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

项目摘要 亚裔美国人是美国所有种族/族裔群体中增长最快的人口， 华裔是美国最大的亚裔群体，占美国亚裔总数的24 人口在成年华裔美国人中，大约43%的人报告英语能力有限 (LEP)在外国出生的华裔美国人中，这一比例更高，其中56%患有LEP。这些 研究表明，LEP和 参与癌症筛查。事实上，LEP可能有助于宫颈癌中观察到的差异 筛查率，与非西班牙裔白色女性相比，华裔美国女性（65.8%）的筛查率较低 妇女（82.8%）。国家健康访谈调查（NHIS）的估计也注意到类似的差异， 筛查，与黑人/非裔美国人相比，中国女性报告使用较低的巴氏试验（68.7%） 女性（84.3%）和AI/AN女性（81.2%），并与其他亚洲亚组（如菲律宾人）进行比较 (82.7%).重要的是，在最近的移民中，中国女性使用巴氏试验的比例最低。 多种因素导致美国华裔LEP女性未筛查，包括缺乏 保险或常规医疗保健提供者，缺乏时间，语言困难和尴尬。新兴 支持用于人乳头瘤病毒（HPV）检测的自采样的技术可以提供有价值的， 增强筛查不足和医疗服务不足的华裔美国妇女能力的循证战略 LEP患者能够参加宫颈癌筛查。尽管先前的研究表明， HPV自我采样可以在低资源社区环境中可行地提供，没有一项研究关注 华裔美国妇女，尽管事实上，这一人口中有最低的宫颈癌筛查 rates.因此，本行政补充的目标是检查社区中的HPV自我采样 150例美国华裔女性LEP患者。在这项随机研究中，75名妇女将接受我们的 之前测试过的宫颈癌筛查加导航社区教育计划，沿着HPV 自我采样工具包; 75名妇女将接受我们以前测试的社区教育计划， 导航到基于诊所的筛查。拟议补助金的目的是：（1）比较 150名美籍华人宫颈癌筛查的自我采集样本与获得基于诊所的样本比较 患有LEP的女性将在6个月随访时评估参与自我采样或基于临床的筛选。它 假设在HPV自我采样计划中， 自我收集的样本将高于诊所方案中获得诊所- 基于筛选。本增刊中提出的研究将是第一个评估HPV的随机研究 自我抽样与LEP服务不足的华裔美国妇女。我们的发现将为未来的证据提供信息- 加强对这一未充分研究的人群的筛查。

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.