Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Elizabeth Dugan

Second Advisor

Qian Song

Third Advisor

Kristie Long-Foley


Lung cancer is the most common cancer globally and mainly affects older adults as approximately 70% of people diagnosed with lung cancer are aged 65 or older. While there is an abundance of research conducted at individual levels identifying risk factors for developing lung cancer, research at geographic levels is less well-developed. The purpose of this dissertation is to investigate the geographic-level risk factors associated with community rates of lung cancer.

Study 1 conducted a systematic review to identify risk factors associated with lung cancer at geographic levels conducted in the empirical literature. CINAHL, ScienceDirect, Web of Science, and PubMed were searched. Inclusion criteria was an outcome of lung cancer incidence, the units of analysis were geographic units (i.e., states, counties, communities), and published in English. Twenty studies were included, and thirteen unique geographic-level risk factors associated with lung cancer incidence were identified.

Informed by the findings of study 1, studies 2 and 3 utilized data from the Healthy Aging Data Report Masterfile’s and other publicly available secondary datasets to examine geographic-level risk factors with lung cancer prevalence in our study sample of N=796 towns in Connecticut, Massachusetts, New Hampshire, and Rhode Island. Study 2 conducted a factor analysis for data reduction purposes and three latent constructs emerged: urbanicity and access to screening facilities, comorbid respiratory conditions, and presence of toxic release facilities. In regression analyses, the latent construct comorbid respiratory conditions was strongly associated with town-level lung cancer and comprehensive smoke free legislation coverage, ozone emissions, and 65+ with low education were also significant risk factors.

Lastly, study 3 aimed to use spatial modelling to identify the direct effects the risk factors had on a town’s lung cancer rates. Hot spot analyses identified multiple clusters of hot and cold rates in our sample and spatial regression models found comorbid respiratory condition prevalence and ozone emissions were found to increase prevalence of lung cancer by 7% and 8%, respectively.

Overall, this dissertation adds to the knowledge base of how place affects health. Findings from the three studies demonstrate the role town-level risk factors play in 65+ lung cancer rates.


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