A Community-Based Prostate Cancer Screening and Education Program for Asian American Men in Medically Underserved Communities.

This study analyzed data from a community-based prostate cancer (PCa) education and screening program (Prostate Outreach Project; POP) to enhance PCa-related knowledge among medically underserved Asian American men. It also examined PCa screening history, clinical abnormalities based on prostate-specific antigen (PSA) tests and digital rectal examination (DRE) results, and follow-up and PCa diagnosis rates. Participants-521 Asian men (251 Vietnamese, 142 Chinese, and 128 South Asians)-were offered PCa screening using PSA tests and/or DRE and an educational session on PCa. Of these men, 277 completed PCa-related knowledge surveys before and after viewing an educational video. Significant between-group differences in PCa-related knowledge were found at pre-assessment (p < 0.001) but not at post-assessment (p = 0.11), at which time all groups showed improved PCa-related knowledge. Most participants (77.9%) had never received PCa screening, but Vietnamese men had the lowest previous screening rate (17.3%). Chinese men had elevated PSA values and the highest abnormal DRE rates. Of the 125 men with abnormal screening outcomes, only 15.2% had adequate follow-up. Of the 144 men diagnosed with PCa in POP, 11.1% were Asians (seven Chinese, six Vietnamese, and three South Asian). Despite the ethnic heterogeneity among Asian men, a community outreach program may successfully enhance their PCa-related knowledge.

Engaging the Asian American Community to Address Cancer Burden: Experiences and Lessons Learned.

BACKGROUND: Reducing cancer health disparities in Asian Americans requires orchestrated efforts and partnerships. OBJECTIVES: To describe the approach used by the University of Texas MD Anderson Cancer Center, HOPE Clinic, and Asian American organizations to understand and engage Houston's Asian American communities in cancer research, as well as to share lessons learned. METHODS: The community-academic-medical partnership used community-based research principles to build the partnership, form the community advisory board, conduct a community needs assessment, and offer cancer prevention engagement and education. RESULTS: Some lessons learned included balancing language needs with limited resources, incorporating more time and resources to conduct health research in an ethnically diverse community, and promoting awareness of research and its role in cancer prevention in Asian American communities. CONCLUSIONS: Community-academic-medical partnerships are promising ways to engage the community, draw on combined expertise, and create research and programs that are scientifically strong and meaningful to the community.

Is Socioeconomic Advantage Associated With Positive Health Behaviors and Health Outcomes Among Asian Indians?

OBJECTIVE: The South Asian Health Needs Assessment was conducted to collect health status information on the rapidly growing Asian Indian (AI) community in the Houston area. Many were highly educated and reported high income levels, factors usually associated with better health outcomes. This study examined the relationship between socioeconomic advantage and the health behaviors and health outcomes of AIs. METHODS: We analyzed cross-sectional survey data from a convenience sample of 1416 AIs. Income was categorized as low, medium, and high. Descriptive statistics were generated by income categories and weighted multinomial regression analyses were conducted to examine the association of income with health behaviors and outcomes, adjusting for age, sex, health insurance, and years in the United States. RESULTS: Income was positively associated with better self-rated health, higher body mass index, moderate physical activity, having shingles vaccine, and cervical cancer screening. Income was inversely associated with perceived stress and heart disease. However, income was not significantly associated with alternative therapies, cigarette smoking, alcohol consumption, self-reported overweight/obesity, fruit and vegetable consumption, diabetes, high blood pressure, high cholesterol and screening for breast, prostate, and colon cancer. CONCLUSIONS: Socioeconomic advantage was not consistently associated with positive health outcomes or desired health behaviors among AIs. We speculate that other factors, including cultural beliefs and acculturation may also impact health behaviors and health outcomes in this group. Further studies examining the influence of these variables on health behaviors and health outcomes are warranted.

Differences in nativity, age and gender may impact health behavior and perspectives among Asian Indians.

OBJECTIVE: Identify health perspectives among Asian Indians in greater Houston area, to guide a tailored community wide survey. DESIGN: Four focus groups of different ages, gender, and nativity were conducted at which participants were asked for their opinions about specific health topics. Key informant interviews were conducted with ten community leaders to validate focus group responses. Recordings from focus groups and key informant interviews were transcribed and analyzed. RESULTS: Diabetes, cancer, and hypertension were primary health concerns. Common themes were sedentary lifestyle and poor health literacy. Older participants were more accepting of having familial hypertension and high cholesterol. Women were more concerned about health of family members and dietary habits. Perspectives differed on eating habits, physical activity, use of Western medicine, and smoking based on nativity. Responses from key informant interviews validated focus group findings. CONCLUSION: Perspectives on health may differ among Asian Indians depending on gender, age, and nativity.

Physical Activity Behaviors and Influences Among Chinese-American Children Aged 9-13 Years: A Qualitative Study.

Low physical activity is a major health issue among Chinese Americans. This study explored Chinese-American children's physical activity behaviors and influencing factors. Twenty-five children of Chinese or Taiwanese descent were interviewed to understand their favorite sports or physical activities, physical activity environments, and influences on their physical activity. All were between the ages of 9 and 13. Interviews were transcribed and coded using thematic data analysis procedures. Major themes included: (1) team sports, particularly basketball, were commonly listed as favorite sports or activities; (2) physical activity occurred mostly at school or an after-school setting; and (3) family played a major role in physical activity. Some trends/differences were detected based on age, sex, and socioeconomic status. Interventions to promote physical activity among Chinese-American children should emphasize team sports and encourage physical activity in schools, but also explore ways to involves families outside of school.

Culture and Diet Among Chinese American Children Aged 9-13 Years: A Qualitative Study.

OBJECTIVE: To examine Chinese American children's behaviors, food preferences, and cultural influences on their diet. DESIGN: Qualitative individual interviews using constructs from the proposed model of dietary acculturation. SETTING: Community centers and Chinese schools in Houston, TX. PARTICIPANTS: Twenty-five Chinese American children aged 9-13 years. PHENOMENON OF INTEREST: Diet, favorite restaurants, and parents' cooking and grocery shopping habits. ANALYSIS: Content analysis and thematic data analysis to identify code categories and themes. Coders also identified patterns based on demographic and acculturation factors. RESULTS: Overall, participants described their diets and associated behaviors as Asian and non-Asian. Key themes included preference for Asian and non-Asian foods; consumption of non-Asian foods for breakfast and lunch, but Asian foods for dinner; infrequent dining at restaurants; grocery shopping at Asian and non-Asian stores; and familial influences on diet. Acculturated children and children of higher socioeconomic status appeared to prefer and consume a more Westernized/non-Asian diet. CONCLUSIONS AND IMPLICATIONS: Results illustrate that Chinese American children in this study practiced both Asian and non-Asian dietary behaviors. Findings corroborated existing acculturation research with parents and caregivers; supported constructs in the model of dietary acculturation; and provide guidance for research and programs related to dietary behaviors, determinants, and culture among this population.

Circle of Sisters: raising awareness of Native American women to breast cancer.

The Circle of Sisters is a breast cancer education initiative that incorporates free mammography for American Indian women. In two separate but similar initiative-sponsored one-day events, 37 American Indian women underwent screening mammography and experienced a full day of culturally tailored educational activities. Women observed a cooking demonstration, participated in moderate exercise activity, strung beads to learn about the dimensions of breast tumors, and listened to an American Indian breast cancer survivor recount her story of diagnosis and treatment. Significant shifts in opinion included an increase in the understanding that a woman's chances of being diagnosed with breast cancer increase with age (p=.015) and with never bearing children (p <.001) and that breast cancer can be detected early (p=.043). The percentage of those expressing an intention to get a mammogram every year grew from 81.1% to 94.6%.

Associations between body size and serum estradiol and sex hormone-binding globulin levels in premenopausal African American women.

CONTEXT: African American (AA) women have the highest rates of premenopausal breast cancer; however, it is unclear whether body size contributes to the hormonal patterns potentially associated with increased breast cancer risk in these women. OBJECTIVE: To characterize the association between body size and serum levels of estradiol and sex hormone-binding globulin (SHBG) levels in a sample of premenopausal AA women. DESIGN: A total of 164 premenopausal AA women who were not pregnant or breastfeeding were recruited for this study. Serum samples were collected during the early follicular phase, and trained staff collected body size measurements. Multiple linear regression models were performed to assess potential associations. MAIN OUTCOME MEASURES: Serum estradiol and SHBG levels. RESULTS: Many (81%) of the women enrolled were overweight or obese. Both waist-to-hip ratio (WHR) (ß = 2.68, P = .008) and waist circumference (WC) (ß = 2.02, P = .046) were positively associated with higher levels of estradiol. All measures of body was significantly and inversely associated with SHBG levels (all P < .05). CONCLUSIONS: Premenopausal AA women with higher WHR or larger WC may have higher levels of estradiol and lower levels of SHBG. Thus, WHR or WC may be better indicators for assessing hormonal patterns implicated in breast cancer pathogenesis in these women.

Perceptions of generic drug discount programs among low-income women: a qualitative study.

PURPOSE: Increasing the awareness and use of generic drug discount programs (GDDP) may improve access to essential prescription drugs. However, little is known about public perceptions of GDDPs. The purpose of this study is to understand the perceptions and utilization patterns of low-income women regarding GDDP. METHODS: Using a purposive sampling strategy, we conducted seven focus groups with a total of 50 participants using a semistructured guide to assess awareness and utilization of GDDP. Transcripts of the focus groups were systematically analyzed across groups with a general inductive approach for qualitative data analysis. RESULTS: Five major categorical themes emerged from the focus group content analysis: 1) Perceived differences between generic and brand-name prescription drugs, 2) barriers to utilizing GDDP, 3) lack of adequate communication between pharmacy, physician and patient about GDDP, 4) perceived health impact of utilizing GDDPs, and 5) perceived health care savings. Most participants indicated that they perceive no difference between generic and brand-name prescription drugs. Lack of awareness was indicated as a barrier to utilization. There was general agreement among participants that GDDP can help to maintain health while saving money. CONCLUSION: Study participants demonstrated generally favorable perceptions regarding GDDPs. Our findings underscore the need for policies that encourage expansion of the GDDP formulary and increasing awareness and utilization of GDDP.

Young Asian Americans' knowledge and perceptions of cervical cancer and the human papillomavirus.

Cervical cancer is a major health disparity among Asian Americans, with cervical cancer rates of Vietnamese women being significantly higher than for the general US female population and low screening rates reported for Asian American females. Focus groups and interviews were conducted with young Vietnamese, Filipino, and Korean adults (ages 18-29) to collect information on knowledge, perceptions and sources of information regarding cervical cancer, Pap tests and the human papillomavirus. 16 Korean, 18 Vietnamese, and 18 Filipino (50% female) adults participated in the study. Many participants had never heard of HPV, cervical cancer and Pap testing. Cervical cancer screening rates were low for Korean and Vietnamese females and were influenced by moral beliefs and lack of awareness. Culturally relevant education materials that consider specific Asian ethnicity and language are needed to increase awareness of cervical cancer, Pap testing, and HPV among Asian American young adults.

CAN DO Houston: a community-based approach to preventing childhood obesity.

BACKGROUND: Comprehensive, community-based efforts may reduce rates of childhood obesity. COMMUNITY CONTEXT: Almost half of the children in Houston are overweight or obese, even though Houston has many available resources that support good nutrition, physical activity, and prevention of weight gain among children. METHODS: We used existing resources to implement a community-based, childhood obesity prevention initiative in 2 low-income neighborhoods in Houston. On the basis of input from community members, we coordinated various activities to promote healthy living, including after-school programs, grocery store tours, wellness seminars, cooking classes, and staff wellness clubs. OUTCOME: Preliminary findings indicated that residents in the communities are using additional opportunities to participate in physical activity and nutrition education. INTERPRETATION: Implementing a successful childhood obesity prevention initiative in an urban setting is feasible with minimal funding through the use of existing resources.

Hepatitis B and hepatitis C prevalence and treatment referral among Asian Americans undergoing community-based hepatitis screening.

OBJECTIVES: We sought to identify cross-sectional hepatitis B virus (HBV) and HCV prevalence among Asian Americans at a community health fair and to assess referral rates. METHODS: We determined HBV prevalence with hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), and antibodies to hepatitis B surface antigen (anti-HBs). We determined HCV prevalence with hepatitis C antibodies. Successful referral occurred when participants with HBV or HCV were contacted, medically evaluated, and given contact information of liver specialists for care. RESULTS: Of 202 people screened, 118 were Asian Americans (65 Chinese and 39 Vietnamese). Twelve had chronic HBV with positive HBsAg. However, chronic HBV prevalence increased from 10.2% to 13.6% by concomitant HBsAg, anti-HBc, and anti-HBs testing. Prevalence of HCV was 6% overall but 15.4% among Vietnamese. Overall, 83% of patients with chronic HBV and 100% of patients with occult HBV or HCV were successfully referred. CONCLUSIONS: Concomitant HBsAg, anti-HBc, and anti-HBs testing permits diagnosis of chronic, occult HBV infections missed by testing with HBsAg alone. Persons identified with HBV or HCV at community health fairs can be successfully referred.

Addressing cancer health disparities using a global biopsychosocial approach.

The Center for Research on Minority Health has translated the biopsychosocial framework to address global cancer health disparities through the integration of biological (eg, endogenous steroids, genetic susceptibility, and pesticide levels) and behavioral (eg, dietary interventions) determinants, along with community-based research (eg, comprehensive involvement of community advisory boards) and educational approaches (eg, kindergarten through postgraduate training). Evidence of successful implementation of this framework includes health disparities training for >2000 individuals ranging from elementary to the postgraduate level, and conducting transdisciplinary projects that incorporate traditional and nontraditional health professionals to examine associations between biological and nonbiological determinants of health. Examples and recommendations for implementation of the biopsychosocial approach as it applies to cancer health disparities research are described.

The Utility of a Connecting Framework to Facilitate Understanding of and Reduce the Disparities in Hospice Care Experienced by Racial and Ethnic Minorities.

Rapidly changing demographics in the United States and diverse cultural beliefs impact hospice utilization and end-of-life care. Healthcare professionals and clinicians need a connecting framework to understand patients' and their family's perspectives regarding utilization of those services. This framework will assist healthcare workers in providing culturally sensitive and appropriate information to patients nearing the end of life, so that they and their loved ones can make informed decisions for optimal care during this passage of life. Considering the variables in this framework may also help facilitate communication between healthcare professionals and patients and reduce misunderstanding among the surviving family members.

Development of a health risk factors questionnaire for Chinese and Vietnamese residents of the Houston, Texas area.

The purpose of the Asian American Health Needs Assessment (AsANA) project was to collect information on the health risks, behaviors, and beliefs among Chinese and Vietnamese residents in the Houston area, two of the largest Asian American subgroups in Texas. The first phase of the project was to develop the AsANA survey instrument, which was adapted from the Texas Community Health Survey, a condensed version of the Behavioral Risk Factors Surveillance System. This report describes the steps used in adapting, modifying and developing the survey instrument, and provides insights, which may assist other investigators conducting similar research.

Is the MEDFICTS rapid dietary fat screener valid for premenopausal African-American women?

OBJECTIVE: To assess the predictive validity of the meats, eggs, dairy, fried foods, fat in baked goods, convenience foods, fats added at the table, and snacks (MEDFICTS) questionnaire, a rapid dietary fat screening instrument, when used with African-American women. DESIGN: A case series design was utilized to assess the validity of MEDFICTS compared to the Arizona Food Frequency Questionnaire. SUBJECTS/SETTING: Data for this study were collected from 184 healthy premenopausal African-American women who completed both the MEDFICTS and the Arizona Food Frequency Questionnaire during screening for eligibility in a nutrition intervention study. STATISTICAL ANALYSES PERFORMED: Analyses of sensitivity, specificity, predictive values, and receiver operating characteristic analysis were used to examine the predictive validity of MEDFICTS. Covariates of correctly and incorrectly identified groups were examined with contingency table analysis and t tests. RESULTS: MEDFICTS was a statistically significant predictor of dietary fat consumption, but underestimated fat consumption of >or=30%. MEDFICTS' sensitivity to detect those consuming >or=30% fat was 57.3%, whereas its specificity (detection of those consuming <30% dietary fat) was 66.0%. Positive and negative predictive values were 80.6% and 38.5%, respectively. A reduction in the threshold score resulted in increased sensitivity but decreased specificity. Women identified by MEDFICTS as consuming <30% dietary fat but who were actually consuming 30% or more reported greater consumption of fats from foods classified as mixed foods. CONCLUSIONS: Study findings suggest MEDFICTS underestimates fat consumption of >or=30%. The inclusion of a category to assess mixed foods could improve the sensitivity and specificity of MEDFICTS for predicting dietary fat consumption. These results demonstrate the need for population-based validation of dietary screening instruments.

Racial disparities and trends in radiation therapy after breast-conserving surgery for early-stage breast cancer in women, 1992 to 2002.

OBJECTIVES: Clinical guidelines recommend that when breast-conserving surgery is provided as primary therapy for early-stage breast cancer, radiation therapy should follow. We do not know whether racial/ethnic disparities in this therapy exist and how disparities may have changed over time. DESIGN AND PATIENTS: We studied 89,110 women who were diagnosed with incident early-stage (American Joint Committee on Cancer stages I-II) breast cancer at > or = 20 years of age from 1992 through 2002 in 12 geographic areas of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registries. These women had no history of other cancers and received breast-conserving surgery. Of these subjects, 81,577 (91.5%) were Caucasians and 7,533 (8.5%) were African Americans. RESULTS: From 1992 to 2002, the percentage of cases who received breast-conserving surgery without radiotherapy increased from 10.8% to 19.8% for Caucasian women and from 13.6% to 27.7% for African Americans. The gap between African American and Caucasian women slightly increased during this period. When data were controlled for patient and tumor characteristics, year of diagnosis, and geographic area, African American women were 24% less likely than Caucasians to receive the recommended therapy (95% confidence interval: 1.18-1.32). CONCLUSIONS: Although current clinical guidelines recommend that women with early-stage breast cancer who are treated with breast-conserving surgery should have subsequent radiation therapy, the percentage of women who did not receive this regimen increased from 1992 to 2002. The gap between African American and Caucasian women has continued from 1992 to 2002.

Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort.

BACKGROUND: Few studies have examined the outcomes for Hispanic men with prostate carcinoma and incorporated socioeconomic factors in association with race/ethnicity in affecting survival, adjusting for factors on cancer stage, grade, comorbidity, and treatment. METHODS: We studied a population-based cohort of 61,228 men diagnosed with local or regional stage prostate carcinoma at age 65 years or older between 1992 and 1999 in the 11 SEER (Surveillance, Epidemiology, and End Results) areas, identified from the SEER-Medicare linked data with up to 11 years of followup. RESULTS: Low socioeconomic status was significantly associated with decreasing survival in all men with prostate carcinoma. Those living in the community with the lowest quartile of socioeconomic status were 31% more likely to die than those living in the highest quartile (hazard ratio [HR] of all-cause mortality: 1.31; 95% confidence interval [CI]: 1.25-1.36) after adjustment for patient age, comorbidity, Gleason score, and treatment. The HR remained almost unchanged after controlling for race/ethnicity (HR: 1.32; 95% CI: 1.26-1.38). Compared with Caucasians, the risk of mortality in African American men was marginally significantly higher (HR: 1.06; 95% CI: 1.01-1.11) after controlling for education, and no longer significant after adjusting for poverty, income, or composite socioeconomic variable; the HR was lower for Hispanic men (HR: 0.80; 95% CI: 0.72-0.89) after adjustment for education and other socioeconomic variables. CONCLUSION: Racial disparity in survival among men with local or regional prostate carcinoma was largely explained by socioeconomic status and other factors. Lower socioeconomic status appeared to be one of the major barriers to achieving comparable outcomes for men with prostate carcinoma.

Houston AANCART best practices: from vision to synergy to reality.

The theme for the 2004 AANCART Academy, "Community Partnerships for Cancer Control: From Vision to Synergy to Reality", characterizes Best Practices for the Houston AANCART site. Researchers and community members share a common vision for addressing the cancer and health disparities that exist in our Asian community. They banded together synergistically to bring to reality the programs and projects that are enabling more Asian Americans to understand their risks for cancer, receive screening and education, and access treatment and survivorship support. Along the way, Houston AANCART was also able to conduct meaningful and relevant community-based participatory research and to train young Asian and other investigators in how to reach out to this community in a culturally sensitive and appropriate manner.