Journal of Preventive Medicine and Public Health

Brief Report

A Cross-sectional Study of Cancer Knowledge and Beliefs Among Faith-based Chinese in the USA Versus Taiwan: Su-I Hou, Xian Cao; J Prev Med Public Health. 2019;52(1):60-65. Published online January 20, 2019; DOI: https://doi.org/10.3961/jpmph.17.051

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Abstract PDF: Objectives
This study examined cancer knowledge, beliefs, and practice among faith-based Chinese in the USA versus Taiwan to gain better understandings on how environment and culture might play a role for tailored cancer education programs.
Methods
A self-administered survey included a validated 10-item Cancer Screening Belief Scale (CSBS), an 8-item Cancer Screening Knowledge Test (CSKT), and a 14-item cancer Warning Signs Test (CWST) was administered. Participants were recruited from 9 Chinese churches (5 in the USA and 4 in Taiwan).
Results
A total of 372 Chinese participated, 50% lived in the USA and 50% in Taiwan. Mean age was 44.31 (standard deviation, 14.74), 60% males, and majority had college education (85%). Taiwan participants scored higher on both CSKT (6.13 vs. 5.52; p<0.001) and CWST (6.80 vs. 5.38; p<0.001). Although perceived screening benefits and barriers were similar, Taiwan participants endorsed higher on screening norms (11.67 vs. 10.82; p<0.001). Taiwan participants also indicated more doctor recommending cancer screenings (42.1% vs. 29.6%; p=0.015), USA participants were more likely to have had annual health exams (65.4% vs. 48.9%; p=0.002). Regression results showed that those resided in the USA were 2.38 times more likely to report annual health exams. Married status (odds ratio [OR], 2.85), college education (OR, 2.38), doctor’s recommendation (OR, 2.87), no family cancer history (OR, 2.47), and those with lower barriers were significant factors on annual health exams.
Conclusions
Taiwan participants scored higher on cancer knowledge and screening norms, while more USA participants reported annual health exams. Taiwan’s universal healthcare might play a role on the different healthcare seeking patterns.; Summary

English Abstract

Factors Associated with Cancer Screening Intention in Eligible Persons for National Cancer Screening Program.: Rock Bum Kim, Ki Soo Park, Dae Yong Hong, Cheol Heon Lee, Jang Rak Kim; J Prev Med Public Health. 2010;43(1):62-72.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.62

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OBJECTIVES
To identify factors associated with cancer screening intention using the Theory of Planned Behavior (TPB). METHODS: Among 55,920 eligible persons for National Cancer Screening Program (NCSP) in J city, 1,100 individuals were contacted. Of these, 797 were interviewed using a structured questionnaire. Thirty-six responses were excluded due to incomplete data. The remaining 761 completed questionnaires were analyzed to find factors associated with cancer screening intention. RESULTS: Cancer screening intention was significantly associated with behavioral attitude (p<0.01) and subjective norm (p<0.01), but not with perceived behavioral control (p=0.29) in the TPB model. These three constructs explained 29.7% of cancer screening intention in multiple linear regression analysis. External factors such as socio-demographic status, health and health behavior variables explained 8.9% of screening intention. Among them, household monthly income, past cancer screening experience, exercise and daily eating habit were significantly associated with screening intention. CONCLUSIONS: Cancer screening intention may be influenced by focusing attitude, subjective norm in TPB model and other external factors. However, further studies are warranted to identify factors influencing cancer screening intention and behavior.

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Original Articles

Socioeconomic Disparities in Breast Cancer Screening among US Women: Trends from 2000 to 2005.: Jaeyoung Kim, Soong Nang Jang; J Prev Med Public Health. 2008;41(3):186-194.; DOI: https://doi.org/10.3961/jpmph.2008.41.3.186

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Abstract PDF

OBJECTIVES
This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. RESULTS: Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. CONCLUSIONS: These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. ontinued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.

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Application of the Theory of Planned Behavior and the Theory of Reasoned Action to Predicting Cervix Cancer Screening Behavior.: Kun Sei Lee, Yong Ik Kim, Chang Yup Kim, Young Soo Shin; Korean J Prev Med. 2001;34(4):379-388.

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Abstract PDF: BACKRGROUND: Cervix cancer is the most common form of cancer among Korea women. In spite of proof that cervical cancer screening could reduce death rates substantially, the screening rates reported by previous Korean studies remain stubbornly very low. Behavioral studies to increase the cervix cancer screening rate are essential in order to develop the cancer screening program. OBJECTIVE: To evaluate the factors which are related to the intention and behavior for cervix cancer screening using the Theory of Planned Behavior (TPB) and the Theory of Reasoned Action (TRA). METHODS: The survey was conducted from July 21st to 26th in 1998. Of 3,218 women, 393(12.2%) between 30 and 65 years old, voluntarily participated in the survey in the 3 Myeons in Choongju city. Charge-free cervix cancer screening was provided for the subjects 3 months later. RESULTS: The R-square of both TPB and TRA to the intention (30% and 42%, respectively) was greater than the actual behavior (21% and 13%, respectively. TPB and TRA were found to provide an appropriate framework for the study of cervix cancer screening behavior. However, TRA was more powerful in explaining the intention, not only because the perceived behavioral control component exhibited lower reliability and validity than other components(attitude and subjective norm), but also because there may have been a few limitations in this study design. Consequently, the use of TRA is preferred in attempting to explain intention and actual behavior in this study. CONCLUSIONS: This study suggests that a successful intervention program should focus on changing attitudes and reducing psychologic barriers, rather than on just providing information. Physician recommendations, and the support of family members and friends are also very important factors in cervix cancer program participation. Physicians, friends, family members, and opinion leaders in rural areas, all of whom could affect the individual subjective norm, may all have the potential to play great roles as facilitators.; Summary

The Predictive Factors to Participation in Cervical Cancer Screening Program.: Young Bok Kim, Won Chul Lee, Myung Kim, Chee Kyung Chung; Korean J Prev Med. 2001;34(3):237-243.

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Abstract PDF: OBJECTIVES
To examine the screening rate of cervical cancer in women and to find out the predictive factors for participation in cervical cancer screening programs within their life-time and within the last two years. METHODS: The data was based on self-reported questionnaires from 1,613 women whose ages ranged from 26 to 60 years; this survey was performed between December 1999 and January 2000. This study analyzed the predictive factors for participation in cervical cancer screening programs within their life-time and within the last two years. A logistic regression analysis was performed in order to derive the significant variables from the predisposing factors (demographic factor, health promotion behavior, reproductive factor), intervention factors (information channel, relation with medical staff), and proximal factors (attitude, social influence, self-efficacy). All analyses were performed by the PC-SAS 6.12. RESULTS: Our analyses showed that the screening rate for the women who received a cervical cancer screening (Pap smear) more than once within their life-time was 56.1% while those who had received one within the last two years was 34.5%. The significant factors for participation in cervical cancer screening program within their life-time were their income, married age, health promotion score, relation with medical staffs, social influence, and self-efficacy. On the other hand, age, number of pregnancies, menarche age, relation with medical staffs, social influences, and self-efficacy were significant factors for those being screened within the last two years. The predictive power of the logit model within their life-time was 68.8% and that within the last two years was 66.6%. CONCLUSION: The predictive factors for participation in cervical cancer screening program within their life-time are different from those for within the last two years, and that women's relations with medical staffs and social influences were the critical factors impacting on cervical cancer screening rates.; Summary

Cancer Screening Rate and Related Factors in Rural Area.: Kun Sei Lee, Soung Hoon Chang, Won Jin Lee; Korean J Prev Med. 2000;33(3):364-372.

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Abstract PDF: OBJECTIVES
Cancer is the second most frequent cause of death in Korea. Cancer screening tests can save lives through early detection. Enhancing the cancer screening rate is an important strategy for reducing cancer mortality. The purpose of our study was to evaluate the screening rate and related factors in a rural area. The study investigated relationships between sociodemographic characteristics, several preventive behaviors, and the experience of several cancer screening behaviors. MATERIALS AND METHODS: The study population was recruited voluntarily from the three rural areas(Myen) in Chungju city. The participants completed structured questionnaire from July 21, 1998 to July 26, 1998. RESULTS: The proportions of the study population who had previously received stomach, liver, breast, or cervix cancer screening tests were 24.5%, 18.5%, 27.0%, 59.2% respectively. The 1-year screening rates of stomach, liver, breast, and cervix cancer were 7.4%, 6.8%, 8.6%, 15.6% respectively. In multivariate logistic analysis, some sociodemographic variables, preventive behaviors, or psychological variables were significantly associated with several cancer screening tests. Those who had previously received a stomach cancer screening test were significantly associated with the presence of chronic disease, physician? recommendation, use of alcohol family history of cancer, or previous liver cancer screening test. Those who had previously received a liver cancer screening test were associated with education level, physician? recommendation and previous stomach cancer screening test. Those who had received a cervix cancer screening test were significantly associated with education level, presence of a transportation vehicle, physician? recommendation use of alcohol and previous breast cancer screening test. And those who had received a previous breast cancer screening test were significantly associated with age, marital status, and earlier cervix cancer screening test. CONCLUSION: Based on the results of this study a strategy to promote cancer screening and health objectives at the district level can be made.; Summary

Factors Associated with the Use of Pap Test in a Rural Area.: Kun Sei Lee, Hye Won Koo, Won Jin Lee, Soung Hoon Chang, Keun Young Yoo; Korean J Prev Med. 1999;32(2):147-154.

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Abstract PDF: OBJECTIVES
To construct basic data to develop strategies for achieving higher Pap test coverage rate by evaluating factors associated with the use of Pap test through population-based survey. METHODS: 16.4%(671) of the 4,090 women, who were eligible population for this study, in 3 Myens of Chung-ju City participated in this study voluntarily from July 21 to 26, 1997. After basic physical examination by trained doctors, they were interviewed with structured questionnaire by well-educated interviewers. RESULTS: It shows that only 54.3% of study participants experienced Pap test. The strongest factor which is related with the use of Pap test was the history of having breast screening tests(aOR=8.71, 95% CI=4.25-17.84). Probability of ever having Pap test was also higher in married women(aOR of single=0.46, 95% CI=0.29-0.72), younger(Ptrend<0.05), more educated (Ptrend<0.001), non-smoker (aOR of smoker=0.26, 95% CI=0.12-0.55), women of ever having hepatitis test(aOR=2.60, 95% CI=1.73-3.88) in multiple linear logistic analysis. CONCLUSIONS: This study suggests that several factors significantly associated with the use of Pap test, and especially, high-risk population for cervical cancer such as women of older ages, less educated, living alone are less likely to have the Pap test. We should concentrate on encouraging high-risk women in the use of Pap test to improve Pap test coverage rate.; Summary

English Abstracts

Women's Willingness to Pay for Cancer Screenin.: Min Son Kwak, Na Young Sung, Jeong Hee Yang, Eun Cheol Park, Kui Son Choi; J Prev Med Public Health. 2006;39(4):331-338.

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Abstract PDF: OBJECTIVES
The goal of this study is to measure women's willingness to pay for cancer screening and to identify those factors associated with this willingness to pay METHODS: A population-based telephone survey was performed on 1,562 women (aged 30 years or over) for 2 weeks (9-23th, July, 2004). Data about sociodemographic characteristics, health behaviors, the intention of the cancer screenings and willingness to pay for cancer screening were collected. 1,400 respondents were included in the analysis. The women's willingness to pay for cancer screening and the factors associated with this willingness to pay were evaluated. RESULTS: The results show that 76% of all respondents have a willingness to pay for cancer screening. Among those who are willing to pay, the average and median amount of money for which the respondents are willing to pay are 126,636 (s.d.: 58,414) and 120,000 won, respectively. As the status of education & the income are higher, the average amount that women are willing to pay becomes much more. The amount of money women are willing to pay is the highest during the 'contemplation' stage. Being willing to pay or not is associated with a change of behavior (transtheoretical model), the income, the concern about the cancer risk, the family cancer history, the marital status, the general health exam, age and the place of residence. Income is associated with a greater willingness to pay. Old age was associated with a lower willingness to pay. CONCLUSIONS: According to the two-part model, income and TTM are the most important variables associated with the willingness to pay for cancer screening. The cancer screening participation rate is low compared with the willingness to pay for cancer screening. It is thought that we have to consider the participants' behavior that&s associated with cancer screening and their willingness to pay in order to organize and manage cancer screening program.; Summary

Participation Rate and Related Socio-demographic Factors in the National Cancer Screening Program.: Na Young Sung, Eun Cheol Park, Hai Rim Shin, Kui Son Choi; J Prev Med Public Health. 2005;38(1):93-100.

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Abstract PDF: BACKGROUND
Cancer is the leading cause of death and one of the largest burdens of disease in Korea. In 1996, the 'Ten year Plan for Cancer Control' was formulated and the government then adopted the plan as a national policy. As part of this plan, the National Cancer Screening Program (NCSP) for Medicaid recipients was formulated, and the government adapted this in 1999. For low-income beneficiaries of the National Health Insurance Corporation (NHIC), the screening program has been in place since 2002. In 2002, the target cancers of NCSP were stomach, breast and cervical cancer. This study was conducted to examine the relationships between the participation rate, the abnormal screening rate and the socio-demographic factors associated with participation in the screening program. METHODS: To analyze the participation rate and abnormal rate for the NCSP, we used the 2002 NCSP records. The information on the socio-demographic factors was available from the database of the beneficiaries in the NHIC and Medicaid. RESULTS: The participation rate of the Medicaid beneficiaries for the stomach, breast and cervical cancer screening were 9.2%, 15.5% and 15.0%, respectively, and 11.3% and 12.5%, except cervical cancer which wasn't be included in the NCSP, for the beneficiaries of the NHIC. The abnormal rate of stomach, breast and cervical cancer screening were 25.7%, 11.2% and 21.0%, respectively, for the beneficiaries of Medicaid and 42.6% and 19.4% for the beneficiaries of the NHIC. On the multiple logistic regression analysis, gender, age and place of residence were significantly associated with participation rates of the NCSP. For stomach cancer, women participated in the NCSP more than men. The participation rate was higher among people in their fifties and sixties than for those people in their forties and those people over seventy years in age. For the breast and cervical cancer, people in their fifties were more likely to participate in the NCSP than people in their forties and people over sixty. For the place of residence, people in the rural areas participated more than those people in any other places. CONCLUSIONS: The above results show that the participation rate and abnormal rate were significantly associated with the socio-demographic factors. To improve the participation rate for the NCSP, more attention should be given to the underserved groups.; Summary

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