Behavioral Risk Factor Survey of Vietnamese -- California, 1991

Since 1975, an estimated 979,700 refugees from Vietnam and other Southeast Asian countries have immigrated to the United States (L. Bussert, Office of Refugee Resettlement, U.S. Department of Health and Human Services, personal communication, 1991). Although public health agencies have reported extensively on the occurrence of infectious diseases in these populations (1-4), the prevalence of risk factors for noninfectious health concerns (e.g., heart disease, cancer, and unintentional injuries) have not been well defined. To characterize risk factors for selected noninfectious diseases and injuries among the estimated 280,200 Vietnamese who have relocated to California, the University of California, San Francisco, and the California Department of Health Services developed a Vietnamese-language version of CDC's Behavioral Risk Factor Surveillance System (BRFSS) for use in a computer-assisted telephone interviewing (CATI) system. This report summarizes findings from the 1991 survey and compares them with data for the general California or U.S. population.

The questionnaire used for this survey was modified from the BRFSS for cultural appropriateness, translated into the Vietnamese language, backtranslated, and pretested. The questionnaire included 96 questions covering 10 target areas: sociodemographics, acculturation, nutrition, exercise, tobacco use, alcohol consumption, hypertension, cholesterol, safety-belt use, and cancer screening. During February and March 1991, the investigators interviewed randomly selected Vietnamese adults aged greater than or equal to 18 years living in private residences in California. The sampling frame consisted of 3988 Vietnamese surnames that had been randomly selected from a data-base listing of Vietnamese surnames from state telephone directories and motor-vehicle registrations. Households were telephoned, and respondents were randomly selected after enumeration of household members.

Of 1705 eligible persons who were contacted, 1011 (59%) agreed to participate. The average age of respondents was 39.8 (standard deviation (SD): 13.3) years. Most (55%) respondents were men; 30% of respondents were unmarried. The average year of immigration was 1981 (SD: 4.4 years). Less than half (45%) had completed high school; 80% reported fewer than 4 years of college. Nearly half (43%) had no health insurance; 28% lived in households with incomes below the poverty level (based on 1991 U.S. Department of Labor definitions by family size). Most (77%) reported limited or no English fluency.

When compared with the total population of California or the United States, prevalence rates for several behavioral risk factors were higher for Vietnamese who had resettled in the United States (Table 1), including rates of smoking (men), no exercise (both sexes), never having had cholesterol checked (both sexes), not knowing cholesterol level (women), never having had recommended breast and cervical cancer screening tests (women), and never having had rectal exams (both sexes). However, rates of alcohol consumption and hypertension (both sexes) and safety-belt nonuse (men) were lower than for the total population of California.

The likelihood of having had a Papanicolaou smear was lower for women who had fewer than 4 years of college (p less than 0.005), women who were unmarried (p less than 0.001), and women who were more recent immigrants (p less than 0.001). Similarly, the likelihood of having had a breast examination was lower for women who were unmarried (p less than 0.001), were more recent immigrants (p less than 0.001), or had no health insurance (p less than 0.02). Failure to have had a mammogram was associated with more recent immigration (p less than 0.03) and income below the poverty level (p less than 0.01). Men were less likely to have had a rectal exam if they were more recent immigrants (p less than 0.01) and less likely to have had a stool occult blood test if they were more recent immigrants (p less than 0.05) or had limited English fluency (p less than 0.002).

Reported by: SJ McPhee, MD, CNH Jenkins, MPH, S Hung, MPH, KP Nguyen, NT Ha, DC Fordham, MPH, Vietnamese Community Health Promotion Project, Div of General Internal Medicine, Dept of Medicine, Univ of California, San Francisco; VL Jang, MS, N Gelbard, MS, LF Folkers, MPH, Health Promotion Section, California Dept of Health Svcs. Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note:Persons of Vietnamese origin are the most rapidly increasing segment of the Asian/Pacific Islander ethnic group in the United States (5). Of the more than 600,000 Vietnamese living in the United States, nearly half (46%) reside in California (6).

The findings in this report indicate that the behavioral risk-factor profiles of the Vietnamese in California differ markedly from those of the total population in that state. In particular, the high prevalence rate of cigarette smoking for men and the low prevalence rates of use of cancer screening tests for both sexes are consistent with previous findings (7). Moreover, based on a study of cancer patterns in Los Angeles County, proportional incidence ratios (PIRs) for cancers of the lung and rectum were higher for Vietnamese men than for all other racial/ethnic groups but lower for cancers of the colon and prostate. Among Vietnamese women, PIRs were higher for cancer of the cervix but lower for cancers of the colon, rectum, breast, and lung (8). Because these data indicate that Vietnamese in California are at higher risk for some chronic diseases, ethnically tailored health promotion programs are needed to reduce these risks and lower barriers to preventive services. In addition, cancer screening programs should target more recent immigrants who are least likely to have received recommended cancer screening tests.

The findings in this report have at least three limitations. First, all prevalence estimates were based on self-reports that were not independently validated. Second, because the CATI methodology excluded potential respondents without telephones, certain information biases might have been introduced. Finally, although these findings can be generalized to all Vietnamese living in California, they may not represent valid estimates of the behavioral risk factors for Vietnamese who reside in other states.

Although ethnic populations may be at higher risk for certain behaviors and health outcomes, national and state health risk-factor surveys often do not sufficiently sample ethnic populations to ensure reliable statistical estimates. Because of these limitations in reliable baseline data, national health objectives for the year 2000 could not be established for Asian/Pacific Islanders and certain other ethnic populations (9). However, the rapid evolution of the demographic composition of the U.S. population impels the collection of such ethnicity-specific risk-factor data. The standard CDC BRFSS methodology is one such approach that can be adapted to survey an ethnic community by using a culturally appropriate and native-language instrument.

References

1. CDC. Screening for hepatitis B virus infection among refugees arriving in the United States, 1979-1991. MMWR 1991;40:784-6.

2. CDC. Health status of Indochinese refugees. MMWR 1979;28:385-90,395-8.

3. CDC. Tuberculosis among Asians/Pacific Islanders--United States, 1985. MMWR 1987;36:331-4.

4. Catanzaro A, Moser RJ. Health status of refugees from Vietnam, Laos, and Cambodia. JAMA 1982;247:1303-8.

5. Fawcett JT, Carino BV, eds. Pacific bridges: the new immigration from Asia and the Pacific Islands. Staten Island, New York: Center for Migration Studies, 1987.

6. Bureau of the Census. 1990 U.S. population census. Summary tape file 1A. Washington, DC: US Department of Commerce, Bureau of the Census, 1990.

7. Jenkins CNH, McPhee SJ, Bird JA, Bonilla NTH. Cancer risks and prevention behaviors among Vietnamese refugees. West J Med 1990;153:34-9.

8. Ross RK, Bernstein L, Hartnett NM, Boone JR. Cancer patterns among Vietnamese immigrants in Los Angeles County. Br J Cancer 1991;64:185-6.

9. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

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