Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 A Comparative Study of Cervical Cancer Among Indigenous Amerindian, Afro-Guyanese, and Indo- Guyanese Women in Guyana Carol Jones-Williams Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Carol Jones-Williams has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Donald Goodwin, Committee Chairperson, Public Health Faculty Dr. Shingairai Feresu, Committee Member, Public Health Faculty Dr. Michael Furukawa, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2016 Abstract A Comparative Study of Cervical Cancer among Indigenous Amerindian, Afro- Guyanese, and Indo-Guyanese Women in Guyana by Carol Jones-Williams MPH, Walden University, 2012 MA, New York University, 1997 BSc, York College, City University of New York, 1994 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Epidemiology Walden University September 2016 Abstract Cervical cancer is a major public health problem in developing countries. In Guyana, factors associated with increasing cervical cancer cases among Indigenous Amerindian women (IAW), Afro- women (AGW), and Indo-Guyanese women (IGW) have not been fully examined. In this comparative cross-sectional study, 5,800 cervical cancer cases were selected from Guyanese women age 13 and above for ethnicity (Indigenous Amerindian, Afro- and Indo Guyanese women), geographical region, marital status, and year and stage at diagnosis. Secondary data from Guyana Cancer Registry for the 2000-2012 study periods were analyzed using chi-square test, multinomial logistic regression, poisson regression, and relative risk. Geographical region was a strong predictor of cervical cancer cases for all three ethnic groups (p < 0.05). The relative risk for cervical cancer for IAW in Regions 2 (RR = 1.2) and 6 (RR = 1.07) was greater than for IAW in Region 4, the reference group for the study period. Comparatively, the relative risk for cervical cancer for AGW in Region 4 was greater than AGW in all other regions except Region 3 (RR = 1.05). Additionally, the relative risk for cervical cancer for IGW in Region 3 (RR = 1.03) was greater than that of IGW in all other regions. Single IAW (1.05) have a higher risk of getting cervical cancer than their married counterparts as compared to AGW (0.96) and IGW (1.00). Implications for social change include development of tailored programs which utilize a socio-ecological model to address cervical cancer issues at the individual, interpersonal, cultural, and community levels. Future research should focus on understanding the epidemiology of cervical cancer and the social factors among the ethnic groups of women. A Comparative Study of Cervical Cancer among Indigenous Amerindian, Afro- Guyanese, and Indo-Guyanese Women in Guyana by Carol Jones-Williams MPH, Walden University, 2012 MA, New York University, 1997 BSc, York College, City University of New York, 1994 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Epidemiology Walden University September 2016 Dedication This milestone achievement is dedicated to two most beautiful and amazing women in my life, to the memory of my dearest mother, Lucille Jones and to my sister and best friend, Marie Jones whose faith, courage and love have inspired and transformed my life to one of excellence. Thank you for always being there for me through the years, for believing in me when my faith failed, and for selflessly caring and loving me. Thank you for allowing me to see the beauty of Jesus in you. Acknowledgements I first would like to thank God for His unfailing love, grace and faithfulness to me throughout every step of this journey. Without Him, I could not have this sunshine in my life today as I achieve another milestone. It is truly wonderful what the Lord has done! All glory, honor and praise to His most precious name! I wish to express my appreciation to my committee members, Dr. Donald Goodwin and Dr. Shingairai Feresu and to Dr. Michael Furukawa, University Reviewer. Thank you for your time and support during this process. Special thanks to Ms. Penelope Layne, Registrar of the Guyana Cancer Registry for granting permission to use their data. To my family and friends, I’m indebted to you all for your unending love, support, prayers and encouragement. To my sisters, Desiree Jones, Marie Jones, Jackie Hammond, Sandra Jones and my sister-in-law, June Morrison-Jones, you are truly a blessing. Thank you for encircling me with your love and providing me with spiritual wisdom while holding my hands all the way to the finish line and to victory. You are truly incredible and I love you very much! My heartfelt gratitude goes to my extraordinary and very talented brother, Grantley Jones, for all the countless hours you have sacrificed and invested in my dissertation. Thank you for unselfishly sharing your insight, wisdom, and guidance every step of the way. You are truly remarkable and I appreciate and love you very much. To my beautiful niece, Jaquana Jones, thank you for your steadfast patience and assistance with the numerous edits to my dissertation. To my friends, Eunice Reid, Janice Phillips and Gloria James, thank you for your encouragement and uplifting words during this process. You are wonderful friends! Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................. viii Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................3 Problem Statement .........................................................................................................4 Nature of the Study ........................................................................................................7 Research Questions and Hypothesis ..............................................................................8 Purpose of the Study ....................................................................................................11 Conceptual Framework ................................................................................................12 Operational Definitions ................................................................................................13 Assumptions .................................................................................................................16 Limitations ...................................................................................................................16 Delimitations ................................................................................................................17 Significance of the Study .............................................................................................17 Implications for Social Change ....................................................................................17 Chapter 2: Literature Review .............................................................................................19 Introduction ..................................................................................................................19 Background of Guyana ................................................................................................20 Biologic Characteristic of Cervical Cancer .................................................................21 Human Papillomavirus Link to Cervical Cancer .........................................................25 i Introduction ........................................................................................................... 25 Epidemiology of HPV Infection ..................................................................................26 Prevalence ............................................................................................................. 26 HVP Prevalence in Indigenous Populations ......................................................... 31 Risk Factors for HPV ...................................................................................................36 Epidemiology of Cervical Cancer ................................................................................38 Cervical Cancer Incidence in Developing Countries ...................................................42 Latin America ......................................................................................................