Baltimore-Washington Metropolitan Area Research Articles

Women's Health Information-Seeking Experiences and Preferences for Health Communications on FDA-Regulated Products: A Qualitative Study in Urban Area.

A key part of any effort to ensure informed health care decision-making among the public is access to reliable and relevant health-related information. We conducted focus groups with women from three generations across the Baltimore-Washington metropolitan area to explore their information-seeking motivations, perceptions, challenges, and preferences regarding three FDA-regulated products: drugs, vaccines, and medical devices. The youngest generation discussed seeking health information for their children; the other two sought information for their own needs. All participants noted that finding health information appropriate to their reading level was a challenge, as was identifying reliable sources of information. All generations identified in-person and live interactions as their preferred method of communication and health care providers as their preferred source for information. All three generations recognized the usefulness of websites, and the two older generations acknowledged the advantages of brochures. Our findings suggest approaches the FDA could consider to improve communications: (a) supporting in-person and live health information interactions; (b) leveraging the agency's standing with the public to highlight it as a leading source of validated health information; (c) increasing the FDA website's visibility in internet searches and making its navigation easier; and (d) using multi-pronged approaches and media for various audiences.

Where to Retire? Experiences of Older African Immigrants in the United States.

Doubling in size since the 1970s, the aging needs of the African immigrant population are not fully understood. This qualitative study examined experiences of aging and retirement planning for African immigrant older adults in the United States (U.S.). Specifically, it explored the factors, processes, and ultimate decision of where these older adults planned to retire. Secondary analysis of semi-structured interviews with 15 older African immigrants in the Baltimore–Washington Metropolitan area was conducted. Data was analyzed using thematic analyses in NVivo. The majority of participants were women, with a mean age of 64. Three overarching themes with ten sub-themes were identified. The themes included: (1) cultural identity, which indicated the participant’s comfort with the U.S. society and culture; (2) decision making, meaning factors that impact participants’ choice of retirement location; and (3) decision made, meaning the final choice of where participants would like to retire. Age-friendliness for immigrant older adults in the U.S. is complex and it includes traditional domains such as physical and sociocultural environment (e.g., housing, transportation, and income). However, immigrant age-friendliness also needs to include wider contextual aspects such as political climate of their country of origin, immigrant status, family responsibilities, and acculturation in the U.S. More research is needed to better understand and facilitate age-friendly environments and transnational aging of immigrant older adults.

Where to Retire? Experiences of Older African Immigrants in the United States

The needs and conceptualization of age-friendliness likely vary for immigrant older adults compared to native-born older adults. For example, Hispanic immigrant older adults often return to their home country following the development of ill health. Doubling in size since the 1970’s, the aging needs of African immigrants are not fully understood. This qualitative study examined experiences of aging and retirement planning for African immigrant older adults in the United States (U.S.). Specifically, it explored the factors, processes, and ultimate decision of where these older adults planned to retire. We analyzed semi-structured interviews with 15 older African immigrants in the Baltimore-Washington Metropolitan area. Data were analyzed using thematic analyses in NVivo. The majority of participants were women, with a mean age of 64. We identified three overarching themes with ten sub-themes. The themes included: 1) cultural identity: indicating participant’s comfort with the U.S. society and culture; 2) decision making: factors that impact participants' choice of retirement location, and 3) decision made: the final choice of where participants would like to retire. Age-friendliness for immigrant older adults in the U.S. is complex and it includes the traditional domains such as physical and sociocultural environment (e.g. housing, transportation, and income). However, immigrant age-friendliness also needs to include wider contextual aspects such as political climate in their country of origin, immigrant status, family responsibilities, and acculturation in the U.S. More research is needed understand and facilitate age-friendly environments for transnational immigrant older adults.

A data-driven travel mode share estimation framework based on mobile device location data.

Mobile device location data (MDLD) contains abundant travel behavior information to support travel demand analysis. Compared to traditional travel surveys, MDLD has larger spatiotemporal coverage of the population and its mobility. However, ground truth information such as trip origins and destinations, travel modes, and trip purposes are not included by default. Such important attributes must be imputed to maximize the usefulness of the data. This paper targets at studying the capability of MDLD on estimating travel mode share at aggregated levels. A data-driven framework is proposed to extract travel behavior information from MDLD. The proposed framework first identifies trip ends with a modified Spatiotemporal Density-based Spatial Clustering of Applications with Noise algorithm. Then three types of features are extracted for each trip to impute travel modes using machine learning models. A labeled MDLD dataset with ground truth information is used to train the proposed models, resulting in a 95% recall rate in identifying trip ends and over 93% tenfold cross-validation accuracy in imputing the five travel modes (drive, rail, bus, bike and walk) with a random forest (RF) classifier. The proposed framework is then applied to two large-scale MDLD datasets, covering the Baltimore-Washington metropolitan area and the United States, respectively. The estimated trip distance, trip time, trip rate distribution, and travel mode share are compared against travel surveys at different geographies. The results suggest that the proposed framework can be readily applied in different states and metropolitan regions with low cost in order to study multimodal travel demand, understand mobility trends, and support decision making.

Cooling effect of urban trees and its spatiotemporal characteristics: A comparative study

Urban trees’ cooling effect would change over time with different extents of warming. We conducted a comparative study of the greater Boston region (BOS) and Baltimore-Washington (BW) metropolitan area, two agglomerations with similar geographic and climatic conditions, as the study area. Cooling rate of urban trees (the changes in land surface temperature (LST) per fraction of tree cover) has been estimated based on the correlation between tree cover and LST on all extreme heat days over five years (2013–2017). We found that (1) the cooling rate of urban trees exhibited a nonlinear correlation with average LST across the two selected metropolitan areas, and the slope of the cooling rate increased rapidly when the average LST increased; (2) the average cooling rate was higher (0.12 °C/%) and more stable in BOS, and lower (0.10 °C/%) while fluctuated in BW; and (3) spatially, for promoting cooling effect, urban trees need to be more dispersed in Boston while more assembled in BW. More importantly, this difference tends to be more pronounced when the background LST increased. We think this different is caused by almost doubled wind speed in Boston than BW, even though they located in the same climate zone. This study further confirmed that not only the total cooling rate of urban trees, but the effects of spatial configuration will also be changed with different extents of outdoor warming in the same city.

Examining the Neighborhood Attributes of Recently Housed Partner Violence Survivors in Rapid Rehousing.

Survivors’ considerations for re-housing following intimate partner violence (IPV) are understudied despite likely neighborhood-level influences on women’s safety. We assess housing priorities and predictors of re-housing location among recent IPV survivors (n = 54) in Rapid Re-housing (RRH) in the Baltimore-Washington Metropolitan Area. Choropleth maps depict residential location relative to census tract characteristics (neighborhood deprivation index (NDI) and residential segregation) derived from American Community Survey data (2013–2017). Linear regression measured associations between women’s individual, economic, and social factors and NDI and segregation. In-depth interviews (n = 16) contextualize quantitative findings. Overall, survivors re-housed in significantly more deprived and racially segregated census tracts within their respective regions. In adjusted models, trouble securing housing (B = 0.74, 95% CI: 0.13, 1.34), comfortability with proximity to loved ones (B = 0.75, 95% CI: 0.02, 1.48), and being unsure (vs unlikely) about IPV risk (B = −0.76, 95% CI: −1.39, −0.14) were significantly associated with NDI. Economic dependence on an abusive partner (B = −0.31, 95% CI: −0.56, −0.06) predicted re-housing in segregated census tracts; occasional stress about housing affordability (B = 0.39, 95% CI: 0.04, 0.75) predicted re-housing in less segregated census tracts. Qualitative results contextualize economic (affordability), safety, and social (familiarity) re-housing considerations and process impacts (inspection delays). Structural racism, including discriminatory housing practices, intersect with gender, exacerbating challenges among survivors of severe IPV. This mixed-methods study further highlights the significant economic tradeoffs for safety and stability, where the prioritization of safety may exacerbate economic devastation for IPV survivors. Findings will inform programmatic policies for RRH practices among survivors.

Genomic diversity of SARS-CoV-2 during early introduction into the Baltimore-Washington metropolitan area.

The early COVID-19 pandemic was characterized by rapid global spread. In Maryland and Washington, DC, United States, more than 2500 cases were reported within 3 weeks of the first COVID-19 detection in March 2020. We aimed to use genomic sequencing to understand the initial spread of SARS-CoV-2 — the virus that causes COVID-19 — in the region. We analyzed 620 samples collected from the Johns Hopkins Health System during March 11–31, 2020, comprising 28.6% of the total cases in Maryland and Washington, DC. From these samples, we generated 114 complete viral genomes. Analysis of these genomes alongside a subsampling of over 1000 previously published sequences showed that the diversity in this region rivaled global SARS-CoV-2 genetic diversity at that time and that the sequences belong to all of the major globally circulating lineages, suggesting multiple introductions into the region. We also analyzed these regional SARS-CoV-2 genomes alongside detailed clinical metadata and found that clinically severe cases had viral genomes belonging to all major viral lineages. We conclude that efforts to control local spread of the virus were likely confounded by the number of introductions into the region early in the epidemic and the interconnectedness of the region as a whole.

Social determinants of hypertension and diabetes among African immigrants: the African immigrants health study

ABSTRACT Objective To examine the association between social determinants of health, hypertension, and diabetes among African immigrants. Methods The African Immigrant Health Study was a cross-sectional study of the health of African immigrants in the Baltimore-Washington Metropolitan Area. The outcomes of interest were self-reported diagnoses of hypertension and diabetes. Logistic regression was used to examine the relationship between educational status, employment, income, social support, health insurance, and self-reported diagnoses of hypertension and diabetes, adjusting for age, sex, and length of stay in the U.S. Results A total of 465 participants with mean (±SD) age 47 (±11.5) years were included. Sixty percent were women, 64% had a college degree or higher, 83% were employed, 67% had health insurance, and 70% were married/cohabitating. Over half (60%) of the participants had lived in the United States for ≥ 10 years, and 84% were overweight/obese. The overall prevalence of hypertension and diabetes was 32% and 13%, respectively. The odds of diabetes was higher (aOR: 5.00, 95% CI: 2.13, 11.11) among those who were unemployed than among those who were employed, and the odds of hypertension was higher among those who had health insurance (aOR:1.73, 95% CI: 1.00, 3.00) than among those who did not. Conclusions Among African immigrants, those who were unemployed had a higher likelihood of a self-reported diagnosis of diabetes than those who were employed. Also, people who had health insurance were more likely to self-report a diagnosis of hypertension. Additional studies are needed to further understand the influence of social determinants of health on hypertension and diabetes to develop health policies and interventions to improve the cardiovascular health of African immigrants.

Recruiting Racially and Ethnically Diverse Dementia Family Caregivers for Survey Research

Recruiting racially and ethnically diverse dementia family caregivers (FCGs) for research can be challenging. The purposes of this presentation are to describe methods of successfully recruiting racially and ethnically diverse dementia FCGs for survey research and to share lessons learned. This study aimed to recruit dementia FCGs who have a chronic health condition and access to a mobile device. FCGs were primarily recruited from the Baltimore-Washington Metropolitan area to complete an online or phone survey about their technology use. A variety of recruitment methods were used including: posting ads in a local newspaper targeting older adults, partnering with a local Alzheimer’s research center and memory treatment center, attending community events, using online research registries, and posting online advertisements. The most successful method of recruiting minorities was by attending community events for caregivers and talking directly with community members about the research study. Online recruitment methods were less successful, but yielded the greatest diversity of participants, including Asian, Native American, mixed race, and African American FCGs. Some challenges associated with recruiting minority FCGs were working with primarily immigrant communities; recruiting FCGs who do not speak English; and building trust among communities that have been negatively impacted by research. Suggestions for future research include using recruitment strategies that enable researchers to build rapport with FCGs, engaging community stakeholders to understand your source population, and using a variety of recruitment methods. Also, online recruiting through credible sources appears to be a somewhat feasible method of recruiting diverse FCGs for survey research.

Recruitment of Youth Living With HIV to Optimize Adherence and Virologic Suppression: Testing the Design of Technology-Based Community Health Nursing to Improve Antiretroviral Therapy (ART) Clinical Trials

BackgroundDespite advances in HIV diagnosis and treatment, adolescents and young adults 12-25 years old have high HIV incidence, poor engagement and retention in treatment, and low rates of adherence and virologic suppression when compared to their older counterparts. HIV has emerged as a chronic disease for which antiretroviral therapy (ART) adherence is critical for virologic suppression and long-term survival. Virologic suppression has been elusive for many youth with HIV (YHIV). Novel strategies designed to facilitate health care systems’ support for YHIV between medical visits are essential for improving ART adherence, virologic suppression, and long-term survival.ObjectiveThe aim of this study is to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH2CHECK) to a standard of care (SOC) control group for improving ART adherence and subsequent viral suppression using a randomized trial design. The objectives are to assess the feasibility, acceptability, and cost-effectiveness of TECH2CHECK as compared to SOC for management of HIV in the outpatient setting and to examine the sustainability of self-care behavior, adherence, and virologic suppression among youth following the intervention period.MethodsWe will recruit 120 adherence-challenged YHIV being followed at clinics specializing in HIV care in the Baltimore-Washington metropolitan area and in Jacksonville. Eligible participants complete an audio, computer-assisted self-interview and are randomized to either TECH2CHECK intervention or the SOC (60 participants in each arm). The primary outcome of interest is virologic suppression (viral load <20 copies/mL) and improved treatment adherence. Participants in the intervention arm receive community health nursing visits at 2 weeks, 6 weeks, 10 weeks, 14 weeks, and 26 weeks. The intervention arm also receives SMS messaging comprising daily adherence and appointment reminders and positive reinforcement for medication adherence daily for 2 weeks, on alternate days for 2 weeks, thrice weekly for 1 month, weekly for 3 months, and every 2 weeks for the rest of the study duration. The control group receives appointment reminders and SOC per clinic protocol. Exploratory analysis will be conducted to determine differences in medication adherence and virologic suppression in the 2 arms and to assess cost-effectiveness and study feasibility and acceptability.ResultsIn the first 23 months of the study (July 2018-April 2020), 56 (55%) of 102 eligible patients were enrolled and randomized. At present, participating youths are primarily African American (53/56, 95%), male (37/56, 66%), and ≥18 years old (53/56, 95%). Follow-up study visits, as required per the protocol, have been completed by 77% (43/56), 94% (45/48), 95% (37/39), 96% (24/25), and 100% (10/10) of participants at the 1-month, 3-month, 6-month, 12-month, and 18-month follow-ups, respectively.ConclusionsPreliminary accrual and retention data suggest that TECH2CHECK is feasible and acceptable.Trial RegistrationClinicalTrials.gov NCT03600103 https://clinicaltrials.gov/ct2/show/NCT03600103International Registered Report Identifier (IRRID)DERR1-10.2196/23480

4056 Dementia family caregivers’ mobile app use and intention to adopt mHealth apps

OBJECTIVES/GOALS: To describe preliminary results of Alzheimer’s and dementia caregivers’ (CGs) mobile app use and intention to adopt mHealth apps for their own chronic condition self-management. To discuss implications for designing and implementing mHealth interventions for CGs. METHODS/STUDY POPULATION: This study aims to recruit 110 racially and ethnically diverse family caregivers (CGs) who have a chronic condition, provide care for persons with Alzheimer’s disease or related dementias, and have access to a mobile device. This is a cross-sectional correlational study collecting data with computer-assisted telephone interviews stored through REDCap. The study survey was created using existing surveys about mobile app use; relevant, well-validated research instruments; and questions from the U.S. Census and other national surveys. CGs are being actively recruited from the Baltimore-Washington metropolitan area using various recruitment strategies that have been effective in prior studies. RESULTS/ANTICIPATED RESULTS: The majority of CGs used websites (86%), mobile devices (68%) or apps (53%) to manage their own health. CGs using health-related apps were tracking their exercise (60%), diet (60%), medical records (50%), and physical health measures (50%). More than 4 out of 5 (82%) predicted they would use mobile apps to self-manage their chronic condition, though only 68% actually planned to use them. 86% of CGs were using mobile apps for non-health related purposes, with the most popular app being weather (90%), followed by social media (74%), music/entertainment (68%), and banking/business apps (63%). CGs used weather and social media apps most often (2 or more times/day) and spent 9 hours/week on apps. DISCUSSION/SIGNIFICANCE OF IMPACT: Websites and mobile apps appear to be feasible modes to deliver health interventions to CGs. Researchers should consider including features of apps most frequently used by CGs, such as the weather, ways to connect with others, and music/entertainment, when delivering mHealth interventions to CGs.

Abstract P397: Social Determinants of Hypertension and Diabetes Among African Immigrants: The African Immigrant Health Study

Introduction: The differences in the risk of cardiovascular disease (CVD) among Black ethnic groups in the U.S. remain largely unexplained. African immigrants are particularly likely to have high rates of hypertension and diabetes, and less likely to be screened, diagnosed or receive treatment. Objective: To examine the association between social determinants of health (SDoH) and hypertension and diabetes among African immigrants. Methods: The African Immigrant Health Study was a cross-sectional study of 465 African immigrants living in the Baltimore-Washington metropolitan area. Data collection was performed through a combination of physical examinations and questionnaires. The outcomes were self-reported hypertension and diabetes. Elements of SDoH collected were education, income, health insurance, employment and marital status. Logistic regression analyses were used to assess the association between SDoH and hypertension/diabetes. Results: The mean age of participants was 46.8(±11.5) years and 60% were women; 64% had ≥ college degree, 83% were employed, 67% had health insurance, and 70% were married/co-habiting. Mean body mass index was 30.7 (±18.3) kg/m 2 . The prevalence of hypertension and diabetes was 32%, and 13% respectively. The odds of diabetes were higher amongst those who were unemployed [aOR: 2.86 (1.39-5.56)] ( Table ). Education, health insurance, income and marital status were not associated with hypertension or diabetes after accounting for age and sex. Conclusion: Among African immigrants, we observed that those who were unemployed had a higher likelihood of self-reported diabetes than those who were employed. Additional studies are needed to further study the contributions of social determinants of hypertension and diabetes as well as and developing health policy and interventions to improve cardiovascular health.

Greenhouse Gas Inventories Underestimate Methane Emissions

A new study in the Baltimore-Washington metropolitan area reveals prior estimates may significantly underrepresent methane emissions, particularly from landfills and natural gas systems.

Prevalence of Viral Hepatitis in Foreign-Born Populations in the Baltimore-Washington Metropolitan Area, 2009-2015.

While the majority of viral hepatitis is experienced in the developing world, migration of people from high prevalence countries contributes to health outcomes in the United States. The purpose of this study was to estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in foreign-born immigrants living in the Baltimore-Washington metropolitan area. This study used cross-sectional data from 5982 individuals screened at community events held from 2009 to 2015. Descriptive statistics were generated to describe the screening results. Positive results for HBV infection (HBsAg+) and HCV infection (HCVAb+) were analyzed according to age, gender, and country of birth. Of 5982, the majority of participants were born in Asia (77.8%). The prevalence of infection was 6.1% for HBV and 3.8% for HCV in Asia-born immigrants compared to 3.7% for HBV and 2.8% for HCV in Africa-born immigrants. Among participants who were Asia-born, prevalence of HBV infection was highest for those from Cambodia (11.9%) compared to Vietnam (8.2%), China (8.1%), Laos (6.1%), and Korea (4.6%). Among participants who were Africa-born, prevalence of HBV was highest for those from Liberia (6.7%) and Sierra Leone (6.7%), followed by Cameroon (4.4%) and Nigeria (4.2%). The highest HCV prevalence occurred among those from Cambodia (10.8%) and Myanmar (4.9%) in Asia and those from Cameroon (11.4%) and Nigeria (4.8%) in Africa. This study suggests that screening data are disaggregated by country of birth, then improvements can be made to programs for prevention, earlier diagnosis, and linkage to care.

The association of perceived discrimination and depressive symptoms among Chinese, Korean, and Vietnamese Americans.

Few studies have investigated ethnic differences in discrimination and depressive symptoms, and the link between them among foreign-born Asian Americans. This study identifies if depressive symptoms and perceived discrimination differ by Asian ethnicity, and if perceived discrimination is associated with depressive symptoms among foreign-born Chinese, Korean, and Vietnamese Americans. This study uses data from the Asian American Liver Cancer Prevention Program (N = 600). Using nonprobability sampling, foreign-born Asian American adults (58% female, Mage = 47.3 years, SD = 11.82) were recruited from the community in the Baltimore-Washington Metropolitan Area. Perceived discrimination was defined using everyday and major discrimination scales; the Centers for Epidemiological Studies-Depression Scale defined the outcome of depressive symptoms. Multiple logistic regressions were conducted to determine if this association exists. A high prevalence of depressive symptoms (one third to one fifth per ethnicity) and ethnic differences between foreign-born Chinese, Korean, and Vietnamese Americans were found; increased perceived discrimination was associated with worse depressive symptomology. Those with "high" and "mild discrimination" had greater odds of being depressed than those who had never experienced discrimination; those with "unfair treatment" had greater odds of being depressed than those who had none. Major experiences of discrimination were less common and less likely associated with depressive symptoms than everyday experiences. Foreign-born Asian Americans experience substantial discrimination and depressive symptoms. Future studies should stratify by Asian ethnicity and examine the differences between minor and major experiences of discrimination to provide appropriate mental health prevention and treatment for this population. (PsycINFO Database Record

Social Norm, Family Communication, and HBV Screening among Asian Americans

Individuals’ behaviors are influenced by those of others in their social environment (i.e., descriptive norms), as well as by how individuals perceive they should behave in that environment (e.g., injunctive norms). Although social norms are thought to play an important role in hepatitis B virus (HBV) screening, limited theoretical or empirical guidance exists on how the underlying process works. In addition, norms are social phenomena that are spread through family discussion about the importance of getting HBV screening. Using the theory of normative social behavior (TNSB), this study examined the roles of injunctive norms (IN), descriptive norms (DN), and family discussion in HBV screening behavior among Asian Americans. Data from a survey of Asian Americans in the Baltimore Washington metropolitan area (N = 877) were used to test underlying theoretical propositions. DN and family discussion emerged as key factors in HBV screening behavior among all Asian Americans. IN were associated with HBV screening among Chinese and Korean Americans, but not for Vietnamese Americans. Family discussion moderated the influence of DN on behavior among Chinese and Vietnamese Americans. However, the main effect of DN on screening behavior was not modified by IN (no interactions between DN and IN). The results indicate that family discussion and social norms are integral in enabling Asian Americans to undergo HBV screening and warrant sensitivity in the design and implementation of a liver cancer prevention program in this high-risk group of Asian Americans.

Abstract 4223: Colorectal cancer knowledge and screening among Asian Americans aged 50-75 years old

Abstract Background: Chinese, Vietnamese, and Korean Americans, three of the largest Asian American (AA) subgroups, have particularly high rates of colorectal cancer (CRC) incidence and mortality. However, CRC screening rates among these Asian Americans remain very low. Increased knowledge of CRC has been shown to be positively correlated with a person’s inclination to undergo screening. Purpose: This study estimated the prevalence of up to date CRC screening and examined the predictors of CRC knowledge and screening compliance among Chinese, Korean, and Vietnamese Americans living in the Baltimore-Washington metropolitan area. Methods: A cross-sectional sample was employed in this study and included 274 Chinese, Korean, and Vietnamese Americans between ages 50-75 years old. A questionnaire was given to participants in either their preferred native language or in English. Data was collected in person. Results: Data from the 2009 California Health Interview Survey (CHIS) indicates that Chinese Americans had higher rates of FOBT at 32.2% than Vietnamese Americans (27.3%) and Korean Americans (24.8%). Compared to these rates from CHIS, we had significantly lower rates of up to date FOBT: less than 10% (9.1%) reported having FOBT in the past year. Vietnamese had the highest rate (13.8%) followed by Korean (7.5%) and Chinese (6.9%). For the prevalence of up to date colonoscopy (&amp;lt;10 years), CHIS data disaggregated by ethnicity among AA shows that Vietnamese Americans (63.7%) had highest rates of having colonoscopy followed by Korean Americans (51.1%) and Chinese Americans (48.7%). In our study, Chinese had higher rates of up to date colonoscopy (63.3%) than Vietnamese (47.5%) and Korean (43.0%). The average CRC Knowledge Score was 6.10 out of 9 (SD=2.91). In bivariate analysis, education, marital status, and self-rated health were highly correlated with CRC knowledge. Those with higher education levels, those married, and those rated with good physical health had increased CRC knowledge. In multivariate analysis, education, health insurance, and CRC knowledge were significantly related to having colonoscopy. Those with high CRC knowledge were more likely to have colonoscopy than those low knowledge (aOR=2.74, 95% CI, 1.13, 6.64). Those who had health insurance had higher likelihood of having colonoscopy than those without health insurance (aOR=4.40, 95% CI, 2.33, 8.32). Those more than high school education were less likely to have colonoscopy than those with less than high school education (aOR=0.37, 95% CI, 0.16, 0.84). Conclusions: The findings of this study suggest that CRC knowledge is a strong predictor of CRC screening behavior in Asian Americans. Lack of CRC screening knowledge still remains an important barrier to screening, and future strategies to increase public awareness on CRC is necessary to achieve greater screening compliance amongst AA populations. Citation Format: Jenny Guo, Hee-Soon Juon, Sunmin Lee. Colorectal cancer knowledge and screening among Asian Americans aged 50-75 years old [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4223. doi:10.1158/1538-7445.AM2017-4223

Predictors of Colorectal Cancer Knowledge and Screening Among Asian Americans Aged 50-75 years old.

Colorectal cancer, the second leading cause of mortality in the USA, can be prevented with colorectal cancer screening. However, many people who should receive the screening do not get screened. To learn more, this study estimated the prevalence of up-to-date colorectal cancer (CRC) screening and examined the relationship between CRC knowledge and screening compliance among Asian Americans living in the Baltimore-Washington Metropolitan area. The study included a cross-sectional sample of 274 Chinese, Korean, and Vietnamese Americans aged 50-75years old. Participants completed a questionnaire regarding CRC knowledge in either their preferred native language or in English, and data were collected in person. The percentage of total participants with up-to-date overall CRC screening was 52.9%. Up-to-date fecal occult blood test (FOBT) screening was 15.0% and colonoscopy was 50.7%. The average CRC knowledge score was 6.10 out of 9 (SD=2.91). Those with high education, high English proficiency, married, health insurance, and good physical health ratings had higher CRC knowledge. In multivariate analysis, CRC knowledge was significantly correlated with increasing up-to-date colonoscopy (aOR=2.74, 1.13-6.64). Having health insurance (aOR=4.40, 2.33-8.32) was another predictor of up-to-date colonoscopy. These findings suggest that CRC knowledge is a strong predictor of CRC screening behavior in Asian American populations. Lack of CRC screening knowledge still remains an important barrier to screening, and increased public awareness is necessary to achieve greater screening compliance.

Hepatitis B Virus Infection and Exposure Among Foreign-Born Asian Americans in the U.S.

: This study reports hepatitis B serologic test results among foreign-born Asian Americans. In 2013 - 2014, a sample of foreign-born Asian American adults, (≥ 18 years of age) were drawn from community-based organizations in the Baltimore-Washington Metropolitan Area. Hepatitis B screening tests were administered, including tests for HBsAg, anti-HBs, and anti-HBc. Among total of 600 people who completed screening, 33 (5.5%) tested positive for HBsAg, indicating chronic hepatitis B virus (HBV) infection. About 44% (n = 263) tested positive for anti-HBc, indicating a previous exposure to HBV. Asian Americans from Vietnam (53.2%) had the highest exposure to HBV, followed by Asian Americans from Korea (43.4%) and China (34.8%) (P < 0.001). In multivariate analysis, gender, age, education, and family history of HBV infection were associated with previous exposure to HBV infection. The prevalence of anti-HBc (44%) in our study group was much higher than that of a nationally representative sample in the NHANES study (6%), indicating that there is higher incidence of HBV in foreign-born Asian Americans than the general U.S. population.

Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial.

BackgroundThis study aimed to evaluate the effect of a lay health worker (LHW) telephone intervention on completing a series of hepatitis B virus (HBV) vaccinations among foreign-born Asian Americans in the Baltimore-Washington Metropolitan area.MethodsDuring the period of April 2013 and March 2014, we recruited Asian Americans who were 18 years of age and older in the community-based organizations. Of the 645 eligible participants, 600 (201 Chinese, 198 Korean, 201 Vietnamese) completed a pretest survey and received hepatitis B screening. Based on the screening results, we conducted a randomized controlled trial among those unprotected (HBsAg-/HBsAB-) by assigning them either to an intervention group (n = 124) or control group (n = 108). The intervention group received a list of resources by mails for where to get free vaccinations as well as reminder calls for vaccinations from trained LHWs, while the control group received only list of resources by mail. Seven months after mailing the HBV screening results, trained LHWs followed up with all participants by phone to ask how many of the recommended series of 3 vaccinations they had received: none, 1 or 2, or all 3 (complete). Their self-reported vaccinations were verified with the medical records. Multinomial logistic regressions were used to examine the effect of the LHW intervention. Process evaluation was conducted by asking study participants in the intervention group to evaluate the performance of the LHWs.ResultsAfter seven months, those in the intervention group were more likely to have 1 or more vaccines than the control group, compared to the no vaccination group (OR = 3.04, 95% CI, 1.16, 8.00). Also, those in the intervention group were more likely to complete a series of vaccinations than the control group, compared to the no vaccination group (OR = 7.29, 95% CI 3.39, 15.67). The most important barrier preventing them from seeking hepatitis B vaccinations was lack of time to get the vaccination. The most important promoters to getting vaccinations, among those who had vaccinations (n = 89), were our intervention program (70.8%) and self-motivation (49.4%). The majority of participants in the intervention group received the phone calls from LHWs (93%) and almost all of them got the reminder to receive vaccines (98%).ConclusionThe LHW intervention was successful at increasing HBV vaccinations rates among foreign-born Asian Americans. This study suggests that this culturally integrated intervention program may be useful for reducing liver cancer disparities from chronic HBV infection in high risk Asian Americans.Trial RegistrationClinicalTrials.gov NCT02760537