FACTORS INFLUENCING THE RECEIPT OF HEPATITIS B VACCINATION AND
SCREENINGS IN VIETNAMESE AMERICANS
Jennifer D. Levy, MPH(c); Giang T. Nguyen, MD, MPH, MSCE; Ethan Nguyen, BA
Abstract
This paper examined factors affecting the receipt of both Hepatitis B vaccination and screening
in the Vietnamese American community of Philadelphia. Hepatitis B is endemic to Southeast
Asia; individuals emigrating from endemic areas are at a particularly high risk of Hepatitis B
infection, resulting in a higher prevalence of liver cancer in the population. Participants for this
study were recruited at Vietnamese community events in Philadelphia to answer a written
questionnaire. In a sample of 207 participants (93% foreign-born.), over one half reported that
they had not received either a screening or vaccination of Hepatitis B in their lifetime. The
number one predictor of receiving either service was that the participant was aware of the cancer
risk that Hepatitis B posed. This association remained strong even when controlling for sociodemographic factors. Based on this finding, future interventions should include messages on the
possible cancer risk associated with Hepatitis B to reach this population.
Vietnamese Americans, numbering 1,122,528 in the 2000 census, are a fast-growing segment of
the Asian American population and currently comprise almost 11% of the nation’s Asian
Americans.1 By 2030, it is estimated that Vietnamese Americans will constitute the second
largest group of Asian Americans in the country.2
Hepatitis B is an important public health issue due to its role in the etiology of liver cancer3, 4 and
the increasing evidence that prevention of Hepatitis B through vaccination can reduce the later
incidence of liver cancer.5, 6 Several studies in U.S. cities have revealed high seroprevalence
rates of Hepatitis B in the Asian/Pacific Islander population.7, 8, 9, 10 Vietnamese males have the
highest incidence rate of liver cancer of any ethnic/racial group in the country (41.8 per 100,000)
and are 11 times more likely to develop liver cancer than their Caucasian counterparts.11 This
high rate of liver cancer may be due, in part, to the high prevalence of Hepatitis B prevalent in
the population as a direct result from low rates of immunization for the disease. About 7-14% of
foreign-born Vietnamese men in the U.S. show serologic evidence of Hepatitis B infection.12
Similarly, Vietnamese American women also face rates of liver cancer that are substantially
higher than that of other racial/ethnic groups,13 reflecting the higher prevalence of Hepatitis B in
this population.
Prior research indicates that Vietnamese Americans often have lower utilization of services in
the primary care setting,14, 15 which may result in lower receipt of Hepatitis B vaccination and
screenings. Lack of knowledge about symptoms and prevention of various cancers,16, 17 and
specifically that Hepatitis B presents a risk of liver cancer, may play a role in information and
service receipt.18,19 Additionally, knowledge about Hepatitis B and modes of transmission is
lacking; one study found that over one-third of Vietnamese American respondents believed that
Hepatitis B could be contracted from sharing a cigarette with an infected person, or by an
infected person sneezing or coughing around them.12 One study assessing cervical & breast
cancer knowledge among Vietnamese American women showed that some believed cancer to be
contagious (29%) and many of the respondents believed breast & cervical cancer occurred due to
poor hygiene (39%).16
Some Vietnamese Americans also exhibit fatalistic viewpoints, believing that nothing can be
done to prevent cancer,16, 17 deterring use of screening procedures. One study found that
Vietnamese Americans were more likely to have positive attitudes towards screenings for
colorectal cancer but were less likely to have received them than their Caucasian counterparts.
The authors posited that Vietnamese Americans were more likely to believe that the test would
find cancer, which lead to avoidance of the screening.20
The objective of this study was to complete community-driven research regarding the predictors
and barriers to use of Hepatitis B-related preventive healthcare services in the Vietnamese
community of Philadelphia.