Date of Award

Spring 5-13-2022

Degree Type


Degree Name

Doctor of Social Work (DSW)

First Advisor

Heather Klusaritz

Second Advisor

Stacie Metz


BACKGROUND: Despite all that is known about the importance of preventative healthcare, over one-third of American women do not receive recommended screenings for breast and cervical cancer in the form of mammograms and pap smears. In recent decades, the original Adverse Childhood Experience (ACE) Study put forth by Kaiser Permanante and The Center for Disease Control has shed light on the strong relationship between ACEs, negative health behavior, and poorer health outcomes later in life. The ACE study has been replicated numerous times since its inception, including by The Philadelphia Urban ACE Survey, which sought to better understand how ACEs specific to urban environments might also impact adult health outcomes and health behaviors. An integration of the Andersen behavioral model of health utilization and trauma theory was used to guide this study. METHODS: This study sought to determine whether an association existed between adverse neighborhood experiences in childhood and adherence to recommended mammogram and pap smear guidelines in adulthood by analyzing secondary data collected from The Philadelphia Urban ACE Survey. A logistic regression model was used after controlling for several factors known to influence mammogram and pap smear utilization. RESULTS: No association was found between community-level ACEs and mammogram and pap smear adherence. Other findings, based on current literature, included both expected and unexpected results. Interpretation, discussion, and implications of the study are discussed, along with suggestions for future research. KEYWORDS: ACEs, expanded ACEs, urban ACEs, community ACEs, mammograms, pap smears

Available for download on Thursday, June 08, 2023