Increasing Breast Cancer Screening in Chinese Immigrants

在纽约市(NYC)，华裔的癌症死亡率是所有种族中最高的 一群人。乳腺癌是中国移民妇女最常见的确诊癌症，她们经历了 在美国生活了十年或更长时间后，患乳腺癌的风险大幅增加。常规乳房X光检查 筛查和及时的随访对于乳腺癌的早期发现和提高存活率至关重要。然而， 纽约市的中国移民妇女报告说，筛查乳房X光检查的利用率很低，而且更不可能 与非拉丁裔白人女性相比，及时完成跟进。在纽约的中国移民是 更有可能生活在贫困线以下，没有保险，没有通常的护理来源。超过50% 高中以下学历，不会说或听不懂英语，也看不到西方人 就算他们有症状，也要先看医生。这个社区内的研究表明，只有 在纽约，23%的华裔移民女性在有生之年做过乳房X光检查。这是一个人口 非常需要基本医疗服务，增加乳腺癌知识，获得乳腺癌的机会 放映。健康差距困扰着医疗保健系统，并产生于经济、 社会和文化因素。健康信念模式(HBM)为解决文化健康问题提供了一个框架 与预防性保健和癌症筛查相关的差异，假设做出参与的决定 健康行为是通过权衡感知到的威胁和好处来决定的。在HBM的指导下， 证人项目使用叙述性交流(例如，讲故事、个人证明)来教育、说服、 并让目标社区参与癌症预防和筛查。我们在少数民族和移民方面的工作 社区已经证明，叙事交流可以增加乳腺癌的参与度 放映。然而，这些干预措施的有效性还没有在中国人中得到实证检验 移民。拟议研究项目的长期目标是提高乳腺癌筛查率。 为纽约市的华裔移民。我们计划通过追求以下具体目标来实现这一目标： 1.在文化和语言上调整目击者项目，这是一个叙事性的乳腺癌教育项目， 对中国移民女性来说。将与社区进行焦点小组和定性访谈 把关人员和利益相关者获取有关干预内容的反馈。目标2.试行测试的可行性和 中国移民女性对可湿性粉剂的可接受性。试点干预的可行性和可接受性将 进行评估，以确定未来大规模试验的效果大小。筛查乳房X光检查收据和 接受乳房X光检查的意图以及其他HBM结构将在事前设计中进行比较 按语言分层。成功完成研究目标将使一个新颖的和变革性的 对癌症筛查领域的贡献，特别是对这一服务不足的人群。

In New York City (NYC), persons of Chinese descent experience the highest cancer mortality rate of any ethnic group. Breast cancer is the most commonly diagnosed cancer in Chinese immigrant women, who experience substantial increases in breast cancer risk after spending a decade or more in the US. Regular mammography screening and timely follow up are crucial for early detection of breast cancer and increased survival. However, Chinese immigrant women in NYC report low utilization of screening mammography and are less likely to complete follow up in a timely manner compared to non-Latina white women. Chinese immigrants in NYC are more likely to live below the poverty line, to lack insurance, and to be without a usual source of care. Over 50% have less than a high school education, cannot speak or understand English, and would not see a western doctor as a first course even if they had symptoms. Research within this community has revealed that only 23% of Chinese immigrant women in NYC had ever had a mammogram in their lifetime. This is a population with great need for basic medical care, increased breast cancer knowledge, and access to breast cancer screening. Health disparities plague the health care system and arise from a complex interplay of economic, social, and cultural factors. The Health Belief Model (HBM) provides a framework for addressing cultural health disparities related to preventive health care and cancer screening by positing that making a decision to engage in a health behavior is determined by weighing perceived threats versus benefits. Guided by the HBM, the Witness Project uses narrative communication (e.g., storytelling, personal testimonials) to educate, persuade, and engage target communities about cancer prevention and screening. Our work in minority and immigrant communities has demonstrated that narrative communication can increase participation in breast cancer screening. However, the efficacy of these interventions has not been empirically tested among Chinese immigrants. The long-term goal of the proposed line of research is to increase breast cancer screening rates for NYC Chinese immigrants. We plan to accomplish this objective by pursuing the following specific aims: AIM 1. Culturally and linguistically adapt the Witness Project, a narrative breast cancer education program, for Chinese immigrant women. Focus groups and qualitative interviews will be conducted with community gatekeepers and stakeholders to obtain feedback on intervention content. AIM 2. Pilot test feasibility and acceptability of WP for Chinese immigrant women. Feasibility and acceptability of the pilot intervention will be assessed to determine effect sizes for a future large scale trial. Screening mammogram receipt and intentions to undergo mammography, as well as other HBM constructs will be compared in a pre-post design stratified by language. Successful completion of the study aims will make a novel and transformative contribution to the field of cancer screening, especially for this underserved population.