Predictors and Barriers to Hepatitis B Screening in a Midwest Suburban Asian Population
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.
KeywordsKnowledge Stigma Vaccination United States
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.
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.
- 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
- 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.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
- 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
- 25.Population Estimates. (2016). Retrieved August 29, 2016, from http://www.census.gov/popest/data/national/asrh/2015/index.html.
- 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
- 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
- 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.
- 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