in API populations, including Vietnamese, Cambodian, Korean, and Chinese Americans, who are known to have a higher prevalence of chronic HBV infection than the general US population (Hwang et al., 2008; Ma et al., 2007b, 2008; Taylor, 2006; Taylor et al., 2000, 2002, 2004, 2005a, 2005b; Thompson et al., 2002; Wu et al., 2007). For example, among Vietnamese Americans, about 64% had never heard of the hepatitis B vaccine (Ma et al., 2007b), about 70% were unaware that Asian Americans are at high risk for chronic hepatitis B (Hwang et al., 2008), most were uninformed about routes of HBV transmission (Taylor et al., 2000, 2005a, 2005b), and only one-third had a doctor’s recommendation to undergo HBV testing (Taylor et al., 2004). In populations of low socioeconomic status, fewer than 10% had been tested for or vaccinated against HBV (Ma et al., 2007a, 2007b). In a group of Cambodian Americans, fewer than 50% had ever heard of or been tested for HBV, and fewer than 25% knew that chronic infection is lifelong and incurable (Taylor et al., 2002).

Misinformation about HBV transmission creates obstacles for prevention and treatment. In qualitative interviews, most Korean Americans expressed the belief that sharing of contaminated food and eating utensils was the most common route of HBV transmission, whereas few mentioned that HBV can be sexually or parenterally transmitted, and none mentioned vertical mother-to-child transmission (Choe et al., 2005). Among Chinese Americans, fewer than half had been tested or vaccinated (Taylor et al., 2006; Thompson et al., 2002), up to 53% believed HBV could be transmitted by contaminated food (Wu et al., 2007), up to 61% were unaware that chronic hepatitis B is typically asymptomatic, and 46% believed that there is a curative treatment for chronic hepatitis B (Wu et al., 2007); about 65% of those who were chronically infected were unaware of their infection status (Lin et al., 2007).

The committee was unable to find studies that looked at hepatitis B awareness among other foreign-born immigrants from highly endemic regions such as sub-Saharan Africa, the Middle East, and Eastern European nations (see Box 3-1). Some educational resources have been translated into a few languages. For example, New York City has translated its hepatitis B educational materials into Chinese, Korean, Spanish, and French (New York Department of Health and Mental Hygiene, 2008).

The incarcerated population has a high risk of being infected with HBV. About 30% of patients who had acute hepatitis B reported a history of incarceration before HBV infection (Charuvastra et al., 2001; Goldstein et al., 2002). Knowledge about HBV transmission in this population is poor and results in missing of opportunities for vaccination and prevention. A voluntary, anonymous survey of 153 male and female inmates of the Rhode Island Department of Corrections revealed that over half the 30% who reported having risk factors for HBV infection did not consider themselves



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