Publication Date



Open access

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Epidemiology (Medicine)

Date of Defense


First Committee Member

Erin Kobetz

Second Committee Member

Tulay Koru-Sengul

Third Committee Member

Olveen Carrasquillo

Fourth Committee Member

Suzanne Belinson


In 2011 over 500,000 women will be diagnosed with cervical cancer worldwide and approximately 250,000 will die of the disease. The majority of incident cases will occur among women who lack routine access to Papalanicolou (Pap) test screening. While access-related factors, such as income and health insurance status, are primary drivers of screening utilization research suggests that a number of individual and contextual social and cultural factors, such as low cervical cancer knowledge, lower educational attainment and non-Western health beliefs can exert an independent or multiplicative effect. Among the immigrant Haitian population of Miami, Florida the incidence of cervical cancer is more than four times greater than that observed in the non-Hispanic White population of Miami-Dade County, Florida and the Pap screening rate is approximately half the national average for U.S. Blacks. The reasons underlying this disparity have not been fully described in this population. This dissertation examines the association between knowledge and screening and evaluates how individual cultural beliefs, the sociocultural environment, and the socioeconomic context of the neighborhoods where these women reside may be upstream determinants of cervical cancer knowledge and Pap screening.


cervical cancer; pap screening; context; Haitian; culture; hierarchical