Chinese-Americans are the largest Asian population in the US, of which 70% are immigrants. In contrast to the generally high use of mammography screening and decline in breast cancer mortality seen in the total US population, Chinese-American women have much lower mammography screening rates and their breast cancer mortality rates are not yet declining. Chinese immigrant women with breast cancer are more likely to be diagnosed with large tumors and die within 5 years than their US-born counterparts. Their low rates of mammography use are associated with knowledge, cultural and attitudinal barriers to screening. Guided by the Health Belief Model, we developed a culturally sensitive video for Chinese women. Our preliminary research showed that viewing the cultural video at home (single video mode) effectively increased Chinese women's mammography use by 12 percentage points over reading a print medium (control group) after a 6-month follow-up. The cultural video also significantly increased knowledge and reduced cultural and attitudinal barriers compared to the control group. However, our data show that a high proportion of Chinese women (59%) still had not had a mammogram after the video intervention, suggesting that a more intensive approach is needed for this population. Thus, guided by Social Network Theory, we pilot tested the video in a small- group setting in which women viewed the video together followed by a peer-led discussion (small-group video discussion). The small-group video discussion enhanced Chinese women's mammography use six-months post-intervention more than the single video mode. We do not know whether small-group video discussion through social support and networks significantly changes personal beliefs and barriers and further promotes screening behavior and whether these two intervention approaches can have long-term effects on behavioral changes. To fill these gaps, our multidisciplinary research team proposes a randomized controlled trial to identify the best intervention approach for increasing mammography adherence among Chinese immigrant women. In this proposed trial, we will recruit 910 Chinese women through Chinese community partnerships in greater Washington DC, New York, and southern California. These women will be immigrants who are non- adherent to the American Cancer Society guidelines that recommend annual mammograms for women over age 40. Participants will be randomized to the two arms: 1) small-group cultural video discussion and 2) single cultural video mode. Participants will be telephone interviewed before and after intervention to assess their changes in key barriers and receipt of mammograms by 6 months and 18 months post-intervention. The small- group video discussion will be led by a trained Chinese community health educator and a research staff using a standardized protocol at all sites. If our theoretically-guided, community-led intervention programs are effective, these programs can be disseminated in Chinese-American communities at large and be translated to other Asian groups to promote overall mammography screening rates among Chinese and Asian women.

Public Health Relevance

Chinese-American women's mammography screening rates are far lower than the Health People 2010 target rates (70%) for women ages 40 and older. This proposed study will test the efficacy of viewing a theoretically based and culturally sensitive video followed by group discussion (vs. single viewing) in increasing mammography use. We will enroll 910 Chinese immigrant women (age e41 and last mammogram >1 year) from Washington DC, New York City, and southern California to participate in our intervention programs. We will assess women's adherence to annual mammography screening guidelines six months and 18 months post intervention. The results of this study will identify optimal avenues for reaching Chinese immigrant women and increasing their regular screening behavior. The results of this study will lead cancer control efforts to effectively decrease breast cancer screening disparities experienced by Chinese-American women.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Nursing Science: Adults and Older Adults Study Section (NSAA)
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Kobrin, Sarah
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Georgetown University
Internal Medicine/Medicine
Schools of Medicine
United States
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