Aids Weekly Plus
Hmong Americans have an elevated risk for chronic hepatitis B, the major risk factor for liver cancer, and a greater risk than either white or other Asian Americans for poor outcomes from liver cancer. Although Hmong Americans may have health insurance, cultural and language barriers can prevent their access to hepatitis B virus (HBV) screening and liver cancer screening. Moon Chen, Jr., professor and associate director for cancer control at the University of California, Davis (UC Davis) and colleagues conducted a study to decrease the probability of earlier death from liver cancer among the Hmong and increase the probability of earlier detection. Moon is also principal investigator for the Asian American Network for Cancer Awareness Research and Training, the National Cancer Institute’s National Center for Reducing Asian American Cancer Health Disparities.
The study randomly assigned 260 Hmong residents of Sacramento into two groups. One group received home-based health education about HBV and liver cancer during two visits from health workers who were fluent in Hmong and were familiar with the culture. A second group learned about healthy nutrition and physical activity. The workers also assessed participants’ knowledge of HBV and liver cancer during the first home visits. Six months later researchers followed up to determine how many participants got HBV screening and assessed their HBV knowledge. Results show that 24 percent of participants who learned about HBV and liver cancer were screened for HBV compared to 10 percent of those who learned about nutrition and physical activity. The participants who learned about hepatitis B and liver cancer also showed significantly greater knowledge about HBV than the controls.
Dao Fang, project manager for the study, explained that it is often difficult for the Hmong to get good medical care not only because of their lack of proficiency in English, but also because often there are no trained interpreters at the community health-care provider settings, and Hmong patients do not know how to request an interpreter. The study also provided the participants with a brochure that they could use to request a hepatitis B screening during health-care visits.
Chen acknowledged that although the health worker visits increased screening rates for hepatitis B, it would require an intensive effort if used as an outreach tool. He suggested that screening rates for HBV could be increased by encouraging health-care providers to suggest HBV screening to their Hmong patients, as the study also showed that having visited a doctor within the last year or having a doctor suggest HBV screening was a strong predictor of a patient getting screened.
The full report, “Increasing Hepatitis B Screening for Hmong Adults: Results from a Randomized Controlled Community-Based Study, was published in the journal Cancer Epidemiology, Biomarkers & Prevention (2013; doi:10.1158/1055-9965.EPI-12-1399).