Publication Date

2022

Document Type

Dissertation/Thesis

First Advisor

Shokrani, Masih

Degree Name

Ph.D. (Doctor of Philosophy)

Legacy Department

School of Interdisciplinary Health Professions

Abstract

Breast cancer is a significant public health problem. Globally, breast cancer is the most common form of cancer and is the leading cause of cancer-related mortality in women. African American women population has a higher mortality rate due to breast cancer when compared to non-Hispanic White women. Additionally, breast cancer incidence rates are also relatively higher in young African American women compared to their non-Hispanic White counterparts. Early detection remains the most important strategy for combatting breast cancer that can significantly reduce the mortality rate. It has been observed that breast cancer has a more devastating effect on younger African American population compared to non-Hispanic White, and therefore, educating younger women aged 18-49 can have a positive impact on changing behaviors and making better strides to emphasize the importance of breast cancer screening. The objective of this research study is to understand the current knowledge and perception of young African American female college students regarding breast cancer and help identify the gaps that exist in their knowledge, perception, health behaviors, and screening practices. To fulfil the objectives of this study, an integrative literature review was conducted to generate systematic evidence regarding current breast cancer screening motivators and challenges in African American women population. Additionally, data was collected from college students regarding their knowledge and perception of breast cancer, screening habits, and associated health behaviors using a self-administered questionnaire. The survey questions for breast cancer related knowledge and breast cancer related perception were developed using a modified version of the pre-validate Breast Cancer Awareness Measure (BCAM) questionnaire and the Champion’s revised Health Belief Model Scales (CHBMS). The common motivators identified for breast cancer screening in African American women included knowledge about cancer, personal experiences, and other factors including ease of transportation, presence of female healthcare providers in the screening facility, and easy access to healthcare facilities. The barriers identified were categorized into five groups – lack of knowledge, concerns about screening related costs, perception of breast cancer and the associated fear, individual or personal factors, and other factors including religious and fatalistic beliefs, perceived discrimination, and accessibility. For the survey based study, the final sample consisted of 623 participants, of which 518 (83.1%) students were non-Hispanic Whites and 105 (16.9%) students were African Americans. Statistical analysis revealed that most of the students had moderate knowledge about breast cancer, its symptoms, and its risk factors. There was no statistically significant difference in breast cancer related knowledge scores between the non-Hispanic White and the African American student groups after adjusting for the covariates education, income, and family history of breast cancer. Additionally, no statistically significant difference in breast cancer related knowledge scores was observed between students who had a family history of breast cancer and students who did not have a family history of breast cancer after adjusting for the covariates education, income, and ethnicity. The breast cancer related perceived susceptibility scores were statistically significantly different between non-Hispanic Whites compared to the African American group [F(1,607) = 17.184, p = < 0.001] after adjusting for the covariates education level, income, and family history of breast cancer. However, the effect size was small (0.028), which indicated that ethnicity only accounted for 2.8% of the variance in breast cancer related perceived susceptibility. Similarly, there was a statistically significant difference in breast cancer related perceived benefit scores between the non-Hispanic White and the African American student groups [F(1,607) = 7.778, p = 0.005] after adjusting for the covariates education, income, and family history of breast cancer. However, the effect size was small (0.013), indicating that ethnicity only accounted for 1.3% of the variance in breast cancer related perceived benefits. A statistically significant difference in breast cancer related perceived susceptibility scores was observed between students who had a family history of breast cancer and students who did not have a family history of breast cancer [F (1,607) = 58.407, p < 0.001], with a medium effect size (0.088), that indicated that family history accounted for 8.8% of the variance in breast cancer related perceived susceptibility. There was no statistically significant difference in breast cancer related perceived barrier scores between the non-Hispanic White and the African American student groups after adjusting for the covariates education, income, and family history of breast cancer. Additionally, no statistically significant difference in breast cancer related perceived benefit and perceived barrier scores were observed between students who had a family history of breast cancer and students who did not have a family history of breast cancer after controlling for the covariates education, income, and ethnicity. Only 29.7% of the total students had an adequate breast cancer screening practice. However, a higher percentage of African American students had adequate screening practices (42.9%) compared to non-Hispanic White students (27%). Statistical analysis further revealed a statistically significant difference in breast cancer related screening habits between the non-Hispanic White and the African American student groups [F(1,607) = 13.916, p < 0.001] after adjusting for the covariates, although the effect size was small (0.022), which indicated that ethnicity accounted for 2.2% of the variance in breast cancer related screening practices. It was also observed that there was a statistically significant association between screening practices and knowledge level for breast cancer [χ2(2) = 12.783, p = .002], although the level of association was small (0.143). There was no statistically significant difference in breast cancer related health behaviors between the non-Hispanic White and the African American student groups, after adjusting for the covariates education, income, and family history of breast cancer. Additionally, there was no statistically significant association between health behaviors and knowledge level for breast cancer. The findings from this study will contribute to the currently limited resources that are available on the knowledge, perception, and screening behaviors of young African American college students. Although a higher number of interventions have been developed for this specific population over the last few years, however, the results from this study indicated that further research is required to understand the complex relationship between the different covariables and the knowledge, perception, and screening practices of breast cancer in African American population.

Extent

152 pages

Language

eng

Publisher

Northern Illinois University

Rights Statement

In Copyright

Rights Statement 2

NIU theses are protected by copyright. They may be viewed from Huskie Commons for any purpose, but reproduction or distribution in any format is prohibited without the written permission of the authors.

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