1

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

and

C. Ed Hsu, PhD, Louis Liu, MAUniversity of Maryland College Park.

Department of Public and Community Health

Julie Bawa, MPH, Ulder Tillman, MD, MPHMontgomery County DHHS.

Mark Li, MD Asian Physician AllianceOral Presentation in the American Public Health Association

Conference. Boston, MA November 4-8, 2006.

2

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.

3

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.

4

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.)

5

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.

6

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.

7

Methods

Hepatitis B Education1. Pre test

2. Educational slides presentation

3. Post test

Hepatitis B Screening1. Blood drawing

2. Notify subjects

3. Free vaccine (to eligible participants)

8

Survey Instrument I: Demographics

1. Gender2. Age3. Marital Status4. Race/ethnicity5. Years living in the US6. Education Level7. Household Income8. Employment Status9. Health Insurance Status10. Montgomery County Residence

9

Survey Instrument II: Questionnaire (True/False)

1. Hepatitis B can be passed on from mother to child during childbirth2. One can be infected with Hepatitis B by sharing food3. About 10% of the Asian Americans populations are infected with

Hepatitis B4. The majority of chronic Hepatitis B patients has no symptoms5. Hepatitis B infection cannot be cured, but the disease can be

managed6. Hepatitis B virus is significantly more contagious than HIV7. Chronic hepatitis B causes liver cancer and cirrhosis if not properly

managed8. Asian Americans have the same risk of dying of liver cancer as their

White counterparts9. Twenty percent of liver cancer is caused by Hepatitis B10. It is safe to breast-feed even if the mother is infected with Hepatitis B

10

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)

11

Preliminary Results I:Hepatitis 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.

12

Preliminary Results II:Hepatitis B Prevalence (Age)

Age 1-Immuned 2-Carrier 3-Unimmuned Total

18~25 72 2 44 (37.29%) 118

26~35 61 3 64 (50%) 128

36~45 27 7 (10.29%) 34 (50%) 68

46~55 42 8 (8.51%) 44 94

56~65 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)

13

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)

14

Summary Results

Important Finding By Race/Ethnicity.

By Age group.

By Duration of residency.

15

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%).

16

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%.

17

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.

18

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.

19

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.

20

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.

21

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.

22

Resources

AAHI Website, Montgomery County, Marylandhttp://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

23

Healthy Asian Communities in Maryland