An extensive body of research suggests that increasing access to contraception can improve the health of women and children and increase their socioeconomic mobility through increased wages and labor force participation. In the United States, however, contraception and childbearing has historically been used as a form of racist and eugenic population control. This thesis outlines the history of contraception in an intersectional context, inspired largely by the work of Martha Bailey and Dorothy Roberts, from forced childbearing during chattel slavery, to the forced and or coercive sterilization of large populations of Black and Brown women in the modern era. Given the historical racism of contraception, combined with the possibilities for increased socioeconomic mobility and self-determination that accompany increased access to contraception, leads this thesis to ask: who lacks access to contraception in the U.S. today? An original analysis of data from the Guttmacher Center determines that Hispanic women are the most likely to lack access to birth control, followed by younger women and impoverished women. These findings, in conversation with the current implications of the racist past of contraception, imply the need for anti-racist contraception programs that prioritize informed consent and patient autonomy. Such programs could improve women’s and child health, decrease government spending, and contribute to increasing economic and racial equality.

Colorectal cancer (CRC) is the second leading cause of death in the United States and has the highest death rate among Blacks. Whereas studies have targeted patients to increase CRC adherence in the general population few studies have focused on improving providers’ adherence to screening guidelines. Also, CRC screening studies among HIV-positive patients consistently show lower screening rates compared to screening rates among HIV negative persons. Results of screening colonoscopy studies among HIV positive patients show higher prevalence of neoplastic lesions and colon cancer is diagnosed at advanced cancer stages; these patients have shorter disease-free survival compared to HIV-negative patients. The aim of this transdisciplinary retrospective–prospective and randomized control study is to examine providers’ adherence to screening colonoscopy guidelines before and after screening reminders, evaluate the impact of an educational screening video and review of colonoscopy decisions tree plus usual care on patient adherence compared to usual care only. Results showed that providers’ adherence to screening colonoscopy guidelines significantly increased after reminders to refer patients were placed in medical records. The randomized trial showed that patients in the intervention group were more adherent to screening colonoscopy appointments compared to patients in the usual care arm. Also, patients with little or no social support in the intervention arm were more likely to keep appointments. This is the first reported study of a Transdisciplinary prevention model integrating evidence-based medicine, behavioral medicine and human factors decision support through a multi-faceted intervention to increase screening colonoscopy adherence in the HIV population. We integrated a provider reminder system, patient informed decision support of colonoscopy educational video and decision tree review in addition to patient provider communication to promote increased provider and patient screening behavior. Further studies are needed to elucidate the impact of patient centered intervention strategies and social support on screening colonoscopy behavior.

Source: Dissertation Abstracts International, Volume: 70-07, Section: B, page: 4118. Adviser: Charles L. Begley. Includes bibliographical references.

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.

This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.

Objectives: Adherence to National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer treatment improves patient outcomes. The aim of this study was to assess disparities associated with ovarian cancer treatment in the state of Kentucky and central Appalachia. Methods: Data on patients diagnosed as having ovarian cancer from 2007 through 2011 were extracted from administrative claims-linked Kentucky Cancer Registry data. NCCN compliance was defined by stage, grade, surgical procedure, and chemotherapy. Selection criteria were reviewed carefully to ensure data quality and accuracy. Descriptive analysis, logistic regression, and Cox regression analyses were performed to examine factors associated with guidelines compliance and survival. Results: Most women were age 65 years or older (62.5%), had high grade (65.9%) and advanced stage (61.0%) ovarian cancer. Two-thirds of cases (65.9%) received NCCN-recommended treatment for ovarian cancer. The hazard ratio (HR) of death for women who did not receive NCCN-compliant care was 62% higher compared to the women who did receive NCCN compliant treatment (HR 1.62, 95% CI 1.11-2.35). Results from the logistic regression showed that NCCN-compliant treatment was more likely for: women age 65-74 years compared to age 20-49 (OR=3.32, 95% CI=1.32- 8.32), late stage compared to early stage cancers (OR 0.32, 95% CI 0.20-0.53), receipt of care at tertiary hospitals (OR=1.92, 95% CI=1.10-3.34), and privately insured compared to Medicaid (OR=0.31, 95% CI=0.13-0.77) or Medicare (OR=0.31, 95% CI=0.15-0.66). Conclusions: When the treatment of ovarian cancer did not follow NCCN-recommendations, patients had a significantly higher risk of death. Women were less likely to receive NCCN-compliant care if they were of younger age (20-49 years), had early stage disease, were not privately insured, or had care provided at a non-tertiary hospital.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Thesis (M.Sc.). / Written for the Faculty of Dentistry, [Dept. of Dental Sciences]. Title from title page of PDF (viewed 2009/07/08). Includes bibliographical references.

Dissertation (Ph.D.)--University of South Florida, 2006. / Title from PDF of title page. Document formatted into pages; contains 216 pages. Includes vita. Includes bibliographical references.

Made available in DSpace on 2015-06-17T19:34:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-26. Added 1 bitstream(s) on 2015-06-18T12:48:27Z : No. of bitstreams: 1 000829996.pdf: 1018440 bytes, checksum: cb239bb801c0120c7ebf1909d8d15f54 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo deste estudo foi verificar as correlações da doença periodontal, perda dentária e edentulismo com fatores socioeconômicos e demográficos, necessidades e uso dos serviços de saúde bem como o impacto dessas correlações na saúde bucal de adultos e idosos brasileiros e comparar a estimativa padrão de necessidades com a abordagem sócio-odontológica. Os dados utilizados foram obtidos da pesquisa epidemiológica conduzida em 2010 pelo ministério da saúde chamada SBBrasil 2010. A amostra foi composta de 9779 pessoas entre 35-44 anos e 7619 idosos entre 65-74 anos. Os desfechos em saúde bucal foram: sangramento pós sondagem e/ou cálculo dentário, perda de inserção periodontal, perda dentária e edentulismo. Nível de escolaridade e renda foram utilizados como indicadores socioeconômicos. Gênero, etnia, região de residência, uso de serviços odontológicos, impacto dos dentes nas atividades diárias e outras variáveis foram adicionadas aos modelos para ajustar a análise. Regressão de Poisson foi realizada para verificar as disparidades socioeconômicas e demográficas em saúde bucal com relação aos determinantes proximais e distais disponíveis no banco de dados. O teste de McNemar foi utilizado para comparar as estimativas padrão de necessidade e o respectivo impacto relacionado. Os resultados mostraram associação (p<0.05) entre aspectos socioeconômicos e demográficos e as variáveis de saúde bucal. Pessoas que declararam até 8 anos de educação formal demonstraram maior prevalência em todas as doenças bucais estudadas. Da mesma forma, adultos que declaram renda de até 500 reais, tiveram maior prevalência em três das quatro doenças estudadas. Etnia esteve associada a sangramento pós sondagem e/ou cálculo dentário (PR=1.19) e perda dentária (PR=1.45) entre adultos que declararam-se pardos. Ter realizado... / The aim of this study was to verify the correlations of periodontal disease, tooth loss and edentulousness with socioeconomic and demographic factors, health needs and health services as well as the impact of these correlations on oral health among Brazilian adults and elderly and compare the standard estimate of need with a sociodental assessment. The data originated from a national epidemiological survey on oral health conducted in 2010 by the Brazilian Health Ministry (SBBrasil 2010). The sample comprised 9779 people between 35-44 years old and 7619 elderly between 65-74 years old. The oral health outcomes were as follows: bleeding on probing and/or dental calculus, periodontal loss of attachment, tooth loss and edentulousness. Education level and declared income were used as indicators of socioeconomic status. Gender, ethnicity, region of residence, use of dental care, impact of teeth in daily activities, and other variables were added to the models to adjust the regression analysis. Poisson regression was performed to verify the socioeconomic and demographic disparities in oral health with regard to the proximal and distal determinants of health available in the data set. McNemar's test was applied to compare standard estimates of need and the respective impact-related. The results showed associations (p<0.05) between socioeconomic and demographic aspects and all oral health variables. People who had up to 8 years of formal education had increased the prevalence to develop any of the oral diseases on this study. As much as adults whom declared income up to 500 BRL, that had increased the prevalence to develop three of the four studied conditions. Ethnicity had association with bleeding on probing/or dental calculus (PR=1.19) and tooth loss (PR=1.45) between adults who declared themselves as brown. Having a consultation...