Date of Award


Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Greer Glazer

Second Advisor

Jacqueline Fawcett

Third Advisor

Dee Baldwin


Healthy People 2010 promoted breast and cervical cancer screening to reduce cancer among all women and reduce disparities in cancer deaths between Black and White women. The REACH 2010 program targeted improving screening rates among Black women and funded a demonstration project to provide outreach, screening, patient navigation and case management for Black women in Boston. The purpose of this study was to describe associations between health insurance and primary care (having a primary care provider [PCP], quality of communications and relationship with PCP) on differences in breast and cervical cancer screening reported by Black women born in the United States and those who were foreign born. The Conceptual Model for Nursing and Health Policy Guidelines for Policy and Program evaluation guided the study. Secondary analysis was performed on data obtained from the Boston Public Health Commission Women's Demonstration Project. Nearly one third of the study population was foreign born. This population was older and less educated than US born women. Having a PCP had greater influence on cancer screening than did health insurance. US born women were more likely to have a PCP than foreign born women, and to be more satisfied with the quality of communication with their PCP. US born women were more likely than foreign born women to report ever having had a Pap smear. Health insurance influence cervical cancer screening for US women only, but having a PCP influenced both groups more than birthplace. For US born women, quality of communications with PCP was a strong predictor of having a recent Pap smear. US born women were more likely to begin mammography earlier, but less likely to have a recent mammogram. Foreign born women with a PCP were more likely to ever have had a mammogram and to have a recent screen than those without a PCP. For US born women, the quality of communication with the PCP was significantly associated with a recent mammogram. Conclusion: Programs to reduce health disparities must address differences within target populations. There is an urgent need to increase access to a diverse and culturally competent interprofessional primary care workforce.