title: Hepatitis B screening among Chinese Americans: a structural equation modeling analysis.
abstract: BACKGROUND
  Hepatitis B Virus (HBV) disproportionately affects new immigrants from endemic regions such as China. Untreated infections increase health risks for liver diseases including cancer. Yet most of those infected are unaware of their disease limiting prevention and early treatment options. The purpose of this community based study was to evaluate a heuristic model identifying factors contributing to Hepatitis B (HBV) screening among Chinese Americans.
  
  
  METHODS
  A cross-sectional design included a sample of 924 Chinese men and women 18 years of age and older of which 718 had complete data for final analysis. Confirmatory factor analysis verified conceptual indicators including access/satisfaction with health care and enabling, predisposing, cultural, and health belief factors. Structural equation modeling was used to identify direct and indirect predictors of Hepatitis B screening.
  
  
  RESULTS
  Bivariate analysis revealed that Chinese respondents who were never screened for HBV were significantly more likely to be below age 40 (69.8%), male (69.2%), had less than a high school education (76.4%), with less than 6 years living in the US (72.8%) and had no health insurance (79.2%). The final model identified enabling factors (having health insurance, a primary health care provider to go to when sick and more frequent visits to a doctor in the last year) as the strongest predictor of HBV screening (coefficient = 0.470, t = 7.618, p < .001). Predisposing factors (education variables) were also significantly related to HBV screening. Cultural factors and Satisfaction with Health care were associated with HBV screening only through their significant relationships with enabling factors.
  
  
  CONCLUSIONS
  The tested theoretical model shows promise in predicting HBV testing among Chinese Americans. Increasing access to health care by expanding insurance options and improving culturally sensitivity in health systems are critical to reach new immigrants like Chinese for HBV screening. Yet such strategies are consistent with DHHS Action plan for the Prevention and Treatment of Viral Hepatitis. Implementing community-based strategies like partnering with relevant Community-Based Organizations are important for meeting HBV policy targets.
authors.affiliation: Department of Public Health, Director of Center for Asian Health, College of Public Health, 1301 Cecil B Moore Ave. Ritter Annex, Rm 913, Philadelphia, PA, 19122, USA. grace.ma@temple.edu.
authors.forename: Grace X
authors.initials: GX
authors.lastname: Ma
authors.affiliation: Center for Asian Health and College of Public Health, Temple University, Philadelphia, PA, 19122, USA. yolanda.zhang1868@gmail.co.
authors.forename: Guo Yolanda
authors.initials: GY
authors.lastname: Zhang
authors.affiliation: Center for Asian Health and College of Public Health, Temple University, Philadelphia, PA, 19122, USA. tue85115@temple.edu.
authors.forename: Shumenghui
authors.initials: S
authors.lastname: Zhai
authors.affiliation: Center for Asian Health and College of Public Health, Temple University, Philadelphia, PA, 19122, USA. shawnma@temple.edu.
authors.forename: Xiang
authors.initials: X
authors.lastname: Ma
authors.affiliation: Center for Asian Health and College of Public Health, Temple University, Philadelphia, PA, 19122, USA. ytan@temple.edu.
authors.forename: Yin
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Department of Health, Research Associate, Center for Asian Health, Temple University; and East Stroudsburg University, DeNike Hall, 200 Prospect St., East Stroudsburg University, East Stroudsburg, PA, 18301-2999, USA. sshive@po-box.esu.edu.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Shive
authors.affiliation: Department of Public and Community Health, University of Maryland, College Park, Maryland, USA. mqw@umd.edu.
authors.forename: Min Qi
authors.initials: MQ
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data*; D002681:China / Q000208:ethnology; D003430:Cross-Sectional Studies; D004522:Educational Status; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005163:Factor Analysis, Statistical; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis*; D006515:Hepatitis B virus; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D014481:United States; D055815:Young Adult