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Background Human papillomavirus (HPV) vaccination rates for adolescents remain relatively low. The purpose of this study is to examine patient and clinician factors associated with HPV vaccination among patients, ages 11–17, of a large community-based primary care network. Methods Electronic health records and administrative data from a large primary care network from January 2017 – June 2018 for patients ages 11–17 (n = 10,682) and the 198 primary care clinicians that saw them were analyzed. Mixed effects logistic regression models examined the association of patient and clinician factors with HPV vaccine uptake. Results Most patients (63.0%) had at least one dose of the HPV vaccine, and 37.7% were up to date. In adjusted analyses, patients who received the tetanus, diphtheria, and pertussis (Tdap) vaccine (OR = 2.8, 95% CI: 2.1–3.9) compared to those who did not receive the vaccine and patients with five or more medical visits (OR = 1.9, 95% CI: 1.6–2.2) had the greatest odds of being up to date with the HPV vaccine series. Compared to White patients, African American/Black (OR = 0.8, 95% CI: 0.6 – 1.0) and Alaskan Native/American Indian (OR = 0.5, 95% CI: 0.3–0.9) patients were less likely to be up to date. Boys were also less likely to be up to date with the HPV vaccine series compared to girls (OR = 0.7, 95% CI: 0.7–0.8). Additionally, patients with family/general practice primary care clinicians were less likely to have their patients up to date than those with pediatricians (OR = 0.8, 95% CI: 0.6 – 1.0). Conclusion HPV vaccine uptake varied by patient characteristics, heath care utilization and primary care clinician specialty. These findings may inform future evidence-based interventions aimed at increasing HPV vaccine uptake among adolescents by targeting patient sub-groups and reducing missed opportunities for vaccination.

Acceptance of the human papillomavirus (HPV) vaccination among parents and clinicians is high, but uptake remains low. Little is known about organizational and primary care team factors that influence the uptake of the HPV vaccine. Interviews with clinicians, clinic support staff, and parents of adolescent patients were conducted to better understand the interrelationships among the people and the organizational processes that influence HPV vaccine uptake at the point of care. Between July 2016 and February 2017, semi-structured interviews of 40 participants (18 clinicians, 12 clinic support staff, and 10 parents of adolescent patients) in a primary care network were conducted. Organizational structures and processes, such as electronic provider reminders, availability of “vaccination only” appointments, and knowledgeable primary care team members contributed to HPV vaccine uptake. Consistently high support of HPV vaccination was found among key informants; however, rather than refuse HPV vaccination, parents are opting to delay vaccination to a future visit. When parents express the desire to delay, clinicians and care team members described often recommending addressing HPV vaccination at a future visit, giving parents the impression that receiving the vaccine was not time-sensitive for their child. Discordance in HPV vaccination recommendations among providers and clinic support staff may contribute to delayed HPV vaccination. Strong, high-quality HPV vaccine recommendations are needed from all primary team members. Clinic interventions to accelerate HPV vaccine uptake may benefit from a team-based approach where every member of the primary care team is delivering the same consistent messaging about the importance of timely HPV vaccination.

Background: Study populations in clinical research must reflect US changing demographics, especially with the rise of precision medicine. However, racial and ethnic minority groups (REMGs) have low rates of participation in cancer clinical trials. Methods: Criteria were developed to identify cancer centers able to accrue a higher than average proportion of REMGs into clinical trials. Comprehensive interviews were conducted with leaders of these cancer centers to identify operational strategies contributing to enhanced accrual of REMGs. Results: Eight US cancer centers reported a REMG accrual rate range in cancer research between 10 and 50% in a 12-month reporting period and met other criteria for inclusion. Fourteen leaders participated in this assessment. Key findings were that centers: had a metric collection and reporting approach; routinely captured race and ethnicity data within databases accessible to research staff; had operational standards to support access and inclusion; developed practices to facilitate sustained patient participation during clinical trials; had strategies to decrease recruitment time and optimize clinical study design; and identified low-resource strategies for REMG accrual. There was also a clear commitment to establish processes that support the patient's provider as the key influencer of patient recruitment into clinical trials. Conclusion: We have identified operational practices that facilitate increased inclusion of REMGs in cancer trials. In order to establish a sustainable cancer center inclusion research strategy, it is valuable to include an operational framework that is informed by leading US cancer centers of excellence. Keywords: Cancer research, Clinical trials, Operations, Disparities, Diversity and inclusion, Racial and ethnic minority groups

BACKGROUND Biospecimens from racially diverse groups are needed to advance cancer research. The Asian American Cancer Education Study was developed to increase the number and proportion of blood biospecimen donations from Asian Americans for cancer research. METHODS The authors' targeted approach included 2 types of community engagement, in-reach (within institution to Asian American patients with cancer) and outreach (external to institution to the general Asian American community). Participants received in-language biospecimen education followed by the opportunity to donate blood biospecimens. Outreach participants donated through our community biospecimen blood drives, and in-reach participants consented to donating an extra tube of blood during their routine blood draws as a patient. Donated blood biospecimens were spun down to serum and plasma to be stored in a biorepository or were sent to the laboratory to test for cancer-related risk factors. RESULTS Three hundred eighty-eight Asian Americans donated 1127 blood biospecimens for cancer research. Four hundred twenty tubes of plasma and serum are currently being stored at the cancer center's biorepository, 39 tubes have been used for cancer genomic research, and 668 tubes were used to characterize cancer-related risk factors. CONCLUSIONS Building upon the past decade of the National Cancer Institute-funded Asian American Network for Cancer Awareness, Research, and Training's foundation of trust and service among Asian Americans, researchers were able to leverage relationships not only to introduce the idea of biospecimen contribution to the community but to also exceed expectations with regard to the quantity of blood biospecimens collected from Asian Americans. Cancer 2018;124:1614-21. © 2018 American Cancer Society.

Author(s): Tepper, Clifford G; Dang, Julie HT; Stewart, Susan L; Fang, Dao M; Wong, Kimberly A; Liu, Stephenie Y; Davis, Ryan R; Dao, Doan Y; Gregg, Jeffrey P; Torok, Natalie J; Chen, Moon S | Abstract: BACKGROUND:An exploratory study was performed to determine the prevalence of the patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs78409 [G] allele among the Hmong as a risk factor for nonalcoholic fatty liver disease (NAFLD). NAFLD/nonalcoholic steatohepatitis is the world's most common chronic liver disease and is expected to replace viral hepatitis as the leading cause of cirrhosis and potential precursor to hepatocellular carcinoma (HCC). Of all populations in California, the Hmong experience the highest risk of death from HCC and the highest prevalence of metabolic syndrome risk factors among Asians that predispose them to NAFLD. Here a genetic explanation was sought for the high rates of chronic liver disease among the Hmong. The literature pointed to the PNPLA3 rs738409 [G] allele as a potential genetic culprit. METHODS:Cell-free DNA was isolated from 26 serum samples previously collected in community settings. Quantitative polymerase chain reaction-based single-nucleotide polymorphism (SNP) genotyping was performed with a validated TaqMan SNP genotyping assay, and results were analyzed with TaqMan Genotyper software. RESULTS:The PNPLA3 rs738409 [CgG] variant occurred at a frequency of 0.46 (12 of 26; 95% confidence interval, 0.27-0.67). This carrier rate would rank the Hmong as the third highest population in the 1000 Genomes Project. CONCLUSIONS:Although this small sample size limits the generalizability, the high frequency rates of this allele along with the presence of metabolic syndrome risk factors warrant further studies into the etiology of NAFLD among the Hmong. Cancer 2018;124:1583-9. © 2018 American Cancer Society.

PURPOSE: Participation of racial and ethnic minority groups (REMGs) in cancer trials is disproportionately low despite a high prevalence of certain cancers in REMG populations. We aimed to identify notable practices used by leading US cancer centers that facilitate REMG participation in cancer trials. METHODS: The National Minority Quality Forum and Sustainable Healthy Communities Diverse Cancer Communities Working Group developed criteria by which to identify eligible US cancer centers—REMGs comprise 10% or more of the catchment area; a 10% to 50% yearly accrual rate of REMGs in cancer trials; and the presence of formal community outreach and diversity enrollment programs. Cancer center leaders were interviewed to ascertain notable practices that facilitate REMG accrual in clinical trials. RESULTS: Eight cancer centers that met the Communities Working Group criteria were invited to participate in in-depth interviews. Notable strategies for increased REMG accrual to cancer trials were reported across five broad themes: commitment and center leadership, investigator training and mentoring, community engagement, patient engagement, and operational practices. Specific notable practices included increased engagement of health care professionals, the presence of formal processes for obtaining REMG patient/caregiver input on research projects, and engagement of community groups to drive REMG participation. Centers also reported an increase in the allocation of resources to improving health disparities and increased dedication of research staff to REMG engagement. CONCLUSION: We have identified notable practices that facilitate increased participation of REMGs in cancer trials. Wide implementation of such strategies across cancer centers is essential to ensure that all populations benefit from advances in an era of increasingly personalized treatment of cancer.

Our objective was to estimate the prevalence of diabetes and pre-diabetes and the risk associated with BMI above the Asian cut-point of 23 in 4 Asian American communities. In a convenience sample of 981 Chinese, Hmong, Korean, and Vietnamese Americans in Sacramento County, California we measured hemoglobin A1c (HbAlc), height, weight, and waist circumference. Diabetes was defined as self-reported diabetes diagnosis or HbA1c≥6.5%, and pre-diabetes as HbAlc 5.7-6.4% with no diabetes diagnosis. We computed age-standardized prevalence of diabetes, pre-diabetes, and BMI and waist circumference above standard and Asian cut-points, and developed multivariable models of the association of diabetes and pre-diabetes with BMI and waist circumference. The 4 ethnic groups differed substantially with respect to diabetes prevalence, BMI, and waist circumference. Hmong had the highest prevalence of diabetes (15.0%, 95% confidence interval [CI] 10.7-19.4%). Diabetes and pre-diabetes were associated with BMI≥25 (diabetes: odds ratio [OR] 3.4, 95% CI 2.1-5.7; pre-diabetes: OR 4.0, 95% CI 2.7-5.8) or between 23 and 25 (diabetes: OR 1.8, 95% CI 1.0-3.1; pre-diabetes: OR 1.6, 95% CI 1.0-2.4). When waist circumference was added to the model, BMI effects were attenuated, and waist circumference ≥40 inches (men) or ≥35 inches (women) was associated with increased risk of diabetes (OR 3.2, 95% CI 1.6-6.2) and pre-diabetes (OR 1.7, 95% CI 1.0-2.9). Our findings support the use of a BMI cut-point of 23 and the importance of central adiposity as a risk factor for diabetes in Asians. Diabetes risk reduction interventions for Asians are essential.

Clinical research increasingly relies upon the availability of appropriate genetic materials; however, the proportion of biospecimens from racial/ethnic minority patients and healthy controls are underrepresented, which preclude equitable research across all patient groups for cancer treatment. National Cancer Institute-funded Community Network Program Centers in California, Florida, and New York collaborated with local community partners to conduct three independent formative research studies with diverse (African American, Asian American, Hispanic, and White) participants to explore their knowledge, attitudes, and beliefs about biobanking, and their experiences with the donation of biospecimens. Our findings demonstrated similarities in overall low knowledge and understanding about the use of biospecimens for research. This was exacerbated for non-English speakers. Racial and ethnic groups differed with regard to a number of factors that are obstacles for participation, e.g., continuing medical mistrust (African Americans), lack of benefit (Hispanics), apprehension about the physical toll of donating (Vietnamese), usage of biospecimen for research (Hmong and Chinese), and suspicion of exploitation by corporate entities (Whites). However, participants uniformly reported general interest and willingness to participate in biobanking for altruistic purposes, particularly to benefit future generations. This interest was framed with a strong admonition that donations should be accompanied by transparency about study sponsorship and ownership, distribution and use of biospecimens, and study information that fit participants' backgrounds and experiences. This cross-cultural regional analysis offers significant insights into the similarities and variations in opinions and perceptions about biobanking and the collection of biospecimens for use in cancer research.

Background The NIH Revitalization Act of 1993 mandated the appropriate inclusion of minorities in all National Institutes of Health-funded research. Twenty years after this Act, the proportion of minority patients enrolled in cancer clinical trials remains persistently low. Clinical trials are the vehicles for the development and evaluation of therapeutic and preventive agents under scientifically rigorous conditions. Without representation in trials, disparities in the cancer burden for minorities are projected to increase.

Background: Biospecimen collection from diverse populations can advance cancer disparities research, but is currently underrepresented. Methods: We partnered with a community-based clinic serving Cantonese-speaking Chinese Americans to develop and revise an educational seminar on biospecimen collection. Through a randomized controlled trial (n = 395), 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% confidence interval (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. See all articles in this CEBP Focus section, “Community Network Program Centers.” Cancer Epidemiol Biomarkers Prev; 23(3); 392–401. ©2014 AACR.

ObjectivesTo investigate risk factor patterns and the simultaneous occurrence of multiple risk factors in the viral, metabolic and lifestyle domains among Asian Americans, who have had the highest mortality rates from hepatocellular carcinoma (HCC).SettingSacramento County, California, USA.ParticipantsEligible participants were county residents ages 18 and older who had not been screened for chronic hepatitis B virus (HBV) and were born in a CDC-defined endemic area or whose parent was born in that area. Of 1004 enrolled, 917 were foreign-born Chinese (130 women, 94 men), Hmong (133 women, 75 men), Korean (178 women, 90 men) or Vietnamese (136 women, 81 men) with complete risk factor data.Primary and secondary outcome measuresWe tested participants for HBV and chronic hepatitis C virus (HCV); measured haemoglobin A1c and waist circumference; and recorded self-reported history of diabetes, hypertension, alcohol use and smoking status. We identified risk factor patterns using cluster analysis and estimated gender-specific age-standardised prevalence rates.ResultsWe identified four patterns: (1) viral (chronic HBV or HCV); (2) lifestyle (current smoker or alcohol user, no viral); (3) metabolic (≥2 metabolic, no lifestyle or viral); and (4) lower risk (≤1 metabolic, no lifestyle or viral). Vietnamese men (16.3%, 95% CI 7.4% to 25.3%) and Hmong women (15.1%, 95% CI 7.8% to 22.5%) had the highest viral pattern prevalence. Hmong women had the highest metabolic (37.8%, 95% CI 29.8% to 45.9%), and Vietnamese men the highest lifestyle (70.4%, 95% CI 59.1% to 81.7%) pattern prevalence. In multiple domains, Hmong men and women were most likely to have viral+metabolic risk factors (men: 14.4%, 95% CI 6.0% to 22.7%; women: 11.9%, 95% CI 5.6% to 18.3%); Vietnamese men were most likely to have lifestyle+viral (10.7%, 95% CI 2.7% to 18.8%), and lifestyle+metabolic but not viral (46.4%, 95% CI 34.4% to 58.5%) risk factors.ConclusionsEfforts to reduce HCC must comprehensively address multiple risk factors.Trial registration numberNCT02596438.

Objective. Without medical intervention, about one-quarter of the 1.4–2.2 million Americans chronically infected with the hepatitis B virus (HBV) will die of HBV-associated conditions, including liver failure and hepatocellular carcinoma. We report on a program in Sacramento County, California, that offered HBV screening to at-risk adults, referred infected individuals to care, and vaccinated uninfected adults who were susceptible to HBV infection (i.e., individuals who tested negative for hepatitis B surface antigen and who were never vaccinated against HBV). Methods. We engaged organizations linked to Chinese, Hmong, Korean, and Vietnamese communities to cosponsor HBV screenings of Asian Americans as part of the Hepatitis Testing and Linkage to Care initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites. We held 28 hepatitis B community screening events throughout Sacramento County, California, in collaboration with these groups from September 2012 to September 2013. Results. We screened 1,004 Asian American adults (i.e., 283 Koreans, 242 Chinese, 233 Vietnamese, 223 Hmong, and 23 people from other Asian communities) for HBV, of whom 98% were foreign born and 87% had a language preference other than English. Of the 76 participants who tested positive for HBV (31 Hmong, 23 Vietnamese, 17 Chinese, two Koreans, and three from other Asian communities), we provided posttest counseling to 51 participants. Conclusion. By collaborating with community groups and addressing barriers to screening, we highlighted the importance of disaggregating chronic HBV infection rates by Asian ethnicity and sex vs. aggregated Asian American rates. Future HBV screening initiatives should target Hmong and Vietnamese men.

Hepatitis B (HBV) induced hepatocellular carcinoma is the greatest cancer health disparity affecting Asian Americans, but the prevalence of screening to detect HBV is suboptimal. Our aims were to determine the effectiveness of electronic health record (EHR) prompts to increase ordering of HBV tests among primary care providers (PCPs) within an academic health system. We conducted a randomized, controlled trial between April and June 2011 among 76 PCPs caring for 175 outpatient adults with Chinese or Vietnamese surnames, with appointments with providers and no history of HBV testing. Providers were randomized to either receive an EHR prompt for HBV testing prior to patients’ appointments or usual care. Primary outcomes were the proportion of patients (1) whose physician ordered a HBsAg test and (2) who completed testing. Secondary outcomes were (A) test results and (B) whether the physicians followed-up on the results. HBsAg tests were ordered for 36/88 (40.9 %) of the intervention patients and 1/87 (1.1 %) of the control patients [χ 2 (df = 1) = 41.48, p

Asian Americans are the fastest growing ethnic group in U.S. However, they represent only 1.7% of U.S. cancer clinical trial participants. This pilot study describes findings on barriers, promoters and recommendations related to cancer clinical trial participation from Asian Americans. The research team conducted 3 focus groups comprised of 21 community members and 4 key informant interviews with healthcare providers. Qualitative methodology was used to identify themes about cancer clinical trial participation. Barriers and promoters were categorized based on themes identified and previous study findings. Eight major themes and 5 recommendations were identified from the focus group data. Five major themes and 7 recommendations were identified from the key informant data. Asian Americans’ decision to participate in cancer clinical trials is largely influenced by their cultural values and practices such as altruism and family-based decision making process. Technology platforms provide promising venues to reach Asian Americans. Family-based decision making process, altruism, and the use of technology platforms may need to be considered when outreaching to Asian Americans on cancer clinical trial participation.

e18643Background: By 2050, racial and ethnic minorities (REMs) will constitute > 50% of the US population. Despite a high prevalence of certain cancers in REM populations, < 10% REMs diagnosed with...

After tobacco use, chronic hepatitis B (CHB) viral infections are the most important cause of cancer globally in that 1 out of 3 individuals have been infected with the hepatitis B virus (HBV). Though infection rates are low (< 1%) in the United States, Asian Americans who comprise about 6% of the population experience about 60% of the CHB burden. This paper reviews the magnitude of hepatitis B (HBV) burden among Asian Americans and the progress being made to mitigate this burden, primarily through localized, community-based efforts to increase screening and vaccination among Asian American children, adolescents, and adults. This review brings to light that despite the numerous community-based screening efforts, a vast majority of Asian Americans have not been screened and that vaccination efforts, particularly for adults, are sub-optimal. Greater efforts to integrate screenings by providers within existing healthcare systems are urged. Evidence-based strategies are offered to implement CDC's three major recommendations to control and prevent hepatitis B through targeted screening and enhanced vaccination efforts.

Introduction: Anal cancer is more frequent among people living with HIV/AIDS (PLWHA), with incidence rates increasing among PLWHA despite effective HIV treatments. This highlights the need for effective anal cancer screening guidelines. As part of the development of such guidelines for anal cancer prevention, participation and retention in clinical trials (CT) is pivotal. Previous studies showed lower participation of Hispanics in cancer-related CT among PLWHA. We are conducting a randomized controlled trial (RCT) aimed to test the effectiveness of an educational intervention in recruiting PLWHA in one of the anal cancer-related CT of the AIDS Malignancy Consortium (AMC) being conducted in Puerto Rico (PR), the Anal Cancer Prevention Study (ANCHOR). This work describes the methodology of this study and baseline characteristics of study participants. Methods: A collaboration in the development of an educational linear video for anal cancer was conducted in 2015 between UC Davis Comprehensive Cancer Center and the University of Puerto Rico (UPR) Comprehensive Cancer Center. As a result, a RCT is being conducted at the 9 immunology/STI clinics of the PR Department of Health, to test the effectiveness of this audiovisual intervention in increasing: (1) HIV/AIDS patients' knowledge of anal cancer and CT; (2) favorable attitudes towards CT; and (3) willingness to participate in ANCHOR, a CT aimed to developing anal cancer screening and treatment guidelines for PLWHA. Our RCT is expected to recruit 308 PLWHA aged ≤ 35 years, that receive HIV care at these clinics, and that have not participated in any cancer CT or have been diagnosed with any cancer type in their lifetime. The randomization of this study is at the clinic level, in which we randomly allocated each clinic to either: the intervention group (receiving the audiovisual educational intervention focused on CT and anal cancer screening) or the control group (receiving a standard CT recruitment education). Participants who agree to participate complete an informed consent, a baseline survey, and an initial contact survey through a face-to-face computer-based interview. Participants are followed-up at 2-weeks (by phone) and 3-months (at the clinic) in order to assess changes in willingness to participate in anal cancer CT and to determine if the participant has called, been screened, or been enrolled into an AMC CT. Results: As of Mid-June 2016, 134 patients had been screened, 125 (93%) PLWHA were eligible, and 124 of them (99%) agreed to participate in the study. Of the recruited participants, the mean age was 55±10 years, 60% were men, 56% had ≤12 years of education, and 96% had an annual family income ≤ $35,000. Close to half (44%) of the participants reported never having heard about CT, while most (84%) could not correctly identify the definition of a CT. Although 98% of participants thought that participating in an anal cancer CT could be beneficial for their health, 91% had never heard of a high-resolution anoscopy (HRA) and 26% were not interested in participating in a CT that used HRA. Among those not interested in participating in a CT that used HRA, the most common reasons reported were: lack of information provided about the study (87%), and fear to the procedure (6%). Conclusions: Preliminary data at the baseline interview showed a high willingness of PLWHA to participate in anal cancer CT; however, there is a lack of knowledge about anal cancer CT and CT in general. The methodology developed as well as the information obtained will be necessary to develop specific strategies to increase knowledge and awareness about anal cancer and anal cancer CT among PLWHA and promote the advance of RCT for cancer prevention among PLWHA. Citation Format: Vivian Colon-Lopez, Omar Valentin-Rivera, Marievelisse Soto-Salgado, Darilyn Rivera, Julie H. Dang, DA Letran, Moon Jr Chen, Ana Patricia Ortiz. Randomized controlled trial to increase anal cancer clinical trial recruitment among persons living with HIV/AIDS in Puerto Rico: Methodology and baseline assessment. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C03.

Personalized medicine cannot be achieved without the public's willingness to contribute biospecimens for cancer research and their support for the research being conducted. In many cases, the historical and cultural mistrust by racial/ethnic minorities in biomedical research stem from the adverse legacy of uninformed consent in communities of color; from Tuskegee to the Havasupai Indians, these events have amplified the disconnect between researchers and these minority communities. Engaging these communities in biospecimen contribution for cancer research requires: time, trust and talent. For sustained and respectful relationships, collecting blood biospecimens must be viewed as mutually beneficial and not as a one-sided effort. These collaborations should build community capacity to not only understand the value of biospecimens for cancer research but also advocate for their need. Researchers should commit to investing the time necessary to developing community relationships and earning community trust. Simultaneously, educational outreach efforts need to be ethnically specific, linguistically diverse, culturally appropriate and cognitively empowering. Building upon the past decade of the NCI funded Asian American Network for Cancer Awareness, Research and Training (AANCART)’s foundation of trust and service with the Asian American community, researchers were able to leverage relationships to not only introduce the idea of biospecimen contribution to the community, but to also exceed our expectations in collecting blood biospecimens from Asian Americans. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):ED01-03.

Background: Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk. Methods: Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. Results: Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3–9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02–1.7), female gender (OR 5.3; 95% CI 1.7–16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3–17.6). The most often cited reason for testing was a doctor's recommendation. Conclusions: LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. Impact: LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued. Cancer Epidemiol Biomarkers Prev; 22(5); 782–91. ©2013 AACR.

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.

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.

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.