Advertisement

Journal of Community Health

, Volume 42, Issue 3, pp 533–543 | Cite as

Predictors and Barriers to Hepatitis B Screening in a Midwest Suburban Asian Population

Original Paper

Abstract

Despite guidelines recommending hepatitis B virus (HBV) screening among the Asian population, not all Asians are screened. We assessed barriers to and factors predicting HBV screening in Michigan. Adults residing in Southeast Michigan self-identifying as Asian were surveyed at Asian grocery stores, restaurants, churches, and community events. 404 persons participated in the survey, 54 % were women, median age was 51 years, 63 % were Chinese, and 93.8 % were born outside the U.S. 181 (44.8 %) had not or could not recall having been screened for HBV. Of these, 89 % said their primary care physicians (PCP) had never brought up screening. Unscreened participants were more likely to think HBV is genetically inherited and cannot be treated than those who had been screened. They were also more likely to think they should avoid close contact with others, would bring shame to their families, and lose their job, if found to be infected with HBV. Among 223 (55.2 %) who had been screened, 48 % said their PCP had the greatest influence in their decision to be screened and 70.9 % said they were screened at a doctor’s visit. Screened participants were more likely to know someone with HBV, have a PCP, and have health insurance. Logistic regression analysis showed knowing someone with HBV was the only predictor for screening. Despite guidelines for HBV screening, only half of the Asian Americans surveyed had been screened. Increasing awareness among PCPs is needed to increase HBV screening in this population.

Keywords

Knowledge Stigma Vaccination United States 

Notes

Acknowledgments

No financial support was received for this project. Shanna Cheng and Elton Li would like to acknowledge and show gratitude to Dr. Anna Lok for her support and mentorship throughout the course of this project. We would also like to acknowledge and show gratitude to the communities, participants, and translators for partaking in our project; and to Ms. Elizabeth Wu for her critical review of the manuscript.

Compliance with Ethical Standards

Conflict of interest

ASL has received research grants from Bristol-Myers Squibb and Gilead. SC and EL have no conflicts of interest to declare.

Human Participants

All human participants verbally and voluntarily consented to be a part of this study. This study was approved by the University of Michigan Institutional Review Board and was granted exemption.

References

  1. 1.
    Barazani, Y., Hiatt, J. R., Tong, M. J., & Busuttil, R. W. (2007). Chronic viral hepatitis and hepatocellular carcinoma. World Journal of Surgery, 31(6), 1245–1250.CrossRefGoogle Scholar
  2. 2.
    Chen, M. S. Jr., & Dang, J. (2015). Hepatitis B among Asian Americans: Prevalence, progress, and prospects for control. World Journal of Gastroenterology, 21(42), 11924.CrossRefPubMedGoogle Scholar
  3. 3.
    Perz, J. F., Armstrong, G. L., Farrington, L. A., Hutin, Y. J. F., & Bell, B. P. (2006). The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. Journal of Hepatology, 45(4), 529–538.CrossRefPubMedGoogle Scholar
  4. 4.
    Shepard, C. W. (2006). Hepatitis B Virus Infection: Epidemiology and Vaccination. Epidemiologic Reviews, 28(1), 112–125.CrossRefPubMedGoogle Scholar
  5. 5.
    Yang, J. D., & Roberts, L. R. (2010). Hepatocellular carcinoma: A global view. Nature Reviews Gastroenterology & Hepatology, 7(8), 448–458.CrossRefGoogle Scholar
  6. 6.
    Roberts, H., Kruszon-Moran, D., Ly, K. N., et al. (2016). Prevalence of chronic hepatitis B virus (HBV) infection in US households: National Health and Nutrition Examination Survey (NHANES), 1988–2012. Hepatology (Baltimore, Md.), 63(2), 388–397.CrossRefGoogle Scholar
  7. 7.
    Ryerson, A, B., Eheman, C, R., Altekruse, S, F., et al. (2016). Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer, 122(9), 1312–1337.CrossRefPubMedGoogle Scholar
  8. 8.
    Sarin, S. K., Kumar, M., Lau, G. K., et al. (2016). Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatology International, 10(1), 1–98.CrossRefPubMedGoogle Scholar
  9. 9.
    Holland, A. T., & Palaniappan, L. P. (2012). Problems with the collection and interpretation of asian-american health data: omission, aggregation, and extrapolation. Annals of Epidemiology, 22(6), 397–405.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kowdley, K. V., Wang, C. C., Welch, S., Roberts, H., & Brosgart, C. L. (2012). Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology (Baltimore, Md.), 56(2), 422–433.CrossRefGoogle Scholar
  11. 11.
    Chandrasekar, E., Kaur, R., Song, S., & Kim, K. E. (2015). A comparison of effectiveness of hepatitis B screening and linkage to care among foreign-born populations in clinical and nonclinical settings. Journal of Multidisciplinary Healthcare, 8, 1.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hu, K. Q. (2008). Hepatitis B virus (HBV) infection in Asian and Pacific Islander Americans (APIAs): How can we do better for this special population. The American Journal of Gastroenterology, 103(7), 1824–1833.CrossRefPubMedGoogle Scholar
  13. 13.
    Weinbaum, C. M., Mast, E. E., & Ward, J. W. (2009). Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. Hepatology, 49(5).Google Scholar
  14. 14.
    Lai, C. J., Nguyen, T. T., Hwang, J., Stewart, S. L., Kwan, A., & McPhee, S. J. (2007). Provider knowledge and practice regarding Hepatitis B screening in Chinese-speaking patients. Journal of Cancer Education, 22(1), 37–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Ma, G. X., Zhang, G., Zhai, S., et al. (2015). Hepatitis B screening among Chinese Americans: A structural equation modeling analysis. BMC Infectious Diseases, 15(1), 1.CrossRefGoogle Scholar
  16. 16.
    Wu, C. A., Lin, S. Y., So, S. K., & Chang, E. T. (2007). Hepatitis B and liver cancer knowledge and preventive practices among Asian Americans in the San Francisco Bay Area, California. Asian Pacific Journal of Cancer Prevention, 8(1), 127.PubMedGoogle Scholar
  17. 17.
    Shiau, R., Bove, F., Henne, J., Zola, J., Fang, T., & Fernyak, S. (2012). Using survey results regarding Hepatitis B Knowledge, community awareness and testing behavior among asians to improve the San Francisco Hep B free campaign. Journal of Community Health, 37(2), 350–364.CrossRefPubMedGoogle Scholar
  18. 18.
    Li, D., Tang, T., Patterson, M., Ho, M., Heathcote, J., & Shah, H. (2012). The impact of hepatitis B knowledge and stigma on screening in Canadian Chinese persons. Canadian Journal of Gastroenterology and Hepatology, 26(9), 597–602.Google Scholar
  19. 19.
    Ma, G. X., Lee, S., Wang, M., et al. (2011). Role of Sociocultural Factors in Hepatitis B Screening Among Asian Americans. Southern Medical Journal, 104(7), 466–472.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Frew, P. M., Alhanti, B., Vo-Green, L., et al. (2014). Multilevel factors influencing hepatitis B screening and vaccination among Vietnamese Americans in Atlanta, Georgia. The Yale Journal of Biology and Medicine, 87(4), 455–471.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Nguyen, T. T., Taylor, V., Chen, M. S. Jr., Bastani, R., Maxwell, A. E., & McPhee, S. J. (2007). Hepatitis B awareness, knowledge, and screening among Asian Americans. Journal of Cancer Education, 22(4), 266–272.CrossRefPubMedGoogle Scholar
  22. 22.
    Vijayadeva, V., Spradling, P. R., Moorman, A. C., et al. (2014). Hepatitis B virus infection testing and prevalence among Asian and Pacific Islanders. The. American Journal of Managed Care, 20(4), 98–104.Google Scholar
  23. 23.
    Chao, S., & So, S. (2011). The Jade Ribbon Campaign: a systematic, evidence-based public awareness campaign to improve Asian and Pacific Islander health. Journal of Communication in Healthcare, 4(1), 46–55.CrossRefGoogle Scholar
  24. 24.
    Yoo, G. J., Fang, T., Zola, J., & Dariotis, W. M. (2012). Destigmatizing Hepatitis B in the Asian American Community: Lessons learned from the San Francisco hep B free campaign. Journal of Cancer Education, 27(1), 138–144.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Population Estimates. (2016). Retrieved August 29, 2016, from http://www.census.gov/popest/data/national/asrh/2015/index.html.
  26. 26.
    Lee, J., Lok, A. S., & Chen, J. (2010). Hepatitis B prevalence among asian americans in michigan: An assessment to guide future education and intervention strategies. Journal of Community Health, 35(5), 534–542.CrossRefPubMedGoogle Scholar
  27. 27.
    Cotler, S. J., Xie, H., Luc, B. J., Layden, T. J., & Wong, S. S. (2012). Characterizing hepatitis B stigma in Chinese immigrants: Hepatitis B stigma. Journal of Viral Hepatitis, 19(2), 147–152.CrossRefPubMedGoogle Scholar
  28. 28.
    Norton, B. L., Voils, C. I., Timberlake, S. H., et al. (2014). Community-based HCV screening: knowledge and attitudes in a high risk urban population. BMC Infectious Diseases, 14(1), 1.CrossRefGoogle Scholar
  29. 29.
    Ma, G. X., Fang, C. Y., Shive, S. E., Toubbeh, J., Tan, Y., & Siu, P. (2007). Risk perceptions and barriers to Hepatitis B screening and vaccination among vietnamese immigrants. Journal of Immigrant and Minority Health, 9(3), 213–220.CrossRefPubMedGoogle Scholar
  30. 30.
    Shi, J., Chyun, D. A., Sun, Z., & Zhou, L. (2013). Assessing the stigma toward chronic carriers of hepatitis B virus: development and validation of a Chinese college students’ stigma scale: Assessing the stigma toward chronic carriers of HBV. Journal of Applied Social Psychology, 43, 46–55.CrossRefGoogle Scholar
  31. 31.
    Taylor, V. M., Tu, S.-P., Woodall, E., et al. (2006). Hepatitis B knowledge and practices among Chinese immigrants to the United States. Asian Pacific Journal of Cancer Prevention, 7(2), 313.PubMedGoogle Scholar
  32. 32.
    Van der Veen, Y. J., Van Empelen, P., Looman, C. W., & Richardus, J. H. (2014). Social cognitive and socio-cultural predictors of hepatitis B virus-screening in Turkish migrants, the Netherlands. Journal of Immigrant and Minority Health, 16(5), 811–821.CrossRefPubMedGoogle Scholar
  33. 33.
    Huang, J., Guan, M. L., Balch, J., et al. (2016). Survey of Hepatitis B knowledge and stigma among chronically infected patients and uninfected persons in Beijing, China: Liver Inernational.Google Scholar
  34. 34.
    Pollack, H., Wang, S., Wyatt, L., Peng, et al. (2011). A comprehensive screening and treatment model for reducing disparities in Hepatitis B. Health Affairs, 30(10), 1974–1983.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Surveillance for Viral Hepatitis—United States, 2014. (2016). Retrieved August 29, 2016, from http://www.cdc.gov/hepatitis/statistics/2014surveillance/index.htm#tabs-1170608-3.
  36. 36.
    Chu, D., Yang, J. D., Lok, A. S., et al. (2013). Hepatitis B screening and vaccination practices in asian american primary care. Gut and Liver, 7(4), 450–457.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sidlow, R., & Msaouel, P. (2015). Improving hepatitis C virus screening rates in primary care: a targeted intervention using the electronic health record. Journal for Healthcare Quality, 37(5), 319–323.CrossRefPubMedGoogle Scholar
  38. 38.
    Smith, B. D., Morgan, R. L., Beckett, G. A., Falck-Ytter, Y., Holtzman, D., & Ward, J. W. (2012). Hepatitis C virus testing of persons born during 1945–1965: recommendations from the Centers for Disease Control and Prevention. Annals of Internal Medicine, 157(11), 817–822.CrossRefPubMedGoogle Scholar
  39. 39.
    Malespin, M., Wong, S., Siqueira, F., et al. (2012). Barriers to treatment of hepatitis B in an urban Chinatown community. Journal of Clinical Gastroenterology, 46(8), 66–70.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.College of Human MedicineMichigan State UniversityEast LansingUSA
  2. 2.Division of Gastroenterology and HepatologyUniversity of Michigan Health SystemAnn ArborUSA

Personalised recommendations