Colorectal cancer (CRC) is the second leading cause of cancer related death in the U.S. among men and women combined. In addition to the personal toll it takes, CRC is estimated to cost billions of dollars annually in medical costs. Due to the high rates and costs of CRC, a significant public health effort has been made to promote participation in screening, which has been shown to be effective at reducing CRC incidence and mortality rates; however, despite efforts to promote screening and research showing its effectiveness, screening rates remain low. Approaches to increasing screening participation focus on understanding the decision-making process people go through regarding screening. Health economics and health psychology provide two unique approaches to understanding this decision-making process. Health economics approaches model screening behavior as a function of the screening characteristics themselves while health psychology approaches model screening behavior as a function of individual factors related to perceptions and beliefs. This dissertation set out to explain individual differences in screening preferences using both health economics and health psychology approaches. This dissertation utilized three different methods, including a systematic review and meta-analysis, a latent class analysis of discrete choice data, and a discrete choice experiment (DCE) that included psychological factors as characteristics of the screening process. We found evidence to support the hypothesis that differences in screening preferences exist and that individual factors like socio-demographic and psychological factors may play a role in explaining these differences. We also found evidence to support the validity of including psychological factors as attributes that vary in a DCE. This dissertation discusses the implications of the findings for theory, research, and the development of future screening programs.

Background and Objective: Sugar-sweetened beverage (SSB) taxes have been increasing in popularity across the United States and have been implemented in some California cities. Studies have shown SSB taxes reduce the consumption of SSB but also increase the consumption of juice, milk and sugary sweets. Support for an SSB tax is influenced by various factors, including the proposed amount of the tax, how the tax is used and the demographics of the population. The purpose of this study is to examine attitudes towards SSB taxes among a predominantly young, Latino population in California.

Method: Discrete Choice Experiment (DCE). Attributes and levels were defined according to the findings of a literature review and focus groups. The DCE included five attributes and within each attribute were separate related choices. Data was analyzed using a conditional logistic regression model. Separate analyses were performed for low and high SSB consumers to determine if participants took into consideration different attributes when making decisions about what to drink.

Results: A total of n= 315 participated in the DCE survey. Overall, participants expressed a preference for water and juice compared to regular soda. The time it takes to get the beverage and price were important attributes which influence their beverage consumption decisions; they want convenience when getting their drinks and to pay less for them.

Conclusion: These data show that for those who are not yet replacing soda with water or juice they would convert easily. The high value these participants place on water may result in a higher reduction in caloric intake if the price to SSB is increased.

Local Health Departments (LHDs) perform a critical role in providing essential public health services to prevent the spread of disease. National surveys of LHDs from 2008 to 2016 indicate a consistent commitment to providing preventive clinical services such as childhood immunizations, screening and treatment of tuberculosis, and screening and treatment of sexually transmitted disease (STDs). Due to the implementation of the Affordable Care Act in 2010, more people have access to health insurance and preventive services. As more resources are re-directed to community health centers and medical homes, LHDs need to reconsider whether to maintain these preventive clinical services. The challenge for LHDs is the uncertainty about the cost to delivering these services. This dissertation estimates the cost for LHDs to deliver childhood immunizations, screening and treatment of tuberculosis and STDs using resource based costing methods, as well as a community engagement framework to explore barriers in achieving optimal childhood immunization rates. Evidence suggests that while the estimated costs to deliver these preventive clinical services varied widely among LHDs, these costs are comparatively lower than published rates. Evidence also suggests that LHDs in rural counties may experience more barriers in delivering childhood immunization services than their non-rural counterparts. These geographic variations include more rural LHDs reporting lower immunization coverage rates, and experiencing barriers such as lack of timely appointments, high cost to provide immunizations, anti-vaccination concerns, and lack of reimbursement for services from both public and private health insurance providers.

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Introduction: The demand for organs currently far exceeds supply. Understanding individuals’ motivations for deciding whether to donate an organ from a deceased relative would guide outreach efforts.

Methods: Focus group participants and literature were used to identify attributes to create a discrete choice experiment (DCE). Participants (N=86 ages 18 to 31 [mean=20.5]) were presented with 16 choices sets and asked to choose whether they would agree to donate a deceased relative’s organs. The choices contained attributes of the recipient (age, kidney’s lifespan, reason for failure, impact if not transplanted), the deceased donor (donor’s wishes and relationship to decision maker), and monetary incentives (amount, payer, payee). Conditional logit analysis was used to estimate the model, and latent class analysis identified two distinct groups of respondents.

Results: The results suggest a strong preference for donating organs, with the age of the recipient, reason for recipient’s need, and impact of not receiving the organ emerging as important factors. The financial incentive was not important. Latent class analysis suggested the two groups: Respondents in Class 1 placed relatively more importance on the wishes of the donor and having a financial incentive, while those in Class 2 placed relatively more weight on the impact should the recipient not receive the organ. Membership is the groups was predicted by gender and reported risk aversion.

Conclusion: DCE proved to be a useful tool for evaluating important factors in organ donation. Future studies can expand with evaluation of a larger sample representative of general population.

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