Hepatitis B Knowledge, Attitudes, and Susceptibility in an Immigrant Caribbean Community

Abstract

Purpose: Hepatitis B (HBV) is the most common underlying cause of liver cancer among immigrant populations, and the prevalence of HBV is 10–75 per 1000 blood donors in the Caribbean. Although Caribbean communities continue to grow in the U.S. little is known about how they are impacted by HBV. Our objective was to evaluate knowledge and attitudes about HBV, as well as susceptibility in an immigrant Caribbean community. Methods: In-person interviews were conducted with Caribbean immigrant men and women attending four community-based health fairs during a six-month period. Knowledge, beliefs, and risk factors for HBV were assessed along with socio-demographic characteristics. Phlebotomy was performed on all consenting participants to determine HBV status. Results: A total of 147 individuals (55% women) representing 9 Caribbean countries completed the screening sessions. The cohort had a mean age of 46 ± 15 years and had been in the U.S. for 14 ± 12 years. The formal education of 75% of the cohort was at High school level or below, and nearly half (48%) had a median household income below $24,000. While 7% of individuals self-identified as being at risk for HBV, 11% were found to have at least one risk factor. The most common identified HBV risk factors were multiple sexual partners (5%) and blood product transfusion (3%). The majority of individuals (70%) were either unsure or did not believe that HBV can be transmitted through sharing dirty needles. Only 28.5% correctly identified unprotected sex as a risk factor for HBV and only 21% believed that using condoms could help prevent its transmission. Men were significantly more likely to believe that HBV is inherited compared to women (41.8% vs. 14.7%; P= 0.003) and they were less willing to seek medical attention if they tested positive for HBV (41.5% vs. 73.8%; P= 0.001). The majority of individuals (67%) were susceptible to HBV with no detectable markers. Among the 47 individuals who tested positive for HBsAb, 42 (89%) had no prior history of vaccination. HBsAg positivity was confirmed in 1 individual. Conclusion: In this representative community-based Caribbean immigrant cohort we identified significant knowledge deficits about HBV. By extension attitudes towards prevention and treatment of HBV may help increase its spread in the community. Studies should be extended to further characterize HBV seroprevalence in the immigrant Caribbean community and efforts should be made to develop and implement community-based HBV interventions aimed at improving knowledge and reducing risk of infection in this susceptible population.