Cancer Disparity Research
Asian Community Cancer Health Disparities Center (ACCHDC)
(U54, PI: Grace Ma, PhD funded by National Cancer Institute, NIH)
Representing 5.6% (17.3 Millions) of the total population and projected to reach 9.2% (40.6 millions) by 2050, Asian-Americans are the fastest growing, and second largest foreign-born, ethnic group in the United States (2010 US Census). Yet, Asian-Americans are the only group in the nation for which cancer is the leading cause of death.
Finding the answer to that question is the focus of a growing body of research. These disparities are the result of a complex interplay of multiple barriers within the Asian-American community, including socioeconomic, psychosocial, and cultural constraints. However, Asian-Americans are also put at risk by a lack of knowledge about cancer risks, prevention strategies, and the U.S. health care system in general.
The ACCHDC works toward the overall goal of reducing cancer health disparities throughout the Asian-American community by increasing knowledge of, access to, and utilization of beneficial biomedical and behavioral procedures.
By using community-based participatory research (CBPR) principles to guide all Center activities, the ACCHDC will finally begin to cast light onto a subject that has languished in the darkness for far too long.
Four Key Components:
- Administrative Core (Leader: Grace Ma, PhD)
- Community Outreach (Leader: Yin Tan, MD, MPH)
- Research Program (Full Study PI: Grace Ma, PhD), (Pilot Study PI: Wanzhen Gao, PhD)
- Training Program (Leader: Carolyn Fang, PhD)
The Community Outreach Program works to increase knowledge and access to cancer prevention and treatment programs within multi-ethnic and multilingual Asian communities.
The Research Program focuses on a large-scale controlled trial conducted to evaluate the effectiveness of a CBPR colorectal cancer (CRC) intervention aimed at increasing screening numbers. The study evaluates the knowledge level of colorectal cancer, including perceived risks of CRC and susceptibility to the disease. Lastly, the trial identifies the benefits of screening and how we might reduce the barriers to obtaining that screening.
The RP also conducts a pilot study to evaluate the effectiveness of a culturally appropriate education intervention in increasing knowledge of biospecimen research. The study also identifies and examines social and cultural factors that may affect overall Asian-American participation in biospecimen research.
The Training Program is aimed at developing and implementing a comprehensive research training program in CBPR methods and providing mentorship and key resources to junior researchers from racial/ethnic minorities and underrepresented groups.
Multilevel Colorectal Cancer Intervention Study
(UO1, PI: Grace Ma, PhD, funded by National Institute of Minority Health and Health Disparities, NIH)
Colorectal cancer (CRC) is the second most commonly diagnosed cancer in the U.S. CRC incidence is rising rapidly in Asian American populations, but they have among the lowest rates of CRC screening and are more likely to be diagnosed with advanced stage disease.
This multilevel intervention study aims to address multiple barriers to improve colorectal cancer prevention and follow up care among medically underserved Vietnamese Americans. This theory-based multilevel CRC intervention addresses sociocultural, behavioral and environmental determinants and intervention strategies at individual, interpersonal, and community organizational levels.
This cluster randomized controlled trial aims to test the hypothesis that clinical preventive services guidelines plus a culturally and linguistically appropriate multilevel CRC intervention will lead to significant clinical outcomes and long-term impact at population level.
Hepatitis C Screening and Access to Care Intervention for High-Risk Ethnic Minority Populations (A Pilot Study)
(PI: Grace Ma, PhD, Clinical Co-I: Gina Simoncini, MD)
Hepatitis C virus (HCV) infection is recognized as one of the main causes of liver diseases and poses an increasing challenge to health care systems locally, regionally and nationally. Chronic HCV disparities exist especially in the birth cohort of baby boomers, drug users, African Americans, and underserved high-risk ethnic minority populations.
Hepatitis C disproportionately affects the African American community. HCV diagnosis and prevention measures require access to information about HCV, prevention and treatment. It is clear that information and health services about HCV have not effectively reached the majority of African Americans and other high-risk racial/ethnic minority populations.
The purpose of this collaborative pilot study is to engage academic, community and clinical partners to improve HCV prevention and intervention of screening and access to care among high-risk racial/ethnic minority populations.
Vietnamese Hepatitis B-Liver Cancer Prevention and Control
(RO1, PI: Grace Ma, PhD funded by National Cancer Institute, NIH)
An estimated 2.2 million individuals in the U.S. live with Hepatitis B Virus (HBV or CHB). This represents more than 8% of the overall population.
Immigration from Asian countries such as Vietnam, China and Korea, which also make up the three largest domestic Asian-American subgroups, plays a large role in that total. While Asian-Americans make up 5.5 % of the total population in the U.S., they account for more than 50% of Americans living with CHB.
Screening rates for HBV are low. And, unfortunately, approximately 15%-40% of those with chronic HBV will develop serious liver diseases during their lifetime.
Barriers to HBV screening include:
- lack of access to health care
- cultural and personal reasons
- lack of health insurance
- not having a regular physician
- not knowing where to get tested
- not being able to afford co-pays
- lack of fluency in English
- difficulties getting appointments
Cultural values, and beliefs and fears about stigma are significant barriers to screening. Despite these high rates of HBV infection and low screening rates, very few interventions have been developed to overcome barriers to HBV screening in Vietnamese-Americans.
We are conducting one of the first largest randomized community-based intervention trials involving 36 Vietnamese community-based organizations. We evaluate the effectiveness of a community-based liver cancer prevention program on hepatitis B (HBV) screening among low-income underserved Vietnamese Americans at high-risk for HBV infection.
Sustaining an HBV Program in Underserved Korean Community
(R24, PI: Grace Ma, PhD, funded by National Institute of Minority Health and Health Disparity, NIH)
46% to 68% of Korean-American adults have never been screened for HBV. However, our prior church-based randomized intervention trial (i.e. CBPR HBV intervention or HBVI), demonstrated that this can change. We showed the efficacy of a multifaceted culturally appropriate intervention using community health educator (CHE) and church health worker (CHW) led group education.
It is critically important then that we effectively disseminate this evidence-based intervention if we want to continue to improve HBV-related behaviors.
We will enroll 20 Korean churches in locations throughout Pennsylvania, New Jersey, and Delaware. The outcome, as well as any newly learned process evaluation approaches, will be used to comprehensively assess the impact of evidence-based HBV intervention implementation strategies in underserved Korean-American communities.
Intervention for Non-Compliant Underserved Asian Americans Infected with HBV
(PI: Grace Ma, PhD, funded by Patient-Centered Outcomes Research Institute (PCORI)
According to the Centers for Disease Control, Asian-Americans represent over half of the 2.2 million chronic HBV (CHB) infections in the U.S. However, adherence to monitoring guidelines at 12 months is low. This study will compare patients who are using a Patient Navigator plus Mobile Phone Text Messaging Intervention to those who only receive standard care.
These patients will be compared based on a variety of factors, including:
- knowledge of CHB
- coping skills
- social support structures
- ability to find benefits
- quality of life
- overall level of anxiety
As access to HBV testing improves and patients receive routine care every six or twelve months, we expect to see better health outcomes among these patient groups.
Optimizing Church-Based Intervention to Improve Colorectal Cancer Screening in Underserved Korean Community
(PI: Grace Ma, PhD, National Cancer Institute, NIH)
Colorectal cancer (CRC) is the second most commonly diagnosed cancer in Asian-Americans and its incidence in the Korean community is actually rising.
To combat this problem, the CAH study team used a community-based participatory research (CBPR) approach to work with 30 Korean church sites in Pennsylvania and New Jersey.
The study design is a randomized trial and was guided by an integrative framework of the Health Belief Model and Social Cognitive Theory, which addresses both individual and healthcare system barriers to care.
Key components of the intervention include:
- Bilingual community health intervention
- Patient navigation
- Health provider engagement in CRC screening and referral
Physician Communication About Colorectal Cancer Screening with Chinese-Speaking Patients
(RO1, PI: Judy Wang, PhD, Co-PI: Grace Ma, PhD, funded by National Cancer Institute, NIH)
Chinese-Americans have lower screening rates for colorectal cancer than any other ethnic groups in the country.
Like other groups, the likelihood of a Chinese patient being screened is strongly dependent upon a physician’s advice. It is especially disturbing that as many as 50% of Chinese immigrants go unscreened because their doctor never recommend them to.
In response, we developed a culturally-targeted, physician-focused communication intervention protocol that promotes ethnic- and language-concordant physician-patient communication and assists physicians in their ability to address patients’ screening concerns.
We adopted the concept of reciprocal learning from the Social Cognitive Theory (SCT). Physicians are taught how to ascertain their patients’ cultural views and health beliefs about screening. The physician can then begin to develop a plan to discuss screening with the patient.
Increasing Cervical Cancer Screening Among Vietnamese Americans
(RO1, PI: Grace Ma, PhD, funded by National Cancer Institute, NIH)
Vietnamese women experience the highest incidence rate of invasive cervical cancer of any racial or ethnic group in the United States. This disparity may be attributed to the low uptake of screening, as screening for cervical cancer in Asian-American women lags far behind that of the general population.
Our recent study indicated that the average Pap test rate for Vietnamese women aged 21 and over is just 53%. This is compared to 85% for non-Hispanic White women. The national goal of cervical cancer screening for all women by 2020 is 93%.
The factors that contribute to such a poor screening rate are complex. Therefore, innovative strategies to address these barriers should be tested and implemented as a significant matter of public health priority.
Reaching this population requires a community-based approach. The multifaceted intervention we developed included CHE-led group education with culturally relevant visual aids, patient navigation assistance, client-physician communication, and continuous six-month screening reminders.
We are testing the approach as a randomized controlled trial (RCT) conducted over five years at 30 Vietnamese community-based organizations (CBOs) in the eastern region of the United States.
Promoting Mammography Adherence in Chinese Immigrants
(R01, PI: Judy Wang, PhD, NYC Site-PI: Grace Ma, PhD, LA Site PI: Annette Maxwell, PhD, funded by National Cancer Institute, NIH)
Asian women living in the United States have higher breast cancer incidence rates than those living in Asian countries and studies have found that immigration is, without question, associated with increased breast cancer risk.
Chinese-Americans are the largest group of Asian-Americans and one of the fastest growing minority populations in the United States. Scientists have found that breast cancer rates among Chinese women who have been in the United States for more than ten years are 80 percent higher than their newly arrived peers.
This puts the rate of breast cancer in American-born Chinese women at almost the same rate as white women. Furthermore, breast cancer rates in China have jumped more than 20 percent over the past ten years.
Minority and immigrant women in the US consistently underutilize mammography screening as a way of detecting breast cancer. Thus, culturally targeted interventions focused on increasing mammography screening is needed for Chinese immigrant women.
Cervical Cancer Screening Program for Korean-American Community
(PI: Carolyn Fang, PhD, Co-PI: Grace Ma, PhD, funded by American Cancer Society)
Korean-American women continue to experience high incidence and mortality rates from cervical cancer. Failure to participate in doctor-recommended screening is one of the key factors contributing to these high incidence rates.
Studies consistently report that Korean-American women have the lowest rates of participation in cervical cancer screening in the country. Some have reported that up to 40% of Korean-American women have never been screened. In one California-based study, the proportion of Korean-American women adherent to current screening guidelines was just 63.4%; a number well below the Healthy People 2020 target of 93.0% screening compliance.
In light of these statistics, programs to enhance screening rates in this population are critically needed. In response, we launched a program that combined community education with navigation in services. The components of the intervention were designed to increase awareness of cervical cancer risks, as well as address both individual-level beliefs and barriers to access to proper healthcare.
A Twitter-Enabled Smoking Cessation Study Among Low-Income Ethnic Minority Women
(R21, PI: Kuang-Yi Wen, Ph.D., funded by National Cancer Institute, NIH)
An estimated 40% of women who smoke quit during their pregnancy, however, up to 80% of these women relapse in the postpartum period, despite the health risks for themselves and their children. The proposed study will develop and test an evidence-based, cognitive-behavioral twitter-enabled system-generated and participant-driven intervention (Tweet2commit) designed to reduce postpartum smoking relapse among low-income ethnic minority women who have quit immediately.
A pilot RCT will be conducted to explore the efficacy of the Tweet2commit intervention on reducing postpartum relapse rates, compared to a Usual Care control. The proposed research will be the first randomized controlled study that leverages the potential of Twitter for disseminating evidence-based smoking cessation strategies and harnessing the participatory nature of tweeting for live interactive mobile support groups among underserved postpartum women.