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Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.

Introduction This is a preliminary report from a research collaboration between Asian Health Services (community health center); Koreans in Alameda County, California; and the University of California at Berkeley School of Public Health. This five-year Centers for Disease Control and Prevention project supports a collaborative community intervention to improve breast and cervical cancer screening behavior among Korean women. Methods A Korean Community Advisory Board and Korean-American staff were recruited, and community sensitive research (CSR) and participatory action research (PAR) principles were applied: (1) building community infrastructure for sustainable action, (2) cultural appropriateness, (3) assuring responsiveness to community needs, and (4) a prevention focus that would assist health care providers. We conducted a population-based telephone survey on 676 Korean adults (272 men and 404 women). Results The collaborative process yielded (1) a high response rate (79%), (2) baseline health information on Korean Americans, (3) broadening of the original research topic, (4) survey responses that will guide intervention design, (5) culturally competent strategies, and (6) expanded Korean-American Community capacity for local action. Conclusions Research collaboration between universities, community-based organizations, and ethnic communities can yield high-quality research. CSR and PAR approaches help break through cultural barriers in otherwise “hard to reach” API subpopulations. Determinants of success include sharing common goals; trust, honesty, and integrity; shared decision making; mutual respect of each partner’s expertise; cultural sensitivity and cultural competence; flexibility, good communication, and mutual learning; and continuity of partners. Actively engaging members of the study population in the research process builds community capacity, thus laying the foundation for future projects that improve health status.

Background Previous research suggests that having a doctor of the same ethnicity may be associated with lower rates of breast and cervical cancer screening in some Asian-American women. This study analyzes the effect of having a Korean, non-Korean, or no regular doctor upon several measures of screening among Korean-American women. Methods A random sample of 339 Korean-American women in Alameda County, California, were surveyed by telephone. Contingency tables and multivariable logistic regression were used to evaluate the association between provider status and six measures of recent screening, controlling for insurance and demographics. Results Having a non-Korean doctor was associated with an increased likelihood of having a Pap smear (odds ratio = 2.19, 95% confidence interval = 1.00, 4.80), mammogram (odds ratio = 7.63, 95% confidence interval = 2.35, 24.84), and clinical breast examination (odds ratio = 3.76, 95% confidence interval = 1.54, 9.20) in the past 2 years, compared to having a Korean doctor. This relationship is less apparent for nonfemale specific screening tests like cholesterol exams and routine checkups. Conclusions Women who have a Korean doctor have less than optimal rates of breast and cervical cancer screening compared to women who have a non-Korean doctor. Having a Korean doctor may indicate less access to preventive health services, and programs to increase screening should target both Korean physicians and their female patients.

OBJECTIVES: This study reports population estimates of Pap smear testing among Korean-American women and evaluates correlates of testing. METHODS: Korean Americans in 2 California counties were surveyed by telephone. Frequencies were age-adjusted to the 1990 census to produce population estimates of testing. Logistic regression models were used to evaluate independent correlates of testing RESULTS: Only 50% of the Korean-American women surveyed had a Pap test in the previous 2 years. The strongest independent correlate was having had a regular check-up in the previous 2 years (odds ratio 7.2, 95% confidence interval 4.2, 12.1). CONCLUSIONS: Rates of Pap testing among Korean-American women are well below national objectives. Collaboration and community-sensitive research are essential to collect data and design programs to improve the health of ethnic minority communities.

Background.Mammography and clinical breast examination (CBE) are underutilized, especially by women from some racial/ethnic minorities. Few published studies of screening practices or correlates for these subgroups exist. Methods.A population-based telephone survey of 1,090 Korean Americans living in two California counties was conducted. To produce population estimates of mammography and CBE testing, we adjusted frequencies to account for different selection probabilities. Multivariable logistic regression was performed to determine independent correlates of testing. Results.Only 34% [95% confidence intervals (CI) 30%, 39%] of Korean American women age 50 and older were estimated to have had a mammogram in the past 2 years. Only 32% (95% CI 28%, 37%) had had a CBE in the past 2 years. The strongest independent correlate of testing was having a regular medical checkup [odds ratio (OR) for mammogram = 9.21, 95% CI 3.98, 21.35; OR for CBE = 11.58, 95% CI 4.71, 28.46]. Conclusions.These estimates are lower than the Healthy People 2000 objectives as well as published estimates for other populations in the United States. Planning and implementing tailored programs to improve screening are best done using a community-sensitive approach, which, because racial/ethnic subgroups are growing, will assume increasing public health importance.