Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Vasileios Margaritis


Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, disability, and cost globally and in the United States. Various sources point to women experiencing greater morbidity, increased health care resource use and higher incidence of mortality resultant from COPD. While exact causality is not fully understood, it is possible that social bias towards COPD in women impacting screening and timely diagnosis may be a contributing factor. This current investigation involved the social ecological model. In this cross-sectional secondary analysis of Behavioral Risk Factor Surveillance System, 2017 data, differences in screening through use of breathing testing among 6334 males and females who have knowledge of COPD were assessed through descriptive statistics, Pearson’s chi-squared test, and binomial logistic regression (BLR). Bivariate analysis indicated a marginally significant association between sex and participation in breathing tests (χ2 = 3.44, p = 0.063), disproportionately impacting women who used tests less. According to BLR models, females were 15.9% more likely not to take the breathing tests compared to males (OR = .841, CI 95%: 0.739-0.961) adjusted for COPD symptoms, and females were 11.7% more likely not to take the breathing test when controlling for healthcare coverage, but this result was marginally significant (OR=.883 CI 95%: .775-1.007). This study can offer insight into the use and patterns of breathing testing among the US population while further describing potential gaps in care, serving as catalyst towards driving necessary education, policy development and broader social change.