In comparison to all other racial/ethnic groups in the United States, Asians experience the highest liver cancer incidence and mortality rates. About 80% of all liver cancers are etiologically related to chronic hepatitis B infection. Considering the rapidly growing Asian population in the United States, prevention and control of hepatitis B infection through screening and vaccination is a critical public health priority. Because hepatitis B is endemic in many Asian populations, it is typically recommended that adults be initially screened for hepatitis B in order to identify those who are chronic carriers so that they may be appropriately counseled and monitored, and refer only susceptible individuals for vaccination. Koreans have the highest liver cancer incidence and mortality rates in Los Angeles County, which is home to the largest concentration of Koreans in the entire United States. Yet, to date, no public health efforts have been directed at hepatitis B prevention and control among Korean adults. The proposed study (P01 Project #3) will address this gap by conducting a group randomized experiment to test the effectiveness of a small group intervention in increasing hepatitis B screening rates in a community sample of Korean adults in Los Angeles. The intervention will be culturally tailored and delivered through Korean Christian churches in Los Angeles. We will recruit and randomize 42 churches to an intervention or control group. Following an in-person baseline interview to assess knowledge, beliefs and behaviors, subjects drawn from intervention churches (N=425) will attend a """"""""small-group discussion"""""""" focusing on hepatitis B and liver cancer control. Control group subjects (N=425) will attend a small group discussion focusing on general cancer prevention and control. Both groups will be re-contacted at 6-months, by telephone, to assess self-reported receipt of hepatitis B testing. The primary study hypothesis is that intervention group subjects will have significantly higher hepatitis B screening rates at follow-up compared to control group subjects. In addition, we predict that the intervention group will have higher knowledge levels at post-test compared to the control group;that knowledge will mediate the effects of the intervention on outcome;and that the intervention will have greater impact among more acculturated as compared to less acculturated subjects. Our research is important because we focus on a cancer that has received little attention from the research community and yet imposes a disproportionate disease burden on Asians. This project will also benefit immensely from being part of the overall program project, which will contribute additional multidisciplinary expertise and provide synergies not available to a stand-alone research endeavor.
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