Lay Health Worker Model to Reduce Liver Cancer Disparities in Asian Americans

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DESCRIPTION (provided by applicant): Hepatitis B virus (HBV) infection is globally most common and serious viral infection of the liver. It can cause premature death from liver diseases or liver cancer. Chronic HBV infection and liver cancer caused by HBV among Asian Americans and Pacific Islanders (AAPIs) is one of the most serious - but frequently neglected-health disparity issues in the U.S. AAPIs account for over half of the 1.3 million chronic hepatitis B cases and deaths from HBV infection. This excess risk can be attributed to high rates of HBV infection (particularly among first-generation immigrants) in combination with low rates of HBV screening and vaccination due to cultural, linguistic, and financial barriers. HBV infection affect Asian Americans disproportionately, and thus it leads to a huge liver cancer disparity among Asian Americans compared to other racial/ethnic groups. In response to these cancer disparities, the objective of this project is to build a sustainable, community-based, participator program of lay health workers (LHWs) who can promote liver cancer prevention programs among high-risk groups of Asian Americans. This proposed study attempts to implement culturally integrated liver cancer prevention programs for Chinese, Korean, and Vietnamese Americans through outreach, screening, education, research, and training in the Baltimore-Washington Metropolitan Area. The specific aims are: (1) To develop a training protocol and certificate program for LHWs; (2) To assess the prevalence of HBV infection; (3) To implement intervention programs, based on screening test results; and (4) To evaluate the effectiveness of LHW intervention on adherence to HBV vaccinations among those unprotected. A total of 600 Asian American adults (200 Chinese, Koreans, and Vietnamese in each group), 18 years of age and older will be recruited from the community. Trained and certified LHWs will recruit participants at community-based organizations and hep B free screening events. All the eligible participants will complete a self-administered questionnaire and receive liver cancer education. Then, they will receive hepatitis B test. Every participant will receive the results of screening tests by mail or phone. We will provide referral services for treatment to those infected. For those unprotected, we will implement intervention programs to increase a series of vaccinations within 6 months using a randomized controlled design. Seven months after mailing the results, we will conduct telephone interviews among those unprotected. Upon completing follow-up, those in the control will receive the delayed LHW intervention. The insights gained from this proposed LHW intervention will be valuable in implementing liver cancer prevention programs for other high-risk non-English speaking populations and will address health disparities among immigrant populations.