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Evaluation of a Hepatitis B Lay Health Worker Intervention for Chinese Americans and Canadians

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Hepatitis B testing is recommended for immigrants from countries where hepatitis B infection is endemic. However, only about one-half of Chinese in North America have received hepatitis B testing. We conducted a randomized controlled trial to evaluate the effectiveness of a hepatitis B lay health worker intervention for Chinese Americans/Canadians. Four hundred and sixty individuals who had never been tested for hepatitis B were identified from community-based surveys of Chinese conducted in Seattle, Washington, and Vancouver, British Columbia. These individuals were randomly assigned to receive a hepatitis B lay health worker intervention or a direct mailing of physical activity educational materials. Follow-up surveys were completed 6 months after randomization. Self-reported hepatitis B testing was verified through medical records review. A total of 319 individuals responded to the follow-up survey (69% response rate). Medical records data verified hepatitis B testing since randomization for 9 (6%) of the 142 experimental group participants and 3 (2%) of the 177 control group participants (P = 0.04). At follow-up, a higher proportion of individuals in the experimental arm than individuals in the control arm knew that hepatitis B can be spread by razors (P < 0.001) and during sexual intercourse (P = 0.07). Our findings suggest that lay health worker interventions can impact hepatitis B-related knowledge. However, our hepatitis B lay health worker intervention had a very limited impact on hepatitis B testing completion. Future research should evaluate other intervention approaches to improving hepatitis B testing rates among Chinese in North America.

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  1. Barnes, P. M., Adams, P. F., & Powell-Griner, E. (2008). Health characteristics of the Asian adult population: United States, 2004–2006. Advance Data, 394, 1–22.

    PubMed  Google Scholar 

  2. Ghosh, C. (2003). Healthy people 2010 and Asian Americans/Pacific islanders: Defining a baseline of information. American Journal of Public Health, 93(12), 2093–2098.

    Article  PubMed  Google Scholar 

  3. Department of Commerce. (2004). We the people—Asians in the United States: Census 2000 special reports. Washington, DC: Department of Commerce.

    Google Scholar 

  4. Statistics Canada (2006). Population by selected ethnic origins.

  5. Nguyen, M., & Keeffe, E. (2003). Chronic hepatitis B and hepatitis C in Asian Americans. Review Gastroenterology Diseases, 3, 125–134.

    Google Scholar 

  6. Lin, S. Y., Chang, E. T., & So, S. K. (2007). Why we should routinely screen Asian American adults for hepatitis B: A cross-sectional study of Asians in California. Hepatology, 46(4), 1034–1040.

    Article  PubMed  Google Scholar 

  7. McBride, G. (2008). Hepatitis B virus-induced liver cancer in Asian Americans: A preventable disease. Journal of the National Cancer Institute, 100(8), 528–529.

    Article  PubMed  Google Scholar 

  8. Tong, M., & Hwang, S. (1994). Hepatitis B virus infection in Asian Americans. Gastroenterology Clinics of North America, 23, 523–536.

    PubMed  CAS  Google Scholar 

  9. Merican, I., Guan, R., Amarapuka, D., et al. (2000). Chronic hepatitis B virus infection in Asian countries. Journal of Gastroenterology and Hepatology, 15(12), 1356–1361.

    Article  PubMed  CAS  Google Scholar 

  10. Asian Liver Center (2005). Hepatitis B in Asian Americans.

  11. Lok, A. S., & McMahon, B. J. (2007). Chronic hepatitis B. Hepatology, 45(2), 507–539.

    Article  PubMed  CAS  Google Scholar 

  12. Lin, O. S., & Keefle, E. (2001). Current treatment strategies for chronic hepatitis B and C. Annual Review of Medicine, 52, 29–49.

    Article  PubMed  CAS  Google Scholar 

  13. Malik, A. H., & Lee, W. M. (2000). Chronic hepatitis B virus infection: Treatment strategies for the next millennium. Annals of Internal Medicine, 132(9), 723–731.

    PubMed  CAS  Google Scholar 

  14. Jenkins, C. N. H., Buu, C., Berger, W., & Son, D. T. (2001). Liver carcinoma prevention among Asian Pacific Islanders. Cancer, 91(Suppl 1), 252–256.

    Article  PubMed  CAS  Google Scholar 

  15. Coronado, G. D., Taylor, V. M., Tu, S. P., et al. (2007). Correlates of hepatitis B testing among Chinese Americans. Journal of Community Medicine, 32(6), 379–390.

    Google Scholar 

  16. Hislop, T. G., Teh, C., Low, A., et al. (2007). Hepatitis B knowledge, testing and vaccination levels in Chinese immigrants to British Columbia, Canada. Canadian Journal of Public Health, 98(2), 125–129.

    Google Scholar 

  17. Hislop, T. G., Teh, C., Low, A., et al. (2007). Predisposing, reinforcing and enabling factors associated with hepatitis B testing in Chinese Canadians in British Columbia. Asian Pacific Journal of Cancer Prevention, 8(1), 39–44.

    PubMed  Google Scholar 

  18. Nguyen, T. T., Taylor, V., Chen, M. S., Jr., Bastani, R., Maxwell, A. E., & McPhee, S. J. (2007). Hepatitis B awareness, knowledge, and screening among Asian Americans. Journal of Cancer Education, 22(4), 266–272.

    Article  PubMed  Google Scholar 

  19. Taylor, V., Tu, S., Woodall, E., et al. (2006). Hepatitis B knowledge and practices among Chinese immigrants to the United States. Asian Pacific Journal of Cancer Prevention, 7, 313–317.

    PubMed  Google Scholar 

  20. Wu, C. A., Lin, S. Y., So, S. K., & Chang, E. T. (2007). Hepatitis B and liver cancer knowledge and preventive practices among Asian Americans in the San Francisco Bay Area, California. Asian Pacific Journal of Cancer Prevention, 8(1), 127–134.

    PubMed  Google Scholar 

  21. Lewin, S. A., Dick, J., Pond, P., et al. (2008). Lay health workers in primary and community health care. The Cochrane Library (1).

  22. Eremenco, S., Cella, D., & Arnold, B. (2005). A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Evaluation & the Health Professions, 28, 212–232.

    Article  Google Scholar 

  23. Tu, S. P., Jackson, C., Teh, C., et al. (2003). Translation challenges of cross-cultural research and program development. Asian American Pacific Islander Journal of Health, 10, 58–66.

    Google Scholar 

  24. Chen, H., Tu, S. P., Teh, C. Z., et al. (2006). Lay beliefs about hepatitis among North American Chinese: Implications for hepatitis prevention. Journal of Community Medicine, 31(2), 94–112.

    Google Scholar 

  25. Taylor, V. M., Hislop, T. G., Jackson, J. C., et al. (2002). A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America. Journal of the National Cancer Institute, 94, 670–677.

    PubMed  Google Scholar 

  26. Chao, S. D., Chang, E. T., Le, P. V., Prapong, W., Kiernan, M., So, S. K. (2007). The Jade ribbon campaign: A model program for community outreach and education to prevent liver cancer in Asian Americans. Journal of Immigrant and Minority Health. [Epub ahead of print].

  27. Juon, H. S., Strong, C., Oh, T. H., Castillo, T., Tsai, G., & Oh, L. D. (2008). Public health model for prevention of liver cancer among Asian Americans. Journal of Community Health, 33(4), 199–205.

    Article  PubMed  Google Scholar 

  28. Thompson, B., Thompson, A. L., Chan, N. L., Hislop, G. T., & Taylor, V. M. (2007). Cost effectiveness of cervical cancer screening among Chinese women in North America. Asian Pacific Journal of Cancer Prevention, 8(2), 287–293.

    PubMed  Google Scholar 

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This publication was supported by grant R01-CA-113663 from the National Cancer Institute, cooperative agreement U01-CA-114640 from the National Cancer Institute, and cooperative agreement U48-DP-000050 from the Centers for Disease Control and Prevention.

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Correspondence to Vicky M. Taylor.

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The contents of the article are solely the responsibility of the authors and do not necessarily represent the views of the National Cancer Institute nor the Centers for Disease Control and Prevention.

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Taylor, V.M., Hislop, T.G., Tu, SP. et al. Evaluation of a Hepatitis B Lay Health Worker Intervention for Chinese Americans and Canadians. J Community Health 34, 165–172 (2009).

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