In its attempt to reduce cancer mortality by 50% by the Year 2000, the National Cancer Institute has published cancer prevention guidelines. However, consumer surveys and medical records audits indicate low levels of acceptance, adoption and compliance with these recommendations. The overall goal of this research project is to promote compliance by Vietnamese immigrants in California. The proposed study would test two interventions, applied separately and in combination: a community outreach intervention (modeled on the investigators' experience with a Vietnamese anti-smoldng media campaign) and a physicians' office inreach intervention (including the investigators' computerized Cancer Prevention Reminder System). The proposal is based on a theoretic model which postulates that interventions targeting both consumer and physician will be most effective in promoting preventive care activities, and on the findings of the investigators' previous research and the work of others. A five-year trial is planned, using a pretest-posttest control group design in four counties in Northern and Southern California with 140,000 Vietnamese, and specifically involving 5 Vietnamese physicians in each community (N=20). Targeted dependent variables are indicators of cancer prevention activities, including: (1) primary prevention by smoking cessation counseling rates) and hepatitis B immunoprophylaxis (hepatitis B serologic screening rates); and (2) secondary prevention by screening (pelvic examination, Pap smear, clinical breast examination, and mammography rates). Primary data sources are: (a) pre-intervention, annual, and post-intervention surveys of Vietnamese consumer's attitudes, knowledge, intentions and behaviors regarding each dependent variable; and (b) pre-intervention and post-intervention medical records audits of screening, counseling, immunization and referral rates. Secondary data will include epidemiologic tracking of California Tumor Registry data including lung, liver, breast, and cervical cancer incidence, stage, survival and mortality rates for Vietnamese. Data will be analyzed by analysis of variance and multiple regression techniques. The long-term goal is to reduce cancer incidence and to enhance early detection of cancer. Specific steps toward this goal include: (1) assessment of the of the inreach and outreach interventions in promoting physician and consumer performance of recommended cancer prevention activities; (2) evaluation of the feasibility and cost-effectiveness of implementing the interventions; and (3) dissemination of the research findings to other health professionals.
