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To the Editor: Hepatitis C virus infection is the most common chronic blood-borne infection in the United States, with an estimated 2.7 million persons infected.¹ Most infected persons may not be aware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk of developing chronic liver disease during the first 2 or more decades after infection.² To help develop and target prevention messages, we included questions about hepatitis C on a national health survey. Our objective was to determine knowledge regarding hepatitis C virus infection, especially among minorities disproportionately affected.

Methods
Healthstyles is a large database of responses to mailed surveys designed specifically for health and lifestyle-related marketing and communication programs. Healthstyles has had more than 2500 respondents annually since 1995 and, in addition to demographic information, includes responses to questions about health behaviors, attitudes, and knowledge. Full details of the methods are published elsewhere.³ Questionnaires were mailed in June 1999 to 3666 adults who completed a prior, more comprehensive survey for which participants were selected by quota sampling and stratified on demographic variables to represent US adults. Racial/ethnic minorities were oversampled, and weighted analysis was performed using SPSS statistical software (SPSS Inc, Chicago, Ill). Five-point Likert scales were used for responses to most statements.

Results
Of 2636 (72% of sample) respondents, 74.6% were white, 11.6% black, and 10.0% Hispanic. Black and white respondents were equally more likely to report at least a high school education (92%) than Hispanics (79%). Blacks and Hispanics were more likely than whites to report household incomes less than $20,000 (41% and 33%, respectively, vs 22%, P<.05). Overall, a large proportion of participants responded either inaccurately or with uncertainty to multiple statements regarding hepatitis C virus infection (Table 1). Although blacks were more likely to report having heard of hepatitis C virus than whites or Hispanics (94% vs 89% and 87%, respectively, P<.05), blacks were less likely to respond accurately to multiple statements regarding hepatitis C risks and prevention.

View this table: [in this window] [in a new window] Table. Comparison of Knowledge About Hepatitis C Among Racial/Ethnic Groups Responding to the 1999 Healthstyles Survey*

Comment
This survey indicates that a substantial proportion of adults are either uncertain or inaccurately informed about hepatitis C and that racial differences in knowledge of hepatitis C may exist. Major limitations of this study are that questions about hepatitis were included in a lengthier standardized health survey, and no information is available on whether this format or wording is culturally appropriate for different populations.

The Centers for Disease Control and Prevention, in partnership with voluntary, professional, and other nongovernmental health organizations, is currently expanding efforts to educate the public and health professionals about prevention and control of hepatitis C virus. Studies designed to assess racial and cultural differences in knowledge about hepatitis C and programs to develop, disseminate, and evaluate culturally appropriate prevention and control messages are needed. As blacks are disproportionately affected by hepatitis C infection (estimated prevalence, 3.2% vs 1.5% in whites),² it is especially important for prevention education and activities to be specifically designed and evaluated for effectiveness in this population.

AUTHOR INFORMATION
Funding: This project was entirely funded by the Hepatitis Branch, Centers for Disease Control and Prevention, through a contract with Porter Novelli, Healthstyles Survey, 1999, Washington, DC.

Acknowledgment: We thank the staff of the Office of Communications, Centers for Disease Control and Prevention, for their role in managing this large survey contract.

Joanna Buffington, MD, MPH; Scott Damon, MAIA; Linda Moyer, RN; David Culver, PhD
Centers for Disease Control and Prevention
Atlanta, Ga

1. Alter MJ, Kruszon-Moran MS, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med. 1999;341:556-562. FREE FULL TEXT 2. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Morb Mortal Wkly Rep. 1998;47(RR-19):1-16. 3. Maibach E, Maxfield A, Ladin K, Slater M. Translating health psychology into effective health communication: the American Healthstyles Audience Segmentation Project. J Health Psychol. 1996;1:261-278. ABSTRACT

Letters Section Editors: Stephen J. Lurie, MD, PhD, Senior Editor; Phil B. Fontanarosa, MD, Executive Deputy Editor.

JAMA. 2000;284:1651-1652.

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