Adolescents and young adults (AYAs) ages 15-39 with cancer have experienced stagnant survival rates for the past 30 years in comparison to those older or younger diagnosed with cancer. Survival disparities for this population may be due to biologic factors, lack of consistent and effective access to care, and unique psychosocial needs of this age group, and taken together, present an opportunity for health policy intervention. Of particular interest are barriers most important to AYAs themselves, appropriate and timely clinical trial enrollment, and the ability to preserve fertility prior to initiating treatment. These barriers may be more difficult to overcome for AYAs that are from rural areas, those that may be un- or under- insured, of lower socioeconomic status or educational attainment, and other social determinant of health related-factors. In this dissertation, I examined the factors that drive the challenges encountered by AYAs with cancer and discuss potential solutions to overcome these challenges. The first aim of this dissertation establishes which challenges or aspects of the cancer experience are most important to AYAs using a mixed methods approach. The second and third aims build off of challenges identified in aim one using quantitative methods. In aim two, AYA clinical trial enrollment in the United States is examined using a nationally-representative sample with a specific focus on rural disparities. In aim three, historical utilization of fertility preservation consultations and procedures are studied among AYAs treated a single institution serving a rural population.

Dissertation (Ph.D.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 206 pages. Includes vita. Includes bibliographical references.

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Most adolescents and young adults who experience psychological distress do not seek professional help. This study aims to enhance the understanding of sociodemographic, psychological, and clinical characteristics associated with the underuse of health services by adolescents and young adults with mental disorders. Data from a cross-sectional, epidemiological study with a population-based sample (N = 1180 participants, 14–21 years old) were used. Participants completed a fully standardized, computer-assisted diagnostic interview (DIA-X-5/D-CIDI) administered by trained clinical interviewers to assess lifetime mental disorders according to DSM-5 as well as lifetime health service use for mental health problems, and completed self-report questionnaires to assess various psychological variables (e.g., stigma). Predictors of health service use were examined using univariate and multiple logistic regression analyses, data were weighted for age and sex to improve representativeness Of n = 597 participants with any lifetime mental disorder, 32.4% [95% CI 28.4; 36.7] had ever used any health services because of a mental health, psychosomatic, or substance use problem. Even less had received psychotherapeutic or pharmacological treatment (Cognitive Behavioral Therapy: 12.1% [9.5; 15.2]; other psychotherapy: 10.7% [8.4; 13.7]; medication: 5.4% [3.7; 7.8]). High education was associated with less health service use (low/ middle/ other vs. high education: 53.8% vs. 26.9%; OR = 0.26, p < .001). In the multiple regression model, stigma toward mental disorders was the single psychological variable associated with a reduced likelihood of using health services (OR = 0.69 [0.52; 0.90], p < .01). These findings draw attention to the treatment gap for mental disorders during adolescence and highlight related factors to be addressed in public health contexts.

Dissertation (Ph.D.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 123 pages. Includes vita. Includes bibliographical references.