This article was downloaded by: [Universite Laval] On: 04 March 2015, At: 09:12 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Cancer Education Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hjce20
Knowledge, attitudes, and practices of breast and cervical cancer screening among vietnamese women a
Chantal T. Pham MD & Stephen J. McPhee MD
a b
a
Suc Khoe La Vang—Vietnamese Community Health Promotion Project , University of California , San Francisco, 400 Montgomery Street, Suite 850, San Francisco, CA b
Associate Professor of Medicine, Division of General Internal Medicine, Department of Medicine , UCSF—Division of General Internal Medicine , 400 Parnassus Avenue, A‐405, San Francisco, California, 94143‐0320 Published online: 01 Oct 2009.
To cite this article: Chantal T. Pham MD & Stephen J. McPhee MD (1992) Knowledge, attitudes, and practices of breast and cervical cancer screening among vietnamese women, Journal of Cancer Education, 7:4, 305-310 To link to this article: http://dx.doi.org/10.1080/08858199209528187
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
J. Canco-Education. Vol. 7, No. 4, pp. 305-310, 1992 Printed in the U.S.A. Perjamon Press Ltd.
0885-8195/92 $5.00 + .00 © 1992 American Association for Cancer Education
KNOWLEDGE, ATTITUDES, AND PRACTICES OF BREAST AND CERVICAL CANCER SCREENING AMONG VIETNAMESE WOMEN
Downloaded by [Universite Laval] at 09:12 04 March 2015
CHANTAL T. PHAM,
MD* and STEPHEN J. MCPHEE, MD*†
Abstract—The Vietnamese are the fastest-growing Asian/Pacific Islander ethnic group in California. Data from Vietnam and elsewhere suggest that cervical cancer and breast cancer are major contributors to cancer morbidity and mortality among Vietnamese women. However, little is known about the cancer knowledge and screening practices of Vietnamese women. Using a structured 57item written questionnaire, we conducted a mailed survey of 400 randomly selected Vietnamese adult women in San Francisco. Overall, 107 women responded (31 %). Of the respondents, 54 (52%) indicated that there was little one could do to prevent cancer. More than a third (39%) thought that breast or cervical cancer could be caused by poor hygiene, and about one-third (29%) thought that these cancers could be contagious. Although virtually all (97%) had heard of cancer, one-third did not know that a breast lump could be a sign of breast cancer (37%) or that abnormal vaginal bleeding could be a sign of cervical cancer (39%). Many (55%) did not know that family history was a risk factor for breast cancer and three-fourths (74%) did not know that having multiple sexual partners was a risk factor for cervical cancer. Fourteen (13%) had not heard of breast self-examination. Of 31 women aged 40, 10 (34%) had never had a mammogram, and of 92 women aged 18,50 (54%) had never had a Papanicolaou test. More recent immigrants (those who entered the United States after 1980-81) and those with Medicaid or no health insurance were less likely to have had a Pap smear than earlier immigrants (p < .001) and those with other types of health insurance (p < .001). Vietnamese women frequently did not know common signs, symptoms, and risk factors for breast and cervical cancer. Many had not had recommended screening tests. These findings suggest a pressing need to develop breast and cervical cancer educational and screening programs for Vietnamese women, especially for more recent immigrants and those of lower socioeconomic status.
dochina and find refuge in other countries. Many of these immigrants have resettled in the Since the end of the Vietnam War in 1975, United States. At the time of the 1980 popupolitical oppression and economic hardship lation census, there were about 261,000 Viethave forced thousands of people to leave In- namese living in the United States.1 By 1990, however, there were approximately 615,000 Research supported by: University of California, San Vietnamese, (a growth increase of about 135% Francisco, School of Medicine, Dean's Fund for Student within the past decade), making them the fastResearch. Results presented in part at the "Third Biennial Sym- est-growing Asian-American ethnic group in posium on Minorities, the Economically Disadvantaged this country.2 With continued immigration and Cancer: Strategic Plans for the Twenty-first Century" from Southeast Asia, relocation from other conference, MD Anderson Cancer Center, Houston, Texas, April 19, 1991, and the American Association of states, and high birth rate, the Vietnamese Cancer Education National Conference, Baltimore, Mary- have also become the fastest-growing Asianland, December 6, 1991. Pacific minority in the state of California. *SucKhoe La Vang—Vietnamese Community Health Promotion Project, University of California, San Fran- Over the last decade, California's Vietnamese cisco, 400 Montgomery Street, Suite 850, San Francisco, community has increased by 212.7%. Among CA. the State's Asian populations, the Vietnamese † Associate Professor of Medicine, Division of General Internal Medicine, Department of Medicine, 400 Parnassus currently rank the fourth in size (9.9%), after Avenue, A-405, San Francisco, California 94143-0320. the Filipinos (25.7%), Chinese (24.8%), and Reprint requests to: Stephen J. McPhee, M.D., Japanese (11 %). 2 UCSF—Division of General Internal Medicine, 400 ParDespite this rapid growth in the Vietnamnassus Avenue, A-405, San Francisco, CA 94143-0320. INTRODUCTION
305
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C. T. PHAM AND S. J. MCPHEE
ese population, little is known about their health status. In particular, data on cancer incidence, mortality, or survival for the Vietnamese are not currently available at either the state or national level. Prior to 1980, the US census did not encode the Vietnamese ethnicity, and the California Tumor Registry Classification of Vietnamese as a separate group began only in 1988. However, data from Vietnam and elsewhere have suggested that cervical cancer and breast cancer are major contributors to cancer mortality among Vietnamese women.3"7 Analyses of the cases recorded by the registry of the Cancer Hospital in Ho Chi Minh City (formerly Saigon) in the years 1976 to 1981 showed that cervical cancer accounted for 53.3%, and breast cancer accounted for 10.4% of all cancers diagnosed among the Vietnamese women.3 Furthermore, a preliminary study of San Francisco/Oakland Surveillance, Epidemiology, and End Results (SEER) data for cervical cancer from 1976 to 1986 with Vietnamese surnames suggests that fewer Vietnamese patients are diagnosed with in situ carcinoma and more Vietnamese are diagnosed at advanced stages (regional or distant métastases) than Caucasian cancer patients.8 This finding suggests not only that early detection and treatment of cancer may be problematic, but that there is a potential for reducing cancer mortality, for the Vietnamese population. Indeed, in a study of cancer risk behaviors among Vietnamese, Jenkins and colleagues showed lower rates of recommended cancer screening activities among the Vietnamese compared to the general US population.9 For Vietnamese women, in particular, little is currently known about their knowledge of breast and cervical cancers, and their attitudes and practices of cancer prevention. To obtain this information, we conducted a survey of the Vietnamese women in San Francisco.
veloped from Vietnamese surnames and addresses listed in the San Francisco telephone books. From this list, 400 households were randomly selected for the sample. Criteria for inclusion in the sample were: (i) Vietnamese ethnicity (as determined by Vietnamese surname), (ii) female gender, (iii) age S: 18 years old, and (iv) residence in San Francisco. Identification of Vietnamese surnamese was facilitated by the fact that twelve family names (Bui, Cao, Doan, Ha, Ho, Huynh, Nguyen, Phan, Tran, Trinh, Vo, and Vuong) account for 85% of the Vietnamese population.10 Because some Chinese-Vietnamese (Vietnamese of Chinese ethnic origin) have Vietnamese names, we included them in the sampling frame.
Source of data and design The source of data was standardized surveys mailed to each of the 400 randomly selected households. The survey questionnaire consisted of 57 items in four major categories: (i) demographic characteristics; (ii) attitudes towards and beliefs about cancer; (iii) knowledge of breast and cervical cancer risk factors, signs, and symptoms; and (iv) awareness and use of breast and cervical cancer screening measures. The questionnaire used primarily a multiple-choice format. To ensure that respondents were familiar with cancer screening test terminologies, a description of each test (ie, breast self-examination, mammogram, and Pap smear test) was included for clarification. The questionnaire was written in English, translated into Vietnamese, and back-translated into English for comparison to ensure cross-cultural validity. This method was suggested by Eyton and Neuwirth11 and previously described by Jenkins and colleagues.9 To determine if the survey was understandable and culturally sensitive, we pretested it with several members of the targeted community who were not San Francisco residents and METHODS made appropriate revisions. We then sent the survey questionnaire and a letter in VietnamSubjects The targeted population was Vietnamese ese describing the study, along with a stamped adult women living in San Francisco during return envelope to each of the selected housethe Fall of 1990. The sampling frame was de- holds. To those who did not respond within
Breast and cervical cancer screening in Vietnamese women
four weeks, we sent a reminder letter and a second questionnaire allowing another four weeks for response. This study was approved by the University of California, San Francisco, Committee on Human Research. Data were analyzed using standard statistical techniques and tests of significance included chi-square for cross-tabulations.
Downloaded by [Universite Laval] at 09:12 04 March 2015
RESULTS
From a list of 1,504 Vietnamese names and addresses, 400 household were randomly selected for the sample. After the first mailing, 47 packages were returned due to incorrect or no-forwarding addresses, and 35 surveys were completed. Following a second request to the remaining 318 households, 8 packages were returned and 72 Vietnamese women replied. Thus, a total of 107 out of 345 eligible households responded to the surveys (giving a response rate of 31%). Demographic data Table 1 shows some demographic characteristics of the respondents. The mean age of respondents was 37 years, and more than half (60%) were married. The respondents' mean length of stay in the United States was 8.4 years. Nearly half reported that they spoke little or no English. Forty-three percent had had less than or equal to a high school education, and nearly half (44%) reported a total household income of less than or equal to $15,000 per year. One-fourth had no health insurance at all, and about one-third received MediCal (California State Medicaid). Attitudes/Beliefs about cancer Survey respondents had a generally negative view towards cancer control. For example, slightly more than half of the 107 respondents (52%) believed that, "there is little one can do to prevent cancer." More than one-third of the respondents (39%) believed that these cancers are due to poor hygiene, and 29% believed that cancer is contagious.
307
Table 1. Demographic characteristics of survey respondents Age (n = 107) Mean (SD) Range Marital status (%; n = 103) Married Single, separated, divorced, widowed
37 (12) 19-77 60 40
No. of years resident in U.S. (n ¡ 100) Mean (SD) 8.4 (4.7) Range Months-15 years Ethnic origin (%; n = 107) Purely Vietnamese 71 Vietnamese-Chinese 29 Spoken-English proficiency (%; n = 107) None-limited 48 Fair-Good 52 Formal educational level (%; n = 106) 1-6 years 21 1-12 years 64_. College and above 36 Health insurance (%; n = 104) No insurance 25 Medi-Cal 31 Private insurance/Medicare 44 Household income (n : 88) 44 $15,000
Cancer knowledge Although virtually all (97%) had heard of cancer, many of these Vietnamese women did not know common signs, symptoms, and risk factors for breast and cervical cancers (Table 2). For example, one-third did not know that a breast lump could be a sign of breast cancer (37%), or that abnormal vaginal bleeding could be a sign of cervical cancer (39%). About half (55%) did not know that family history was a risk factor for breast cancer and three-fourths (74%) did not know that having multiple sexual partners was a risk factor for cervical cancer. Cancer screening knowledge and practices Table 3 summarizes the respondents' level of awareness of breast and cervical cancer screening activities. In general, most had heard of breast self-examination (87%) and clinical
308
C. T. PHAM AND S. J. MCPHEE
Downloaded by [Universite Laval] at 09:12 04 March 2015
Table 2. Cancer knowledge of survey respondents Heard of cancer (%; n = 106) Lack of knowledge about presenting signs and symptoms of cancer (%) Breast lumps (n = 92) Bleeding other than usual menstruation (n = 89) Significant weight loss without dieting (n = 91) Lack of knowledge about risk factors for breast and cervical cancers (%) Breast cancer Positive family history (n = 98) Cervical cancer Veneral disease (n = 91) More than 1 sexual partner (n = 91) Sexual intercourse at an early age (age 18,50 (54%) reported never having had a Pap smear test, compared to only 6% of women in the general California population. n Among the respondents, lack of cancer screening was significantly related to length of stay in the United States, and insurance status was used as a proxy for socioeconomic status. More recent immigrants (those who entered the United States after 1980-81) were less likely to have had a pelvic examination or a Papanicolaou test than earlier immigrants. For example, 76% of women who immigrated after 1981, had never had a Pap smear test-compared to 33% of women who had immigrated before 1981 ( x 2 = 15.1, p < .001). Similarly, those who were covered by California Medicaid or had no insurance at all were less likely to have had the test than those with private insurance or Medicare; 74% of those covered by Medicaid or had no health insurance had not had a Pap smear test compared to 30% of those with private insurance or Medicare (X2 = 16.4, p
Journal of Cancer Education Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hjce20
Knowledge, attitudes, and practices of breast and cervical cancer screening among vietnamese women a
Chantal T. Pham MD & Stephen J. McPhee MD
a b
a
Suc Khoe La Vang—Vietnamese Community Health Promotion Project , University of California , San Francisco, 400 Montgomery Street, Suite 850, San Francisco, CA b
Associate Professor of Medicine, Division of General Internal Medicine, Department of Medicine , UCSF—Division of General Internal Medicine , 400 Parnassus Avenue, A‐405, San Francisco, California, 94143‐0320 Published online: 01 Oct 2009.
To cite this article: Chantal T. Pham MD & Stephen J. McPhee MD (1992) Knowledge, attitudes, and practices of breast and cervical cancer screening among vietnamese women, Journal of Cancer Education, 7:4, 305-310 To link to this article: http://dx.doi.org/10.1080/08858199209528187
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
J. Canco-Education. Vol. 7, No. 4, pp. 305-310, 1992 Printed in the U.S.A. Perjamon Press Ltd.
0885-8195/92 $5.00 + .00 © 1992 American Association for Cancer Education
KNOWLEDGE, ATTITUDES, AND PRACTICES OF BREAST AND CERVICAL CANCER SCREENING AMONG VIETNAMESE WOMEN
Downloaded by [Universite Laval] at 09:12 04 March 2015
CHANTAL T. PHAM,
MD* and STEPHEN J. MCPHEE, MD*†
Abstract—The Vietnamese are the fastest-growing Asian/Pacific Islander ethnic group in California. Data from Vietnam and elsewhere suggest that cervical cancer and breast cancer are major contributors to cancer morbidity and mortality among Vietnamese women. However, little is known about the cancer knowledge and screening practices of Vietnamese women. Using a structured 57item written questionnaire, we conducted a mailed survey of 400 randomly selected Vietnamese adult women in San Francisco. Overall, 107 women responded (31 %). Of the respondents, 54 (52%) indicated that there was little one could do to prevent cancer. More than a third (39%) thought that breast or cervical cancer could be caused by poor hygiene, and about one-third (29%) thought that these cancers could be contagious. Although virtually all (97%) had heard of cancer, one-third did not know that a breast lump could be a sign of breast cancer (37%) or that abnormal vaginal bleeding could be a sign of cervical cancer (39%). Many (55%) did not know that family history was a risk factor for breast cancer and three-fourths (74%) did not know that having multiple sexual partners was a risk factor for cervical cancer. Fourteen (13%) had not heard of breast self-examination. Of 31 women aged 40, 10 (34%) had never had a mammogram, and of 92 women aged 18,50 (54%) had never had a Papanicolaou test. More recent immigrants (those who entered the United States after 1980-81) and those with Medicaid or no health insurance were less likely to have had a Pap smear than earlier immigrants (p < .001) and those with other types of health insurance (p < .001). Vietnamese women frequently did not know common signs, symptoms, and risk factors for breast and cervical cancer. Many had not had recommended screening tests. These findings suggest a pressing need to develop breast and cervical cancer educational and screening programs for Vietnamese women, especially for more recent immigrants and those of lower socioeconomic status.
dochina and find refuge in other countries. Many of these immigrants have resettled in the Since the end of the Vietnam War in 1975, United States. At the time of the 1980 popupolitical oppression and economic hardship lation census, there were about 261,000 Viethave forced thousands of people to leave In- namese living in the United States.1 By 1990, however, there were approximately 615,000 Research supported by: University of California, San Vietnamese, (a growth increase of about 135% Francisco, School of Medicine, Dean's Fund for Student within the past decade), making them the fastResearch. Results presented in part at the "Third Biennial Sym- est-growing Asian-American ethnic group in posium on Minorities, the Economically Disadvantaged this country.2 With continued immigration and Cancer: Strategic Plans for the Twenty-first Century" from Southeast Asia, relocation from other conference, MD Anderson Cancer Center, Houston, Texas, April 19, 1991, and the American Association of states, and high birth rate, the Vietnamese Cancer Education National Conference, Baltimore, Mary- have also become the fastest-growing Asianland, December 6, 1991. Pacific minority in the state of California. *SucKhoe La Vang—Vietnamese Community Health Promotion Project, University of California, San Fran- Over the last decade, California's Vietnamese cisco, 400 Montgomery Street, Suite 850, San Francisco, community has increased by 212.7%. Among CA. the State's Asian populations, the Vietnamese † Associate Professor of Medicine, Division of General Internal Medicine, Department of Medicine, 400 Parnassus currently rank the fourth in size (9.9%), after Avenue, A-405, San Francisco, California 94143-0320. the Filipinos (25.7%), Chinese (24.8%), and Reprint requests to: Stephen J. McPhee, M.D., Japanese (11 %). 2 UCSF—Division of General Internal Medicine, 400 ParDespite this rapid growth in the Vietnamnassus Avenue, A-405, San Francisco, CA 94143-0320. INTRODUCTION
305
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306
C. T. PHAM AND S. J. MCPHEE
ese population, little is known about their health status. In particular, data on cancer incidence, mortality, or survival for the Vietnamese are not currently available at either the state or national level. Prior to 1980, the US census did not encode the Vietnamese ethnicity, and the California Tumor Registry Classification of Vietnamese as a separate group began only in 1988. However, data from Vietnam and elsewhere have suggested that cervical cancer and breast cancer are major contributors to cancer mortality among Vietnamese women.3"7 Analyses of the cases recorded by the registry of the Cancer Hospital in Ho Chi Minh City (formerly Saigon) in the years 1976 to 1981 showed that cervical cancer accounted for 53.3%, and breast cancer accounted for 10.4% of all cancers diagnosed among the Vietnamese women.3 Furthermore, a preliminary study of San Francisco/Oakland Surveillance, Epidemiology, and End Results (SEER) data for cervical cancer from 1976 to 1986 with Vietnamese surnames suggests that fewer Vietnamese patients are diagnosed with in situ carcinoma and more Vietnamese are diagnosed at advanced stages (regional or distant métastases) than Caucasian cancer patients.8 This finding suggests not only that early detection and treatment of cancer may be problematic, but that there is a potential for reducing cancer mortality, for the Vietnamese population. Indeed, in a study of cancer risk behaviors among Vietnamese, Jenkins and colleagues showed lower rates of recommended cancer screening activities among the Vietnamese compared to the general US population.9 For Vietnamese women, in particular, little is currently known about their knowledge of breast and cervical cancers, and their attitudes and practices of cancer prevention. To obtain this information, we conducted a survey of the Vietnamese women in San Francisco.
veloped from Vietnamese surnames and addresses listed in the San Francisco telephone books. From this list, 400 households were randomly selected for the sample. Criteria for inclusion in the sample were: (i) Vietnamese ethnicity (as determined by Vietnamese surname), (ii) female gender, (iii) age S: 18 years old, and (iv) residence in San Francisco. Identification of Vietnamese surnamese was facilitated by the fact that twelve family names (Bui, Cao, Doan, Ha, Ho, Huynh, Nguyen, Phan, Tran, Trinh, Vo, and Vuong) account for 85% of the Vietnamese population.10 Because some Chinese-Vietnamese (Vietnamese of Chinese ethnic origin) have Vietnamese names, we included them in the sampling frame.
Source of data and design The source of data was standardized surveys mailed to each of the 400 randomly selected households. The survey questionnaire consisted of 57 items in four major categories: (i) demographic characteristics; (ii) attitudes towards and beliefs about cancer; (iii) knowledge of breast and cervical cancer risk factors, signs, and symptoms; and (iv) awareness and use of breast and cervical cancer screening measures. The questionnaire used primarily a multiple-choice format. To ensure that respondents were familiar with cancer screening test terminologies, a description of each test (ie, breast self-examination, mammogram, and Pap smear test) was included for clarification. The questionnaire was written in English, translated into Vietnamese, and back-translated into English for comparison to ensure cross-cultural validity. This method was suggested by Eyton and Neuwirth11 and previously described by Jenkins and colleagues.9 To determine if the survey was understandable and culturally sensitive, we pretested it with several members of the targeted community who were not San Francisco residents and METHODS made appropriate revisions. We then sent the survey questionnaire and a letter in VietnamSubjects The targeted population was Vietnamese ese describing the study, along with a stamped adult women living in San Francisco during return envelope to each of the selected housethe Fall of 1990. The sampling frame was de- holds. To those who did not respond within
Breast and cervical cancer screening in Vietnamese women
four weeks, we sent a reminder letter and a second questionnaire allowing another four weeks for response. This study was approved by the University of California, San Francisco, Committee on Human Research. Data were analyzed using standard statistical techniques and tests of significance included chi-square for cross-tabulations.
Downloaded by [Universite Laval] at 09:12 04 March 2015
RESULTS
From a list of 1,504 Vietnamese names and addresses, 400 household were randomly selected for the sample. After the first mailing, 47 packages were returned due to incorrect or no-forwarding addresses, and 35 surveys were completed. Following a second request to the remaining 318 households, 8 packages were returned and 72 Vietnamese women replied. Thus, a total of 107 out of 345 eligible households responded to the surveys (giving a response rate of 31%). Demographic data Table 1 shows some demographic characteristics of the respondents. The mean age of respondents was 37 years, and more than half (60%) were married. The respondents' mean length of stay in the United States was 8.4 years. Nearly half reported that they spoke little or no English. Forty-three percent had had less than or equal to a high school education, and nearly half (44%) reported a total household income of less than or equal to $15,000 per year. One-fourth had no health insurance at all, and about one-third received MediCal (California State Medicaid). Attitudes/Beliefs about cancer Survey respondents had a generally negative view towards cancer control. For example, slightly more than half of the 107 respondents (52%) believed that, "there is little one can do to prevent cancer." More than one-third of the respondents (39%) believed that these cancers are due to poor hygiene, and 29% believed that cancer is contagious.
307
Table 1. Demographic characteristics of survey respondents Age (n = 107) Mean (SD) Range Marital status (%; n = 103) Married Single, separated, divorced, widowed
37 (12) 19-77 60 40
No. of years resident in U.S. (n ¡ 100) Mean (SD) 8.4 (4.7) Range Months-15 years Ethnic origin (%; n = 107) Purely Vietnamese 71 Vietnamese-Chinese 29 Spoken-English proficiency (%; n = 107) None-limited 48 Fair-Good 52 Formal educational level (%; n = 106) 1-6 years 21 1-12 years 64_. College and above 36 Health insurance (%; n = 104) No insurance 25 Medi-Cal 31 Private insurance/Medicare 44 Household income (n : 88) 44 $15,000
Cancer knowledge Although virtually all (97%) had heard of cancer, many of these Vietnamese women did not know common signs, symptoms, and risk factors for breast and cervical cancers (Table 2). For example, one-third did not know that a breast lump could be a sign of breast cancer (37%), or that abnormal vaginal bleeding could be a sign of cervical cancer (39%). About half (55%) did not know that family history was a risk factor for breast cancer and three-fourths (74%) did not know that having multiple sexual partners was a risk factor for cervical cancer. Cancer screening knowledge and practices Table 3 summarizes the respondents' level of awareness of breast and cervical cancer screening activities. In general, most had heard of breast self-examination (87%) and clinical
308
C. T. PHAM AND S. J. MCPHEE
Downloaded by [Universite Laval] at 09:12 04 March 2015
Table 2. Cancer knowledge of survey respondents Heard of cancer (%; n = 106) Lack of knowledge about presenting signs and symptoms of cancer (%) Breast lumps (n = 92) Bleeding other than usual menstruation (n = 89) Significant weight loss without dieting (n = 91) Lack of knowledge about risk factors for breast and cervical cancers (%) Breast cancer Positive family history (n = 98) Cervical cancer Veneral disease (n = 91) More than 1 sexual partner (n = 91) Sexual intercourse at an early age (age 18,50 (54%) reported never having had a Pap smear test, compared to only 6% of women in the general California population. n Among the respondents, lack of cancer screening was significantly related to length of stay in the United States, and insurance status was used as a proxy for socioeconomic status. More recent immigrants (those who entered the United States after 1980-81) were less likely to have had a pelvic examination or a Papanicolaou test than earlier immigrants. For example, 76% of women who immigrated after 1981, had never had a Pap smear test-compared to 33% of women who had immigrated before 1981 ( x 2 = 15.1, p < .001). Similarly, those who were covered by California Medicaid or had no insurance at all were less likely to have had the test than those with private insurance or Medicare; 74% of those covered by Medicaid or had no health insurance had not had a Pap smear test compared to 30% of those with private insurance or Medicare (X2 = 16.4, p
