Date of Award

Fall 12-2018

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

MARIA E FERNANDEZ, PHD

Second Advisor

J MICHAEL WILKERSON, PHD

Third Advisor

KAYO FUJIMOTO, PHD

Abstract

This dissertation was a secondary analysis of data from a Cancer Prevention Research Institute of Texas (CPRIT)-funded [grant # PP100077 & PP120086] cancer-control intervention with The University of Texas Health Science Center at Houston (UTHealth) School of Public Health and United Way 2-1-1. The aims of the three dissertation papers were addressed by examining a sub-sample of 2-1-1 callers that were drawn from the parent study baseline data. Participants were required to need at least once cancer prevention service to be included in the parent study and dissertation analyses. This dissertation was a cross-sectional analysis of de-identified data examining the associations between perceived neighborhood problems and cancer screening, perceived neighborhood problems and cancer fatalism, and perceived discrimination and cancer screening. Paper one examined the association between perceived neighborhood problems and colorectal, cervical and breast cancer screening. Adjusted logistic regression results showed that perceived neighborhood problems were not associated with colorectal cancer screening, cervical screening, or breast cancer screening. However, participants that had either public or private insurance had higher odds of being screened for colorectal cancer, cervical cancer, and breast cancer, compared to participants without insurance. Paper two examined the association between perceived neighborhood problems and cancer fatalism. The results of the multiple regression analysis showed that perceived neighborhood problems were associated with fatalism [R2 = .21, F(11, 556) = 13.09, p < 0.0001]. Paper 3 examined how perceived medical and interpersonal discrimination were independently associated with cancer screening. Adjusted logistic regression showed that perceived medical discrimination was associated with a reduced likelihood of being screened for colorectal cancer screening (OR=0.59; 95% CI 0.31, 0.99), but not cervical or breast cancer screening. Perceived interpersonal discrimination was not associated with colorectal, cervical, and breast screening. Additionally, participants that had insurance had higher odds of being screened for cervical cancer (aOR= 2.33, 95% CI = 1.79, 3.03), and breast cancer (aOR= 5.84, 95% CI = 3.72, 9.17), but not colorectal cancer (aOR= 0.28, 98% CI= 0.14, 0.55). The results of all papers 2 and 3 suggest that perceived neighborhood problems and discrimination are potentially associated with lower utilization of cancer screening services. This finding is important because it provides further evidence that environmental conditions, real or perceived, constrain behavior.

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