Evidence-Based Approach to Empower Asian American Women in Cervical Cancer Screening

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PROJECT SUMMARY Asian Americans are the fastest growing population across all US racial/ethnic groups, and individuals of Chinese origin represent the largest US Asian subgroup, accounting for up to 24% of the total US Asian population. Among adult Chinese Americans, approximately 43% report limited English language proficiency (LEP); this rate is even higher among foreign-born Chinese Americans, among which 56% have LEP. These data are meaningful in light of studies demonstrating a strong negative association between LEP and participation in cancer screening. Indeed, LEP may be contributing to the disparity observed in cervical cancer screening rates, which are lower among Chinese American women (65.8%) compared with non-Hispanic White women (82.8%). Estimates from the National Health Interview Survey (NHIS) also note similar disparities in screening, with Chinese women reporting lower Pap test use (68.7%) compared to Black/African American women (84.3%) and AI/AN women (81.2%) and in comparison with other Asian subgroups such as Filipinas (82.7%). Importantly, among recent immigrants, proportions of Pap test use were lowest for Chinese women. Multiple factors contribute to non-screening among Chinese American women with LEP including lack of insurance or regular healthcare provider, lack of time, language difficulties, and embarrassment. Emerging technologies supporting self-sampling for human papillomavirus (HPV) testing may offer a valuable, evidence-based strategy for empowering underscreened and medically underserved Chinese American women with LEP to be able to participate in cervical cancer screening. Although prior studies have demonstrated that HPV self-sampling can be feasibly offered in low-resource community settings, not one study has focused on Chinese American women, despite the fact that this population has among the lowest cervical cancer screening rates. Therefore, the goal of this administrative supplement is to examine HPV self-sampling in a community sample of 150 Chinese American women with LEP. In this randomized study, 75 women will receive our previously tested community education program on cervical cancer screening plus navigation, along with HPV self-sampling kits; and 75 women will receive our previously tested community education program plus navigation to clinic-based screening. The aim of the proposed supplement is to: (1) Compare rates of providing a self-collected sample vs. obtaining clinic-based cervical cancer screening among 150 Chinese American women with LEP. Participation in self-sampling or clinic-based screening will be assessed at 6-month follow-up. It is hypothesized that the proportion of Chinese American women in the HPV self-sampling program who provide a self-collected sample will be higher than the proportion of women in the clinic-based program who obtain clinic- based screening. The research proposed in this supplement will be the first randomized study to evaluate HPV self-sampling among underserved Chinese American women with LEP. Our findings will inform future evidence- based programs to enhance screening in this understudied population.