Search

Asian communities in North America include large numbers of immigrants with limited English proficiency. Hepatitis B virus (HBV) infection is endemic in most Asian countries and, therefore, Asian immigrant groups have high rates of chronic HBV infection. We conducted a group-randomized trial to evaluate the effectiveness of a hepatitis B English as a second language (ESL) educational curriculum for Asian immigrants. Eighty ESL classes were randomized to experimental (hepatitis B education) or control (physical activity education) status. Students who reported they had not received a HBV test (at baseline) completed a follow-up survey 6 months after randomization. The follow-up survey assessed recent HBV testing and HBV-related knowledge. Provider reports were used to verify self-reported HBV tests. The study group included 218 students who reported they had not been tested for HBV. Follow-up surveys were completed by 180 (83%) of these students. Provider records verified HBV testing for 6% of the experimental group students and 0% of the control group students (P = 0.02). Experimental group students were significantly (P < 0.05) more likely than control group students to know that immigrants have high HBV infection rates, HBV can be spread during sexual intercourse and by sharing razors, and HBV infection can cause liver cancer. Our ESL curriculum had a meaningful impact on HBV-related knowledge and a limited impact on HBV testing levels. Future research should evaluate the effectiveness of ESL curricula for other immigrant groups and other health topics, as well as other intervention approaches to increasing levels of HBV testing in Asian immigrant communities.

Objectives: According to recent census data, 1,216,600 Canadians are of Chinese descent, and over 80% of Chinese Canadians are foreign born. Approximately 10% of Chinese immigrants are chronic carriers of hepatitis B, compared with less than 0.5% of the general population. English as a second language (ESL) classes provide ready access for individuals with limited English proficiency who are not reached by English language health education materials and media campaigns. We conducted a group-randomized trial to evaluate the effectiveness of a hepatitis B ESL educational curriculum for Chinese immigrants. Methods: Five community-based organizations that provide ESL education in the greater Vancouver area participated in the study. Forty-one ESL classes (which included 325 Chinese students) were randomly assigned to experimental or control status. A follow-up survey, conducted six months after randomization, assessed knowledge about hepatitis B. Generalized estimating equations were used to analyze the data. Results: Follow-up surveys were completed by 298 (92%) of the students. At follow-up, experimental group students were significantly (p Conclusion: Our findings indicate that ESL curricula can have a positive impact on health knowledge among Chinese immigrants with limited English. Future research should evaluate the effectiveness of ESL curricula for other immigrant groups, as well as other health topics. Key words: Chinese; health education; hepatitis B

Background. Chinese immigrants to North America experience cancer-related health disparities and underutilize preventive care. Little is known about Chinese immigrants' sources of health information. Methods. A population-based survey of Chinese immigrants was conducted in Vancouver, British Columbia, Canada and Seattle, Washington. Results. The study group included 899 individuals. Less than three fourths of the respondents reported receiving health information from health care providers, and only a minority used the Internet as a source of health information. We found significant differences between the sources of health information in Seattle and Vancouver. Conclusions. Health educators should consider available media outlets as well as the characteristics of a target community when planning intervention programs for Chinese immigrants.

Chinese immigrants to North America have substantially higher rates of chronic hepatitis B infection than the general population. One area for strategic development in the field of health education is the design and evaluation of English-as-a-Second language (ESL) curricula. The theoretical perspective of the Health Behavior Framework, results from a community-based survey of Chinese Canadian immigrants with limited English proficiency, and findings from focus groups of ESL instructors as well as Chinese ESL students were used to develop a hepatitis B ESL educational module. This research was conducted in Vancouver, British Columbia. Survey data showed that less than three-fifths of the respondents had been tested for hepatitis B, and documented some important hepatitis B knowledge deficits. Further, only about one-quarter had ever received a physician recommendation for hepatitis B serologic testing. The ESL curriculum aims to both promote hepatitis B testing and improve knowledge, and includes seven different ESL exercises: Warm-up, vocabulary cards, information-gap, video, jigsaw, guided discussion, and problem/advice cards. Our quantitative and qualitative methods for curriculum development could be replicated for other health education topics and in other limited English speaking populations.

Regular physical activity reduces the risk of many chronic conditions. Multiple studies have shown that Asians in North America engage in less physical activity than the general population. One area for strategic development in the area of health education is the design and evaluation of English as a second language (ESL) curricula. The PRECEDE model and findings from focus groups were used to develop a physical activity ESL curriculum for Chinese immigrants. In general, focus group participants recognized that physical activity contributes to physical and mental wellbeing. However, the benefits of physical activity were most commonly described in terms of improved blood circulation, immune responses, digestion, and reflexes. The importance of peer pressure and the encouragement of friends in adhering to regular physical activity regimens were mentioned frequently. Reported barriers to regular physical activity included lack of time, weather conditions, and financial costs. The ESL curriculum aims to both promote physical activity and improve knowledge, and includes seven different ESL exercises. Our curriculum development methods could be replicated for other health education topics and in other limited English-speaking populations.

Cervical cancer is a significant cause of mortality and morbidity for Chinese Canadian women, due in part to inadequate Pap screening. A community-based survey was conducted involving 528 Chinese immigrant women residing in British Columbia, Canada, in order to identify barriers and facilitators to Pap testing. This paper addresses the relationship between knowledge level about cervical cancer risk factors and Pap screening practices.Female trilingual Chinese interviewers conducted personal at-home interviews about knowledge of cervical cancer risk factors, history of Pap screening, sociodemographic and acculturation factors.The average summary score for knowledge about cervical cancer risk factors was 5.2/10, and knowledge level was significantly associated with the woman's educational level and the gender of the doctor providing usual care. Seventy-four per cent of respondents reported ever having received a Pap test, and 56% reported having received a test within the last two years. Respondents with the highest knowledge were more likely to have ever received a Pap test (OR 6.4, 95% CI: 2.6, 15.9), and to have recently received a test (OR 3.1, 95% CI: 1.4, 6.7).The average knowledge level about cervical cancer risk factors is low in Chinese Canadian women, especially among those with less education and who receive their usual care from a male doctor. Knowledge of these risk factors influences Pap screening behaviour. Culturally and linguistically appropriate education interventions addressing Pap testing and risk factors for cervical cancer are needed in the Canadian Chinese community. Educational resources are also needed for their primary care givers.

BACKGROUND: Though breast cancer is the most common malignancy among Chinese women, screening mammography is underutilized. This study examined barriers and facilitators of screening mammography among Chinese Canadian women. METHODS: Using community-based sampling, Chinese women in British Columbia were interviewed in 1999 about multiple preventive health behaviours. We included 213 women in the mammography analysis; main outcome measures were ever having a mammogram and routine mammography. RESULTS: Seventy-five percent of women 50 to 79 years old reported ever having had a mammogram, and 53% had two or more mammograms within the last five years. Receiving a recommendation for a mammogram from medical personnel or from a family member, and believing that cancer cannot be prevented by faith were independently associated with both screening outcomes. CONCLUSIONS: A multifaceted approach to screening mammography promotion in Chinese Canadian women is suggested. Interventions that include education of and by medical providers and family members should be considered.

Asians in North America remain one of the most poorly understood minorities in terms of their preventive care needs, and their health problems have received little attention (1,2). Census Bureau information indicates there were over 2 million ethnic Chinese living in North America by the early 1990s. Furthermore, Chinese are now the largest Asian subgroup in both Canada and the United States (3,4). Over the last four decades, Chinese immigration to North America has increased dramatically. Consequently, North America’s Chinese population is heterogeneous and largely foreign-born (4–6). One of the six U.S. national goals for reducing racial/ethnic health disparities specifically addresses cancer screening rates (7). Several analyses (8,9) have suggested that Chinese women have higher invasive cervical cancer rates than the general North American population. The rates of invasive cervical cancer among Chinese and non-Latina white women living in Los Angeles are 12.3 and 7.2 per 100 000, respectively (9). Chinese women in British Columbia have twice the cervical cancer risk of whites in the province (8). Few reports have addressed Papanicolaou (Pap) testing levels among Chinese in North America. However, 45% of Chinese women who participated in an ethnically focused behavioral risk factor survey conducted in Oakland, California, during 1989–1990 had never been screened for cervical cancer (compared with 5% of the total female population of California), and only 37% of Chinese women respondents to a 1994 San Francisco survey were routinely obtaining Pap testing (10,11). Furthermore, Canadian investigators found that the proportion of Chinese among all British Columbia women having cervical smears was statistically significantly lower than the proportion of Chinese women among the general population (8). Door-to-door canvassing is believed to be an effective way of recruiting minority women to cancer control programs, and it has been demonstrated that in-home educational sessions can increase Pap testing participation among minority women (12,13). Several research groups have demonstrated that direct mail strategies (including invitational letters and/or pamphlets) can be effective in promoting cervical cancer screening attendance among some population subgroups (14,15). However, little information is available about effective Pap testing interventions for Chinese populations in North America. We conducted a randomized controlled trial to evaluate the impact of two culturally and linguistically appropriate cervical cancer control educational interventions: a “high intensity” outreach worker-based intervention and a “low intensity” direct mail intervention. In this article, we report our findings with respect to the impact of our intervention approaches.

According to recent census data, 1,216,600 Canadians are of Chinese descent, and over 80% of Chinese Canadians are foreign born. Approximately 10% of Chinese immigrants are chronic carriers of hepatitis B, compared with less than 0.5% of the general population. English as a second language (ESL) classes provide ready access for individuals with limited English proficiency who are not reached by English language health education materials and media campaigns. We conducted a group-randomized trial to evaluate the effectiveness of a hepatitis B ESL educational curriculum for Chinese immigrants.Five community-based organizations that provide ESL education in the greater Vancouver area participated in the study. Forty-one ESL classes (which included 325 Chinese students) were randomly assigned to experimental or control status. A follow-up survey, conducted six months after randomization, assessed knowledge about hepatitis B. Generalized estimating equations were used to analyze the data.Follow-up surveys were completed by 298 (92%) of the students. At follow-up, experimental group students were significantly (p0.05) more likely than control group students to know that immigrants have higher hepatitis B infection rates than people who were born in Canada; hepatitis B can be spread during childbirth, during sexual intercourse and by sharing razors; hepatitis B is not spread by sharing eating utensils; and hepatitis B infection can cause cirrhosis and liver cancer.Our findings indicate that ESL curricula can have a positive impact on health knowledge among Chinese immigrants with limited English. Future research should evaluate the effectiveness of ESL curricula for other immigrant groups, as well as other health topics.

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 six 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 nine (6%) of the 142 experimental group participants and three (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

Objective: Although Chinese are one of the fastest growing minorities in Canada, there is little information about heart disease prevention behaviour in Chinese immigrants. Our objective was to examine the knowledge and practices of Chinese immigrants regarding heart disease prevention. Methods: 504 randomly selected Chinese adult immigrants participated in a community-based, in-person survey in Vancouver during 2005. The survey included questions on heart disease prevention knowledge and practices. Results: Although respondents were quite knowledgeable about heart disease risk factors, their behaviours to reduce heart disease risk were generally low. Thirteen percent of respondents consumed five or more servings of fruit/vegetables per day; 37% engaged in regular physical activity; 54% never used tobacco; 81% had received a blood pressure check in the past 2 years; and 54% had received a cholesterol test in the past 5 years. Differences were found in these behaviours by gender, age, English fluency, birth country and duration of residence in North America. The associations are presented between these demographic variables and heart disease prevention behaviours. Conclusion: Heart disease prevention programs are needed in Chinese immigrant populations, especially aimed at increasing fruit/vegetable consumption and regular physical activity. Efforts are also needed to decrease tobacco use and to increase cholesterol testing. Key words: Heart diseases; health knowledge, attitudes, practice; Asian Continental Ancestry Group; emigration and immigration Resume Objectif : Bien que les Chinois constituent l’une des minorites dont la croissance est la plus rapide au Canada, on manque d’information sur les habitudes de prevention des maladies coronariennes des immigrants chinois. Nous avons cherche a examiner les connaissances et les pratiques de ces immigrants en matiere de prevention des maladies coronariennes. Methode : 504 immigrants chinois adultes selectionnes au hasard ont pris part a une enquete locale effectuee en personne a Vancouver en 2005. L’enquete comportait des questions sur les connaissances et les pratiques liees a la prevention des maladies coronariennes. Resultats : Les repondants etaient tres bien renseignes sur les facteurs de risque des maladies coronariennes, mais ils avaient dans l’ensemble peu de comportements visant a reduire ces risques. Treize p. cent consommaient cinq portions ou plus de fruits et legumes par jour; 37 % pratiquaient regulierement une activite physique; 54 % ne consommaient jamais de produits du tabac; 81 % avaient fait verifier leur pression arterielle au cours des deux annees precedentes; et 54 % avaient subi un test de cholesterolemie au cours des cinq annees precedentes. Des ecarts ont ete observes dans ces comportements selon le sexe, l’âge, la maitrise de l’anglais, le pays de naissance et la duree de residence en Amerique du Nord. Nous presentons les liens entre ces variables demographiques et les habitudes de prevention des maladies coronariennes. Conclusion : Des programmes de prevention des maladies coronariennes sont necessaires dans les populations immigrantes d’origine chinoise, surtout pour ce qui est d’accroitre la consommation de fruits et legumes et l’activite physique pratiquee regulierement. Il faudrait aussi prendre des mesures pour reduire le tabagisme et promouvoir les tests de cholesterolemie. Mots cles : maladies coronariennes; connaissances, attitudes et pratiques liees a la sante; Groupe d’ascendance asiatique; emigration et immigration

Background. Chinese immigrants in Canada have a disproportionately high risk for hepatitis B compared with non-Hispanic Whites. Hepatitis B is the leading cause of hepatocellular carcinoma among Asian immigrants to North America. English-as-a-second-language (ESL) classes are an effective way of reaching newly immigrated individuals and are a potential channel for delivering health messages. Methods. Using data from 6 focus groups among ESL instructors and students, we characterized perceptions about activities that are successfully used in ESL classrooms and strategies for delivering hepatitis B information. Results. Instructors and students generally reported that activities that focused on speaking and listening skills and that addressed content relevant to students’ daily lives were successful in the classroom. Instructors generally avoided material that was irrelevant or too difficult to understand. Focus group participants offered strategies for delivering hepatitis B information in ESL classrooms; these strategies included addressing symptoms and prevention and not singling out a specific population subgroup to avoid stigmatization. Conclusions. These findings might assist efforts to develop ESL curricula that target immigrant populations.

Liver cancer, a significant health problem in Chinese, can be controlled through HBV blood testing, vaccination, and community education about HBV. The PRECEDE framework has been very helpful in identifying factors associated with health practices.The objective was to identify factors associated with HBV testing in Chinese Canadians, using the PRECEDE framework.Five hundred and thirty-three randomly selected Chinese Canadian adults were interviewed about HBV blood testing practices. Factors were grouped as predisposing, reinforcing and enabling.Fifty-five percent had received HBV blood testing. Several predisposing factors, all reinforcing factors and one enabling factor were associated with HBV testing in bivariate analysis. A physician's recommendation for testing was the strongest factor associated with testing in multiple logistic regression analysis (OR=4.4, p0.0001).Many Chinese Canadian adults in Vancouver have not been tested for HBV. Continuing educational efforts are needed and the PRECEDE framework can inform the development of health education interventions.

Background: Little is known about hepatitis B (HBV) and liver cancer control in Chinese in Canada. Liver cancer, a significant health problem in Asia, is preventable and can be controlled through HBV blood testing, vaccination, and community education about HBV. Objective: The overall goal was to increase HBV testing and vaccination in Chinese adult Canadians. The objective was to present findings on HBV testing, vaccination and knowledge in Chinese immigrants. Methods: 504 randomly selected Chinese adult immigrants residing in Vancouver responded to the survey which examined HBV blood testing and vaccination practices, HBV knowledge levels and socio-demographic characteristics. Face-to-face interviews were conducted in Cantonese, Mandarin, or English. Results: 57% of participants reported that they had received HBV blood testing, 38% had been vaccinated, and 6% were known HBV carriers. There were gender differences, with lower rates of testing and vaccination, and higher chronic carrier rates, among men. Over 80% knew that HBV can be spread by asymptomatic persons and can cause cirrhosis and liver cancer. However, confusion existed about the routes of HBV transmission. Interpretation: A sizeable proportion of Chinese adult immigrants in Vancouver have not been tested or vaccinated for HBV. Knowledge level, especially about routes of HBV transmission, was low. This is a concern, given that chronic HBV infection is the most common cause of liver cancer in Asian North Americans. To improve knowledge, reduce risk of infection and the burden of chronic infection and its sequelae in immigrant populations, continuing educational efforts are needed. MeSH terms: Hepatitis B; liver neoplasms; health knowledge, attitudes, practices; asian continental ancestry group; emigration and immigration

Translation of cross-cultural surveys and programs pose unique challenges. This paper identifies potential pitfalls of current translation guidelines and presents solutions employed for one project.We followed current guidelines for translation of survey instruments including forward and back translation, and also utilized qualitative methods to decenter survey questions. In addition, our project adapted translation by committee with a core translation team of bilingual/trilingual investigators and staff members with diverse skills and complementary degrees of proficiency in the languages and dialects of interest.This approach resulted with a mechanism for emic equivalence, identifying and resolving dialectic and sociolinguistic concerns, selecting appropriate written Chinese styles, and providing appropriate linguistic training to interviewers.An understanding of the history of a people and its ramifications for the language are important components of the translation process. Allocation of appropriate time, resources, and skills are critical to the successful development of valid cross-cultural survey instruments and effective programs.

INTRODUCTION: Liver cancer rates are higher in North American Chinese than non-Asian ethnic/racial groups, largely due to chronic hepatitis B virus (HBV) infection. METHODS: A community-based survey of Chinese women (n = 147) was completed during 1999 to examine HBV knowledge and practices in Vancouver, British Columbia. RESULTS: Most women had heard of HBV (85%) but smaller proportions knew about some routes of transmission (e.g., sexual intercourse) and sequelae of infection. Knowledge about HBV was significantly associated with education level (p=0.005), English fluency (p

To examine the influence of diet-related psychosocial constructs on the dietary practices of Chinese populations living in North America.Data are from a cross-sectional survey of 244 women of Chinese ethnicity living in Seattle, WA, USA and Vancouver, BC, Canada. Using an interviewer-administered questionnaire and PRECEDE/PROCEED as our model, we collected information on diet-related psychosocial (predisposing, enabling, and reinforcing) factors; consumption of foods reflecting Western and Chinese dietary practices; and past and current consumption of fruits, vegetables and fat.Participants generally believed that there were strong relationships between diet and health, but only about a quarter were aware of nutrition information from the government. Food cost, availability, and convenience did not appear to be major concerns among these participants. Respondents' older relatives and spouses tended to prefer a Chinese diet and also had a strong influence on the household diet. Associations of the psychosocial factors with demographic characteristics, adoption of Western dietary practices, and consumption of fruits and vegetables were informative. For example, older, less educated respondents considered it very important to eat a low fat, high fruit and vegetable diet; while younger, more educated participants who were employed outside the home did not think the Chinese diet is healthier than a typical Western diet (all p0.05). Western acculturated respondents were more likely to believe in a relationship between diet and cancer/heart disease and report that preparing Chinese meals is inconvenient (p0.05). Respondents with in-family normative pressure to maintain Chinese eating patterns ate more fruits and vegetables (4.4 vs 3.7 servings), while knowledge of nutrition information from the government was associated with increased fruit and vegetable consumption after immigration (all p0.05).Chinese cultural beliefs play an important role in the dietary practices of Chinese living in North America. Therefore, traditional health beliefs, as well as socioeconomic and environmental factors related to diet should be incorporated into the design and implementation of culturally appropriate health promotion programs for Chinese immigrants.

Two novel cyclic tetrapeptides: cyclo[Lys-Tyr-Lys-Ahx-] 7a and cyclo[Lys-Trp-Lys-Ahx-] 7b were synthesized by coupling protected amino acid in solution and the subsequent cyclization effected by the pentafluorophenyl ester method as described in previous papers. These cyclic peptides were designed and synthesized to study their interaction with DNA, based on previous reports that linear peptides Lys-Tyr-Lys and Lys-Trp-Lys could bind to various forms of DNA and cleaved supercoiled DNA at apurinic sites. Ethidium bromide displacement assay showed that the apparent DNA binding constant of linear Lys-Tyr-Lys and cyclic peptide 7a are far below 1 x 10(3) M(-1), whereas those of cyclic peptide 7b and linear Lys-Trp-Lys are 1.9 x 10(4) M(-1) and 9.5 x 10(3) M(-1), respectively. Kinetic studies using agarose gel electrophoresis showed that cyclic peptide 7b and Lys-Trp-Lys possessed DNA nicking activity on natural supercoiled phi X174 DNA with nicking rate of 50.7 and 75.6 pM min(-1) at 65 degrees C, respectively, whereas cyclic peptide 7a and linear Lys-Tyr-Lys were devoid of the corresponding activity. The DNA nicking rate increased significantly with increase in reaction temperature. At reaction temperatures lower than 65 degrees C, the DNA nicking rate of cyclic peptide 7b exceeded that of linear Lys-Trp-Lys. The addition of 1 microM ferrous ion did not give significant enhancement effect on the DNA nicking rate by the peptides. UV irradiation gave a marked rate enhancement on the DNA nicking rate of linear Lys-Trp-Lys and a moderate enhancement on the DNA nicking rate of cyclic peptide 7b.