Health Care Providers' Perspectives on Barriers and Facilitators to Cervical Cancer Screening in Vietnamese American Women.

INTRODUCTION: Vietnamese American women (VAW) are diagnosed and die at twice the rate than White non-Hispanic American women (16.8/100,000 vs. 8.1/100,000 and 4.4/100,000 vs. 2.4/100,000, respectively). Despite efforts to increase cervical cancer (CC) screening among VAW, the participation rates are persistently low (69% to 81%). The purpose of this study was to explore health care providers' (HCPs) perspectives on barriers and facilitators to CC screening in VAW. METHOD: This qualitative descriptive pilot study, used open-ended semistructured interviews with 10 HCPs. RESULTS: The HCPs had two to 23 years treating VAW. Major barriers and facilitators identified by the HCPs were as follows: VAW's decision making about CC screening; sexual health divide; language discordance, relying on interpreters; breaking suspicion; VAW's exposure to health sources of CC screening; sustainable trust; and motivated health care practices. DISCUSSION: HCPs perceived the reasons for VAW not being screened or delaying CC screening were due to their lack of knowledge, cultural barriers, language, and issues related to trust.

Feasibility of a Multicomponent Breast Health Education Intervention for Vietnamese American Immigrant Women.

PURPOSE/OBJECTIVES: To determine the feasibility and acceptability of an intervention with targeted cultural and health belief messages to increase rates of mammography among Vietnamese American (VA) immigrant women. 
. DESIGN: One-group, pre-/post-test, pilot, quasiexperimental design.
. SETTING: Portland, Oregon, metropolitan area. 
. SAMPLE: 40 VA immigrant women aged 50 years or older.
. METHODS: Participants who had not had a mammogram within the past 12 months were recruited. The intervention consisted of one interactive group teaching session, followed by individual counseling delivered about 10 days later to overcome barriers to screening. Participants completed a baseline survey prior to the group teaching and again at 12 weeks after the session.
. MAIN RESEARCH VARIABLES: The intervention, guided by the Transtheoretical Model of Change and the Health Belief Model, involved movement in stage of change based on women's readiness, as well as perceived susceptibility, perceived benefits, perceived common barriers, and perceived cultural barriers. Mammogram completion and knowledge of breast cancer and mammography were examined.
. FINDINGS: The recruitment response rate was 58%. Knowledge about breast cancer, breast cancer susceptibility, and the benefits of mammography as related to breast cancer significantly increased following the intervention.
. CONCLUSIONS: Acceptability of the targeted program, good feasibility, and very low attrition was achieved. 
. IMPLICATIONS FOR NURSING: This intervention can be adapted for other populations, including other Asian groups, and other cancer screenings.

The Effectiveness of Support Groups in Asian Breast Cancer Patients: An Integrative Review.

Cancer support group has been studied as an intervention to improve patient psychosocial well-being. The effectiveness of support groups among Asian breast cancer (BC) patients has been unclear and received limited attention to the evidence of its effectiveness. The social-cognitive processing theory underlies the principles of support groups and advocates that a positive, supportive social environment can improve cognitive processing. The purpose of this paper is to present an integrative review of research evidence on the effectiveness of cancer support groups with Asian BC patients. Empirical studies related to support group among Asian and Asian American BC patients published between 1982 and April 2014 are reviewed. There are 15 studies selected (12 from the Asian-Pacific region and 3 from Western countries). The review includes 1 qualitative study, 3 descriptive studies, 1 mixed method design, and 10 experimental or quasi-experimental studies. The support group intervention activities include psycho-educational program such as health education, problem-solving, and stress management. These studies support the effectiveness of support group in alleviating psychological distress and supporting quality of life of Asian BC women. Overall, there is limited research on the use and effectiveness of support groups with Asians cancer patients in Asia and in Western countries. Without accounting for Asian immigrants overseas, the Asian population is expected to grow from 4.3 to 5.3 billion by 2050. As cancer patients become more diverse due to global emigration, more rigorous studies examining the effectiveness of psychosocial intervention among transcultural cancer patients are needed.

A Longitudinal Examination of Stages of Change Model Applied to Mammography Screening.

Application of behavior change theories to ethnically diverse groups is limited. In a secondary analysis of intervention study data, we tested the validity of the transtheoretical model (TTM) of change among Chinese American immigrant women. Three hundred mammography non-adherent women were randomized to an intervention or control group. Compared with contemplators (60%), precontemplators reported higher perceived mammography barriers (p < .001) and lower breast cancer susceptibility (p < .01). Baseline contemplators were 1.5 times more likely to have a mammogram post intervention compared with precontemplators. Upward shift in stage of change was higher in the intervention than the control group at 3 months (odds ratio [OR] = 6.14), 6 months (OR = 4.82), and 12 months (OR = 2.85). Women with an upward shift at 3 months were more likely to complete mammography at 12 months (OR = 15.44). The results supported the TTM stages of change. Education targeted to Chinese women's stages of change has significant potential to decrease breast cancer screening disparities.

Mammography Screening of Chinese Immigrant Women: Ever Screened Versus Never Screened.

PURPOSE/OBJECTIVES: To compare the differences in mammogram completion rates over time between Chinese American women with and without a history of mammogram screening
. DESIGN: Secondary analysis of a randomized, controlled intervention study. SETTING: Metropolitan areas of Portland, Oregon. SAMPLE: 300 foreign-born Chinese immigrant women aged 40 years or older. Of these, 83 women (28%) had never had a mammogram. METHODS: Participants who had not been screened with a mammogram within the past 12 months were randomized into either an education group or a control (brochure) group. All participants completed a baseline survey, which was administered again at 3, 6, and 12 months
. MAIN RESEARCH VARIABLES: Mammography history, breast cancer knowledge, perceived risks, susceptibility, benefits, and common and cultural barriers
. FINDINGS: Women who had never been screened were less likely to have insurance, a regular healthcare provider, or to have been instructed to have a mammogram. Postintervention in the education group, mammogram completion was not significantly different between those with or without a history of screening (p = 0.52). In the control brochure group, significantly more women with a history of screening had a mammogram (p = 0.03). CONCLUSIONS: Practitioners must be aware of differential effects of education on mammography cancer screening based on women's history of screening
. IMPLICATIONS FOR NURSING: Print material may not be as effective with women who have never been screened with a mammogram. Targeted approaches based on such understanding has the potential to decrease the breast cancer screening disparity among Chinese immigrant women
.

Breast Health Intervention Effects on Knowledge and Beliefs Over Time Among Chinese American Immigrants--a Randomized Controlled Study.

Chinese American immigrant women, nonadherent with mammography in the past 12 months, (N = 300) were enrolled in a randomized controlled trial designed to change knowledge and beliefs and increase mammogram use. This report describes intervention effects on changes in knowledge and beliefs between the control and educational groups over four time points (baseline and 3, 6, and 12 months). Variables measured included knowledge, perceived susceptibility, perceived general barriers to mammography, perceived benefits to mammography, and four cultural barriers to mammography (crisis orientation, modesty, use of Eastern medicine, reliance on others). At all three post-intervention time points, women in the education group had significantly higher knowledge scores than those in the control group, regardless of whether they had completed a mammogram during the study. Women in the education group reported higher perceived susceptibility to breast cancer at 3-month post-intervention. At 3- and 6-month post-intervention, regardless of mammogram screening completion, women reported lower concerns about modesty related to mammography when compared to the control group. By the 12-month post-intervention, women in the education group reported significantly fewer perceived barriers than the control group. A targeted breast health program successfully changed breast health knowledge and beliefs that were sustained for up to 6-12 months. Education targeted to women's knowledge and beliefs has significant potential for decreasing disparity in mammogram use among Chinese American immigrant women.

A breast health educational program for Chinese-American women: 3- to 12-month postintervention effect.

PURPOSE: To test the efficacy of a culturally targeted breast cancer screening educational program in increasing mammogram completion in Chinese-American immigrant women. DESIGN: Randomized controlled study. SETTING: Chinese communities, Portland, Oregon. SUBJECTS: From April 2010 to September 2011, 300 women were randomized to receive a theory-based, culturally targeted breast cancer screening educational intervention (n = 147) or a mammography screening brochure published by the National Cancer Institute (n = 153). INTERVENTION: The two-part intervention consisted of group teaching with targeted, theory-based messages followed by individual counseling sessions. MEASURES: Mammography completion, perceived susceptibility, perceived benefits, perceived barriers, perceived cultural barriers, and demographic variables. ANALYSIS: A 2 × 3 mixed logistic model was applied to determine odds ratio of mammogram completion. RESULTS: Behavior changed in both groups, with a total of 170 participants (56.7%) reporting a mammogram at 12 months. The logistic model indicated increased odds of mammogram completion in the intervention compared to the control group at 3, 6, and 12 months. When controlling for marital status, age, and age moved to the United States, the intervention group was nine times more likely to complete mammograms than the control group. CONCLUSION: The culturally targeted educational program significantly increased mammogram use among Chinese immigrant women. Further testing of effectiveness in larger community settings is needed. The intervention may also serve as a foundation from which to develop education to increase cancer screening among other minority subgroups.

Adaptation and testing of instruments to measure cervical cancer screening factors among Vietnamese immigrant women.

PURPOSE: Vietnamese American women diagnosed with cervical cancer are more likely to have advanced cancer than non-Hispanic White women. We sought to (a) develop a culturally sensitive Vietnamese translation of the Revised Susceptibility, Benefits, and Barriers Scale; Cultural Barriers to Screening Inventory; Confidentiality Issues Scale; and Quality of Care from the Health Care System Scale and (b) examine the psychometric properties. DESIGN: Cross-sectional study with 201 Vietnamese immigrant women from the Portland, Oregon, metropolitan area. METHOD: We used a community-based participatory research approach and the U.S. Census Bureau's team approach to translation. RESULTS: Cronbach's alpha ranged from .57 to .91. The incremental fit index ranged from .83 to .88. DISCUSSION AND CONCLUSIONS: The instruments demonstrated moderate to strong subscale internal consistency. Further research to assess structural validity is needed. IMPLICATIONS FOR PRACTICE: Our approaches to translation and psychometric examination support use of the instruments in Vietnamese immigrant women.

Academic-community partnership development lessons learned: evidence-based interventions to increase screening mammography in rural communities.

Early detection of breast cancer leads to higher survival; yet, women who live in rural areas have lower screening rates and receive diagnosis at later stages. Effective screening approaches have been published in scientific journals but are not easily available to and understandable by community members. This article describes the development of an academic-community collaboration to implement evidence-based interventions to increase screening.

Improving colorectal cancer screening in Asian Americans: Results of a randomized intervention study.

BACKGROUND: The objective of this study was to use a randomized controlled trial design to test the impact of an educational intervention delivered by specially trained community health workers among Chinese, Korean, and Vietnamese participants ages 50 to 75 years on knowledge, attitudes, beliefs, and intentions regarding colorectal cancer screening. METHODS: Baseline data were collected on participants' demographic characteristics, knowledge, attitudes, beliefs about cancer, its risk factors, and intention to keep up to date on cancer screening in the future. Fifteen intervention sessions were held between April and June of 2011. Follow-up surveys were administered in the postintervention period to both intervention and control participants. Those randomized to the control group received educational pamphlets in their native language. RESULTS: The intervention had the greatest influence on the Chinese subgroup, which had improved scores relative to the control group for perceived behavior control and intentions (preintervention vs postintervention change: control group, -0.16; intervention group, 0.11; P = .004), behavioral beliefs on cancer screening (preintervention vs postintervention change: control group, -0.06; intervention group, 0.24; P = .0001), and attitudes toward behavior (preintervention vs postintervention change: control group, -0.24; intervention group, 0.35; P ≤ .0001). The intervention had no effect on behavioral beliefs about cancer, control beliefs, or perceived behavioral control (reliance on family). Although the intention to stay up to date for cancer screening increased in 2 study groups (Chinese and Vietnamese), these increases were not significant. CONCLUSIONS: An educational program delivered by culturally specific community health educators using culturally appropriate language influences some knowledge, attitude, and behavioral beliefs but not others.

Differences in knowledge, attitudes, beliefs, and perceived risks regarding colorectal cancer screening among Chinese, Korean, and Vietnamese sub-groups.

Asian ethnic subgroups are often treated as a single demographic group in studies looking at cancer screening and health disparities. To evaluate knowledge and health beliefs associated with colorectal cancer (CRC) and CRC screening among Chinese, Korean, and Vietnamese subgroups, a survey assessed participants' demographic characteristics, healthcare utilization, knowledge, beliefs, attitudes associated with CRC and CRC screening. Exploratory factor analysis identified six factors accounting >60 % of the total variance in beliefs and attitudes. Cronbach's alpha coefficients assessed internal consistency. Differences among Asian subgroups were assessed using a Chi square, Fisher's exact, or Kruskal-Wallis test. Pearson's correlation coefficient assessed an association among factors. 654 participants enrolled: 238 Chinese, 217 Korean, and 199 Vietnamese. Statistically significant differences existed in demographic and health care provider characteristics, knowledge, and attitude/belief variables regarding CRC. These included knowledge of CRC screening modalities, reluctance to discuss cancer, belief that cancer is preventable by diet and lifestyle, and intention to undergo CRC screening. Chinese subjects were more likely to use Eastern medicine (52 % Chinese, 25 % Korean, 27 % Vietnamese; p < 0.001); Korean subjects were less likely to see herbs as a form of cancer prevention (34 % Chinese, 20 % Korean, 35 % Vietnamese; p < 0.001). Vietnamese subjects were less likely to consider CRC screening (95 % Chinese, 95 % Korean, 80 % Vietnamese; p < 0.0001). Important differences exist in knowledge, attitudes, and health beliefs among Asian subgroups. Understanding these differences will enable clinicians to deliver tailored, effective health messages to improve CRC screening and other health behaviors.

Feasibility of a targeted breast health education intervention for Chinese American immigrant women.

PURPOSE/OBJECTIVES: To assess the feasibility and acceptability of a targeted educational intervention to increase mammography screening among Chinese American women. DESIGN: One-group pre- and post-test quasiexperimental design. SETTING: Metropolitan areas of Portland, OR. SAMPLE: 44 foreign-born Chinese American women aged 40 years and older. METHODS: Participants who had not had a mammogram within the past 12 months were recruited and enrolled to a targeted breast health educational program. Before starting the group session, participants completed a baseline survey, which was administered again 12 weeks postintervention. MAIN RESEARCH VARIABLES: Completion of mammography screening test, movement in stage of readiness, mammography and breast cancer knowledge, perceived susceptibility, perceived benefits, and perceived common and cultural barriers. FINDINGS: The study response rate was high (71%). Of the 42 women who completed the study, 21 (50%) had a mammogram postintervention. The top three reasons for not completing a mammogram at the end of the study were no need or no symptom, busy, and reliance on family for assistance. Mean breast cancer susceptibility scores increased significantly at post-test as theorized (t[40] = -2.88, p < 0.01). Participants were more likely to obtain a mammogram when they had been in the United States for 3-15 years. CONCLUSIONS: A targeted program that aims to increase breast health knowledge, improve access, and remove barriers may promote mammography screening among Chinese American immigrant women. IMPLICATIONS FOR NURSING: This promising intervention now being tested under a randomized, controlled design can be adapted to other Asian subgroups. KNOWLEDGE TRANSLATION: Targeted breast health intervention is feasible for improving mammography screening among Chinese immigrant women. Educating these women about early detection is important, as the first sign of breast cancer usually shows on a woman's mammogram before it can be felt or any other symptoms are present. Immigrant women may be too busy to dedicate proper time to self-care behaviors; therefore, making it easier and faster for them to obtain a mammogram may improve the screening rate.

Contributing factors to colorectal cancer and hepatitis B screening among Vietnamese Americans.

PURPOSE/OBJECTIVES: To identify factors associated with screening for colorectal cancer (CRC) and hepatitis B, because hepatitis B can increase the risk of liver cancer. DATA SOURCES: MEDLINE®, CINAHL®, and PsycINFO databases from January 1998 to April 2012. DATA SYNTHESIS: The 23 reviewed studies included 15 descriptive, 2 intervention, 3 qualitative, 2 chart or medical record review, and 1 mixed method. Most studies used an investigator-developed instrument with no reported reliability. Inconsistent operational definitions for contributing factors to screening made it challenging to make comparisons. CONCLUSIONS: CRC and hepatitis B screening are consistently low among Vietnamese Americans. Contributing factors included sociodemographics, knowledge, cultural beliefs, and external factors. External factors such as having a regular place of care and a healthcare provider were crucial because they influenced adherence to screening recommendations. Use of a public media education plus healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appeared to be promising for improving CRC screening. Additional intervention studies are needed to increase screening. IMPLICATIONS FOR NURSING: Vietnamese is a fast-growing subgroup within the Asian American Pacific Islander (AAPI) group that may require targeted approaches to screening for disease. Future studies should focus on immigrants or those who were born in the United States (men and women) as disaggregated subgroups. Such research can inform culturally sensitive and appropriate interventions that may improve cancer screening rates. KNOWLEDGE TRANSLATION: Although Vietnamese is the fourth largest racial-ethnic subgroup within the AAPI group, the literature about contributing factors to CRC and hepatitis B screening is limited among this subgroup. CRC and hepatitis B screening are consistently low among Vietnamese Americans. Use of public media education plus a healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appears promising for improving CRC screening.

A community-based participatory research approach to understanding pap testing adherence among Vietnamese American immigrants.

OBJECTIVE: To explore factors potentially influencing Pap testing practices among Vietnamese American immigrant women (VIW, foreign-born) and describe their awareness of cervical cancer screening resources in their community. DESIGN: Descriptive study guided by the ecological model and community-based participatory research principles. SETTING: Portland, Oregon, metropolitan area. PARTICIPANTS: Vietnamese American immigrant women (211) who were age 21 and older. METHODS: We used descriptive statistics and logistic regression analyses to analyze a self-administered questionnaire that was pretested and translated using a team approach. RESULTS: Approximately 74% of VIW who completed the survey reported at least one Pap test, and 69% reported Pap testing history adherent to national guidelines. The factor most strongly associated with Pap testing receipt was suggestion from a friend, followed by longer residency in the United States, lower perceived common barriers, and lower perceived cultural barriers, for example, lack of family support and use of Eastern/Asian medicine. The factor most strongly associated with guideline adherence was having health insurance, followed by a recommendation from a physician or nurse practitioner. Only 11% of VIW knew where to obtain a free or low-cost Pap tests. CONCLUSION: Nurses can influence rates of Pap testing among VIW by providing health education through outreach programs targeted at lay health workers and their social networks, identifying at-risk patients such as recently immigrated women, reducing perceived common and cultural barriers to Pap testing, and helping women seek alternative payment options if they lack health insurance. Primary health care providers should be reminded of their essential role in increasing Pap testing adherence.

Findings from focus groups indicating what Chinese American immigrant women think about breast cancer and breast cancer screening.

OBJECTIVES: To explore beliefs of Chinese American, immigrant women related to breast cancer and mammography. DESIGN: Qualitative description with semistructured focus groups. SETTING: Metropolitan Portland, Oregon. PARTICIPANTS: Thirty eight foreign-born Chinese women, age 40 and older, in five focus groups. METHODS: Focus group discussions in Chinese were audiotaped, transcribed, and translated into English. Using a process of directed content analysis, group transcripts were coded for themes based on the discussion guide. RESULTS: Three main themes emerged from the analysis: knowledge and beliefs; support, communication, and educational needs; and access to care. Subthemes included beliefs such as barriers and facilitators to screening and perceptions about personal breast cancer risk. Several women were profoundly affected by the negative breast cancer-related experiences of relatives and friends. Some common myths remain about causes and treatment of breast cancer. CONCLUSIONS: Although Chinese American immigrant women share beliefs with other minority women in the United States, some culturally related barriers such as alienation due to cultural reasons for not sharing diagnosis with anyone and beliefs about the efficacy of Eastern versus Western medicine may affect adherence to screening and treatment. Facilitators included being told to get the test and getting screened for the sake of the family, whereas erroneous information about the cause of breast cancer such as diet and stress remained. Primary care providers such as advanced practice nurses should take into account culturally driven motivations and barriers to mammography adherence among Chinese American immigrant women. Provider/client interactions should involve more discussion about women's breast cancer risks and screening harms and benefits. Such awareness could open a dialogue around breast cancer that is culturally sensitive and nonthreatening to the patient. Information may need to be tailored to women individually or targeted to subethnic groups rather than using generic messages for all Asian immigrant women.

Measuring breast cancer and mammography screening beliefs among Chinese American immigrants.

Disparities in breast cancer outcomes persist among Asian American women. Breast cancer is the most commonly diagnosed cancer among Chinese American women. This article describes the psychometric evaluation of an instrument measuring knowledge and beliefs related to breast cancer and screening among Chinese American women aged 40 or older. A sample of 100 foreign-born Chinese American women were recruited from an Asian community. Guided by the health belief model, a questionnaire was adapted from three existing questionnaires. Principal axis factoring analyses yielded a three-factor solution that accounted for 53% of the variance in the breast cancer items and a four-factor solution that accounted for 69% of the variance in the cultural items (Cronbach's alphas = .71-.89). Whereas these findings contribute to the understanding of the psychometric properties of an instrument targeted for Chinese American women, additional research is needed to evaluate its utility and efficacy for other Asian Americans.

Cervical cancer beliefs and pap test screening practices among Chinese American immigrants.

PURPOSE/OBJECTIVES: To examine beliefs and Pap test utilization among Chinese American women, the largest Asian female population in the United States. RESEARCH APPROACH: Cross-sectional descriptive, correlational study. SETTING: Metropolitan areas of Portland, OR. PARTICIPANTS: 100 foreign-born Chinese women aged 40 years and older. METHODOLOGIC APPROACH: Three questionnaires were modified, translated, combined, and pretested. Participants completed the self-administered questionnaire in a group setting. MAIN RESEARCH VARIABLES: Utilization of Pap test screening, health beliefs, and cultural and sociodemographic variables. FINDINGS: Sixty-eight percent reported having a Pap test within the prior three years (adherence), and 84% reported ever having a Pap test. The odds of Pap test use and adherence decreased with increasing age. Women with insurance or a regular healthcare provider had better odds of Pap test use and adherence. Older age, older age when a participant moved to the United States, and increased modesty were negatively associated with ever having had a Pap test. CONCLUSIONS: Age and cultural beliefs influence Pap test use and adherence. The strength of provider recommendation and healthcare access as predictors suggest areas for interventions designed to increase screening for cervical cancer. INTERPRETATION: Nurses play a vital role in preventive health care, especially with the growing number of advanced practice nurses delivering primary care. Primary healthcare providers should be reminded of their influential role in increasing adherence to cancer screening. Further health policy action is necessary to extend screening coverage to those who do not have adequate health insurance.

Breast cancer beliefs and mammography screening practices among Chinese American immigrants.

OBJECTIVE: To explore knowledge and beliefs (perceived risk factors, susceptibility, benefits, common barriers, and cultural barriers) in relation to mammography screening practices among Chinese American women. DESIGN: A descriptive study guided by the Health Belief Model. SETTING: Metropolitan area in the northwestern United States. PARTICIPANTS: One hundred Chinese immigrant women, 40 years or older. MAIN OUTCOME MEASURES: The percentage of Chinese American women ages 40 and older who ever received a mammogram and who received a mammogram within the past year. RESULTS: Although 86% of the respondents reported that they had once had a mammogram, only 48.5% had a mammogram within the past year. The strongest factor associated with having a mammogram within the past year was having an immediate family member diagnosed with breast cancer, followed by having insurance that covered a mammogram and lower perceived barriers to obtaining a mammogram. Respondents had low knowledge of breast cancer and mammography screening guidelines. They also perceived low susceptibility to breast cancer. CONCLUSIONS: Nurses may influence the mammogram rates among Chinese American women by providing health education to family members of patients with breast cancer, reducing perceived barriers to mammogram, and seeking alternative payment mechanisms for patients who do not have insurance coverage for mammogram.

Breast and cervical cancer screening practices and inventions among Chinese, Japanese, and Vietnamese Americans.

PURPOSE/OBJECTIVES: To review research on breast and cervical cancer screening practices among Chinese, Japanese, and Vietnamese Americans. DATA SOURCES: MEDLINE and the Cumulative Index to Nursing and Allied Health Literature databases. DATA SYNTHESIS: Of the 28 studies reviewed, 19 (68%) were descriptive and 9 (32%) were interventions. Instruments were developed or translated into the native language. Inconsistent operational definitions for positive facilitators and negative barriers made comparisons across studies difficult. CONCLUSIONS: Research about breast and cervical cancer screening is limited in these groups. All of the studies reviewed indicated low adherence to cancer screening guidelines. Some interventions showed promising results. Poor awareness about cancer was reported; positive facilitators and negative barriers were identified. IMPLICATIONS FOR NURSING: The rapidly increasing number of Asian Americans in the United States underscores the need for further research in this area. Future studies should focus on each population as a disaggregated subgroup. Cancer control interventions should be culturally competent.