Publication Date




Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Sociology (Arts and Sciences)

Date of Defense


First Committee Member

Linda Liska Belgrave

Second Committee Member

Amie L. Nielsen

Third Committee Member

John W. Murphy

Fourth Committee Member

Hilary L. Surratt


Vulnerable populations are affected by social ills resulting from unjust social, political, and economic systems. The consequences of these structural inequalities may affect health care utilization patterns. I examined the health needs, barriers, and utilization of health care services among a sample of Black, female street-based sex workers in Miami, Florida, while exploring the impact of violence, both physical and structural, on utilization of health care services. To do this, both quantitative and qualitative methods were applied. I used focus group data and a grounded theory approach to illuminate health care experiences and the relationship between structural violence and health care utilization for this group of women. For the quantitative portion, I used Andersen’s Behavioral Model for Vulnerable Populations to test which variables were most efficient in predicting utilization, as well as to test the effect of victimization on utilization. Overall, results indicated that having a consistent and meaningful link or resource for accessing health care facilitates utilization for this group of women and determines future utilization behaviors. Vulnerable and traditional domains in Andersen’s model contributed to predicting health care utilization behaviors, particularly enabling and need variables; however, victimization had no effect on utilization. From the qualitative data, the Experiential Model of Health and Health Care Utilization was constructed linking health definitions, goals, and experiences of seeking health care at one level, all of these to structural violence at a more abstract level and the general ideology that maintains a repressive system. Recommendations for future research are included.


structural violence; vulnerable populations; health care utilization; sex workers; meaning of health; health disparities