Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

Kendra Ratnapradipa

Second Committee Member

Ariane Rung

Third Committee Member

Anthony Blake

Fourth Committee Member

Ishrat Kamal-Ahmed


Objective: To determine if, among women aged 21-65, there is a positive association between avoiding healthcare due to cost and not being up to date on cervical cancer screening.

Methods: This cross-sectional study utilized the 2022 Behavioral Risk Factor Surveillance System dataset. A total of 123,275 women, aged 18-69 without a hysterectomy, were analyzed with bivariate and multivariate analyses. The outcome was length of time since last cervical cancer screening. The exposure was avoiding healthcare in the last 12 months due to cost.

Results: Women who avoided healthcare due to cost had higher odds of not being up to date on cervical cancer screening (aPOR 1.57; 95% CI 1.34,1.84). Risk factors included increased age (Aged 60-69: aPOR 4.02; 95% CI 3.16, 5.11), insurance status, certain races, lacking transportation, lacking primary healthcare providers, and location. Protective factors included increased annual income ($100,000+: aPOR 0.72; 95% CI 0.58, 0.89), speaking Spanish, increased education, and certain races.

Conclusions: This study demonstrates the effect of cost on cervical cancer screening and draws attention to the need for cost-effective health services for at-risk women.

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