University of California, San Francisco Vietnamese Community Health Promotion Project has received funds from the Center for Disease Control and Prevention (CDC) of more than $900,000 per year for the next four years to improve screening and management of breast and cervical cancer among Vietnamese in Santa Clara County.
The award is part of the CDC's initiative "Racial and Ethnic Approaches to Community Health (REACH 2010)," a national project targeting six priority health areas with a goal of eliminating by the year 2010 disparities in health status experienced by racial and ethnic minority populations.
The six target health areas include: infant mortality, improving breast and cervical cancer screening and management, cardiovascular disease, diabetes, improving child and/or adult immunization levels, and HIV/AIDS.
"Vietnamese-American women have the highest cervical cancer rate of any ethnic group in the United States," according to Stephen McPhee, MD, UCSF professor of medicine and principal investigator of the UCSF project. "The rate of cervical cancer in this population is five times the rate of Caucasian women." In recent studies by the National Institutes of Health, it has been reported that Vietnamese women in America have a rate of 43 cases of cervical cancer per 100,000 compared to a rate of 8.7 cases per 100,000 in the general population. "But no one knows the reason for the high rate of cervical cancer to date; no one has done a study to explain it," according to McPhee. "It's such a tragedy because Pap smears to detect this cancer are so simple to do."
Although there has been little research conducted to determine the cause for the high rate among Vietnamese, experts often point to low cancer screening rates for this population. Some Vietnamese people believe that cancer is a death sentence, and don't know that early detection can greatly increase chances of survival. Such misconceptions combined with language gaps and unfamiliarity with the concept of preventive care could be responsible for the low numbers of Vietnamese American women who have routine Pap smears, experts have said. Cultural beliefs about the nature of cervical cancer affect screening practices, said Thoa Nguyen, director of the project.
Notions that there is little one can do to prevent cancer, and that the disease is caused by poor hygiene or bad karma are not uncommon, according to a UCSF study. Further, the study pointed out that many Vietnamese do not know that abnormal vaginal bleeding could be a sign of cervical cancer or that having multiple sexual partners is a risk factor.
Last year, a preliminary project began to raise awareness about cancer screening. With a grant of $290,000 from the CDC, the UCSF Vietnamese Community Health Promotion Project began the organizational phase of the program. The staff made contact with ten Santa Clara County organizations which met during the year to form a coalition, and worked closely with local health care providers in the community, McPhee said.
After placing advertisements in local Vietnamese newspapers, large community forums were held where Vietnamese women could gather and provide feedback to the coalition. Using the technique of smaller, intensive focus groups, the community members were asked what kinds of barriers prevented cervical cancer screenings. The coalition identified the barriers in the community from this proactive input, and developed intervention strategies.
Several approaches have been used previously by the UCSF Vietnamese Community Health Promotion Project to communicate the need for Pap smears in the early detection of cervical cancer in the Vietnamese community, McPhee said.
These included distribution of calendars with reminders to get Pap smears, mounting large billboards with cervical cancer prevention information in conspicuous locations in the community, running newspaper articles on the subject of cervical cancer prevention, distributing a poster designed by Vietnamese artists in the community, and training lay people to educate the community with culturally appropriate materials in the Vietnamese language. McPhee said that the National Cancer Institute has requested some of the materials prepared for these outreach efforts for reproduction and national use in other Vietnamese communities.
Over the next four years, the new phase of the action plan will include six activities to be implemented by the coalition. The organization will:
- Conduct a media campaign to broadcast messages about cervical cancer, Pap smear screenings, and available health care services on Vietnamese radio, TV, billboards and in newspapers; then the coalition will organize, print and distribute educational materials at large community gatherings, community-based organizations, and shopping centers where Vietnamese women gather.
- Train lay health workers (about 50 women from the community) about cervical cancer, the importance of getting Pap smears and where to go to get low-cost or free Pap smears. Each of these women will contact 20 other women and provide information about and support to those getting Pap smears.
- Establish a Vietnamese clinic (1/2 day a month) to provide Pap smears for under-insured or uninsured women in Santa Clara County. The coalition will assist the women in applying for public health insurance, to ensure that no woman will be refused a Pap smear due to lack of health insurance.
- Establish a Pap smear registry with the development of a system to remind providers and patients when their next Pap smear is due.
- Restore a Breast and Cervical Cancer Control Program clinic in Santa Clara County to provide free Pap smears to all women, even if they have no health insurance.
- Conduct continuing medical education seminars for Vietnamese doctors with educational courses that will encourage providers to take an active role in referring and recommending their female patients to get a Pap smear.
McPhee said that the goals for the REACH for Health Initiative Activities 2010 are ambitious. By March, 2004, its major objectives include ensuring that: in the population of Vietnamese American women in Santa Clara County, 95 percent will know that they should have an annual Pap smear; 50 percent of uninsured will know where to go for a low-cost or free Pap smear; and 85 percent will have had at least one Pap smear.
Other organizations which have joined coalition of the Vietnamese REACH for Health Initiatives 2010 include the Asian Americans for Community Involvement, Blue Cross of California, Catholic Charities' Youth Empowered for Success (Y.E.S), Community Health Partnership, Indochinese Resettlement and Cultural Center, Kaiser Permanente, Santa Clara County Public Health Department, Southeast Asian Community Center, Vietnamese Physicians Association of Northern California and the Vietnamese Voluntary Foundation, Inc.