UNIVERSITY OF CALIFORNIA, SAN DIEGO SAN DIEGO STATE UNIVERSITY Breast Cancer Screening Disparities among Ethnically Diverse Women in California: A Latent Profile Analysis A dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Philosophy in Clinical Psychology by Arianna Aldridge Gerry Committee in charge: University of California, San Diego Professor Mark Myers Professor Thomas Rutledge San Diego State University Professor Scott C. Roesch, Chair Professor Vanessa Malcarne Professor Linda Gallo 2011 Copyright Arianna Aldridge Gerry, 2011 All rights reserved. The Dissertation of Arianna Aldridge Gerry is approved, and is acceptable in quality and form for publication on microfilm and electronically: Chair University of California, San Diego San Diego State University 2011 iii DEDICATION This dissertation is dedicated to my parents, Andrew and Sylvia Aldridge, whose faith, wisdom, support, and love have inspired my passion for discovery, creativity, and determination to realize my aspirations. Their foundation of love and support has fueled my efforts throughout the arduous process of research, writing, and defending my dissertation. I am forever grateful and blessed to have such incredible parents who have loved and supported me on every step of my journey. In dedication to my husband, Jon Gerry, who has been a source of inspiration and support throughout my entire dissertation endeavor. He balanced my life when it could have become narrow in scope, fostered my creativity, and inspired me to persevere when the completion of my dissertation felt illusive. I am blessed to have such an amazing husband who lights up my life each day, and with whom I can share this pivotal point in my career. In dedication to my mentor, Scott C. Roesch, whose guidance, support, insight, statistical expertise, and mentorship have been instrumental in all aspects of my graduate training. Dr. Roesch enabled me to formulate, develop, and hone my abilities as a researcher and clinical psychologist. He fostered a collaborative environment, challenged me to stretch my ideas and research perspectives, inspired confidence, and encouraged me to pursue my research interests. I cannot express my gratitude for the opportunities I have had as his mentee. He is truly the best mentor I could have ever hoped for to guide me through my graduate training and beyond. iv TABLE OF CONTENTS Signature Page……………………………………………………………………………iii Dedication………………………………………………………………………………...iv Table of Contents………………………………………………………………………....v List of Tables………………………………………………………………………….….vi Vita……………………………………………………………………………………....vii Abstract…………………………………………………………………………..........xviii Introduction…………………………………………………………………………….…1 Background & Significance……………………………………………………………….6 Breast Cancer Survival & Correlates of Risk……..…………………………………...6 Modifiable Risk Factors & Health Behaviors.......……………………………………10 Screening for Breast Cancer………………………………………………………….14 Disparities in Screening Behavior……………………………………………………20 Methods…………………………………………………………………………………..37 Data Source & Sample………………………………………………………………..36 Study Design………………………………………………………………………….39 Observed Variables for the LPA……………………………………………………...41 Dependent Variables………………………………………………………………….53 Results…………………………………………………………………………………....54 Sample Frequencies & Descriptives………………………………………………….54 Statistical Analyses…...………………………………………………………………56 Ethnicity Moderator Analyses………………………………………………………. 65 Discussion………………………………………………………………………………..76 LPA Class Interpretation……………………………………………………………..76 Ethnicity and Class Interaction Interpretation………………………………………..86 Study Limitations……………………………………………………………………..97 Summary and Future Recommendations……………………………………………100 References……………………………………………………………………………....103 Tables………………………………………………………………………………...…131 v LIST OF TABLES Table 1: Model fit Indexes for the 2-, 3-, & 4-Class Solutions………………………..131 Table 2a: Health Conditional Response Means and Probabilities……………………..132 Table 2b: Stress Conditional Response Means and Probabilities……………………...133 Table 2c: Demographic Conditional Response Means and Probabilities……………...134 Table 3: Interactions of Health Classes x Ethnicity for Screening Outcomes…………135 Table 4: Interactions of Stress Classes x Ethnicity for Screening Outcomes………….136 Table 5: Interactions of Demographic Classes x Ethnicity for Screening Outcomes….137 Table 6: Representation of Women by Ethnicity in Classes…………………………...138 vi CURRICULUM VITA ARIANNA ALDRIDGE GERRY, Ph.D. AREAS OF CURRENT INTEREST . Stress, Coping, and Adjustment with Chronic Illness . Relationship of Stress, Sleep, Immune Functioning, and Breast Cancer . Ethnic Disparities in Mental and Community Health . Dissemination of Mental Health Interventions for Adults with Chronic Illness EDUCATION 2011-2013 NIH T32 Postdoctoral Research Training Fellowship Stanford University Department of Psychiatry and Behavioral Sciences Center on Stress and Health 2010-2011 Clinical Psychology Internship (APA – accredited) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA Behavioral Medicine Track: Rotations: Behavioral Medicine Clinic, Pain, MOVE Time, Co-Ed Intensive Treatment Unit, ACT Mini Rotation, Hematology/Oncology, Primary Care, Health Services Research & Development. 2011 Ph.D. in Clinical Psychology University of California, San Diego & San Diego State University UCSD/SDSU Joint Doctoral Program in Clinical Psychology. Dissertation: “Breast cancer screening disparities among ethnically diverse women in California: A latent profile analysis.” Chair: Scott C. Roesch, Ph.D. 2010 M.P.H., San Diego State University, Public Health and Behavior 2008 M.S., San Diego State University, Clinical Psychology 2003 B.S., Santa Clara University, Psychology Minor: General Business Degree Honors: Magna Cum Laude GRANTS AWARDED 2007-2010 NRSA Pre-doctoral fellowship award (F31HD056623) “Stress and coping in minority adolescents: An internet-based daily diary study.” Funded by the National Institute of Child Health and Human Development. vii HONORS & AWARDS 2008 Dorathe L. Frick Memorial Award “In recognition of significant contributions made to the Doctoral Training Facility and the Doctoral Program by a third year doctoral student.” – UCSD/SDSU 2007-2010 UCSD Student Travel Scholarship Award 2007-2010 SDSU Student Travel Scholarship Award 2003 B.S. Magna Cum Laude – Santa Clara University (SCU) 2003 Wilheim Wundt Award: “Outstanding performance in scholarship, psychological research and service.” – SCU 2003 National Dean’s List 2000-2003 SCU Dean’s List 2003 Valedictorian Nomination – SCU 1999-2003 4-year Academic Scholarship Award – SCU RESEARCH EXPERIENCE 2011 Psychology Intern/Research Associate Veterans Affairs Palo Alto Health Care System, Palo Alto, CA Health Services Research & Development Supervisor – Julie Weitlauf, Ph.D. Co-investigator on a study that examines trauma exposure (e.g., physical/verbal abuse) and psychosocial dysfunction (e.g., depression, social strain, sexual dissatisfaction) as barriers to cervical cancer screening. The study examines these relationships prospectively within the Women’s Health Initiative data. Supervisor – Michael Cucciare, Ph.D. Investigating the role of perceived consequences and social norms of alcohol/substance use as mediators of the relationship of coping, physical, and mental health as they relate to alcohol or substance use behavior. The study will also explore whether brief MI intervention within Primary Care settings changes perceptions and norms, ultimately modifying alcohol/substance use behavior. 2005-Present Research Associate/Lab Manager SDSU Stress & Coping Lab, San Diego, CA Committee Chair: Scott C. Roesch, Ph.D. Examination of daily stress, coping, and adjustment in ethnic minority adolescents, including health disparities. Involved in refining the daily diary website, measurement selection, implementation of the study, and supervising and training research assistants. Responsible for performing statistical analyses; Latent Profile Analysis (LPA) and Hierarchical Linear Modeling. Dissertation research: Explores health, stress, and demographic variables associated with women’s breast cancer screening behaviors among ethnically diverse women in California. Primary aims of the viii study are to establish typologies of women, through LPA, to identify breast cancer screening profiles that may distinctly influence screening participation. 2007-2010 Research Associate/Statistical Consultant UCSD Moores Cancer Center & Community Outreach, San Diego, CA Supervisors: Vanessa Malcarne, Ph.D., & Georgia Sadler, Ph.D., MBA . Validation of American Sign Language (ASL) and Spanish translated psychosocial and physical health measures (e.g., SF-12 Health Survey, Center for Epidemiological Studies Depression Scale, Multidimensional Health Locus of Control, & Barriers to Clinical Trial Participation). Statistical analyses included confirmatory factor analysis, structural equation modeling, multiple groups analysis, and multilevel modeling. 2008-2009 Research Associate/Statistical Consultant UCSD Department of Psychiatry: Addictions Research, San Diego, CA Supervisor: Mark Myers, Ph.D. Validation of a newly developed measure the Behavioral Undercontrol Questionnaire, assessing risky youth behavior (e.g., alcohol/substance abuse) in a sample of ethnically diverse sample of UCSD undergraduates. Statistical analyses included confirmatory factor analysis and multiple groups analysis. 2003-2005 Clinical Research Assistant The Parkinson’s