Colorectal Cancer Screening Among Korean American Immigrants: Unraveling the Influence of Culture

Purpose: Cancer screening has been shown to be an effective measure in reducing cancer morbidity, and it is largely responsible for the decline in cancer mortality rates in the general U.S. population. However, Korean American immigrants report the lowest colorectal cancer screening rate across all U.S. racial/ethnic groups. This underutilization of cancer screening has led Korean Americans to have one of the nation's highest incidence and mortality rates for colorectal cancer. This study seeks to explore factors influencing colorectal cancer screening behavior among Korean American immigrants, particularly using Champion's health belief model. To address culturally specific issues regarding cancer screening among Korean Americans, this study also adopted items that measure cultural belief and attitudes toward cancer screening as well as cultural health concerns in general.

Methods: Using a convenience and purposive sampling method, 407 Korean American immigrants residing in New York City were recruited for this study. Participants were asked to fill out a structured questionnaire consisting of questions that asked about their cancer literacy, cancer screening, health history, cultural beliefs and attitudes toward cancer, as well as acculturation and demographic information. SPSS 17.0 for Windows was used to analyze the resultant data.

Results: As expected, results showed low rates of cancer screening among Korean Americans. Only 41% of the sample had ever undergone a blood stool test, and a mere 28% of the respondents had ever received a sigmoidoscopy and/or colonoscopy. Binary logistic regression revealed several significant predictors for colorectal cancer screening. An individual's receipt of a blood stool test on at least one occasion was seen to be significantly associated with increased age , active health insurance , and higher levels of confidence in the effectiveness of the screening test . Family and social support was another predictor for recent receipt of blood stool test . Factors associated with receipt of a signoidoscopy and/or a colonoscopy at least once in the individuals' lifetime were increased age , either low-or mid-level monthly income , active health insurance, higher levels of confidence in the screening , and less fatalistic beliefs regarding cancer . As was the case with the blood stool test, receipt of a signoidoscopy and/or a colonoscopy within the past year was associated with social support from family or friends . Perception of the seriousness of colorectal cancer was the most important predictor for recent receipt of a signoidoscopy and/or a colonoscopy, a finding that reinforces the claims of the Health Belief Model.

Implications: The findings reinforce the fact that Korean Americans are particularly vulnerable to colorectal cancer due to underuse of available screening measures. Ethnic- and culture-specific intervention strategies for enhancing colorectal cancer screening in this group are discussed, with particular attention to increasing colorectal cancer literacy and confidence in screening measures, targeting cultural beliefs that yield a fatalistic understanding of cancer, and involving informal social networks such as family members and friends in designing cancer screening intervention.