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Disparities of Invasive Cervical Cancer Incidence and Related Factors in Ohio: An Integrated Approach

Plascak, Jesse John
http://rave.ohiolink.edu/etdc/view?acc_num=osu1374147375

Abstract Details

2013, Doctor of Philosophy, Ohio State University, Public Health.
Despite reductions overall, socioeconomic and geographic disparities of invasive cervical cancer incidence (ICCI) persist. Elevated rates of ICCI within Central Appalachia have remained for decades. The goals of this research were to theoretically integrate current knowledge of the causes of socioeconomic disparities with the causes of ICCI disparities within Central Appalachia, to describe the multilevel and spatial characteristic of ICCI in Ohio, and to investigate relationships between sociopolitical, economic, and biobehavioral factors together with the prevalence of cervical abnormalities. Ecosocial theory posits that population patterns of health are consequences of historically interacting, social, economic and political processes. Literature searches of various databases, directories, and websites was conducted to integrate the current understanding of the processes contributing to both socioeconomic and ICCI disparities within Central Appalachia. Individual-level demographic and ICCI data from the Ohio Cancer Incidence Surveillance System were used to describe the multilevel and spatial characteristics of ICCI. Area-level data were gathered for census tract- school district- and county-levels from various Federal and State sources. Hierarchical logistic regression models were used to investigate variation of ICCI at individual- and area-levels. Spatial data analysis techniques described the spatial variation of ICCI at each level and quantified the degree and location of clustering. Individual-level data from the Community, Awareness, Resources and Education Project were used to investigate the relationships between sociopolitical, economic, and biobehavioral factors together with the prevalence of cervical abnormalities. Area-level data were gathered for from various Federal and State sources. Structural equation modeling (SEM) was used to investigate relationships between several latent variables. Mediating effects were also investigated. Ecosocial theory suggests that relationships may exist between historically dependent sociopolitical (i.e., land-use/land-tax policy, public education funding), environmental (i.e., rurality), built environment (i.e., physical activity facilities), socioeconomic factors (i.e., community resources, individual-level SEP), and ICCI or ICCI -related factors (i.e., HPV infection and persistence, tobacco use) in Central Appalachia. Multilevel analysis indicates that county-level teen birth rate and percent without health insurance, and school district-level childhood poverty were associated with increased odds of ICCI, while county-level Chlamydia rate, school district-level taxable land value per a pupil, and census tract-level SEP were associated with decreased odds of ICCI. The spatial distribution of school district-level ICCI changed with model covariate adjustment. Less than 4.3% of ICCI variation was due to area-level factors. SEM analysis indicated positive relationships between risky sexual behavior and HPV infection and persistence and cervical abnormalities; negative relationships between age and risky sexual behavior and tobacco use; and negative relationships between individual-level SEP and tobacco use, risky sexual behavior, and HPV infection and persistence. Advantages of this integrative approach include: 1) a deeper understanding of factors and processes that may contribute to the cause and persistence of ICCI disparities in Central Appalachia, 2) empirical evidence of a previously unconsidered, sociopolitical association with ICCI disparities, and 3) detailed descriptions of the distribution of ICCI measured at multiple geographic levels. Persistent ICCI disparities in Central Appalachia may be the result of complex relationships between historically-dependent social, economic, political, cultural, and environmental processes.
Electra Paskett, Ph.D. (Advisor)
Catherine Calder, Ph.D. (Committee Member)
Amy Ferketich, Ph.D. (Committee Member)
Ningchuan Xiao, Ph.D. (Committee Member)
319 p.
Biostatistics; Ecology; Economic History; Environmental Justice; Epidemiology; Geography; Health; History; Political Science; Public Health; Regional Studies; Statistics
cervical cancer, disparities, Central Appalachia, integrative, sociopolitical, socioeconomic, ecologic, historical, multilevel, spatial, path analysis

Recommended Citations

Citations

  • Plascak, J. J. (2013). Disparities of Invasive Cervical Cancer Incidence and Related Factors in Ohio: An Integrated Approach [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1374147375

    APA Style (7th edition)

  • Plascak, Jesse. Disparities of Invasive Cervical Cancer Incidence and Related Factors in Ohio: An Integrated Approach. 2013. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1374147375.

    MLA Style (8th edition)

  • Plascak, Jesse. "Disparities of Invasive Cervical Cancer Incidence and Related Factors in Ohio: An Integrated Approach." Doctoral dissertation, Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1374147375

    Chicago Manual of Style (17th edition)

osu1374147375
669
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This open access ETD is published by The Ohio State University and OhioLINK.