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  Improving Health-Care Access, Quality for All  
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FEATURES
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STEPPING STONES TO REDUCING CANCER DISPARITIES

Addressing cultural issues as stepping stones to reducing cancer disparities

"" PHOTO — The Hmong community is the focus of an outreach effort to educate members about cancer prevention and treatment.
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The Hmong community is the focus of an outreach effort to educate members about cancer prevention and treatment.
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Time Magazine called Sacramento the most culturally diverse city in the nation. UC Davis Cancer Center researchers realize this diversity is one of the best opportunities they have to make significant progress in addressing health disparities.

"Lessening health disparities requires enhanced efforts in disease prevention, health promotion and the delivery of appropriate care," said Ralph deVere White, director of the UC Davis Cancer Center. "Focused research, such as what we conduct here at the Cancer Center, advances a deeper. understand of how fundamental causes of disparity — such as socioeconomic issues — shape the determinants of health and illness."

Reaching out to Hmong

Through a National Cancer Institute-funded project known as AANCART — for Asian American Network for Cancer Awareness, Research and Training — Moon Chen, Jr., associate director for Cancer Disparities and Research at the UC Davis Cancer Center, is leading a first-time effort to address the fears and traditional beliefs that prevent many Hmong from getting regular cancer screenings and recognizing early cancer symptoms.

"The cancer burden facing the Hmong and other Asian-American communities is unique, unusual and unnecessary," says Chen. "Unique, because Asian-Americans are the only racial group who experience cancer as the leading cause of death. Unusual, because the leading cancer killers of Asian-Americans are infectious in nature. Unnecessary, because the risk factors for many of the cancers, such as those due to viruses or tobacco, are preventable."

A course called "Cancer Awareness 101" is the centerpiece of AANCART's Hmong outreach. It is designed to give members of the Hmong community, particularly the elders and shamen who often serve as medical decision makers for their families, the same baseline cancer knowledge that more mainstream Americans grow up knowing:

  • Excess sun exposure can cause skin cancer.
  • Regular Pap tests prevent deaths from cervical cancer.
  • Smoking causes lung cancer.
  • Breast self-exams can detect tumors while they are small and easier to treat.

The awareness course has been so successful that it has evolved from an initial one-day community presentation in 2003, Chen says, to regularly scheduled health-care programming on Hmong radio.

Chen is focusing new efforts on vaccinating the Hmong people against the hepatitis B virus, the predominant cause of liver cancer among Asian-Americans. The vaccination effort is one of the newer projects funded under a recently expanded National Cancer Institute grant.

PHOTO — Cancer epidemiologist Moon Chen, Jr. is helping the Hmong community understand their cancer risks. ""

Cancer epidemiologist Moon Chen, Jr. is helping the Hmong community understand their cancer risks.
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"In many respects, the hepatitis B vaccine is the world's first effective anti-cancer vaccine," Chen said. "However, we wish we had vaccinations for more kinds of cancer."

The first AANCART project, funded in 2000 to document cancer awareness, found that "Asian-Americans are not 'hard to reach' but hardly reached," said Chen.

"We know that reaching people requires tailoring messages and methods that are linguistically appropriate, culturally competent and scientifically sound."

The goal for this current project is to immunize all Hmong children in Sacramento County from birth to age 18 against the hepatitis B virus.

In California, documented immunization against the hepatitis B virus is required for a child to enter kindergarten, fourth grade and seventh grade, making part of Chen's vaccination efforts supported by society.

But if a Hmong child is older than 13 or has moved to Sacramento County from another location in the country, he or she is likely to be missed. The outreach will target many of those children and adults who have not yet been immunized.

In a related effort, Chen recently launched the Sacramento region's first Vietnamese-language cancer information and referral line. Callers who leave messages on the Vietnamese Cancer Screening Referral and Resource Line at (916) 449-5544 will hear from Vietnamese-speaking counselors who will answer questions about cancer risk factors, prevention strategies, screening guidelines, signs and symptoms, diagnostic options, and treatment approaches.

American Indian outreach

Providing information about breast cancer to American Indian women is another target of the Cancer Center's program on outreach research and education, said Marlene von Friederichs-Fitzwater, director of the program.

Grants from the Susan G. Komen Breast Cancer Foundation have enabled von Friederichs-Fitzwater to plan an outreach strategy, with the help of an advisory committee of 10 women from six different tribes. They are using new technologies for educational and informational interventions in a way that would be most effective for American Indian women.

"Breast cancer death rates are a very serious problem in American Indian women," von Friederichs-Fitzwater said. "Unfortunately, the available generic information on breast cancer is not culturally sensitive to their values, beliefs and lifestyles. We're working with the advisory committee to learn about and develop interventions that will meet their needs."

American Indian women's beliefs center around spirituality and less around pathology, von Friederichs-Fitzwater said. "For instance, they do not want to use the word 'cancer' because to do so gives the word power."

Also involved is the Turtle Health Foundation, headquartered in Sacramento and an American Indian-owned, Indian-run health organization, with connections to 36 tribal and urban health programs in California.

"" PHOTO — Linda Navarro is a member of an advisory group on breast cancer prevention for American Indian women.
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Linda Navarro is a member of an advisory group on breast cancer prevention for American Indian women.
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Linda Navarro, a member of the Torres Martinez Desert Cahuilla tribe, is director the Turtle Health Foundation and was for 26 years director of the California Rural Indian Health Board's Traditional Indian Health Education Program. She's a member of von Friederichs-Fitzwater's advisory committee.

"The tribal clinics have made great headway," Navarro said. "They know the value of health screening and have tracking systems in place, but knowledge varies from tribe to tribe and even clinic to clinic. In addition, life has changed for our people," she noted. "Native foods are scarce. Many people no longer live in their aboriginal lands. They need incentives to protect their health."

An interactive, multimedia DVD has been produced and evaluated by 26 American Indian women and will be evaluated by another 25 later this spring. Initial reactions have been positive, said von Friederichs-Fitzwater. The women rank the DVD high in cultural appropriateness, quality of information and motivational language encouraging healthier lifestyles and good breast-health behaviors. They also preferred the DVD to print materials. Eventually, the DVD will be distributed to women who attend all California tribal health clinics.

Colorectal cancer screening

Another recently funded grant focuses on implementing a colorectal cancer screening and prevention program for California's Asian-American and Latino populations. Funded by the Centers for Disease Control, the effort is a collaboration between the California Department of Health Services' Cancer Control Branch and UC Davis' AANCART program. In addition, AANCART and the Department of Health Services will work with the California division of the American Cancer Society to target similar outreach to the state's African American population.

"This collaboration with the Department of Health Services, American Cancer Society and the UC Davis Cancer Center is another example of the synergy involving public, voluntary and academic/research sectors to address the unequal burden of cancer in California," Chen said.

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  "This collaboration with the Department of Health Services, American Cancer Society and the UC Davis Cancer Center is another example of the synergy involving public, voluntary and academic/research sectors to address the unequal burden of cancer in California" — Moon Chen, Jr.  
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