Defense Date


Graduation Date

Fall 1-1-2017


One-year Embargo

Submission Type


Degree Name





School of Nursing

Committee Chair

Alison M. Colbert

Committee Member

Joan S. Lockhart

Committee Member

Ismail Jatoi

Committee Member

Nancy Breen


mammography utilization, health disparity, African American, homelessness, vulnerable population, national health interview survey, behavioral model, Gail risk score, breast cancer health disparity


Purpose: Breast cancer presents differently among women causing breast cancer health disparities with women of color disproportionally shouldering later-stage screening, incidence, and treatment, and greater mortality. This study assessed 10 predictors and rates of recent and long-term mammography utilization for women 43-79 years of age to better understand differences among age strata and races. This was the first study to use both the calculated Gail Risk scores (calculates absolute breast cancer risk over time intervals) from the 2010 National Health Interview Survey (NHIS) and a temporary homelessness variable in predicting mammography utilization using national-level data.

Theoretical Framework: A modified Behavioral Model for Vulnerable Populations guided this study and provided a unique and well-established framework in evaluating vulnerable population domains and ethnicities.

Methods: Secondary data analysis of 2010 NHIS data was completed, that included a Cancer Control Module (cancer control questions), which is incorporated into the NHIS every five years. Using logistic regression, N= 6,334; n=1,141 for African American (AA) was used to examine mammography utilization differences between and among age strata and races (AA, Non-Hispanic White, and Hispanic), with focus on younger AA women in their 40s. Wald F test statistics with two-sided p-values

Results:AA had the highest (79.3%) of lowest risk Gail Risk scores, while Whites had the highest (30.7%) of highest risk Gail Risk scores. There was no statistically significant difference in Gail Risk scores by race on recent, Wald F(2, 299)=1.76, p=0.18, and long-term Wald F(2, 299)-0.58, p=0.56. Women in the 50-64 age strata had greater odds of both recent, Wald F(2, 299)=7.52, p

Significance to Nursing: Risk assessment and mammography are vital prevention modalities in mitigating breast cancer health disparities. It is important for women to know their risk and for continued testing of predictor interactions to improve mammography knowledge and practice.



Additional Citations

Kidd, A. D., Colbert, A. M., & Jatoi, I. (2015). Mammography: review of the controversy, health disparities, and impact on young african american women. Clin J Oncol Nurs, 19(3), E52-58. doi: 10.1188/15.CJON.E52-E58