Hmong Women Research Articles

Claiming Place: On the Agency of Hmong Women

Claiming Place: On the Agency of Hmong Women

Daughters Learning from Fathers: Migrant Family Literacies that Mediate Borders

Scholarship in literacy and composition studies has demonstrated the significance of family literacy practices, especially as they relate to educational experiences and achievement. Often, the literacies of migrant and refugee families are considered in terms of conflict: conflict within families, and between families and institutions. This article seeks to illuminate spaces where migrant family literacies inspire positive relations, specifically in daughter-father interactions. In this ethnographic study of Hmong women, I show that literacy alters traditional relationships between fathers and daughters, reframes disempowering gender dynamics, and supports daughters’ access to public realms. These literate interactions have lasting effects throughout daughters’ lives as they pursue education, professions, and political advocacy opportunities.

Abstract B80: Multiple Risk Factors for Hepatocellular Carcinoma (HCC) among Asian Americans: Implications for Intervention

Abstract Multiple Risk Factors for Hepatocellular Carcinoma (HCC) among Asian Americans: Implications for Intervention Introduction: Asian Americans have the highest mortality rates from HCC compared to all other racial/ethnic populations. Historically, mitigating their HCC risks has been through screening for hepatitis B (HBV) and providing linkage to care to those who are chronically infected; however, HCC has multiple risk factors. Besides HBV, obesity-related metabolic factors, including diabetes, and chronic hepatitis C (HCV) are becoming important risk factors for HCC. Lifestyle factors, such as alcohol and tobacco use, also increase risk of HCC. Our study is among the first to measure seven literature-documented HCC risk factors to assess the prevalence of combined risk factors in this population. Objectives and hypothesis: We sought to measure the joint prevalence of 7 HCC risk factors in 3 domains (viral, metabolic, and lifestyle), and hypothesized that a substantial proportion of foreign-born Asian Americans are at risk in multiple domains. Methods: We focused on Asians born in HBV endemic areas (≥ 2%) and tested 967 adult foreign-born Chinese, Hmong, Korean, and Vietnamese American residents of Sacramento County, CA for HBV and HCV; measured hemoglobin A1c (HbA1c) and waist circumference; and recorded self-reported history of diabetes, hypertension, consumption of alcohol in the past 30 days, and smoking status. Metabolic risk factors included high glucose, defined as HbA1c ≥ 5.7% or self-reported diagnosis of diabetes; a large waist circumference, defined according to Asian cut-points (≥ 35 inches for men, ≥ 32 inches for women); and self-reported hypertension. We computed gender-specific age standardized prevalence rates with 95% confidence intervals (CI) for viral, metabolic, and lifestyle risk factors, alone and in combination. Results: Chronic HBV was much more common than HCV in Chinese, Hmong, and Vietnamese Americans; both HBV and HCV were very uncommon among Koreans. Vietnamese men (15.3%, 95% CI 6.9-23.7%) and Hmong women (15.0%, 95% CI 7.6%-22.3%) had the highest viral risk factor prevalence. High glucose was most common among Chinese men (56.3%, 95% CI 43.2-69.3%), followed by Korean men (49.3%, 95% CI 33.4-65.3%). A large waist circumference was most common among Hmong women (83.9%, 95% CI 75.0-92.8%) and Hmong men (66.9%, 95% CI 54.7-79.1%) and least common among Korean men (36.0% 95% CI 19.7-53.2%), Korean women (40.5%, 95% CI 31.3-49.8%), and Vietnamese men (41.8%, 95% CI 30.0-53.7%). Hmong women had the highest prevalence of hypertension (26.8%, 95% CI 18.2-35.4%), and Vietnamese men had the lowest (12.9%, 95% CI 2.7-23.1%). Hmong women had the highest prevalence of at least one metabolic risk factor (85.8%, 95% CI 78.2-93.5%), followed by Hmong men (79.5%, 95% CI 69.6-89.5%), with Korean women having the lowest (54.0%, 95% CI 46.1-62.0%). Among men, smoking was most common among Chinese (28.1%, 95% CI 15.8-40.4%) and least common among Koreans (16.6%, 95% CI 3.4%-29.8%); Vietnamese men were most likely (75.5%, 95% CI 65.6-85.3%) and Hmong least likely (27.4%, 95% CI 16.4-38.4%) to consume alcohol. Among women, smoking was very uncommon in all ethnic groups; alcohol consumption was most common among Vietnamese women (19.0%, 95% CI 11.1-26.9%) and least common among Hmong (5.8%, 95% CI 0.5-11.1%). Vietnamese men were the most likely to have risk factors in two or more domains (59.5%, 95% CI 47.0%-71.9%), followed by Hmong men (43.4%, 95% CI 30.9-55.9%), Chinese men (41.6%, 95% CI 28.2-55.1%), Korean men (31.6%, 95% CI 15.1-48.0%), Vietnamese women (19.9%, 95% CI 11.9-27.8%), Hmong women (19.4%, 95% CI 11.6-27.1%), Chinese women (13.6%, 95% CI 4.4-22.85), and Korean women (11.3%, 95% CI 3.3-19.4%). Conclusion: Considerable ethnic variation in the prevalence of viral, metabolic, and lifestyle risk factors exists. Efforts to reduce HCC need to concurrently address multiple risk factors. Citation Format: Susan L. Stewart, Julie HT Dang, Moon S. Chen, Jr. Multiple Risk Factors for Hepatocellular Carcinoma (HCC) among Asian Americans: Implications for Intervention. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B80.

Claiming Place: On the Agency of Hmong Women ed. by Chia Youyee Vang, Faith Nibbs, Ma Vang

Reviewed by: Claiming Place: On the Agency of Hmong Women ed. by Chia Youyee Vang, Faith Nibbs, Ma Vang Lori Kido Lopez (bio) Claiming Place: On the Agency of Hmong Women, edited by Chia Youyee Vang, Faith Nibbs, and Ma Vang. Minneapolis: University of Minnesota Press, 2016. 347pp. $30.00 paper. ISBN: 978-0-8166-9778-6. Claiming Place: On the Agency of Hmong Women dives headfirst into rectifying the classic problem of the burden of representation—that Hmong women compose a minority population that is often forgotten or overlooked, and that when we do hear about them, their stories are inevitably limited to a set of reductive portrayals. Indeed, the book is wholly preoccupied with underrepresentation, or the concern that single images of Hmong women as rendered in photographs, scholarship, literature, and media will come to stand in for all Hmong women. Given that a meaningful solution to these problems is to populate the landscape with a plenitude of powerful scholarship that serves to diversify the available voices and perspectives, this collection is well positioned to address these concerns and others. Editors Chia Youyee Vang, Faith Nibbs, and Ma Vang have assembled an impressive collection of twelve chapters (plus introduction and afterword) documenting and theorizing the experiences of Hmong women that is both long overdue and sorely needed. The book is organized into four sections: “History and Knowledge Formation,” “Social Organization, Kinship and Politics,” “Art and Media,” and “Gender and Sexuality.” While these sections reveal a broad interdisciplinarity and wide range of foci, the individual contributions connect strongly across sections. Throughout discussions of everything from military histories and divorce customs to Facebook use and genderqueer identities, the writers hew closely to the stated mission of the book—to center the voices and stories of Hmong women, and to theorize their agency and empowerment in doing so. The writers often build from seminal works in gender studies, postcolonial studies, as well as South and Southeast Asian scholars in their literature reviews—a citational practice that offers a strength to the collection, as it points to the larger conversations in which these pieces are engaged, and provides points of access and connection for scholars across disciplines. Moreover, the chapters often reference one another in building their arguments, which provides a coherency and depth akin to that of a monograph. The portrait that emerges is of a thriving and vibrant Hmong culture in which women are often at the helm, if we only know where to look and what questions to ask. One of the central arguments of the book is that Hmong women’s empowerment can take place through and within Hmong culture, repudiating the assumption that Hmong culture is to blame for oppressing women, or that Western norms and cultures provide the only possibility for liberation. This is demonstrated through examinations of the active role that Hmong women have played in taking up employment and becoming educated, in rewriting [End Page 130] the spiritual consequences of divorce, in creating supportive communities using online social media, and in developing sewing practices that document Hmong histories and support entrepreneurship and innovation, among others. Julie Keown-Bomar and Ka Vang hone in on the question of agency in a chapter that repositions Hmong families as a key form of support in helping Hmong women to achieve their goals, while Mai Na M. Lee reveals the agency embodied by military leader Vang Pao’s many wives, whose matrimonial form of political power has long been neglected and misunderstood. The collection is at its strongest in chapters that move beyond critique and revision to specifically focus on building new theory and methodological approaches, such as Ma Vang’s “Rechronicling Histories: Toward a Hmong Feminist Perspective.” In closely examining Hmong women’s life stories and personal histories in terms of “narrative refusal,” or the limits and incoherencies of their accounts, she is able to posit a theory of movement as central to Hmong knowledge formation. This focus on the impact of forced migration and displacement upon Hmong families gives new meaning to the title of the book, as we see that the fraught act of “claiming place” itself is deeply connected to the production of knowledge...

The relationship between osteoporosis and body composition in pre- and postmenopausal women from different ethnic groups in China

ABSTRACTObjective: To investigate the ethnic differences in osteoporosis (OP) and body composition (BC) and their relationship in the Maonan, Mulam, Hmong, and Yao minorities in China.Design: A total of 860 Maonan, Mulam, Hmong, and Yao women were included in this cross-sectional study. Demographic, health history, and lifestyle information was collected using questionnaires. BC was measured through bioelectrical impedance analysis, and bone mineral density (BMD) was assessed via calcaneal quantitative ultrasound.Results: Compared with premenopausal women, postmenopausal women exhibited a lower fat-free mass (FFM), muscle mass (MM), limb muscle mass, and T-score but a higher waist-to-hip ratio and prevalence of OP in each minority (p < .05). After adjustment for age, Hmong women displayed the highest body mass index, fat mass, percentage of body fat, visceral fat, and subcutaneous fat contents, while Yao women presented the highest T-scores and lowest prevalence of OP among the four minorities (p < .05). Having a greater number of children and an older age were significant risk factors for OP in all ethnic groups (p < .05, OR > 1). In addition, our results revealed that FFM and MM exhibited exactly the same weak positive relationship with the T-score (r = 0.081, p < .05) after adjusting for menopausal status and age in all of the participants. Furthermore, significant ethnic differences in the relationship between BC and the T-score existed in the four minorities studied here.Conclusions: BC and OP prevalence varied by menopausal status and ethnic group, and ethnic-specific relationships between BC and BMD were present in the four minorities. More research is needed to further investigate the ethnic differences in BC, OP, and risk factors for lower BMD to develop targeted prevention strategies to reduce the burden of OP across different ethnic groups in China.

Always on the Phone: The Invisible Role of Hmong Women in Diasporic Media Industries

This article examines the emerging media institution of Hmong teleconference radio, a global form of mobile communication that is largely operated and accessed by Hmong American women. Interviews with Hmong Americans about this participatory form of mass media reveal the ways in which it is opening new pathways for diasporic communication, but also the ways that it is criticized and delegitimized. It argues that Hmong teleconference radio offers a rich case study for analyzing mobile phone cultures in a digital era, ultimately showing how women's labor and entrepreneurship within the mobile media realm can be minimized or altogether obscured through gendered hierarchies of value.

Prevalence of Hepatitis B Infection Among Pregnant Women Presenting for Antenatal Care at a Tertiary Hospital in Central California With a Focus on Hmong Women

Introduction: The overall prevalence of chronic hepatitis B infection (HBV) in the United States (US) is estimated to be low around 0.4 % however it is much higher in certain ethnic groups such as, the Hmong. It is suggested that the primary mode of transmission of HBV among these high prevalence groups is vertical transmission. However, data regarding the true prevalence of HBV among Hmong women of childbearing age is limited. The aim of this study was to expand the limited data on HBV prevalence among this population so that further studies on prevention and treatment can be explored. Methods: Retrospective chart review was performed to identify pregnant women who had presented for antenatal care from 2008-2013 to Community Regional Medical Center, a tertiary medical center in the Central California Valley using ICD-9 codes for obstetrical visits. Among these pregnant women those who had HBV were then further identified using ICD-9 codes for HBV. Data was stratified based on ethnicity and race. The data was tabulated using Microsoft Excel and prevalence rates with 95% confidence intervals (CIs) were calculated. Results: Between 2008 and 2013, there were 122,727 antenatal care related visits to our center. Of those, 38,662 individual pregnant women were identified and121 were found to have HBV. We identified a total HBV prevalence of 0.3% (95% CI, 0.26-0.37) in our sample consistent with the estimated overall prevalence in the US. However, among Asian Americans it was higher at 2.6% (95% CI, 2.08-3.2) with highest among Hmong at 3% (95% CI, 2.31-3.83). Native Hawaiian/Pacific Islanders also had a higher prevalence at 2.7% (95% CI, 0.33-9.3). Lowest prevalence was seen among Caucasians and African-Americans at 0.1% [Table 1].Table 1: Prevalence of HBV among Pregnant Women Presenting for Antenatal CareConclusion: With the implementation of HBV screening for all pregnant women and universal vaccination, the overall rates of HBV infection have declined. However, this may not be the case among certain races and ethnicities. Our study identified disparity in HBV infection among pregnant women with high prevalence among Asian Americans especially, the Hmong women compared to the general pregnant population in the US. This study offers a representative sample of the pregnant women in the Central California Valley and a high risk ethnic group such as the Hmong that can aid efforts to screen and prevent vertical transmission of HBV.

The Development of the Milwaukee Consortium for Hmong Health: Capacity Building Through Direct Community Engagement.

Hmong women experience increased incidence and mortality rates for cervical cancer, yet their cancer risk is often masked by their inclusion within the comparatively low-risk Asian American and Pacific Islander (AAPI) category. Key to this disparity is late stage at diagnosis, a consequence of low rates of screening. This article describes the establishment and community engagement efforts of the Milwaukee Consortium for Hmong Health, established in 2008 to build capacity to investigate and address barriers to screening and cancer care. The Consortium facilitated a series of three community dialogues to explore with community members effective ways to overcome barriers to accessing screening and cancer care. The community dialogues produced a series of six recommendations for action, detailed herein, supported and prioritized by the community. We posit that the integral involvement of the Hmong community from the outset promoted buy-in of ensuing Consortium education and outreach efforts, and helped to ensure fit with community perspectives, needs, and priorities.

Preterm birth among the Hmong, other Asian subgroups and non-Hispanic whites in California.

BackgroundWe investigated very preterm (VPTB) and preterm birth (PTB) risk among Hmong women relative to non-Hispanic whites and other Asian subgroups. We also examined the maternal education health gradient across subgroups.MethodsCalifornia birth record data (2002–2004) were used to analyze 568,652 singleton births to white and Asian women. Pearson Chi-square and logistic regression were used to assess variation in maternal characteristics and VPTB/PTB risk by subgroup.ResultsWhite, Chinese, Japanese, Korean, Asian Indian, and Vietnamese women had 36–59 % lower odds of VPTB and 30–56 % lower odds of PTB than Hmong women. Controls for covariates did not substantially diminish these disparities. Cambodian, Filipino and Lao/Thai women’s odds of VPTB were similar to that of Hmong women. But they had higher adjusted odds of PTB compared to the Hmong. There was heterogeneity in the educational gradient of PTB, with significant differences between the least and most educated women among whites, Chinese, Japanese, Asian Indians, Cambodians, and Laoians/Thais. Maternal education was not associated with PTB for Hmong, Vietnamese and Korean women, however.ConclusionsStudies of Hmong infant health from the 1980s, the decade immediately following the group’s mass migration to the US, found no significant differences in adverse birth outcomes between Hmong and white women. By the early 2000s, however, the disparities in VPTB and PTB between Hmong and white women, as well as between Hmong and other Asian women had become substantial. Moreover, despite gains in post-secondary education among childbearing-age Hmong women, the returns to education for the Hmong are negligible. Higher educational attainment does not confer the same health benefits for Hmong women as it does for whites and other Asian subgroups.

Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services.

Simultaneous serum aquaporin-4 antibody and CSF NMDA receptor antibody-positive encephalitis.

A 29-year-old Hmong woman presented with 3 months of worsening imbalance and intermittent vertigo followed by right facial numbness, slurred/nonsensical speech, and memory impairment. She reported generalized weakness, fatigue, and anorexia with more than 10 kg weight loss. She denied paresthesia, vision loss, nausea, vomiting, or hiccups. Neurologic examination revealed impaired short-term memory, expressive aphasia, mild right appendicular ataxia, and profound abulia.

Research challenges and lessons learned from conducting community-based research with the Hmong community.

Conducting research with underserved communities with little exposure to research presents a number of challenges and opportunities. Our study used a community-based approach to better understand factors that influence breast and cervical cancer screening among Hmong women. This article shares lessons learned during the process of developing and conducting qualitative research with a Hmong community with limited experience with research. We conducted 17 key informant and 84 in-depth interviews with Hmong women and men. Research team discussions, insights from Hmong research team members, input from our Community Advisory Committee, and project documents were sources of information about the process of conducting research in this community. Lessons learned concern including a cultural insider as an investigator; building community partnerships and support; establishing and working with a community advisory committee; hiring and training bilingual, bicultural staff; and using culturally appropriate materials and methods in a small, kinship-based community. We used multiple strategies to ensure that this study was conducted in a culturally appropriate manner. The lessons learned from our experiences can provide guidance to researchers on methodological and practical issues in conducting research with the Hmong and can inform future research with the Hmong and other similar underserved populations.

Illicit Distribution of Prescription Drugs: Report of Inadvertent Chloroquine Toxicity and a Market Survey of Businesses Serving Ethnic Minority Populations.

To report a case of life-threatening cinchonism from illicit purchase of chloroquine and survey local ethnic markets to determine what medications are sold without a prescription. A 44-year-old Hmong woman presented with abdominal pain and vomiting 30 minutes after ingesting 20 presumed acetaminophen pills in a self-harm gesture. Initial vital signs were normal, and an electrocardiogram (ECG) showed normal sinus rhythm, QRS = 130 ms, and QTc = 455 ms. Her systolic blood pressure dropped to 84 mm Hg, which was unchanged after 3 L normal saline, but improved after 150 mEq NaHCO3. A repeat ECG showed QRS = 114 ms and QTc = 588 ms. Serum labs were significant for K 2.8 mmol/L and Mg 1.8 mg/dL; 2.5 hours later, the family brought in the medication, which was 250 mg tablets of chloroquine phosphate. K and Mg were repleted, and she was admitted to the intensive care unit with complete recovery. Serum chloroquine level 9 hours after ingestion was 530 ng/mL (therapeutic = 20-400 ng/mL). We identified local ethnic markets through patient and hospital employee referrals and Internet searches. In our survey, 3 of 4 ethnic markets sold prescription medications: 35 were identified, of which 5 are discontinued by the FDA (diphenidol, phenacetin, metamizole, phenylbutazone, and sibutramine). A variety of prescription medications, including 5 discontinued by the FDA, were available in markets serving our community's ethnic minorities. Health care workers should be aware of this public health risk, which can result in serious toxicity, as described in this case of chloroquine overdose.

Evaluating Teaching Techniques in the Hmong Breast and Cervical Cancer Health Awareness Project

Cancer health disparities are a reality for Hmong women who are often diagnosed at a later stage and have low literacy and experienced care that are not culturally appropriate. Lack of attention to cultural appropriateness and literacy levels of cancer screening materials may contribute to disproportionately low levels of cancer screening among Hmong women. The purposes of this study were to evaluate the Hmong Health Awareness Project (HHAP), a program designed to create awareness and acceptance of breast and cervical cancer screening, and to examine participants' perceptions of the utility of the content of the workshops. Hmong researchers partnered with three Midwestern Hmong community centers to implement six workshops. Three teaching techniques: pictographs, videos, and hands-on activities were utilized to teach Hmong participants about cancer screening. Participants included 150 Hmong (male participants = 30 and female participants = 120). Teach-back method was used to assess the participants' understanding of cancer screening throughout the workshops. Qualitative data were collected in focus groups to assess the feasibility of teaching methods and participants' perceptions of the utility of the content of the workshops. Directed content analysis was used to analyze participants' responses. The three teaching techniques were helpful in increasing the Hmong people's understanding about breast and cervical cancer screening. Nearly, all participants perceived an increased in their understanding, greater acceptance of cancer screening, and increased willingness to be screened. Men expressed support for screening after the workshops. Findings can guide future interventions to improve health communications and screening and reduce diagnostic disparities among Hmong and immigrant populations.

Teenage Marriage among Hmong American Women

As Hmong transition to life in America, efforts are made by Hmong to maintain traditional cultural practices. This article explores the traditional practice of early marriage among Hmong women and their responses to this practice. As Hmong women acculturate to American ways, women may question the role of traditional practices in their identity and everyday lives. This study examines the family socialization and individual processes associated with teenage marriage among Hmong American women. Interviews with 12 Hmong American women who were married in their teens describe their experiences.

Considerations of Culture and Community in the Production of Hmong Health

Health is locally produced by individuals, families, and households through the interplay and strategic utilization of a variety of internal and external resources, yet distally influenced by the larger ecological environment within which these are situated. The specific environmental factors that influence health vary across time and space, but are important to understanding and addressing health disparities. Data for this project come from 33 Hmong women who participated in focus groups conducted as part of an exploratory community‐based research study investigating cervical cancer screening disparities in the Milwaukee, Wisconsin Hmong community. Participants identified a number of factors broadly falling into two ecological contexts—culture (beliefs about disease causation, treatment seeking, and modesty) and community (collective decision making, health literacy, and language)—influencing screening decisions. Understanding of these factors is important for developing culturally embedded and locally relevant solutions aimed at effectively increasing cervical cancer screening rates and improving health outcomes for Hmong women.

Perinatal HIV testing among African American, Caucasian, Hmong and Latina women: exploring the role of health-care services, information sources and perceptions of HIV/AIDS

Perinatal HIV transmission disproportionately affects African American, Latina and potentially Hmong women in the United States. Understanding racially and ethnically diverse women's perceptions of and experiences with perinatal health care, HIV testing and HIV/AIDS may inform effective health communications to reduce the risk of perinatal HIV transmission among disproportionate risk groups. We used a qualitative descriptive research design with content analysis of five focus groups of African American, Caucasian, Hmong and Latina women of reproductive age with low socioeconomic status distinguished by their race/ethnicity or HIV status. A purposive stratified sample of 37 women shared their health-care experiences, health information sources and perceptions of HIV testing and HIV/AIDS. Women's responses highlighted the importance of developing and leveraging trusted provider and community-based relationships and assessing a woman's beliefs and values in her sociocultural context, to ensure clear, consistent and relevant communications. Perinatal health communications that are culturally sensitive and based on an assessment of women's knowledge and understanding of perinatal health and HIV/AIDS may be an effective tool for health educators addressing racial and ethnic disparities in perinatal HIV transmission.

Sources of Breast and Cervical Cancer Information for Hmong Women and Men

Despite low breast and cervical cancer screening levels among Hmong women in the United States reported in the literature, understanding of the barriers to screening for Hmong women is limited. Health literacy issues may influence screening behavior for this population. This qualitative study explored sources of information about breast and cervical cancer, including screening, and identified barriers to seeking such information for Hmong women and men. Researchers conducted semi-structured, in-depth interviews with 84 Hmong women and men living in Oregon. Interviews were audio-recorded and transcribed. Transcripts of 83 usable interviews were analyzed using content analysis. Health care providers and the Internet were the most frequently cited sources of information about breast and cervical cancer, including screening. Other sources were family, friends, and other media. Over half of the participants indicated that nothing would prevent them from seeking information about these topics. These findings suggested that health care providers and the Internet may be important sources of information about breast and cervical cancer screening for Hmong women. Additional research is needed to examine further Hmong women's health literacy needs and preferences with regards to breast and cervical cancer screening.

Barriers and Facilitators of Cervical Cancer Screening among Women of Hmong Origin

This qualitative study explored the barriers and facilitators of cancer screening among women of Hmong origin. Using a community-based participatory research approach, we conducted focus groups (n=44) with Hmong women who represented four distinct demographic groups among the Hmong community. The participants described sociocultural barriers to screening, which included a lack of accurate knowledge about the causes of cervical cancer, language barriers, stigma, fear, lack of time, and embarrassment. Structural barriers included attitudes and practices of health care providers, lack of insurance, and negative perceptions of services at clinics for the uninsured. Health care providers may require additional training and increased time per visit to provide culturally sensitive care for refugee groups such as the Hmong. Health-related social marketing efforts aimed at improving health literacy may also help to reduce health inequities related to cancer screening among the Hmong.

Hepatitis B knowledge, screening, and vaccination among Hmong Americans.

We examined Hmong women and men's knowledge of hepatitis B and their screening and vaccination behavior. In-depth interviews were conducted with Hmong in Oregon aged 18 and older (n=83). Independent samples t-test was used to assess mean differences in knowledge by demographic characteristics. Qualitative data were analyzed using content analysis. Most participants had heard of hepatitis B (96.4%). Fifty-three percent of participants had been screened, and half had been vaccinated (50.6%). Transmission knowledge was significantly higher among younger participants, those born in the U.S., and those who reported seeking preventive care. Sequelae knowledge was significantly higher among those who sought preventive care. Transmission and sequelae knowledge were not associated with screening and vaccination. Qualitative data showed that, of those hepatitis B positive participants, most did not have a comprehensive understanding of their illness. Intervention strategies should address knowledge deficits and improve health literacy, especially among Hmong who have hepatitis B.