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Hepatitis B
PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1278-1288

Successful Promotion of Hepatitis B Vaccinations Among Vietnamese-American Children Ages 3 to 18: Results of a Controlled Trial

Stephen J. McPhee, MD*, Thoa Nguyen*, Gary L. Euler, MPH, DrPH{ddagger}, Jeremiah Mock, MSc, PhD*, Ching Wong, BS*, Tram Lam, BS*, Walter Nguyen§, Sang Nguyen, MSW§, Martin Quach Huynh Ha, PhD, Son T. Do, MD|| and Chau Buu, MD**

* Suc Khoe La Vang! (Health is Gold!), the Vietnamese Community Health Promotion Project, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California
{ddagger} Adult Vaccine-Preventable Diseases Branch, Epidemiology and Surveillance Division, National Immunization Program, CDC, Atlanta, Georgia
§ EDCC, Dallas, Texas
Research and Development Institute, Houston, Texas
|| Plano, Texas
** Houston, Texas

Objective. Chronic infection with the hepatitis B virus is endemic in Southeast Asian populations, including Vietnamese. Previous research has documented low rates of hepatitis B vaccine coverage among Vietnamese-American children and adolescents ages 3 to 18. To address this problem, we designed and tested in a controlled trial 2 public health outreach "catch-up" campaigns for this population.

Design. In the Houston, Texas metropolitan area, we mounted a media-led information and education campaign, and in the Dallas metropolitan area, we organized a community mobilization strategy. We evaluated the success of these interventions in a controlled trial, using the Washington, DC metropolitan area as a control site. To do so, we conducted computer-assisted telephone interviews with random samples of ~500 Vietnamese-American households in each of the 3 study sites both before and after the interventions. We assessed respondents’ awareness and knowledge of hepatitis B and asked for hepatitis B vaccination dates for a randomly selected child in each household. When possible, we validated vaccination dates through direct contact with each child’s providers.

Results. Awareness of hepatitis B increased significantly between the pre- and postintervention surveys in all 3 areas, and the increase in the media education area (+21.5 percentage points) was significantly larger than in the control area (+9.0 percentage points). At postintervention, significantly more parents knew that free vaccines were available for children in the media education (+31.9 percentage points) and community mobilization (+16.7 percentage points) areas than in the control area (+4.7 percentage points). An increase in knowledge of sexual transmission of hepatitis B virus was significant in the media education area (+14.0 percentage points) and community mobilization (+13.6 percentage points) areas compared with the control area (+5.2 percentage points). Parent- or provider-reported data (n = 783 for pre- and n = 784 for postintervention surveys) suggest that receipt of 3 hepatitis B vaccinations increased significantly in the community mobilization area (from 26.6% at pre- to 38.8% at postintervention) and in the media intervention area (28.5% at pre- and 39.4% at postintervention), but declined slightly in the control community (37.8% at pre- and 33.5% at postintervention). Multiple logistic regression analyses estimated that the odds of receiving 3 hepatitis B vaccine doses were significantly greater for both community mobilization (odds ratio 2.15, 95% confidence interval 1.16–3.97) and media campaign (odds ratio 3.02, 95% confidence interval 1.62–5.64) interventions compared with the control area. The odds of being vaccinated were significantly greater for children who had had at least 1 diphtheria-tetanus-pertussis shot, and whose parents were married, knew someone with liver disease, had heard of hepatitis B, and had greater knowledge about hepatitis B. The odds of being vaccinated were significantly lower for older children.

Conclusions. Both community mobilization and media campaigns significantly increased the knowledge of Vietnamese-American parents about hepatitis B vaccination, and the receipt of "catch-up" vaccinations among their children.

Key Words: hepatitis B vaccination • catch-up • Vietnamese-Americans

Abbreviations: HBV, hepatitis B virus • HepB, hepatitis B vaccine • CDC, Centers for Disease Control and Prevention • DTP, diphtheria, tetanus toxoid, and pertussis • VFC, Vaccines for Children • EDCC, East Dallas Counseling Center • OR, odds ratio • CI, confidence interval

Received for publication Aug 6, 2002; Accepted Nov 20, 2002.




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F. Zhou, G. L. Euler, S. J. McPhee, T. Nguyen, T. Lam, C. Wong, and J. Mock
Economic Analysis of Promotion of Hepatitis B Vaccinations Among Vietnamese-American Children and Adolescents in Houston and Dallas
Pediatrics, June 1, 2003; 111(6): 1289 - 1296.
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