
- Institute of Medicine. Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. Washington, DC: The National Academies Press; 2010.
- Kemp W, Pianko S, Nguyen S, Bailey MJ, Roberts SK. Survival in hepatocellular carcinoma: impact of screening and etiology of liver disease. J Gastroenterol Hepatol. 2005;20(6):873–81. CrossRef
- Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004;130(7):417–22. CrossRef
- Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50(3):661–2. CrossRef
- Centers for Disease Control and Prevention. Notice to readers: national hepatitis B initiative for Asian Americans/Native Hawaiian and other Pacific Islanders. Morb Mortal Wkly Rep. 2009;58(18):503.
- Hsieh CC, Tzonou A, Zavitsanos X, Kaklamani E, Lan SJ, Trichopoulos D. Age at first establishment of chronic hepatitis B virus infection and hepatocellular carcinoma risk. a birth order study. Am J Epidemiol. 1992;136(9):1115–21.
- Hwang SJ, Tong MJ, Lai PP, Ko ES, Co RL, Chien D, Kuo G. Evaluation of hepatitis B and C viral markers: clinical significance in Asian and Caucasian patients with hepatocellular carcinoma in the United States of America. J Gastroenterol Hepatol. 1996;11(10):949–54.
- Lin SY, Chang ET, So SK. Why we should routinely screen Asian American adults for hepatitis B: a cross-sectional study of Asians in California. Hepatology. 2007;46(4):1034–40. CrossRef
- Reeves TJ, Bennett CE. The Asian and Pacific Islander Population in the United States. Washington, DC: Census Bureau. Current Population Reports; 2003:20–540.
- U.S. Census Bureau. The American community-Asians: 2004. the American community survey reports. Washington, DC: Department of Commerce; 2007.
- McPhee SJ. Caring for a 70-year-old Vietnamese woman. JAMA. 2002;287(4):495–504. CrossRef
- Goodman RA, Sikes RK. Hepatitis B markers in Southeast Asian refugees [letter]. JAMA. 1984;251(16):2086. CrossRef
- Klontz KC. A program to provide hepatitis B immunoprophylaxis to infants born to HBsAg-positive Asian and Pacific Island women. West J Med. 1987;146(2):195–9.
- Centers for Disease Control and Prevention. Screening for hepatitis B virus infection among refugees arriving in the United States, 1979-1991. MMWR Morb Mortal Wkly Rep. 1991;40(45):784–6.
- Miller BA, Chu KC, Hankey BF, Ries LA. Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U S. Cancer Causes Control. 2008;19(3):227–56. CrossRef
- U.S. Census Bureau. American Community Survey. 201. Selected population profile in the United States. Population group: Vietnamese alone. Data Set: 2005-2007 American Community Survey 2003-year estimates. Available at: http://factfinder.census.gov. Accessed January, 2010.
- Swallen KC, Glaser SL, Stewart SL, West DW, Jenkins CN, McPhee SJ. Accuracy of racial classification of Vietnamese patients in a population-based cancer registry. Ethn Dis. 1998;8(2):218–27.
- Lauderdale DS, Kestenbaum B. Mortality rates of elderly Asian American populations based on Medicare and Social Security data. Demography. 2002;39(3):529–40. CrossRef
- Taylor VM, Nguyen TT, Hoai Do H, Li L, Yasui Y. Lessons learned from the application of a Vietnamese surname list for survey research. J Immigr Minor Health. 2009. doi:10.1007/s10903-009-9296-x
- The American Association for Public Opinion Research. Standard definitions: final dispositions of case codes and outcome rates for surveys. 4th ed. Lenexa: AAPOR; 2006.
- Maxwell AE, Bastani R, Chen MS, Jr, Nguyen TT, Stewart SL, Taylor VM. Constructing a theoretically-based set of measures for liver cancer control research studies. Prev Med. 2010;50(1–2):68–73.
- Bastani R, Glenn BA, Taylor VM, Chen MS, Jr, Nguyen TT, Stewart SL, Maxwell AE. Integrating theory into community interventions to reduce liver cancer disparities: the health behavior framework. Prev Med. 2010;50(1–2):63–7.
- Taylor VM, Yasui Y, Burke N, Nguyen T, Chen A, Acorda E, Choe JH, Jackson JC. Hepatitis B testing among Vietnamese American men. Cancer Detec Prev. 2004;28(3):170–7. CrossRef
- Taylor VM, Yasui Y, Burke N, Choe JH, Acorda E, Jackson JJC. Hepatitis B knowledge and testing among Vietnamese-American women. Ethn Dis. Autumn. 2005;15(4):761–7.
- Grytdal SP, Liao Y, Chen R, Garvin CC, Grigg-Saito D, Kagawa-Singer M, Liang S, McPhee SJ, Nguyen TT, Tran JH, Gallagher KM. Hepatitis B testing and vaccination among Vietnamese- and Cambodian-Americans. J Commun Health. 2009;34(3):173–80. CrossRef
- Taylor VM, Hislop TG, Tu SP, Teh C, Acorda E, Yip MP, Woodall E, Yasui Y. Evaluation of a Hepatitis B lay health worker intervention for Chinese Americans and Canadians. J Commun Health. 2009;34(3):1625–72. CrossRef
- McPhee SJ, Bird JA, Davis T, Ha NT, Jenkins CN, Le B. Barriers to breast and cervical cancer screening among Vietnamese-American women. Am J Prev Med. 1997;13(3):205–13.
- Nguyen TT, McPhee SJ, Gildengorin G, Nguyen T, Wong C, Lai KQ, Lam H, Mock J, Luong TN, Bui-Tong N, Ha-Iaconis T. Papanicolaou testing among Vietnamese Americans: results of a multifaceted intervention. Am J Prev Med. 2006;31(1):1–9. CrossRef
- Hipgrave DB, Nguyen TV, Vu MH, Hoang TL, Do TD, Tran NT, Jolley D, Maynard JE, Biggs BA. Hepatitis B infection in rural Vietnam and the implications for a national program of infant immunization. Am J Trop Med Hyg. 2003;69(3):288–94.
- Centers for Disease Control and Prevention. Cost of vaccinating refugees overseas versus after arrival in the United States, 2005. Morb Mortal Wkly Rep. 2008;57(9):229–32.
- Bastani R, Glenn BA, Maxwell AE, Jo AM. Hepatitis B testing for liver cancer control among Korean Americans. Ethn Dis. 2007;17(2):365–73.
- Ma GX, Fang CY, Shive SE, Toubbeh J, Tan Y, Siu P. Risk perceptions and barriers to Hepatitis B screening and vaccination among Vietnamese immigrants. J Immigr Minor Health. 2007;9(3):213–20. CrossRef
- Coronado GD, Taylor VM, Tu SP, Yasui Y, Acorda E, Woodall E, Yip MP, Li L, Hislop TG. Correlates of hepatitis B testing among Chinese Americans. J Commun Health. 2007;32(6):379–90. CrossRef
- Nguyen TT, McPhee SJ, Nguyen T, Lam T, Mock J. Predictors of cervical Pap smear screening awareness, intention, and receipt among Vietnamese-American women. Am J Prev Med. 2002;23(3):207–14. CrossRef
- Taylor VM, Yasui Y, Burke N, Nguyen T, Acorda E, Thai H, Qu P, Jackson JC. Pap testing adherence among Vietnamese American women. Cancer Epidemiol Biomark Prev. 2004;13(4):613–9.
- California Health Interview Survey. CHIS 2007 methodology series: report 4 – response rates. Los Angeles: UCLA Center for Health Policy Research; 2009.
- Centers for Disease Control and Prevention. 2007 Behavioral Risk Factor Surveillance System summary data quality report. Available at ftp://ftp.cdc.gov/pub/Data/Brfss/2007SummaryDataQualityReport.pdf, accessed January 18, 2010.
- Nguyen TT, Taylor V, Chen MS Jr, Bastani R, Maxwell AE, McPhee SJ. Hepatitis B awareness, knowledge, and screening among Asian Americans. J Cancer Educ. 2007;22(4):266–72. CrossRef
- Jenkins CN, McPhee SJ, Bird JA, Pham GQ, Nguyen BH, Nguyen T, Lai KQ, Wong C, Davis TB. Effect of a media-led education campaign on breast and cervical cancer screening among Vietnamese-American women. Prev Med. 1999;28(4):395–406. CrossRef
- Nguyen TT, McPhee SJ, Bui-Tong N, Luong TN, Ha-Iaconis T, Nguyen T, Wong C, Lai KQ, Lam H. Community-based participatory research increases cervical cancer screening among Vietnamese-Americans. J Health Care Poor Underserved. 2006;17(2 Suppl):31–54.
- Mock J, McPhee SJ, Nguyen T, Wong C, Doan H, Lai KQ, Nguyen KH, Nguyen TT, Bui-Tong N. Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women. Am J Public Health. 2007;97(9):1693–700. CrossRef
- Nguyen TT, Le G, Nguyen T, Le K, Lai K, Gildengorin G, Tsoh J, Bui-Tong N, McPhee SJ. Breast cancer screening among Vietnamese Americans: a randomized controlled trial of lay health worker outreach. Am J Prev Med. 2009;37(4):306–13. CrossRef
- McPhee SJ, Nguyen T, Euler GL, Mock J, Wong C, Lam T, Nguyen W, Nguyen S, Huynh Ha MQ, Do ST, Buu C. Successful promotion of hepatitis B vaccinations among Vietnamese-American children ages 3 to 18: results of a controlled trial. Pediatrics. 2003;111(6 Pt 1):1278–88. CrossRef
- Hu KQ. Hepatitis B virus (HBV) infection in Asian and Pacific Islander Americans (APIAs): how can we do better for this special population? Am J Gastroenterol. 2008;103(7):1824–33. CrossRef
- Factors Associated with Hepatitis B Testing Among Vietnamese Americans
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Journal of General Internal Medicine
Volume 25, Issue 7 , pp 694-700
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- hepatitis B
- Vietnamese Americans
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- Author Affiliations
- 1. Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- 2. San Francisco State University, San Francisco, CA, USA
- 3. School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- 4. Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- 5. Department of Internal Medicine, University of California, Davis Cancer Center, Davis, CA, USA