THE FACTORS IMPACTING WOMEN’S BEHAVIORS TOWARD BREAST CANCER SCREENING UTILIZATION IN THE UNITED STATES

Abstract

Breast cancer is the most common cancer among women in the U.S. Health disparities exist in breast cancer outcome which could be caused by disparities in the utilization of breast cancer screening. This dissertation investigated the factors impacting women’s behaviors toward mammography screening (MS) utilization and assessed the associated racial/ethnic and age disparities. Chapter 1 introduced the public health problem. Chapter 2 evaluated the impact of women’s SES and their spouses’ characteristics. This is a cross-sectional study using year 2021 data of the National Health Interview Survey (NHIS). Multiple logistic regression models were used, and ORs were reported. Compared to women with low SES, women with middle or high SES were more likely to utilize MS and more likely to adhere to the screening guidelines. Women who have the same race as their spouses and those with younger spouses were more likely to utilize MS and more likely to adhere to the guidelines. Chapter 3 assessed the impact of IT-based healthcare communication (e.g., scheduling a medical appointment on the internet and communicating with healthcare providers by email). This study was conducted using the NHIS from 2011 to 2018. Multiple logistic regression models were used, and ORs were reported. The study found that all IT-based healthcare communication strategies had a statistically significant positive association with MS utilization in all years. White and older women benefited the most from IT-based healthcare communication. Chapter 4 focused on the impact of depressive symptoms and physical activity. This is a longitudinal study that used the Health and Retirement Study data (1996- 2016). Mixed-effects logistic regression models were used, and ORs were reported. The study found that women with moderate or high depressive symptoms were more likely to utilize MS. The odds of the utilization were higher among active women compared to inactive. MS utilization disparity between women with higher depressive symptoms versus low was greater among Hispanics and Blacks compared to Whites, and among older women. Finally, recommendations and future work are discussed (chapter 5 and 6). Considering the factors impacting MS may help increase its utilization and contribute to eliminating disparities in breast cancer mortality.