Vaccinating Asian Pacific Islander children against hepatitis B: ethnic-specific influences and barriers

Hepatitis B virus (HBV) is a known cause of liver cancer, especially among Asian and Pacific Islanders (API). Despite national recommendations and school entry requirements for vaccination, many children are not fully vaccinated with the Hepatitis B vaccine (Hep B) before entering school. The purpose of this study was to measure ethnic group-specific hepatitis B vaccination rates among school-aged API children after implementation of universal recommendations and school laws, and quantify ethnic-specific risk factors associated with late and incomplete vaccinations.

A multilingual questionnaire was distributed to parents of second and fourth graders in nine Los Angeles County (LAC) elementary schools with high proportions of API students. Data on Hepatitis B vaccination dates, source of health care and health information, cultural factors, and general knowledge and attitudes about HBV and vaccination were collected and analyzed.

Overall, 1,696 (77%) of 2,183 questionnaires were returned. Of these, 1,024 were from API children. The API second graders in this survey had a 72% coverage rate, ranging from 46% to 94% among the individual ethnic groups. Fifty-one percent of API fourth graders had three doses of Hep B vaccine, ranging from 38% to 69% among the individual ethnic groups. Factors influencing coverage levels among API fourth graders were speaking limited English at home, living in the United States less than five years, and not having discussed hepatitis B vaccination with a health care provider. Factors influencing low immunization levels differed among the API ethnic groups.

Analysis and intervention on a non-aggregate level are necessary for designing both effective and cultural-specific outreach programs for diverse API communities such as LAC's.