Search

The prevalence of chronic hepatitis B (HBV) among college-age US-born Asian and Pacific Islanders (A/PI) is not well known.To compare the prevalence of hepatitis B surface antigen (HBsAg) seropositivity in US-born to A/PI-born students at a public university.Undergraduate who self-identified themselves as A/PI.Of 145 US-born A/PI, 1.4% (confidence interval [CI] = 0.0%, 3.3%) tested positive for HBsAg compared to 3.3% (CI = 0.5%, 6.1%) of the 152 A/PI-born students. Approximately 1/3 of all students were unaware of their HBV vaccination status.HBsAg prevalence among A/PI undergraduates, including US-born, is considerably higher (3 to 11 times) than the mainstream US population (0.3% to 0.5%) and supports the Centers for Disease Control and Prevention (CDC) recommendations for testing all persons of A/PI ancestry, including US-born persons whose parents were born in regions with HBsAg prevalence ofor=8%. Awareness of HBV vaccination status was relatively low and vaccination did not assure that individuals were HBsAg negative.

This article describes the setting for the first Office of Minority Health funded Minority Community Health Demonstration Grant Project targeted toward the Southeast Asian minorities of Cambodians, Laotians, and Vietnamese, explains how the theoretical basis of the Indigenous Model was implemented, and offers lessons learned and suggestions for future minority health programs. Three examples of how the Indigenous Model was applied, in some instances, in unanticipated ways are discussed. Lessons related to implementing the Indigenous Model for minorities are suggested

Objective Measurement tools such as surveys assessing knowledge, attitudes, and behaviors need to be theoretically consistent with interventions. The purpose of this article is to describe the first steps in the process of constructing a theoretically based set of measures that is currently used in three trials to reduce liver cancer disparities. Methods Guided by a common theoretical formulation—the Health Behavior Framework—we identified constructs relevant for liver cancer control research, compiled items from previous studies and constructed new items, and translated and pilot tested items in collaboration with members of the Vietnamese, Korean, and Hmong communities. Results We constructed three questionnaires in Vietnamese, Hmong, and Korean languages that are slightly different due to cultural and language nuances but contain a core set of measures assessing identical constructs of the Health Behavior Framework. Initial research demonstrates that items are easily understood and that they are generally related to hepatitis B screening as expected. Conclusions Researchers are encouraged to follow a similar process for creating theory-based assessment tools. Measuring common theoretical constructs can advance liver cancer control and other health research by facilitating a more systematic comparison of findings across different populations and intervention strategies.

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.

California has significantly decreased racial/ethnic and educational disparities in smoke-free home and indoor work policies. California's ethnic-specific surveys present an opportunity to disaggregate data and examine the impact of California's smoke-free social norm campaign for Asian-American women.The California Tobacco Use Surveys for Chinese Americans and Korean Americans were conducted in 2003 and analyzed in 2008 to compare women with lower (or= high school graduate) or higher education status for smoke-free policy adoption and enforcement.Lower-educated and higher-educated women had similar proportions of smoke-free policies at home (58%) or indoor work (90%). However, lower-educated women were more likely than higher-educated women to report anyone ever smoking at home (OR=1.62, 95% CI=1.06, 2.48, p=0.03) and exposure during the past 2 weeks at an indoor workplace (OR=2.43, 95% CI= 1.30, 4.55, p=0.005), even after controlling for ethnicity, smoke-free policy, knowledge about the health consequences of secondhand smoke exposure, and acculturation. There was no interaction between education and knowledge about secondhand smoke health harms.The intended consequences of California's tobacco-control efforts have resulted in similar rates of smoke-free policies at home and in indoor work environments among Asian-American women across educational levels. However, an unintended consequence of this success is a disparity in enforcement by educational status, with lower-educated Asian-American women reporting greater smoke exposure despite similar rates of knowledge about the health consequences of secondhand smoke exposure. Besides establishing policies, lower-educated Asian-American women may need to be empowered to assert and enforce their right to smoke-free environments.

In a previous paper, "Evaluating the Impact of P.L. 99-252 on Decreasing Smokeless Tobacco Use," the context of this law and the theoretical framework for an evaluation plan for measuring its impact were described. In this paper, the methodology and selected findings from this project as well as their implications are discussed. This discussion includes the identification of the six indicators considered to be the most relevant, valid, reliable, accessible, and practical for measuring the impact of this law on decreasing smokeless tobacco use, as well as a report on the feasibility analysis of three of these indicators. Pilot data on two indicators--pounds of smokeless tobacco sold and incidence rates of tobacco-induced leukoplakia--are presented and analyzed.

The purpose of this paper is to provide an analytic review of population-based efforts to measure smoking prevalence levels among Asian Americans, and peer-reviewed smoking cessation research targeting Asian Americans. The heterogeneity of Asian Americans has hindered precise determinations of their smoking prevalence and has contributed to the difficulty of implementing standardized smoking cessation interventions. First, we reviewed abstracts of published articles accessible through PUBMED between 1995 and 2005 as well as other reports accessible to the authors to ascertain tobacco control interventions focusing on any Asian American population and the available data sources of Asian Americans' tobacco use. Only two clusters of controlled studies and one uncontrolled smoking cessation intervention study focused on Asian Americans have been published in the peer-reviewed literature. These studies had various degrees of success in cessation. Second, we compiled a list of data sources that contain tobacco use information for Asian Americans in California. These sources could potentially be used to shed light on the strategies of cessation intervention for this group. Community-based trial on tobacco cessation is lacking for Asian Americans even though some of the subgroups bear the heavy burden of smoking. Various survey data that have Asian American tobacco use information should be thoroughly analyzed and the results appropriately interpreted as the basis of intervention for this community. We concluded with three specific recommendations for further research on smoking cessation intervention research focused on Asian Americans.

Asian immigrants to the U.S. are participants in a natural experiment on the effects of social norms on tobacco cessation. Smoking is socially acceptable in most Asian countries. When Asian smokers move to U.S. states such as California, they experience a radically different social norm toward smoking. This study examines ever smokers among two groups of Asian immigrants in California, Chinese and Koreans, and finds that most have quit smoking. The quit ratios (percent of ever smokers who have quit) for Chinese (52.5%) and Korean immigrants (51.1%) have quit ratios for ever smokers in California in general (53.3%), which is among the highest in the U.S. These high quit ratios contrast sharply with much lower quit ratios for Chinese in China (11.5%) and for Koreans in Korea (22.3%). Such large differences in quit ratios are the results of accumulated differences over the years, because of dramatic differences in annual cessation rates: Chinese in California quit at roughly seven times the rate of Chinese in China, and Koreans in California three times that of Koreans in Korea. Analyses further show that these large differences in annual cessation rates come mainly from the fact that these immigrants in California made quit attempts at a much higher rate than their counterparts in their home countries. These results suggest that creating an impetus to drive up quit attempts, which often results from a significant change in social norms toward smoking, is the most important strategy to improve cessation on the population level.

BACKGROUND. Annually, only 3% of adult patients participate in cancer clinical trials (CCT). Accrual barriers include lack of CCT awareness and uncertain third-party coverage. In 2002, a California law (SB37) required all insurers to reimburse costs related to CCT. The objective of the current study was to increase awareness of CCT and SB37 through a mass multimedia campaign (MMC) in the University of California (UC) Davis (UCD) Cancer Center catchment area. The authors assessed willingness to participate in and accrual to CCT. METHODS. Changes in CCT/SB37 awareness and willingness to participate were investigated before the MMC versus after the MMC and in UCD respondents versus UC San Diego (UCSD) catchment respondents—a control group that was not exposed to the MMC—by Pearson chi-square and logistic regression analyses. RESULTS. Of 1081 post-MMC respondents, 957 were from UCD, and 124 from UCSD. UCD respondents had a greater awareness of CCT (59% vs 65%; P < .01) and SB37 (17% vs 32%; P < .01) compared with UCSD respondents. Willingness to participate did not change in either cohort. Awareness level predicted willingness (odds ratio, 2.3; P < .01). Blacks, Asians, and lowest income (

Background: Biospecimen collection from diverse populations can advance cancer disparities research, but are currently underrepresented. Little is known about the baseline knowledge, attitudes, and behaviors related to biospecimen collection among most racial/ethnic minority populations. Furthermore, appropriate messages that might increase biospecimen donations have yet to be explored and developed. Among Asian Americans, Chinese Americans are the largest subgroup, of which Cantonese-speaking men may have a higher cancer risk because they have the highest smoking prevalence rate (21.7%) among Californian Chinese, compared to 7.2% for English-speaking and 14.1% for Mandarin-speaking men; this rate is higher than the general California population whose rate is 15.2%. The purpose of this study was to evaluate the impact of an educational seminar on an Asian American community's willingness to donate biospecimens in a randomized, controlled trial. Methods: We partnered with a community-based clinic, Chinatown Public Health Center (CPHC) in San Francisco, serving Cantonese-speaking Chinese Americans to develop and revise an educational seminar on biospecimen collection. As a community-based participatory research project, the CPHC health education team was a key partner in all aspects of this study including design, recruitment, conduct, data collection, and analysis. Over 700 Chinese Americans from the general community contacted CPHC about the study from a bilingual flyer distributed at CPHC health education outreach events. From the large community response, 511 Chinese American adults were screened, 400 were randomized, and 395 were available for analysis. In the trial, the intervention seminar was compared with a control seminar (cancer prevention) on change in willingness to donate biospecimens. Results: At baseline, many were willing to donate a biospecimen (saliva, urine, hair, toenails, blood, unused cancerous tissue) whether healthy or hypothetically had cancer. Also, many would donate because future generations would benefit, and few had concerns about donation. In logistic regression analyses, there was an intervention effect for willingness to donate: urine if had cancer (OR=2.2, 95% CI: 1.3-3.7), toenails if healthy (OR=2.1, 95% CI: 1.4-3.2) or had cancer (OR=2.3, 95% CI: 2.0-2.7), hair if healthy (OR=1.8, 95% CI: 1.3-2.5) or had cancer (OR=2.8, 95% CI: 1.9-4.0), and unused cancerous tissue (OR=1.8, 95% CI:1.2-2.9). There was also an intervention effect for donating because future generations would benefit (OR=2.0, 95% CI: 1.4-3.0), and this attitude was a strong independent predictor for willingness to donate all biospecimens, whether healthy or had cancer (OR=2.9-4.2). Conclusion: Cantonese-speaking Chinese American participants of an educational seminar on biospecimen collection showed greater increases in willingness to donate biospecimens and donating for the benefit of future generations, than participants who attended a control seminar. Impact: Donating for the benefit of future generations is a theme that should be incorporated in messages that encourage biospecimen donation for Chinese Americans. Citation Format: Elisa K. Tong, Lei-Chun Fung, Susan L. Stewart, Debora A. Paterniti, Julie H.T. Dang, Moon S. Chen, Jr.. Impact of a biospecimen collection seminar on willingness to donate biospecimens among Chinese Americans: Results from a randomized, controlled community-based trial. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA25.

The Asian American Network for Cancer Awareness, Research, and Training (AANCART) is the first special populations network for Asian Americans on a national basis and includes collaborating organizations from Boston, New York, Houston, Seattle, San Francisco, Los Angeles, Hawaii, and Sacramento (where it is headquartered at the University of California, Davis). NCI funding of AANCART in 2000 brought together investigators and leaders from 9 cities across 6 states to establish an infrastructure for addressing cancer awareness, research, and training. Since 2000, AANCART has conducted needs assessments, held community awareness activities and trainings, trained trainees, sponsored National Asian American Cancer Control Academies, and produced presentations, publications, and grants. All specific aims have been attained, including the establishment of an infrastructure to promote Asian American cancer awareness, research, and training in 4 targeted regions; the establishment of partnerships to promote accrual to clinical trials, training, and pilot studies; and the formulation and successful implementation of grant-funded research to reduce the cancer burden among Asian Americans. AANCART's first 5 years have increased cancer awareness, trained special populations scientists, and advanced the field of Asian American cancer control research. Cancer 2006. (c) 2006 American Cancer Society.

The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females.

Asian Americans are the nation's fastest growing racial group in terms of percentages, and they constitute a very heterogeneous population. The author reviewed the literature and proposed an agenda to reduce cancer health disparities based on this review and the accomplishments and aspirations of the National Cancer Institute-funded Asian American Network for Cancer Awareness, Research, and Training. The Asian American cancer burden is unique, unusual, and, to a certain extent, unnecessary. The Asian American cancer burden is unique, because Asians are the only racial/ethnic population to experience cancer as the leading cause of death. The unusual aspects of the cancer burden among Asian Americans include experiencing proportionally more cancers of infectious origin, such as human papillomavirus-induced cervical cancer, hepatitis B virus-induced liver cancer, and stomach cancer, than any other racial/ethnic population and, at the same time, experiencing an increasing numbers of cancers associated with “Westernization.” To a certain extent, the cancer burden for Asian Americans is unnecessary if barriers to cancer screening, overcoming resistance to physician visits, and culturally competent interventions to reduce smoking, unhealthy diet, and increasing proper exercise can be instituted. Reducing cancer health disparities among Asian Americans will involve research into their unique, unusual, and unnecessary cancer burden. Cancer 2005. © 2005 American Cancer Society.

Although chronic infection with hepatitis B virus (HBV) is one of the major risk factors for liver cancer, the level of knowledge about liver cancer risk factors and HBV transmission, as well as vaccination have not been assessed in this population. We interviewed Hmong youth living in Fresno, California about liver cancer risk factors. General knowledge of HBV was common, but knowledge of specific modes of transmission was low. For example, only 49% knew that HBV was transmitted by sexual intercourse. We also observed very low prevalence of HBV vaccination (12%), although a majority reported knowing that shots can prevent disease (68%). Liver cancer prevention and control methods targeted to Hmong youth are needed.

In April 2000, the National Cancer Institute funded the Asian American Network for Cancer Awareness Research and Training (AANCART), the first Special Populations Network focused on Asian Americans on a national scale that had as its first specific aim, the building of a robust and sustainable infrastructure to increase cancer awareness, research, and training among Asian Americans in four major cities (New York, Seattle, San Francisco, and Los Angeles). The infrastructure was established to enable attainment of its two other specific aims related to partnerships: participation of Asian Americans in clinical and prevention trials, training, and development of pilot projects; and formulating grant-funded research to reduce the burden of cancer among Asian Americans. All three of these aims have been reached.1 The objectives of this paper are to (1) describe AANCART’s transdisciplinary infrastructure; (2) document its effectiveness; and (3) delineate principles that may be transferable to other transdisciplinary approaches to health concerns.

The purpose of this paper is to describe the content for the Asian American Network for Cancer Awareness Research and Training (AANCART) with respect to Asian American demographic characteristics and their cancer burden, highlights of accomplishments in various AANCART regions, aspirations for AANCART, and an interim assessment of AANCART's activities to date.The author compiled literature and other data references to describe the context for Asian American demographic characteristics and their cancer burden. As the AANCART Principal Investigator, he collected data from internal AANCART reports to depict highlights of accomplishments in various AANCART regions and offer evidence that AANCART's first two specific aims have been attained.With respect to our first specific aim, we have built an infrastructure for cancer awareness, research and training operationally at a Network-wide basis through program directors for biostatistics, community, clinical, and research and in our four original AANCART regions: New York, Seattle, San Francisco, and Los Angeles. With respect to our second specific aim, we have established partnerships as exemplified by working collaboratively with New York's Charles B. Wang Community Health Center in securing external funding with them for a tobacco control initiative and nationally with the American Cancer Society. With respect to our third specific aim, we have been fortunate to assist at least eight junior investigators in receiving NCI-funded pilot studies. The most notable change was the transfer of AANCART's national headquarters from Columbus, Ohio to Sacramento, California along with potentially an increased diversification of Asian American ethnic groups as well as an expansion to Hawaii and Houston.As of the end of year 2 of AANCART, AANCART's two specific aims have been achieved. We are focusing on our third specific aim.

This article describes the results from two studies of Chinese Americans. In one study, a convenience sample of patients completed face-to-face interviews to assess smoking patterns in the home, knowledge of tobacco, and ways in which health interventions could be communicated to the community. The other study involved two focus group discussions with the primary purpose of learning how spouses, health care workers, and the media can participate in smoking cessation interventions. A convenience sample of 795 patients at the Charles B. Wang Community Health Center in New York City's Chinatown was interviewed using face-to-face interviews. The focus group discussions were conducted using 15 volunteers. One discussion was conducted in Mandarin and the other in Cantonese. Although 92.7% of the respondents prefer people not smoke in the home, only 21% ban smoking with few exceptions. The focus group participants indicated that often the smoker is the oldest male and he also is the person who establishes the rules. Nearly half of the respondents receive most of their health-related information from their physician, and the focus group participants stated that physicians are highly regarded in their culture. Finally, the majority of respondents receive health-related information from Chinese language media. These results will assist in the planning of a smoking cessation intervention targeting Chinese Americans. The physician represents a key player in any intervention, and public health antismoking messages may be communicated effectively through Chinese language media.

Background. Cigarette smoking prevalence rates among Southeast Asian males are among the highest reported in comparison with other ethnic male groups in the United States. The objective of this study is to profile current smokers, former smokers, and never smokers among Southeast Asian males, based on subject characteristics. Methods. Southeast Asian (Cambodian, Laotian, and Vietnamese) males residing in the Greater Columbus, Ohio, area were surveyed, utilizing culturally sensitive instruments and interviewers, with respect to demographic and acculturation variables. All subjects were biochemically verified by collecting a saliva sample at the time of the interviews. Results. Those Southeast Asian males who quit smoking tended to be older, employed, more assimilated into the U.S. culture, and of Cambodian ethnicity. The current smokers, relative to never smokers, tended to be older, not in the labor force, traditionally oriented to their native culture, less educated, and of Laotian or Vietnamese ethnicity. Conclusions. Specific strategies for smoking cessation programs would indicate more intense, and possibly different, efforts be directed at Southeast Asian males of Laotian and Vietnamese ethnicity who are younger, unemployed and less assimilated into the U.S. culture. On the other hand, smoking prevention programs would target those individuals who are at highest risk of smoking.

Purpose.To present evidence that the model of healthy Asian Americans and Pacific Islanders (AAPIs) stereotype is a myth.Search Method.The authors retrieved literature from the National Library of Medicine's compact disk databases (Cancerlit, CINAHL, Health, and MEDLINE), and examined pertinent federal government publications supplemented by the authors' knowledge of other published materials.Important Findings.This review paper presents three reasons why AAPIs are underserved: (1) the population growth rate has been unusually rapid and recent; (2) data regarding the health status of AAPIs are inadequate; and (3) the myth that AAPIs are model minority populations in terms of their health status was promulgated.Major Conclusions.The conclusions are as follows: (1) AAPIs are heterogenous with respect to demographic factors and health risk factors; (2) because the current databases on the health status of AAPIs include small sample sizes, both the quantity and quality of these data need to be improved with respect to appropriate gender and ethnic group representation; (3) Risk factor and mortality data for AAPIs suggest that the burden of certain preventable diseases, namely, tuberculosis, hepatitis-B, liver cancer, and lung cancer may be higher than those of any other racial and ethnic population. The model healthy AAPI stereotype is a myth.

PURPOSE. This paper is based on the author's keynote address given at the Seventh International Conference on the Health Problems of Chinese in North America. METHODS. The author/speaker reviewed the literature related to Chinese American health problems within the context of the broader demographic and aggregated health data reported on Asian Americans and Pacific Islanders. FINDINGS. In addition to background demographic statistics provided on Chinese Americans, the author/speaker focused on two categories of diseases: (1) communicable diseases; and (2) chronic diseases because of the greater availability of data on these categories. Communicable diseases from which Chinese Americans appear to suffer disproportionally are tuberculosis and hepatitis B. Infection with the hepatitis B virus also makes Chinese Americans much more susceptible to chronic liver diseases including cancer. Chinese also suffer disproportionally more from nasopharyngeal cancer; because of higher than average adult male smoking rates, these men can be expected to suffer disproportionally from a future epidemic of lung cancer cases. Unhealthy acculturation patterns in food consumption point towards changing profiles of cardiovascular morbidity and mortality as well as higher rates of dietary related cancers. OBSERVATIONS. Rather than conclusions, observations of the current health status of Chinese Americans were offered. Four measures that organizations such as the Chinese medical societies and Chinese American health professionals can pursue to advance the health status of Chinese Americans, particularly in the area of heaslth policy, are: (1) voting; (2) collecting data on health status; (3) writing for professional journals; and (4) being active in policy development. KEY WORDS. Chinese Americans; health status; tuberculosis; hepatits B; cancer; diet; acculturation; smoking

Background/Aim: Hepatitis B virus (HBV) infection is the principal risk factor for hepatocellular carcinoma (HCC) among Asian Americans. Earlier detection of HBV may be life-saving; however, rates of HBV screening in Asian Americans remain unusually low. The purpose of this study was to test the feasibility of an electronic health record (EHR)-based provider intervention to increase HBV screening in Asian Americans within an academic health system. Methods: Entry criteria were: outpatients, ages 18–64, with Chinese or Vietnamese surnames scheduled for appointment in a primary care clinic with no record of an HBsAg test, and who were not pregnant. Providers at any of 15 primary care clinics were randomly assigned to the control or intervention arm. Providers in the intervention arm received a standardized EHR message 24 hours prior to the appointment which referred to the patient as a candidate for HBV screening and included recommendations for testing. Providers in the control group (“usual care”) received no message. Outcome measures to compare differences between intervention and control arms were the proportion of patients with (1) HBsAg tests ordered by providers; (2) HBsAg tests completed by patients. Results from patients who were tested for HBV were reported. Results: One hundred thirty patients meeting entry criteria were seen by 63 providers during the 3 month study period. Sixty seven patients were seen by 31 providers who were randomized to the intervention arm and 63 patients were seen by 32 providers randomized to the control arm. Patient demographics did not differ significantly between groups. The mean number of patients per provider was 2.09 and 2.03 in the intervention and control groups, respectively. For outcome (1), providers ordered HBsAg tests for 36/67 (53.7%) intervention patients versus 1/67 (1.6%) control patients (p < 0.001). For outcome (2), 29/36 (80.6%) intervention patients completed their HBsAg test versus 0/1 control group patient. Four (13.7%) of 29 patients tested positive for HBsAg, 12 (41.4%) were reactive for anti-HBs and 13 (44.8%) were HBV-naïve. Patient demographics (gender, ethnicity, and mean age) did not significantly differ between patients with and without an HBsAg test ordered. Providers were more likely to order the HBV screening if the patients came in for preventive care rather than patients who had a specific medical issue (p = 0.040). There were no significant differences in provider characteristics (gender, ethnicity or medical specialty) between those that ordered the HBsAg test and those that did not. Conclusions: Electronic prompting resulted in significantly greater rates of HBsAg tests ordered by providers (p < 0.001) and markedly greater rates of HBsAg tests completed by patients than “usual care.” As a result, earlier detection of patients who tested HBsAg positive occurred and represents a promising intervention to significantly increase HBV screening that could reduce HBV-induced HCC disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B99.

Hepatitis B virus (HBV) induced liver cancer represents the most glaring cancer health disparity facing Asian Americans. While liver cancer is relatively uncommon in the U.S., it leads all other cancer sites in the percentage increase in mortality, with dismal survival rates. The disease disproportionately affects all populations of color, but particularly Asian Americans, who experience the highest rates of liver cancer. Community-centered interventions to control HBV/liver cancer among Asian Americans, operationally defined as organized activities to increase awareness of HBV risks among Asian Americans and the promotion of HBV screening and vaccination, include programs working in policy/advocacy, screening, and community-based controlled intervention trials. These interventions have led to: 1) fostering the adoption of universal hepatitis B vaccination at birth, credited with averting at least 700,000 deaths annually; 2) community-based screenings that reach more than 21,000 individuals per year, catalyzing referrals for additional screening and treatment; and 3) the initiation of at least seven community-centered controlled intervention trials to increase vaccination or serological testing among Asian Americans. Despite the many advantages and accomplishments of community-centered interventions, large numbers of Asian Americans remain unaware of their HBV status and concerns exist regarding the validity of self-reported serological testing or vaccination for HBV as the measure of intervention effectiveness. In addition, in order to reduce the rate of liver cancer and other complications, there is a need to ensure continued community-centered HBV education and appropriate quality of care provided to those who have chronic hepatitis B diagnosed by screening. Greater integration of community-centered efforts with clinic-based interventions, which have complementary assets, appears to be a promising approach to reduce the unnecessary HBV/liver cancer disparities among Asian Americans as well as all populations at risk. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PL02-02.

Background/Aim: Access to sufficient quantities of racially-specific blood samples for research purposes increases the likelihood of developing personalized approaches for cancer treatment and insights that can result from enhanced molecular and genomic characterizations of biospecimens. However, blood samples from Asian Americans who are the only U.S. racial/ethnic group to experience cancer as the leading cause of death appear to be extremely limited. Hence the aim of our study was to test the feasibility of developing, implementing, and evaluating an intervention to increase the number of blood biospecimens contributed by Asian Americans. Since all Asian Americans are not alike, this presentation focuses only on one Asian American group, the Hmong, who represent one of the most recent groups of Asian Americans. Methods: We first conducted a community needs assessment to identify factors that appear to affect Asian Americans’ decisions to contribute biospecimens. That assessment revealed that blood specimens ranked in the bottom four choices of biospecimens that Asian Americans (Chinese, Hmong, Vietnamese) preferred to contribute. With respect to contributing biospecimens, the first preference (43%) for Hmong was to contribute biospecimens during a community event. The main reason Hmong participants would consider contributing biospecimens was to look at diseases passed down in families. Of the three Asian groups, the Hmong preferred visual and oral education over written materials. Second, we exhaustively reviewed the limited literature on biospecimens contributions. Hmong consider blood as the source of strength and vitality and believe that there is a limited amount of blood in their bodies. Once drawn, they believe that blood cannot be replaced. Hence, some Hmong patients are more apt to refuse blood draws because they believe blood is not renewed. The needs assessment and literature review thus depicted considerable cultural and cognitive factors that needed to be integrated into a successful intervention to collect biospecimens from Hmong. Thus, we partnered with a trusted community-based organization, Hmong Women's Heritage Association (HWHA), with whom we have collaborated with for over 8 years. Based on that collaboration, we developed an intervention that incorporated our empirical findings and literature review. That intervention relied on preparing HWHA bilingual, bicultural Hmong lay health workers to explain the value of blood donations as ways to contribute to cancer research and to explain how cancer may be addressed. We held the blood drive during a well-publicized community event and we provided modest incentives for participation. Results: On April 16, 2011, the Asian American National Center for Reducing Cancer Health Disparities in collaboration with the UC Davis Cancer Center Biorepository and the Hmong Women's Heritage Association hosted the first-ever Asian American biospecimen community drive. Expecting only to draw 40 samples, we collected 174 vials of blood from 87 “healthy” volunteers, 82 were Hmong volunteers. Conclusions: Despite the overwhelming cultural and cognitive barriers associated with blood as a means of biospecimen contribution, the outpour of community support is a testament to 1) The trust the community has in Hmong Women's Heritage Association; 2) The time, commitment, and dedication of the staff; and lastly 3) The talent of the those individuals who worked on everything from the IRB consenting process to the talent of the community for rising above their cultural reservations and who wholeheartedly contributed to the greater good of their community. Developing an effective intervention to increase the collection of blood biospecimens must be customized to the population group. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A28.

PURPOSES OF THE PAPER: The purposes of this paper are as follows: (1) discuss seven design considerations and their respective lessons learned or resolutions in initiating the National Institutes of Health's only funded smoking cessation grant targeting Asian Americans; (2) present empirical findings that resulted from the design considerations alluded to previously; and (3) delineate unresolved challenges on conducting smoking cessation research particularly for adult Southeast Asians. SUMMARY OF METHODS UTILIZED: The authors base this paper on their empirical data collected as part of the "Lay-led Smoking Cessation Approach for S.E. Asian men" study. Data collected include baseline data from 1553 adult Southeast Asianslpar;721 women and 832 menrpar; in Ohio as well as subsequent data collected on selected individuals. The investigators faced seven major, conceptual issues in initiating smoking cessation research focusing on Southeast Asian adults. These seven considerations related to: language, culture, nicotine addiction characteristics, verification of smoking exposure and smoking status, knowledge of the health consequences of smoking, social environmental factors, and criteria for evaluating effectiveness of the proposed intervention. Smoking cessation interventions must be conducted in the appropriate Asian language because current smokers are the least likely to understand spoken English. Culturally speaking, Cambodian and Laotian male smokers are significantly more likely to have traditional Southeast Asian values than their never smoker counterparts. As a measure of addiction to nicotine, the median time until the first cigarette was 30 minutes for both Cambodians and Vietnamese suggesting that these men are highly addicted. Cotinine levels were negatively correlated with time to the first cigarette and positively correlated with numbers of cigarettes. Knowledge of the health consequences of smoking is lower than mainstream populations. Almost 100 per cent of Southeast Asian male smokers have at least one "best" friend who smokes. Verification of smoking status through saliva cotinine testing suggest that actual smoking rates among Southeast Asians are higher than selfshy;report rates. The largest proportion of Cambodian and Vietnamese smokers are in the precontemplation stage while Laotian smokers are proportionally more likely to be in the contemplation stage. CONCLUSIONS: Design considerations discussed represent considerations beyond those that are normally considered in communityshy;based research for majority populations. The quality and quantity of empirical data collected with due attention to these conceptual considerations appear to substantiate the validity of these considerations. Authors delineated challenges for initiating smoking cessation research among Southeast Asians. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: This paper is particularly relevant for increasing the data base on adult Cambodians, Laotians, and Vietnamese. KEY WORDS: Asian Americans, Cambodians, Laotians, Vietnamese, culture, language, tobacco, smoking cessation, nicotine

PURPOSE OF THE PAPER: The purpose of this paper is to offer a current assessment of the health status of Asian Pacific Islander Americanslpar;APIAsrpar; with respect to relevant Healthy People 2000 objectives and an assessment of Federal resource allocations targeted at APIAs. SUMMARY OF METHODS UTILIZED: The author reviewed documents from the relevant progress reports made to the Assistant Secretary on Health on Healthy People 2000 objectives, other Federal documents, and a review of the literature. PRINCIPAL FINDINGS: Adequate progress has been made on only one of the eight objectives targeted at APIAs; progress on the remaining objectives is either "not on target," require more data to evaluate, or inappropriate for APIAs at this time. Examples of APIA health problems not included in Healthy People 2000 objectives were documented. Illustrations of inadequate allocations of Federal health resources were cited. CONCLUSIONS: APIAs have been among the most neglected minority group with regards to health status surveillance, health services, and have been the most overlooked in Federal resource allocations. However, as greater awareness of data deficits and health status is presented, policy makers have the opportunity to improve the situation. A policy to improve the health status of APIAs must be multifaceted and minimally include the facets of data needs, intervention approaches, a research agenda, and advocacy. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: A 1993 review of the health status of APIAs with regards to the eight Healthy People 2000 and areas not covered by Healthy People 2000 were reviewed. KEY WORDS: Asian Americans, health status, health policy, health planning, tobacco, diet, diseases

Background: Racially specific biospecimens increase the likelihood of developing personalized treatment approaches for cancer patients in comparison to utilizing biospecimens that may have originated from individuals of a different race than the patient. Thus increasing the proportion of biospecimens from Asian Americans would increase the likelihood of having biospecimens that may be more applicable to cancer treatments for Asian American cancer patients. We have not found any reliable data on the proportion of biospecimens derived from Asian Americans in any database due to a variety of factors. However, we assume that the proportion is relatively low. Therefore to increase contributions among Asian Americans, particularly for English-limited patients, we are developing a video and accompanying brochure in Cantonese, Hmong, Vietnamese and English for Asian Americans that explain the need for biospecimens and recruit them to donate biospecimens for cancer research. Objectives: To test the feasibility of an in-language biospecimen education video and brochure intervention to increase biospecimen contributions among Asian Americans Methods: By mid-August, our educational video and brochure in Cantonese, Hmong, Vietnamese, and English will have been professionally produced. Our assumption is that respondents will use the language that they will be most comfortable in. Thus, respondents who view the video and ask for the brochure in one of the Asian language are presumed to be less acculturated than those who view the video and ask for the English language brochure. By mid-September, we shall have pilot-tested it with multiple Asian Americans both in a group and in individualized settings. In particular, Chinese, Hmong, and Vietnamese UC Davis Cancer Center patients undergoing cancer surgery will be given the educational video to view and the brochure to read prior to surgery and prior to receiving the biorespository consent form. Results: We anticipate presenting data by language and report responses on the basis of the extent to which respondents learned more about biospecimens and whether their new knowledge about biospecimen would now predispose them to more likely contribute biospecimens. We shall report on the extent to which the educational materials increased knowledge and willingness to contribute biospecimens for research. Conclusions: Increasing the proportion of Asian American biospecimens for cancer research will increase the likelihood of more personalized cancer therapies for Asian Americans. Our pilot study is among the first to empirically assess the potential of in-language video and brochures to increase biospecimen contributions by Asian Americans. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B43.