Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Priscilla K. Gazarian

Second Advisor

Ling Shi

Third Advisor

Suzanne G. Leveille


Screening aims to detect breast and cervical cancers at early treatable stages and reduce cost of care and mortality rates. The Affordable Care Act (ACA) allowed more women to gain access to cancer screening services. Recent national data showed that gaps in mammogram and pap smear screening reduced among non-Hispanic Black (NHB) women while it remained among other minority groups. This study compared cancer screening rates by race and ethnicity and examined: (1) access to care (health insurance and having a primary care provider) (PCP), (2) cancer beliefs/attitudes, and (3) the mediation effects of the three negative cancer beliefs/attitudes (fatalism, worry, and lower cancer risk perception) on access to care in relation to mammogram and pap smear screening. Descriptive statistic, bivariate analysis, and logistic regression models were used to examine these associations. This is a secondary data analysis of four iterations of Health Information National Trends Survey (HINTS) 2014-2019 data to maximize the sample size. Findings indicated that mammogram and pap smear screening rates were not lower among minority women when compared to non-Hispanic White (NHW) women. Negative cancer beliefs and attitudes differed by race groups. Yet, there was no association between negative cancer beliefs and attitudes and mammogram and pap smear screening when race is adjusted. Access to care factors mediated the relation between race and mammogram screening only. However, among a subsample of minority woman having a PCP was not associated with mammogram and pap smear screening. These findings provide vital information for health professionals and policy makers about screening behaviors among minority women after the ACA. Further investigations are warranted on minority women’s experience when accessing health care system mainly on mistrust and health provider communication.


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