title: Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study.
abstract: BACKGROUND
  Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk.
  
  
  METHODS
  Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation.
  
  
  RESULTS
  Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation.
  
  
  CONCLUSIONS
  LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing.
  
  
  CONCLUSIONS
  LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued.
authors.affiliation: University of California Davis Comprehensive Cancer Center, 4800 2nd Avenue, Suite 2200, Sacramento, CA 95817, USA. moon.chen@ucdmc.ucdavis.edu
authors.forename: Moon S
authors.initials: MS
authors.lastname: Chen
authors.forename: Dao M
authors.initials: DM
authors.lastname: Fang
authors.forename: Susan L
authors.initials: SL
authors.lastname: Stewart
authors.forename: May Ying
authors.initials: MY
authors.lastname: Ly
authors.forename: Serge
authors.initials: S
authors.lastname: Lee
authors.forename: Julie H T
authors.initials: JH
authors.lastname: Dang
authors.forename: Tram T
authors.initials: TT
authors.lastname: Nguyen
authors.forename: Annette E
authors.initials: AE
authors.lastname: Maxwell
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Bowlus
authors.forename: Roshan
authors.initials: R
authors.lastname: Bastani
authors.forename: Tung T
authors.initials: TT
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D001213:Asian / Q000208:ethnology; D003150:Community Health Workers; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D055815:Young Adult