1. 1 A Hepatitis B Education and Screening Program for The Asian American Community Montgomery County, Maryland C. Ed Hsu, PhD, Louis Liu, MA University of Maryland College Park. Department of Public and Community Health Julie Bawa, MPH, Ulder Tillman, MD, MPH Montgomery County DHHS. Mark Li, MD Asian Physician Alliance Oral Presentation in the American Public Health Association Conference. Boston, MA November 4-8, 2006.

2. 2 Prevalence of HBV Infections by Race/Ethnicity Chronic HBV infection rates in Non-Hispanic White (0.1%), Hispanic (0.1%), and African-Americans (0.5%): Versus Chronic HBV infection rate in Asian Americans and Pacific Islanders (AAPI) 7%: – Non US-born AAPI: 9% – US-born AAPI: 1.5% Data source: Stanford Asian Liver Center.

3. 3 National Statistics of HBV AAPI account for 1/2 of the 1.3 million chronic hepatitis B cases annually. AAPI accounted for half of the deaths resulted from chronic hepatitis B infection in the US. AAPI are 3 to 13 times more likely to die from liver cancer than Caucasians – Chinese American at 6 times higher risk – Korean Americans at 8 times, – Vietnamese Americans at 13 times.

4. 4 Purposes of Hepatitis B Project Implement a Hepatitis B prevention (including both education/preventive screening) program in Asian community of Montgomery County, MD. This is accomplished by developing a collaborative partnership among: Montgomery County Asian American Health Initiative; The Asian American Physician Alliance in Maryland; University of Maryland College Park; Community-based Organizations (e.g., the CCACC, KCC, MVMA, and others) and Faith-based (Church, Temple, etc.)

5. 5 Funding Support The project receives financial support from: Asian American Health Initiative, Montgomery Co., MD The project received voluntary assistance from Health professionals in Maryland. Many Asian faith-based and community-based organizations.

6. 6 Objectives To reduce the health disparities between Asian American community and their racial counterparts in terms of hepatitis B-related morbidity and mortality. – Establish baseline data of prevalence rate among Asian communities; – Pretest and post tests to measure the changes in perception and knowledge related to HBV prevention; – Provide free screening to 680 Asian Americans residing in Montgomery County, Maryland; – Give free vaccines to those who are unprotected and aged between 18 to 35 to 300+ Asian residents who are unimmunized.

7. 7 Methods Hepatitis B Education 1. Pre test 2. Educational slides presentation 3. Post test Hepatitis B Screening 1. Blood drawing 2. Notify subjects 3. Free vaccine (to eligible participants)

8. 8 Survey Instrument I: Demographics 1. Gender 2. Age 3. Marital Status 4. Race/ethnicity 5. Years living in the US 6. Education Level 7. Household Income 8. Employment Status 9. Health Insurance Status 10. Montgomery County Residence

9. 9 Survey Instrument II: Questionnaire (True/False) 1. Hepatitis B can be passed on from mother to child during childbirth 2. One can be infected with Hepatitis B by sharing food 3. About 10% of the Asian Americans populations are infected with Hepatitis B 4. The majority of chronic Hepatitis B patients has no symptoms 5. Hepatitis B infection cannot be cured, but the disease can be managed 6. Hepatitis B virus is significantly more contagious than HIV 7. Chronic hepatitis B causes liver cancer and cirrhosis if not properly managed 8. Asian Americans have the same risk of dying of liver cancer as their White counterparts 9. Twenty percent of liver cancer is caused by Hepatitis B 10. It is safe to breast-feed even if the mother is infected with Hepatitis B

10. 10 Outreach Activities: 8 sites 1. 04/16/06: Cambodian Buddhist Temple (13800 New Hampshire Ave, Silver Spring, MD) 2. 03/26/06: Korean Global Mission Church (13421 Georgia Ave. Silver Spring, MD 20906) 3. 03/11/06: Taiwanese Presbyterian Church (Newport Mill Rd. & Church Lane, Wheaton, MD 20902) 4. 02/18/06: Hampshire View Baptist Church (360 Ednor Rd. Silver Spring, MD 20905) 5. 02/18/06: Thai Temple 6. 01/21/06: Korean Global Mission Church (13421 Georgia Ave. Silver Spring, MD 20906) 7. 12/11/05: The Vietnam Catholic Church (11814 New Hampshire Ave. Silver Spring, MD 20904) 8. 12/10/05: Capital Chinese Church (810 University Blvd. West, Wheaton, MD 20902)

11. 11 Preliminary Results I: Hepatitis B Prevalence (Race/Ethnicity) Group1-Immuned2-Carrier3-UnimmunedTotal Asian Indian 707 (50%)14 Cambodian 143 (8.1%)20 (54.1%)37 Chinese 9411 (5.4%)102 (49.3%)207 Filipino 101 (4%)12 (52.2%)23 Korean 1058 (4.1%)83 (42.3%)196 Taiwanese 401 (1.9%)12 (22.6%)53 Thai 153 (7.3%)23 (56.1%)41 Vietnamese 566 (5.9%)40 (39.2%)102 Other* 008 (100%)8 Total 341 (50%)33 (4.8%)307 (45.1%)681 *Other group includes: Indonesian, Sri Lanka, Pakistani, etc. Data as of 4/30/2006.

12. 12 Preliminary Results II: Hepatitis B Prevalence (Age) Age1-Immuned2-Carrier3-UnimmunedTotal 18~25 72244 (37.29%)118 26~35 61364 (50%)128 36~45 277 (10.29%)34 (50%)68 46~55 428 (8.51%)4494 56~65 67545117 66+ 3133569 Total 30028266 (44.78%)594 Source: Quest Laboratory. Data table prepared by Louis Liu, University of Maryland. (Data as of: 3/31/06)

13. 13 Preliminary Results III: Hepatitis B Prevalence (By Residence History) Residence history1-Immuned2-Carrier3-UnimmunedTotal Born in the US 2001737 Less than 1 year 2079 1 ~ 4 years 1911131 5 ~ 9 years 3532563 10 years or more 15219143314 NA 72563140 Total 30028266594 Source: Quest Laboratory. Data table prepared by Louis Liu, University of Maryland. (Data as of: 3/30/06)

14. 14 Summary Results Important Finding By Race/Ethnicity. By Age group. By Duration of residency.

15. 15 Discussion I: generally consistent with the literature The literature suggests: Vietnamese Americans are at a higher risk of dying of HepB, followed by Korean Americans and Chinese Americans. In the present study, Cambodian (8.1%) and Thai (7.3%) has the highest prevalence of carriers. Followed by Vietnamese (5.9%), Chinese (5.3%), and Korean (4.1%).

16. 16 Discussion II: N ew findings from the study Prevalence of HepB in API: The literature indicates that the prevalence of HepB carrier in Asian countries is 10%, in API is 7%, in non US-born API is 9%. The present study suggests that the average infection rates across 7 Asian American groups is 4.8% in non US-born Asian Americans is 5.1%.

17. 17 Discussion III: new findings from the study Unimmunized rates: highest unimmunized rates occurred in the other group (100%), followed by Thai (56%), Cambodian (54%), Chinese (49%), Asian Indian (46%), and Korean (42%). Immunized rates: Taiwanese community has the highest immunized rate (75%), followed by Korean and Vietnamese (54%) communities.

18. 18 Important Messages The case of Cambodian/Thai community – high carrier rate and high unimmunized rate. The ‘other’ group – high unimmunized rate. For immigrants, the prevalence rate is positively related to the duration of US residence.

19. 19 Limitations Asian group representations Participation rates varied by Asian subgroup. Potential selection bias Subjects may overly represented members of faith-based vs. community-based organizations.

20. 20 Conclusion: More health data of Asian community should be collected Asian American community (vs other racial counterparts) in the present study has a higher HBV prevalence. What gets measured/counted gets done. Continue to collect and report health data — help communities help themselves.

21. 21 Next Steps In FY07, our group will continue to: Conduct Hepatitis B/Liver Cancer education in Maryland. Collect Asian American health data. Disseminate results by presenting in academic conferences and publishing the results in peer-reviewed journals. Submit grants for additional support.

22. 22 Resources AAHI Website, Montgomery County, Maryland http://www.aahiinfo.org Related Links Stanford Asian Liver Center http://liver.stanford.edu/ http://liver.stanford.edu/ OMB Directive 15 Maryland Office of Minority Health and Health Disparities CDC Office of Minority and Women's Health CDC Office of Minority and Women's Health White House Initiative on Asian Americans and Pacific Islanders White House Initiative on Asian Americans and Pacific Islanders

23. 23 Healthy Asian Communities in Maryland