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Reducing Disparities in Colorectal Cancer Screening among Low-Income Non-Elderly Adults in the United States

Eom, Kirsten Yuna (2021) Reducing Disparities in Colorectal Cancer Screening among Low-Income Non-Elderly Adults in the United States. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause
of cancer deaths in the U.S. Despite the high prevalence of CRC, incidence and mortality rates of
CRC have been steadily decreasing since early 2000s as it is one of few screening-amenable
cancers. However, disparities in CRC screening persist among low-income non-elderly adults as
they face a number of socioeconomic barriers to timely access to care. Chapter one assesses
temporal trends in CRC screening services utilization among low-income non-elderly adults using
national survey data for 2003 – 2018. We observe an overall increasing trend in receipt of any
CRC screening and visual tests while an unchanging trend for stool tests during this period.
However, the proportion of low-income non-elderly adults receiving any CRC screening remained
lower than the national average in 2018. Our study expands the current knowledge of patterns in
CRC screening services among low-income non-elderly adults in the U.S. Chapter two identifies
predictors of CRC testing among Pennsylvania Medicaid enrollees using Medicaid administrative
claims data for 2015 – 2019. Being male, being Hispanic, having chronic conditions, and using
primary care services are positively associated with CRC tests among Medicaid enrollees while
being older is negatively associated with receiving CRC tests. With a recent increase in incidence
of CRC among younger adults, our findings can inform state Medicaid agencies to improve quality
of service and overall health status among the populations that they serve. Chapter three examines v
multilevel factors related to CRC screening, including expanded Medicaid coverage under the
ACA and improved care delivery with the Colorectal Cancer Control Program (CRCCP) and
interactions between these two policies using multi-state secondary survey data for 2003 – 2018.
We found no significant systematic impacts of the ACA and CRCCP on lifetime CRC screening
uptake. Future research should consider the complex nature of decision-making processes for CRC
screening use among heterogenous populations of low-income non-elderly adults in the U.S. The
findings of this dissertation will provide insights into the effectiveness of policies and programs
developed to reduce disparities in cancer prevention and detection and help inform future


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Eom, Kirsten Yunakye3@pitt.edukye3
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSabik, Lindsay Mlsabik@pitt.edulsabik
Committee MemberJarlenski, Marian Pmarian.jarlenski@pitt.edumarian.jarlenski
Committee MemberRothenberger, Scott Drothenberger@pitt.edurothenberger
Committee MemberSchoen, Robert Erschoen@pitt.edurschoen
Date: 12 May 2021
Date Type: Publication
Defense Date: 16 April 2021
Approval Date: 12 May 2021
Submission Date: 26 April 2021
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 218
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Cancer Screening Disparities, Colorectal Cancer, Low-Income Adults, Medicaid Expansions
Date Deposited: 12 May 2021 17:20
Last Modified: 12 May 2022 05:15

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