Journal of Community Health

, Volume 37, Issue 5, pp 1071–1080 | Cite as

Ethnic Differences in Prevalence and Barriers of HBV Screening and Vaccination Among Asian Americans

  • Carol Strong
  • Sunmin Lee
  • Miho Tanaka
  • Hee-Soon Juon
Original Paper


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.


HBV infection Asian Americans HBV prevalence Health care access barriers 


  1. 1.
    Ganem, D., & Prince, A. M. (2004). Hepatitis B virus infection–natural history and clinical consequences. New England Journal of Medicine, 350(11), 1118–1129.PubMedCrossRefGoogle Scholar
  2. 2.
    Beasley, R. P. (1988). Hepatitis B virus. The major etiology of hepatocellular carcinoma. Cancer, 61(10), 1942–1956.PubMedCrossRefGoogle Scholar
  3. 3.
    McMahon, B. J. (2009). The natural history of chronic hepatitis B virus infection. Hepatology, 49(5 suppl), S45–S55.PubMedCrossRefGoogle Scholar
  4. 4.
    Altekruse, S. F., McGlynn, K. A., & Reichman, M. E. (2009). Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. Journal of Clinical Oncology, 27(9), 1485–1491.PubMedCrossRefGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention (CDC). (2006). Screening for chronic hepatitis B among Asian/Pacific Islander populations–New York City, 2005. MMWR Morbidity Mortality Weekly Report, 55(18), 505–509.Google Scholar
  6. 6.
    Lee, H., Hontz, I., Warner, A., & Park, S. J. (2005). Hepatitis B infection among Asian American Pacific Islanders in the Rocky Mountain area. Applied Nursing Research, 18(1), 2–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Ma, G. X., Shive, S. E., Fang, C. Y., Feng, Z., Parameswaran, L., Pham, A., et al. (2007). Knowledge, attitudes, and behaviors of hepatitis B screening and vaccination and liver cancer risks among vietnamese Americans. Journal of Health Care for the Poor and Underserved, 18(1), 62–73.PubMedCrossRefGoogle Scholar
  8. 8.
    Choe, J. H., Taylor, V. M., Yasui, Y., Burke, N., Nguyen, T., Acorda, E., et al. (2006). Health care access and sociodemographic factors associated with hepatitis B testing in Vietnamese American men. Journal of Immigrant and Minority Health, 8(3), 193–201.PubMedCrossRefGoogle Scholar
  9. 9.
    Taylor, V. M., Jackson, J. C., Chan, N., Kuniyuki, A., & Yasui, Y. (2002). Hepatitis B knowledge and practices among Cambodian American women in Seattle, Washington. Journal of Community Health, 27(3), 151–163.PubMedCrossRefGoogle Scholar
  10. 10.
    Hu, K. Q. (2008). Hepatitis B virus (HBV) infection in Asian and Pacific Islander Americans (APIAs): How can we do better for this special population? American Journal of Gastroenterology, 103(7), 1824–1833.PubMedCrossRefGoogle Scholar
  11. 11.
    Liang, W., Wang, J. H., Chen, M. Y., & Mandelblatt, J. S. (2009). Language use and the receipt of cancer screening recommendations by immigrant Chinese American women. Journal of Womens Health (Larchmt), 18(2), 201–207.CrossRefGoogle Scholar
  12. 12.
    Juon, H.-, Kim, M., Shankar, S., & Han, W. (2004). Predictors of adherence to screening mammography among Korean American women. Preventive Medicine, 39(3), 474–481.PubMedCrossRefGoogle Scholar
  13. 13.
    Coronado, G. D., Taylor, V. M., Tu, S. P., Yasui, Y., Acorda, E., Woodall, E., et al. (2007). Correlates of hepatitis B testing among Chinese Americans. Journal of Community Health, 32(6), 379–390.PubMedCrossRefGoogle Scholar
  14. 14.
    Taylor, V. M., Yasui, Y., Burke, N., Nguyen, T., Chen, A., Acorda, E., et al. (2004). Hepatitis B testing among Vietnamese American men. Cancer Detection and Prevention, 28(3), 170–177.PubMedCrossRefGoogle Scholar
  15. 15.
    Nguyen, T. T., McPhee, S. J., Stewart, S., Gildengorin, G., Zhang, L., Wong, C., et al. (2010). Factors associated with hepatitis B testing among Vietnamese Americans. Journal of General Internal Medicine, 25(7), 694–700.PubMedCrossRefGoogle Scholar
  16. 16.
    Huang, K., & Carrasquillo, O. (2008). The role of citizenship, employment, and socioeconomic characteristics in health insurance coverage among Asian subgroups in the United States. Medical Care, 46(10), 1093–1098.PubMedCrossRefGoogle Scholar
  17. 17.
    Ward, E., Halpern, M., Schrag, N., Cokkinides, V., DeSantis, C., Bandi, P., et al. (2008). Association of insurance with cancer care utilization and outcomes. CA Cancer Journal for Clinicians, 58(1), 9–31.CrossRefGoogle Scholar
  18. 18.
    Taylor, V. M., Yasui, Y., Burke, N., Choe, J. H., Acorda, E., & Jackson, J. C. (2005). Hepatitis B knowledge and testing among Vietnamese-American women. Ethnicity and Disease, 15(4), 761–767.PubMedGoogle Scholar
  19. 19.
    Alter, M. J. (2003). Epidemiology and prevention of hepatitis B. Seminars in Liver Disease, 23(1), 39–46.PubMedCrossRefGoogle Scholar
  20. 20.
    Ayers, J. W., Juon, H. S., Lee, S., & Park, E. (2010). Hepatitis B vaccination prevalence and its predictors among Asian, Pacific Islander, Native American, and multiracial adults in the national health and nutrition examination survey. Journal of Immigrant and Minority Health, 12(6), 847–852.PubMedCrossRefGoogle Scholar
  21. 21.
    Kwong, S. L., Stewart, S. L., Aoki, C. A., & Chen, M. S., Jr. (2010). Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007. Cancer Epidemiology, Biomarkers and Prevention, 19(11), 2747–2757.PubMedCrossRefGoogle Scholar
  22. 22.
    Murakami, H., Van Cuong, N., Huynh, L., & Hipgrave, D. B. (2008). Implementation of and costs associated with providing a birth-dose of hepatitis B vaccine in Viet Nam. Vaccine, 26(11), 1411–1419.PubMedCrossRefGoogle Scholar
  23. 23.
    Centers for Disease Control and Prevention (CDC). (2007). Progress in hepatitis B prevention through universal infant vaccination–China, 1997–2006. MMWR Morbidity and Mortality Weekly Report, 56(18), 441–445.Google Scholar
  24. 24.
    Chen, L., Juon, H. S., & Lee, S. (2011). Acculturation and BMI among Chinese, Korean and Vietnamese adults. Journal of Community Health. doi:10.1007/s10900-011-9476-1.
  25. 25.
    Taylor, V. M., Seng, P., Acorda, E., Sawn, L., & Li, L. (2009). Hepatitis B knowledge and practices among Cambodian immigrants. Journal of Cancer Education, 24(2), 100–104.PubMedCrossRefGoogle Scholar
  26. 26.
    Taylor, V. M., Jackson, J. C., Pineda, M., Pham, P., Fischer, M., & Yasui, Y. (2000). Hepatitis B knowledge among Vietnamese immigrants: Implications for prevention of hepatocellular carcinoma. Journal of Cancer Education, 15(1), 51–55.PubMedGoogle Scholar
  27. 27.
    StataCorp. (2009). Stata Statistical Software. Release 11, 2009.Google Scholar
  28. 28.
    Cohen, C., Holmberg, S. D., McMahon, B. J., Block, J. M., Brosgart, C. L., Gish, R. G., et al. (2011). Is chronic hepatitis B being undertreated in the United States? Journal of Viral Hepatitis, 18(6), 377–383.PubMedCrossRefGoogle Scholar
  29. 29.
    Lai, A. C., & Salili, F. (1996). Stress in parents whose children are hepatitis B virus (HBV) carriers: a comparison of three groups in Guangzhou, China. Child: Care, Health and Development, 22(6), 381–396.CrossRefGoogle Scholar
  30. 30.
    Juan, S. (2009). Hepatitis B tests for jobs set to stop. Available at: Accessed 5/11, 2011.
  31. 31.
    Juan, S. (2011). Stop screening would-be workers. Available at: Accessed 5/11, 2011.
  32. 32.
    Lesmana, L., Leung, N., Mahachai, V., Phiet, P., Suh, D., Yao, G., et al. (2006). Hepatitis B: Overview of the burden of disease in the Asia-Pacific region. Liver International, 26, 3–10.CrossRefGoogle Scholar
  33. 33.
    Chen, J. Y., Swonger, S., Kominski, G., Liu, H., Lee, J. E., & Diamant, A. (2009). Cost-effectiveness of insuring the uninsured: The case of Korean American children. Medical Decision Making, 29(1), 51–60.PubMedCrossRefGoogle Scholar
  34. 34.
    Daley, M. F., Hennessey, K. A., Weinbaum, C. M., Stokley, S., Hurley, L. P., Crane, L. A., et al. (2009). Physician practices regarding adult hepatitis B vaccination: A national survey. American Journal of Prevention and Medicine, 36(6), 491–496.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Carol Strong
    • 1
  • Sunmin Lee
    • 2
  • Miho Tanaka
    • 3
  • Hee-Soon Juon
    • 3
  1. 1.Institute of SociologyAcademia SinicaNankangTaiwan
  2. 2.Department of Epidemiology and BiostatisticsUniversity of Maryland School of Public HealthCollege ParkUSA
  3. 3.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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