Keeping Each Other Accountable: Social Strategies for Smoking Cessation and Healthy Living in Vietnamese American Men.

Vietnamese American males have high smoking rates. This study explored social support mechanisms provided by lay health workers (LHWs) and family members through a smoking cessation intervention. Eight focus groups (N = 54) were conducted in Vietnamese stratified by intervention arms (Tobacco [experimental] and healthy living [control]) with 18 smokers, 18 family members, and 18 LHWs. Smokers reported feeling more accountable for their health behaviors, and smoking changes were reinforced by family members, peers, and LHWs through conversations facilitated during and outside the program. Culturally appropriate interventions with multiple social support mechanisms may reduce smoking in minority populations.

A Cluster Randomized Controlled Trial of a Lay Health Worker Intervention to Increase Healthy Eating and Physical Activity Among Vietnamese Americans.

INTRODUCTION: Americans have low levels of knowledge of and adherence to recommendations for healthy eating of fruits and vegetables and for physical activity (HEPA). We conducted a cluster randomized controlled trial of a lay health worker intervention to increase HEPA among Vietnamese Americans. METHODS: We randomized 64 lay health workers to 2 intervention arms. Each lay health worker recruited 10 participants aged 50 to 74. From 2008 to 2013, using flip charts, lay health workers led 2 educational sessions on HEPA (intervention) or colorectal cancer (comparison). We assessed HEPA knowledge and self-reported behaviors by preintervention and postintervention surveys 6 months apart. RESULTS: Of the 640 participants, 50.0% were female, 38.4% had lived in the United States for 10 years or fewer, and 71.4% reported limited English proficiency. Knowledge of the recommended intake of fruits and vegetables (≥5 servings daily) increased from 2.6% to 60.5% in the intervention group (n = 311) and from 2.9% to 6.7% in the comparison group (n = 316) (intervention vs comparison change, P < .001). Knowledge of the physical activity recommendation (≥150 minutes weekly) increased from 2.6% to 62.4% among intervention participants and from 1.0% to 2.5% among comparison participants (P < .001). Consumption of 5 or more daily servings of fruits and vegetables increased more in the intervention group (8.4% to 62.1%) than in the comparison group (5.1% to 12.7%) (P < .001). Participants reporting 150 minutes or more of physical activity weekly increased from 28.9% to 54.0% in the intervention group and from 38.0% to 46.8% in the comparison group (intervention vs comparison change, P = .001). CONCLUSION: A lay health worker intervention increased both healthy eating and physical activity knowledge and self-reported behaviors among older Vietnamese Americans.

Effectiveness of Lay Health Worker Outreach in Reducing Disparities in Colorectal Cancer Screening in Vietnamese Americans.

OBJECTIVES: We conducted a cluster randomized controlled study of a lay health worker (LHW) intervention to increase colorectal cancer (CRC) screening rates among Vietnamese Americans, who typically have lower rates than do non-Hispanic Whites. METHODS: We randomized 64 LHWs to 2 arms. Each LHW recruited 10 male or female participants who had never had CRC screening (fecal occult blood test, sigmoidoscopy, or colonoscopy). Intervention LHWs led 2 educational sessions on CRC screening. Control LHWs led 2 sessions on healthy eating and physical activity. The main outcome was self-reported receipt of any CRC screening at 6 months after the intervention. We conducted the study from 2008 to 2013 in Santa Clara County, California. RESULTS: A greater proportion of intervention participants (56%) than control participants (19%) reported receiving CRC screening (P < .001). When controlling for demographic characteristics, the intervention odds ratio was 5.45 (95% confidence interval = 3.02, 9.82). There was no difference in intervention effect by participant gender. CONCLUSIONS: LHW outreach was effective in increasing CRC screening in Vietnamese Americans. Randomized controlled trials are needed to test the effectiveness of LHW outreach for other populations and other health outcomes.

Cognitive Interviews of Vietnamese Americans on Healthy Eating and Physical Activity Health Educational Materials.

The purpose of this study was to better understand if a health educational presentation using culturally adapted materials was understandable and culturally appropriate, and that the content was retained, in an older Vietnamese American population. This study used cognitive interviewing. A convenient sampling was used to recruit eight participants by staff of a community-based organization from its client base. This is the first study to document that family eating style poses a challenge for estimating food intake among Vietnamese Americans. Participants who ate in a family eating style were not able to recall or estimate the number of servings of protein and vegetables. Some older Vietnamese Americans used food for healing and self-adjusted portion sizes from dietary recommendations. Cognitive interviewing is a useful method to improve comprehension, retention, and cultural appropriateness of health educational materials. Further nutrition research concerning intake measurement in ethnic groups that practice a family eating style is warranted.

Effectiveness of a controlled trial to promote colorectal cancer screening in Vietnamese Americans.

OBJECTIVES: We conducted a controlled trial of a public education and provider intervention to increase colorectal cancer (CRC) screening rates among Vietnamese Americans, who typically have lower rates than non-Hispanic Whites. METHODS: The public education intervention included a Vietnamese-language CRC screening media campaign, distribution of health educational material, and a hotline. The provider intervention consisted of continuing medical education seminars, newsletters, and DVDs. Vietnamese in Alameda and Santa Clara Counties, California, received the intervention from 2004 to 2006; Vietnamese in Harris County, Texas, were controls and received no intervention. A quasi-experimental study design with pre- and postintervention surveys of the same 533 participants was used to evaluate the combined intervention. RESULTS: The postintervention-to-preintervention odds ratio for having ever had a sigmoidoscopy or colonoscopy was 1.4 times greater in the intervention community than in the control community. Knowledge and attitudes mediated the effect of the intervention on CRC screening behavior. Media exposure mediated the effect of the intervention on knowledge. CONCLUSIONS: Improving CRC knowledge through the media contributed to the effectiveness of the intervention.

Effectiveness of continuing medical education in increasing colorectal cancer screening knowledge among Vietnamese American physicians.

Colorectal cancer (CRC) screening rates are lower in Vietnamese Americans than in non-Hispanic Whites. Most Vietnamese Americans have ethnically concordant physicians and are willing to have CRC screening if their physicians recommend it. We conducted two continuing medical education (CME) seminars with participants recruited from the Vietnamese Physician Association of Northern California to increase their CRC screening knowledge. We used pre- and post-CME surveys to evaluate the CMEs and per-item McNemar's tests to assess changes in knowledge. Correct responses increased significantly from pre- to post-CME for all five items on CRC burden and four of 11 items on screening guidelines and practices at the first CME and for five of seven items on screening guidelines and practices at the second CME. Continuing medical education seminars were effective in increasing CRC screening knowledge among Vietnamese American physicians. This increase may lead to physicians' recommending and their patients' completing CRC screening tests.

Attitudes toward hepatitis B and liver cancer prevention among Chinese Americans in the San Francisco Bay Area, California.

BACKGROUND: Chronic hepatitis B and associated liver cancer constitute important health threats with disparity among Asian/Pacific Islander Americans (APIs). However, many APIs are unaware of and unprotected against these diseases. METHODS: To inform the development of community-based programs to increase hepatitis B and liver cancer awareness and prevention among APIs, we conducted a series of qualitative focus groups in 2007 to identify motivations and deterrents related to hepatitis B education, testing, and vaccination among San Francisco Bay Area Chinese Americans. Six focus groups were held in Cantonese, English, or Mandarin for women or men, respectively. Recorded transcripts were transcribed, translated, and then coded by consensus. RESULTS: Factors that motivated individuals to be tested for hepatitis B included peace of mind, prevention of transmission to others, informed decision-making ability, convenience, and pre-vaccination screening. Primary motivations for hepatitis B vaccination were protection of future health and avoidance of hepatitis B. However, factors that discouraged people from testing or vaccination included costs, lack of health insurance, fear of side effects, worries about reliability or efficacy, poor patient-doctor communication, reliance on professional opinion, apparent good health, inconvenience, and personal preference. Individuals were generally in favor of informing relatives and friends about hepatitis B testing and vaccination, and offered several reasons for and against educating others about these activities. CONCLUSIONS: In summary, our study identifies common attitudes and influences regarding the decision to take preventive action against hepatitis B and liver cancer. These findings can be applied toward the design of more effective educational and outreach materials and programs for Chinese Americans and possibly other APIs.

Colorectal cancer screening in Vietnamese Americans.

BACKGROUND: Rates of colorectal cancer screening in Vietnamese Americans are lower than those in non-Hispanic Whites. In this article, we describe rates of colorectal screening, identify determinants, and recommend educational strategies to improve screening. METHODS: A cross-sectional sample of 867 Vietnamese aged 50 to 74 years drawn from a sampling frame of individuals in the Alameda and Santa Clara Counties, California, and Harris County, Texas, area telephone directories with Vietnamese surnames were interviewed in 2004. RESULTS: Colorectal screening recognition, receipt, currency, and intention rates were low. CONCLUSIONS: Although the screening rates are low, Vietnamese are receptive to screening if providers recommend it.

Using focus groups to develop interventions to promote colorectal cancer screening among Vietnamese Americans.

BACKGROUND: Colorectal cancer is the third most common cancer in Vietnamese Americans. Their colorectal screening rates are lower than the rates of whites. METHODS: Four focus groups were conducted to identify Vietnamese American sources and credibility of health information, media utilization, and intervention approaches. RESULTS: Vietnamese Americans trusted doctors and patient testimonials and had access to, and received most of their health information from, Vietnamese- language print and electronic media. Recommended intervention approaches include promoting doctors' recommendation of screening and using Vietnamese-language mass media, print materials, and oral presentations. CONCLUSIONS: Focus groups are useful in determining communication channels and intervention approaches.