摘要：Objectives. We sought to promote cervical cancer screening among Vietnamese American women in Santa Clara County, Calif. Methods. In 2001–2004, we recruited and randomized 1005 Vietnamese American women into 2 groups: lay health worker outreach plus media-based education (combined intervention) or media-based education only. Lay health workers met with the combined intervention group twice over 3 to 4 months to promote Papanicolaou (Pap) testing. We used questionnaires to measure changes in awareness, knowledge, and Pap testing. Results. Testing increased among women in both the combined intervention (65.8% to 81.8%; P <.001) and media-only (70.1% to 75.5%; P <.001) groups, but significantly more in the combined intervention group ( P =.001). Among women never previously screened, significantly more women in the combined intervention group (46.0%) than in the media-only group (27.1%) obtained tests ( P <.001). Significantly more women in the combined intervention group obtained their first Pap test or obtained one after an interval of more than 1 year (became up-to-date; 45.7% to 67.3%, respectively; P <.001) than did those in the media-only group (50.9% to 55.7%, respectively; P =.035). Conclusions. Combined intervention motivated more Vietnamese American women to obtain their first Pap tests and to become up-to-date than did media education alone. Cervical cancer can cause a woman to lose her fertility because of surgery or radiation treatment and can result in untimely death. Vietnamese American women have the highest incidence of cervical cancer of any racial or ethnic group in the United States, 5 times higher than that of non-Hispanic Whites (43.0 per 100000 vs 7.5 per 100000). 1 In 1999, the Centers for Disease Control and Prevention initiated the Racial and Ethnic Approaches to Community Health (REACH 2010) program to reduce health disparities. In response, we formed a coalition of researchers and community members in Santa Clara County, Calif, called the Vietnamese REACH for Health Initiative, to address the cervical cancer disparity experienced by Vietnamese American women. This disparity is entirely preventable. Persistent infection with a high-risk human papillomavirus (HPV) is generally accepted as the major cause of cervical cancer. 2 However, both active and passive exposure to cigarette smoke is an additional risk factor. 3 Although Vietnamese American women have a low prevalence of active smoking, passive smoke exposure is a genuine problem for them given the high prevalence of smoking by Vietnamese men. 4 – 6 For this reason, we considered even Vietnamese American women who had not been sexually active to be at risk for cervical cancer and thus eligible for screening. Papanicolaou (Pap) test screening is highly effective for detecting precancerous cervical dysplasia and koilocytosis, which is highly suggestive of HPV infection. We conducted a baseline communitywide survey of Vietnamese American women in Santa Clara County that showed that only 78% had ever had a Pap test, compared to other survey data showing a rate of 96% among non-Hispanic White women. 7 , 8 The survey also showed that women who had never obtained a Pap test were more often older than 65 years, unmarried or widowed, were less educated, had a male Vietnamese doctor, had never requested a Pap test, had never had their doctor recommend a Pap test, and felt that their doctor did not always treat them respectfully. Therefore, we sought to encourage Vietnamese American women in Santa Clara County to obtain regular Pap tests and receive appropriate follow-up. We implemented a comprehensive, multifaceted program (details reported elsewhere). 9 , 10 Here we report the final outcomes of 2 components—the lay health worker outreach program and the media-based health education campaign. When our project began, the largest proportion (41%) of the 1.22 million Vietnamese in the United States lived in California, with 105 000 living in Santa Clara County. 11 Many Vietnamese in Santa Clara County were working in high-tech manufacturing plants, restaurants, shops, nail salons, and social service agencies. Nearly all Vietnamese were first-generation immigrants who fled Vietnam after the fall of Saigon. The first immigrants, who arrived in 1975, were primarily officials and high-ranking military officers and their families and were generally well educated, from urban areas, and healthy. In the 1980s, large numbers of refugees arrived, including the so-called “boat people.” Most were from rural areas, less educated, and in poorer health. Survivors of “reeducation” (concentration) camps and family members of those already living in the United States immigrated in the late 1980s and 1990s. For more than 50 years, lay health workers (LHWs) have reached out to underserved populations to reduce cardiovascular disease, diabetes, and cancer. 12 – 15 LHWs typically work through their social networks to reach those who have poor access to health services or health information, such as immigrants who do not understand the health care system, do not know their rights, or rely on family and friends for information. 16 – 20 LHW outreach has been used in African American and Latino communities but rarely in Asian American communities. 21 – 24 Evaluations of LHW outreach have shown that LHWs provide emotional, instrumental (in the form of money or services), informative, and appraisal support. 16 , 18 – 20 , 25 – 27 Results have varied in the few randomized controlled studies of LHW outreach for the prevention of chronic diseases. 10 , 12 , 13 , 28 – 33 Among African Americans and Latinas, LHW outreach has increased mammography 13 , 30 , 31 but not Pap testing rates. 13 , 31 One prior LHW outreach study showed increases among Vietnamese American women in recognition, receipt, and maintenance of breast and cervical cancer screening. 21
