Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Matthew J. Hayat, Ph.D.

Second Advisor

Harry J. Heiman, M.D., M.P.H


BACKGROUND: In 2014, more than fifty thousand Americans died of colorectal cancer (CDC). Adults between the ages of fifty and seventy-five are urged to be obtain colorectal cancer screenings. The United States Congress voted the Patient Protection and Affordable Care Act (ACA) into law in 2010. Medicaid expansion began in 2014. States could opt in to have their Medicaid expansion, with the federal government paying for most of the additional cost.

AIMS: This study investigates whether the rates of adults ages 50-75 receiving a colorectal cancer screening has significantly changed from 2008 (pre-ACA) to 2016 (post ACA and Medicaid expansion) by analyzing states that did expand Medicaid as compared to those states that did not.

METHODS: This study utilizes the Behavioral Risk Factor Surveillance System (BRFSS) data from 2008 and 2016 to explore the changes in rates of colorectal screening between a selection of states that expanded and failed to expand Medicaid. The data is analyzed in SAS 9.4, utilizing PROC FREQ to analyze the categorical variables and PROC GENMOD to produce marginal models.

RESULTS: Subjects in states that did not participate in the Medicaid expansion in January 2014 were 0.90 [0.80, 1.01] times as likely to have received a screening sigmoidoscopy or colonoscopy than participants in states that did participate in the Medicaid expansion.

DISCUSSION: The marginal model failed to show a statistically significant difference in receipt of sigmoidoscopy or colonoscopy between participants who lived in Medicaid expanded states and non-expanded states; the p-value is greater than the alpha of 0.05 and the 95% confidence interval contains 1. This suggests the Medicaid expansion did not have a significant impact on receipt of sigmoidoscopy or colonoscopy.