Abstract

Black women have the highest mortality rate due to breast cancer compared to any other racial/ethnic group in the U.S. and are more likely to be diagnosed with late-stage breast cancer compared to White women. Though the causes of these disparities are multifactorial, early detection by mammography, in combination with improved treatment, is related to improved breast cancer survival outcomes. Recently, the rate of Black women reporting having had a screening mammogram in the last two years has increased, and by some accounts surpassed, that of White women. This dissertation assesses this change in mammography among Black women in order to help inform future policies impacting preventive health care, which can lead to early diagnoses, and thus improvements in women’s health and reductions in the economic impact of treatment costs. The objective of the study was to identify factors, including geographic place and space, associated with the spatial variation of the increased screening mammography observed for Black women in the U.S. from 2008 to 2012. The central hypothesis was that the spatial distribution of the change in screening utilization is not random, and that the geospatial pattern of change is associated with changes in access to health care when controlling for education, income, demographic factors, and the larger ecological sociodemographic context. The central hypothesis was tested by pursuing the following aims: 1) Assess whether the geographic pattern of change from 2008-2012 of screening mammography among Black women in the U.S. is spatially clustered; and 2) Identify individual- and ecological-level factors associated with the geographic pattern of change from 2008-2012 of screening mammography among Black women in the U.S. Statistical software was used for assessing aspatial data, and Geographic Information Systems (GIS) was used for descriptive mapping and implementing spatial statistical analyses. Results indicate that changes in screening are not consistent across the U.S., Black and White women have increased and decreased screening in different regions, and the impact of variables associated with screening varies by location.

LLU Discipline

Social Policy and Social Research

Department

Social Policy and Research

School

School of Behavioral Health

First Advisor

Susanne Montgomery

Second Advisor

Janice De-Whyte

Third Advisor

Seth Wiafe

Degree Name

Doctor of Philosophy (PhD)

Degree Level

Ph.D.

Year Degree Awarded

2017

Date (Title Page)

9-2017

Language

English

Library of Congress/MESH Subject Headings

Mammography; Early Detection of Cancer; Geographic Information Systems; Ethnicity

Type

Dissertation

Page Count

xiv, 162 p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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