Date of Award

Spring 5-2018

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Susan Boser, Ph.D.

Second Advisor

John A. Anderson, Ph.D.

Third Advisor

Alex Heckert, Ph.D.


With early detection through regular screening, cervical cancer is one of the most preventable diseases. Yet in the United States, thousands of women die from cervical cancer every year. Many barriers to cervical cancer screenings exist, including lack of insurance coverage for preventive health services. Research shows that insurance coverage for preventive services such as cervical cancer screening is linked to higher participation in recommended screenings. Under the Affordable Care Act, coverage for preventive healthcare screenings became available to millions of low-income women in those states that opted to offer expanded Medicaid.

However, Pennsylvania’s approach to this expanded coverage was unique. From 2010 until 2014 Pennsylvania did not expand Medicaid. From 2014 until 2016 Pennsylvania transitioned from a waiver program to full Medicaid expansion. The sequential introduction of these three different insurance models in the same state provided an opportunity to examine the impact of insurance coverage on participation in cervical cancer screenings among low-income women.

This study used quantitative methods to examine screening participation of low-income women across the three phases of Medicaid expansion in Pennsylvania. The study used secondary data collected from an annual survey performed by the Centers for Disease Control and Prevention entitled The Behavioral Risk Factor Surveillance Survey (BRFSS). The BRFSS is a well-established data source, and research supports the use of the BRFSS for state-level studies.

The results of this study show that insurance coverage had a positive effect on participation in cervical cancer screening. Low-income uninsured women were less likely (34%, Medicaid; 30% Medicare; 29% Private) than insured women to participate in cervical cancer screening. Other findings suggest that age is a significant predictor (p

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