A Hepatitis B Education and Screening Program for The Asian American Community Montgomery County, Maryland

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A Hepatitis B Education and Screening Program for
The Asian American Community Montgomery County,
Maryland
C. Ed Hsu, PhD, Louis Liu, MAUniversity of
Maryland College Park. Department of Public and
Community Health Julie Bawa, MPH, Ulder Tillman,
MD, MPH Montgomery County DHHS. Mark Li, MD
Asian Physician Alliance
Oral Presentation in the American Public Health
Association Conference. Boston, MA November 4-8,
2006.
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Prevalence of HBV Infections by Race/Ethnicity

• Chronic HBV infection rates in Non-Hispanic White
  (0.1), Hispanic (0.1), and African-Americans
  (0.5)
• Versus
• Chronic HBV infection rate in Asian Americans and
  Pacific Islanders (AAPI) 7
• Non US-born AAPI 9
• US-born AAPI 1.5

Data source Stanford Asian Liver Center.
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National Statistics of HBV

• AAPI account for 1/2 of the 1.3 million chronic
  hepatitis B cases annually.
• AAPI accounted for half of the deaths resulted
  from chronic hepatitis B infection in the US.
• AAPI are 3 to 13 times more likely to die from
  liver cancer than Caucasians
• Chinese American at 6 times higher risk
• Korean Americans at 8 times,
• Vietnamese Americans at 13 times.

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Purposes of Hepatitis B Project

• Implement a Hepatitis B prevention
  (including both education/preventive screening)
  program in Asian community of Montgomery County,
  MD.
• This is accomplished by developing a
  collaborative partnership among
• Montgomery County Asian American Health
  Initiative
• The Asian American Physician Alliance in
  Maryland
• University of Maryland College Park
• Community-based Organizations (e.g., the CCACC,
  KCC, MVMA, and others) and Faith-based (Church,
  Temple, etc.)

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Funding Support

• The project receives financial support from
• Asian American Health Initiative, Montgomery Co.,
  MD
• The project received voluntary assistance from
• Health professionals in Maryland.
• Many Asian faith-based and community-based
  organizations.

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Objectives

• To reduce the health disparities between Asian
  American community and their racial counterparts
  in terms of hepatitis B-related morbidity and
  mortality.
• Establish baseline data of prevalence rate among
  Asian communities
• Pretest and post tests to measure the changes in
  perception and knowledge related to HBV
  prevention
• Provide free screening to 680 Asian Americans
  residing in Montgomery County, Maryland
• Give free vaccines to those who are unprotected
  and aged between 18 to 35 to 300 Asian residents
  who are unimmunized.

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Methods

• Hepatitis B Education
• Pre test
• Educational slides presentation
• Post test
• Hepatitis B Screening
• Blood drawing
• Notify subjects
• Free vaccine (to eligible participants)

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Survey Instrument I Demographics

1. Gender
2. Age
3. Marital Status
4. Race/ethnicity
5. Years living in the US
6. Education Level
7. Household Income
8. Employment Status
9. Health Insurance Status
10. Montgomery County Residence

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Survey Instrument II Questionnaire (True/False)

1. Hepatitis B can be passed on from mother to child
   during childbirth
2. One can be infected with Hepatitis B by sharing
   food
3. About 10 of the Asian Americans populations are
   infected with Hepatitis B
4. The majority of chronic Hepatitis B patients has
   no symptoms
5. Hepatitis B infection cannot be cured, but the
   disease can be managed
6. Hepatitis B virus is significantly more
   contagious than HIV
7. Chronic hepatitis B causes liver cancer and
   cirrhosis if not properly managed
8. Asian Americans have the same risk of dying of
   liver cancer as their White counterparts
9. Twenty percent of liver cancer is caused by
   Hepatitis B
10. It is safe to breast-feed even if the mother is
    infected with Hepatitis B

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Outreach Activities 8 sites

1. 04/16/06 Cambodian Buddhist Temple (13800 New
   Hampshire Ave, Silver Spring, MD)
2. 03/26/06 Korean Global Mission Church (13421
   Georgia Ave. Silver Spring, MD 20906)
3. 03/11/06 Taiwanese Presbyterian Church (Newport
   Mill Rd. Church Lane, Wheaton, MD 20902)
4. 02/18/06 Hampshire View Baptist Church (360
   Ednor Rd. Silver Spring, MD 20905)
5. 02/18/06 Thai Temple
6. 01/21/06 Korean Global Mission Church (13421
   Georgia Ave. Silver Spring, MD 20906)
7. 12/11/05 The Vietnam Catholic Church (11814 New
   Hampshire Ave. Silver Spring, MD 20904)
8. 12/10/05 Capital Chinese Church (810 University
   Blvd. West, Wheaton, MD 20902)

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Preliminary Results IHepatitis B Prevalence
(Race/Ethnicity)
Group 1-Immuned 2-Carrier 3-Unimmuned Total
Asian Indian 7 0 7 (50) 14
Cambodian 14 3 (8.1) 20 (54.1) 37
Chinese 94 11 (5.4) 102 (49.3) 207
Filipino 10 1 (4) 12 (52.2) 23
Korean 105 8 (4.1) 83 (42.3) 196
Taiwanese 40 1 (1.9) 12 (22.6) 53
Thai 15 3 (7.3) 23 (56.1) 41
Vietnamese 56 6 (5.9) 40 (39.2) 102
Other 0 0 8 (100) 8
Total 341 (50) 33 (4.8) 307 (45.1) 681
Other group includes Indonesian, Sri Lanka,
Pakistani, etc. Data as of 4/30/2006.
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Preliminary Results IIHepatitis B Prevalence
(Age)
Age 1-Immuned 2-Carrier 3-Unimmuned Total
1825 72 2 44 (37.29) 118
2635 61 3 64 (50) 128
3645 27 7 (10.29) 34 (50) 68
4655 42 8 (8.51) 44 94
5665 67 5 45 117
66 31 3 35 69
Total 300 28 266 (44.78) 594
Source Quest Laboratory. Data table prepared by
Louis Liu, University of Maryland. (Data as of
3/31/06)
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Preliminary Results III Hepatitis B Prevalence
(By Residence History)
Residence history 1-Immuned 2-Carrier 3-Unimmuned Total
Born in the US 20 0 17 37
Less than 1 year 2 0 7 9
1 4 years 19 1 11 31
5 9 years 35 3 25 63
10 years or more 152 19 143 314
NA 72 5 63 140
Total 300 28 266 594
Source Quest Laboratory. Data table prepared by
Louis Liu, University of Maryland. (Data as of
3/30/06)
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Summary Results

• Important Finding
• By Race/Ethnicity.
• By Age group.
• By Duration of residency.

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Discussion I generally consistent
with the literature

• The literature suggests Vietnamese Americans
  are at a higher risk of dying of HepB, followed
  by Korean Americans and Chinese Americans.
• In the present study, Cambodian (8.1) and Thai
  (7.3) has the highest prevalence of carriers.
• Followed by Vietnamese (5.9), Chinese (5.3),
  and Korean (4.1).

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Discussion II New findings from
the study

• Prevalence of HepB in API The literature
  indicates that the prevalence of HepB carrier in
  Asian countries is 10,
• in API is 7,
• in non US-born API is 9.
• The present study suggests that the average
  infection rates
• across 7 Asian American groups is 4.8
• in non US-born Asian Americans is 5.1.

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Discussion III new findings from the study

• Unimmunized rates highest unimmunized rates
  occurred in the other group (100), followed by
  Thai (56), Cambodian (54), Chinese (49), Asian
  Indian (46), and Korean (42).
• Immunized rates Taiwanese community has the
  highest immunized rate (75), followed by Korean
  and Vietnamese (54) communities.

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Important Messages

• The case of Cambodian/Thai community high
  carrier rate and high unimmunized rate.
• The other group high unimmunized rate.
• For immigrants, the prevalence rate is positively
  related to the duration of US residence.

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Limitations

• Asian group representations
• Participation rates varied by Asian subgroup.
• Potential selection bias
• Subjects may overly represented members of
  faith-based vs. community-based organizations.

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Conclusion More health data of Asian community
should be collected

• Asian American community (vs other racial
  counterparts) in the present study has a higher
  HBV prevalence.
• What gets measured/counted gets done.
• Continue to collect and report health data help
  communities help themselves.

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Next Steps

• In FY07, our group will continue to
• Conduct Hepatitis B/Liver Cancer education in
  Maryland.
• Collect Asian American health data.
• Disseminate results by presenting in academic
  conferences and publishing the results in
  peer-reviewed journals.
• Submit grants for additional support.

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Resources

• AAHI Website, Montgomery County, Maryland
• http//www.aahiinfo.org
• Related Links
• Stanford Asian Liver Center http//liver.stanford.
  edu/
• OMB Directive 15
• Maryland Office of Minority Health and Health
  Disparities
• CDC Office of Minority and Women's Health
• White House Initiative on Asian Americans and
  Pacific Islanders

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Healthy Asian Communities in Maryland
Asian American Health Initiative