Breast Health Project for Hmong Women and Men

Institution: University of California, Los Angeles
Investigator(s): Marjorie  Kagawa-Singer , Ph.D., R.N., M.N., M.A. - Mary Anne  Foo , M.P.H., CHES -
Award Cycle: 1999 (Cycle V) Grant #: 5BB-1501 Award: $496,322
Award Type: CRC Full Research Award
Research Priorities
Sociocultural, Behavioral, and Psychological Issues>Sociocultural, Behavioral, and Psychological Issues: the human side
Imaging, Biomarkers, & Molecular Pathology>Improved access to screening: reaching every woman



Initial Award Abstract (1999)
Breast cancer is the leading cause of cancer death in Asian American and Pacific Islander (AAPI) women, yet AAPI women have the lowest screening rates, in aggregate, of all ethnic populations (only 45% of AAPI women reporting that they have ever had a mammogram). Very little information exists on the breast screening and early detection practices of AAPIs. Although over 57 groups comprise the AAPI category, and they constitute 10.7% of the US population, only seven published manuscripts exist on four groups of AAPI women: Chinese, Vietnamese, Native Hawaiian and Cambodian women. No studies have been published on Hmong breast screening practices, and these women probably have the lowest screening rates of all AAPI women (25.6% ever having had a mammogram).

This is the first intervention project that we know of to focus on Hmong women and breast cancer. Our goal is to test a more culturally competent and effective breast health program through two research questions: 1) Will the use of a culturally identified mode of health promotion, the enlistment of husbands and male community leaders, increase the use of breast screening and early detection practices by Hmong women? and 2) What elements of the tailoring process of breast cancer education outreach are required to motivate Hmong women to obtain mammograms compared to other hard to reach populations?

We will use two innovative strategies in this three-year project to reduce inequities in breast cancer outcomes and disseminate needed information to the community: 1) enlist the support of Hmong men in the community, thereby capitalizing on the cultural strengths of social support and decision making styles and the community's capacities to ensure their well-being, and 2) analyze the successful strategies of other programs in hard-to-reach ethnic minority populations and cross-cultural theoretical constructs in order to identify those culturally specific elements of an educational program that require tailoring for cultural congruence to increase effectiveness, and those universal strategies that could be implemented without change to develop more cost effective health promotion programs in the future.

No published studies exist on breast cancer early detection practices among the Hmong. Our pilot data indicates that although Hmong women have among the lowest screening rates of any ethnic population in the US, they expressed a desire for more information, a desire to have the men included in education, and a willingness to go for screenings. We know of no published studies in any ethnic group that have used the strategy of enlisting the men or male leaders of sociocentric or familial cultural groups to promote the use of breast screening services for the early detection of breast cancer.

We will implement the study in three communities: two intervention communities and one comparison community. In year 1, the team will design a culturally based intervention for women and men, develop the educational materials based on our previous BCRP-funded pilot study findings, and conduct baseline assessments of current community practices, screening rates, and breast health resources. In year 2, we will implement the intervention in two communities. And in year three, we will conduct process and impact evaluations, and implement the intervention in the comparison community.

We hypothesize that there will be significant improvement in mammography, utilization of breast self-exam, and clinical breast exam due to our intervention, and the impact would be that subsequent programs in AAPI populations and other underserved populations could be designed with greater effectiveness and in a more cost effective manner.


Final Report (2005)
Breast cancer is the leading cause of cancer death in Asian American and Pacific Islander (AAPI) women, yet AAPI women have the lowest screening rates, in aggregate, of all ethnic populations (45%). Approximately 10.7% of the US population is comprised of over 57 different AAPI groups. Hmong women are among those at highest risk for health problems and underutilization of life-saving screening services due to high rates of low education, poverty, language isolation, and cultural barriers. Life is Precious (LIP) was a three year community collaborative outreach project developed in response to this disparity. LIP’s goal was to increase mammography screening rates among women in the Hmong community, primarily in the Southern California area. In a collaborative effort with the UCLA School of Public Health and CSU Fullerton, three community-based organizations were involved in the implementation of this breast health education project: Families in Good Health (FiGH) in Long Beach [comparison community], Stone Soup (SS) in Fresno, and the Union of Pan Asian Communities (UPAC) in San Diego.

LIP was the first intervention project initiated by the Hmong community, which focused specifically on Hmong women and breast health education. It was uniquely designed to educate both Hmong women and men about breast cancer by developing culturally specific education materials to teach them how to increase the chances of early detection and treatment through mammography screening, clinical breast examinations (CBE), and breast self examinations (BSE), as well as to build community capacity to provide the services needed for optimal cancer treatment should that be necessary.

Two innovative strategies were used in this 3-year project to reduce inequities in breast cancer outcomes and disseminate needed information to the community. The first involved the enlisted support of Hmong men in the community in an effort to capitalize on the cultural strengths of social support, family integrity, and decision making styles to promote breast screening practices among women. The second was the analysis of successful strategies utilized by other programs in hard-to-reach ethnic minority populations and cross-cultural theoretical constructs in order to identify those culturally specific elements of an educational program that require tailoring for cultural congruence to more cost effective health promotion programs in the future. These outreach strategies also used participatory action processes.

At the start of this project, no published studies existed on breast cancer early detection practices among the Hmong community or any studies on any ethnic group that utilized the strategy of enlisting men or male leaders of sociocentric or familial cultural groups to promote the use of breast screening services. Data from the 1997 study, which assessed breast cancer knowledge, attitudes, and behaviors among Hmong women and men, indicated that although Hmong women have among the lowest screening rates of any ethnic population in the US, they expressed a desire for more information, a desire to have the men included in education, and a willingness to go for screenings.


Symposium Abstract (2003)
Our project reports on the findings of breast screening rates for Hmong women in California who resided in our two intervention sites of San Diego and Fresno and our comparison site of Long Beach. We conducted face to face interviews with 603 women before and after the intervention of a breast cancer education program presented to Hmong men and women in their language and in their homes. The intervention program consisted of health outreach workers who presented a teaching curriculum and video to both men and women in small groups (sometimes together, but usually in gender specific groups). The comparison site consisted of a female Health Outreach worker who was conducting breast health education efforts on her own in the community with small groups of women. Health Outreach Workers conducted the surveys.

Hmong women in southern California have one of the lowest screening rates of all ethnic populations. The pre-intervention survey showed that only 45.8% of all the women had heard of a mammogram, and only 28.6% of the women had had a mammogram.

After the intervention 80% of the women had heard of a mammogram, and almost 55% of the women in the intervention communities obtained a mammogram, compared to a 5% increase in the control community. According to the Transtheoretical Model of Stages of Change in desired behavior, the majority of Hmong women were at the pre-contemplation phase. An increase of 25% in the intervention sites was significant. Our intervention program had a significant effect on whether or not a woman went in for screening.

We developed two scales, one for knowledge about breast cancer, and one for attitudes about breast cancer. There was no change in attitudes before or after the intervention. All three groups of women had relatively positive attitudes towards breast cancer (73% scored 4-7 on a scale of 1-7 on positive attitudes toward breast cancer as a curable disease) both before and after the intervention. On knowledge about the causes and prevention of breast cancer, however, only 12.18% of the women scored 7-13 on a scale of 1-13 on knowledge before the intervention compared to 41.55% after the intervention. These numbers include the comparison sites as well. The percentages are actually higher for the intervention sites alone, however, education was going on in the comparison site as the “standard of practice” without the training tools and curriculum. We will present a model of the predictive value of these scales on screening.
Breast Cancer Screening Among Hmong Women in California
Periodical:Journal of Cancer Education
Index Medicus:
Authors: Tanjisiri SP, Kagawa-Singer M, Foo Ma, et. al.
Yr: 2001 Vol: 16 Nbr: 1 Abs: Pg:50-54