Date of Conferral

9-11-2026

Date of Award

September 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Edward Irobi

Abstract

Disparities in head and neck cancer (HNC) diagnosis may contribute to poorer outcomes among socially and economically disadvantaged populations. This quantitative secondary data analysis examined associations between socioecological factors and advanced primary tumor category among adults with HNC residing in Pennsylvania and New Jersey. Guided by the socioecological model, deidentified data (N = 350) from two Fox Chase Cancer Center research protocols were analyzed using three domain-specific multivariable logistic regression models. Primary tumor category was classified as lower (Tis–T2) or advanced (T3–T4) based on tumor size and/or local extent. Black participants had greater adjusted odds of advanced primary tumor category than White participants in the individual-level (OR = 2.66, 95% CI [1.40, 5.07], p = .003), community-level (OR = 2.95, 95% CI [1.34, 6.49], p = .007), and oral-health (OR = 3.13, 95% CI [1.64, 5.95], p < .001) models. These findings suggest that the measured factors did not explain the racial difference in primary tumor presentation. Educational attainment, primary payer, age, gender, and Social Deprivation Index were not significantly associated with advanced primary tumor category. Although the overall oral-health block was not significant, loose teeth without injury were inversely associated with advanced primary tumor category (OR = 0.23, 95% CI [0.06, 0.90], p = .034). This unexpected association may reflect differences in symptom recognition, dental care, reporting, referral, or other unmeasured factors. The findings support positive social change by informing equity-focused HNC education, symptom recognition, timely evaluation, referral, and access to diagnostic services for populations at increased risk of advanced tumor presentation.

Download

Included in

Public Health Commons

Share

 
COinS