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标题：Effectiveness of a Controlled Trial to Promote Colorectal Cancer Screening in Vietnamese Americans
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作者：Bang H. Nguyen ; Stephen J. McPhee ; Susan L. Stewart 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：5
页码：870-876
DOI：10.2105/AJPH.2009.166231
语种：English
出版社：American Public Health Association
摘要：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. Colorectal cancer (CRC) is the fourth most common cancer in the United States¹ and the third most common among both Vietnamese men and women in California.² Asian Americans have lower CRC screening rates than do non-Hispanic Whites, and there is variation in screening rates among Asian Americans.³ CRC screening is effective at reducing mortality both by removing premalignant polyps and detecting early cancers.^{4 – 9} The US Preventive Services Task Force recommends a fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy for adults, beginning at age 50 years and continuing until age 75 years.¹⁰ Despite these recommendations and the effectiveness of CRC screening, screening rates remain low. Among Americans aged 50 years or older, only 18.7% had an FOBT during the preceding year and only 50.6% had a sigmoidoscopy or colonoscopy during the preceding 10 years.¹¹ Vietnamese Americans have lower CRC screening rates than do non-Hispanic Whites and some other Asian Americans.^{3 , 12 – 14} In California, the proportions who have ever had an FOBT, ever had a sigmoidoscopy or colonoscopy, had an FOBT in the past year, and had a sigmoidoscopy or colonoscopy in the past 5 years are significantly lower among Vietnamese Americans (29%, 36%, 18%, and 34%, respectively) than among non-Hispanic Whites (58%, 57%, 26%, and 52%, respectively).¹⁴ Vietnamese Americans are 1 of the fastest-growing US populations. From 1990 to 2000, their numbers grew by 83%, from 614 547 to 1 122 528.^{15 , 16} Those aged 50 years and older were almost all born in Vietnam and maintain their traditional culture and language.¹⁷ Vietnamese Americans are relatively poorer, more socially and economically disadvantaged, more medically underserved, and have more language barriers than do non-Hispanic Whites. Compared with non-Hispanic Whites nationally, Vietnamese are twice as likely to be living below the poverty level (16% versus 9%) and have only about two thirds the per capita income ($15 655 versus $23 918). In addition, 31% of Vietnamese Americans speak English not well or not at all and 46% of Vietnamese households are linguistically isolated (have no one aged 14 years or older who speaks English at least very well).¹⁸ In Santa Clara County, California, Vietnamese aged 50 to 74 years are significantly more likely not to have graduated from college (74% versus 53%), to be uninsured (11% versus 2%), to be unemployed or a homemaker (29% versus 12%), and to rate their health as fair or poor (52% versus 46%) than are non-Hispanic Whites.¹² To reduce disparities in CRC screening, we conducted a controlled trial to increase CRC screening rates among Vietnamese Americans.