All ETDs from UAB

Advisory Committee Chair

Mieke B Thomeer McBride

Advisory Committee Members

Monica Baskin

Cindy L Cain

Ronit Elk

Verna M Keith

Document Type

Dissertation

Date of Award

2020

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Although several racial/ethnic minority women groups (e.g., Latina, Black, Asian-American, and Native-American women) have lower breast cancer incidence than white women, they are more likely to die from breast cancer. One possible explanation for this discrepancy is racial/ethnic differences in mammography use. Mammography has been shown to contribute to the discovery of tumor proliferation earlier which translates to less breast cancer complications like greater risk of breast cancer-related mortality. Previous studies on racial/ethnic differences in mammography adherence (e.g., annual and biannual mammography adherence) have been inconclusive, and they generally overlook important contextual factors, namely neighborhood quality and geographic location (e.g., rural, urban), despite their known importance for health. In this dissertation, I examine racial/ethnic differences in mammography adherence, neighborhood component differences in mammography adherence, racial/ethnic differences in mammography adherence among rural women, and whether neighborhood components moderate the association between race-geographical location and mammography adherence. To address these questions, I draw on the theoretical frameworks of Racism as a Fundamental Cause of Health Inequalities, Andersen’s Model of Healthcare Utilization, and Intersectionality to develop my own theoretical perspective “The Race-Place Nexus Theory of Healthcare Use.” In terms of sociological theory, this study extends racism as a fundamental cause theory’s discussion around neighborhood perception/quality which is scant in its current condition. it corrects a missed opportunity of Andersen’s Healthcare Model of Utilization to incorporate an intersectional sociological lens and provide a nuanced treatment of the ways neighborhoods predispose and enable cancer screening use and how marginalized social locations matter for cancer screening use. This theoretical framework guides my analysis of the 2016 California Health Interview Survey, a statewide-representative, cross-sectional sample of the California population. The study’s analytical sample is 7,779 women aged 45 and older living in California. Bivariate descriptive statistics, logistic regression, and marginal predicted probabilities were employed as analytical methods to estimate differences in annual and biannual mammography adherence. Findings indicate that Native-American women experience lower odds and Latina and Black women higher odds of mammography adherence compared to white women, but this depends on the time interval of mammography adherence (e.g., annual or biannual). Neighborhood trust is a significant moderator of annual mammography adherence among Latina, Native-American, and Asian-American women. Lastly, there is a significant association with neighborhood produce availability with biannual mammography adherence. This study attempts to explore mammography differences by race/ethnicity, given a breast cancer mortality racial disparity exists, because mammography is positioned as a health technology that detects tumor malignancies which are often more problematic for women of color. However, this study finds unexpectedly that Latina women are more likely than their white counterparts to be mammography adherent, however, breast cancer is the leading cause of mortality in this group. This finding underscores that urgency of policymakers, healthcare providers, and health disparities to search for other social determinants that help explain this phenomenon and help advocate for providing health-enhancing resources to be distributed across women’s lives that will improve this situation.

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