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

项目摘要 子宫颈抹片检查的采用，使子宫颈癌的发病率和死亡率在2000年显著下降。 美方然而，在许多亚裔美国人亚组中，筛查率并不理想， 低于非西班牙裔白色人、非西班牙裔黑人和西班牙裔妇女。研究表明，韩国 特别是越南裔美国妇女，与其他国家相比， 民族/种族群体。多种因素可能导致亚裔美国妇女不接受筛查。 尴尬，成本，缺乏保险或定期医疗保健提供者，缺乏时间和语言困难 是在这一人群中进行筛查的主要障碍。支持人类自我采样的新兴技术 乳头状瘤病毒（HPV）检测可能为增强亚裔美国人的能力提供有价值的循证策略 妇女谁一直抵制-或无法-获得诊所为基础的宫颈癌筛查。国家 现在的指南包括每5年进行一次HPV筛查，作为适当的宫颈癌筛查 战略因为在非临床环境中HPV自我采样的准确性与HPV检测相当， 临床医生获得的样本，自我收集可能是一个重要的战略，提高筛查率 在筛选不足的人群中。在美国，提供自我采样工具包改善了筛查 资源有限的妇女中的比例较高，并且非常可以接受。值得注意的是， 自我采样的尴尬减少，一些研究发现它改善了随后的临床参与- 基于筛选。虽然先前的研究已经证明，HPV自我采样可以在 在资源匮乏的社区环境中，没有一项研究关注服务不足的亚裔美国妇女，尽管 这一人群的宫颈癌筛查率最低。因此， 拟议的项目是在800名亚裔美国妇女的社区研究中检查HPV自我采样。 使用配对设计，12个社区网站（n=400名女性）将收到我们之前测试的社区 有关子宫颈癌普查及导航的教育计划，以及沿着人类乳头状瘤病毒自我采样工具包;及 社区站点（n=400）将收到我们之前测试的社区教育计划以及导航， 临床筛查。建议项目的目的是：（1）比较提供自收集 在800名亚裔美国妇女中进行样本与获得基于诊所的筛查;（2）检查 参与;（3）评估HPV自我采样与基于诊所的筛查的相对成本效益。 人口统计学、社会/文化环境和物理环境因素将在基线、 干预和6个月随访。参与自我采样或基于诊所的筛选将在6- 月随访。该项目将是第一个大规模的研究，以评估HPV自我采样， 服务不足的亚裔美国女性研究结果将为未来的循证计划提供信息， 在全国范围内加强亚裔美国妇女的筛查参与。

PROJECT SUMMARY The introduction of the Pap test has led to significant reductions in cervical cancer incidence and mortality in the US. However, screening rates are suboptimal in many Asian American subgroups, and remain persistently lower than rates in non-Hispanic White, non-Hispanic Black, and Hispanic women. Studies report that Korean and Vietnamese American women, in particular, have among the lowest rates of screening compared to other ethnic/racial groups. Multiple factors may contribute to non-screening among Asian American women. Embarrassment, cost, lack of insurance or regular healthcare provider, lack of time, and language difficulties are key barriers to screening in this population. Emerging technologies supporting self-sampling for human papillomavirus (HPV) testing may offer a valuable, evidence-based strategy for empowering Asian American women who have been resistant -- or unable -- to obtain clinic-based cervical cancer screening. National guidelines now include primary HPV screening every 5 years as an appropriate cervical cancer screening strategy. Because HPV self-sampling in non-clinical settings has comparable accuracy to HPV-testing on clinician-obtained samples, self-collection may represent an important strategy for increasing screening rates among underscreened populations. In the United States, the provision of self-sampling kits improved screening rates among women with limited resources and was highly acceptable. Notably, women reported experiencing less embarrassment with self-sampling, and some studies found it improved subsequent participation in clinic- based 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 underserved Asian American women, despite the fact that this population has among the lowest cervical cancer screening rates. Therefore, the goal of the proposed project is to examine HPV self-sampling in a community-based study of 800 Asian American women. Using a matched-pair design, 12 community sites (n=400 women) will receive our previously tested community education program on cervical cancer screening plus navigation, along with HPV self-sampling kits; and 12 community sites (n=400) will receive our previously tested community education program plus navigation to clinic-based screening. The aims of the proposed project are to: (1) Compare rates of providing a self-collected sample vs. obtaining clinic-based screening among 800 Asian American women; (2) Examine mediators of participation; and (3) Assess the relative cost-effectiveness of HPV self-sampling vs. clinic-based screening. Demographics, social/cultural environment, and physical environment factors will be assessed at baseline, post- intervention, and 6-month follow-up. Participation in self-sampling or clinic-based screening will be assessed at 6- month follow-up. The proposed project will be the first large-scale study to evaluate HPV self-sampling among underserved Asian American women. Study findings will inform future evidence-based programs designed to enhance screening participation among Asian American women nationally.