Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Robert Wall Emerson


The aim of this three-paper format dissertation is to explore three topics relevant to public health and vision loss. The three papers are independent studies, yet build upon each other by first describing the population of people aged 40 years and older in the United States in terms of visual impairment, diagnosed eye disease/injury, and their use of eye care, and then next exploring the factors that influence eye care use for both the general population and the subpopulation of people with diagnosed diabetes. The first paper provides a state-level examination of the characteristics of people aged 40 years and older with vision loss, self-reported eye diseases associated with aging, eye health care access, and eye health behaviors for four states that utilized the Behavioral Risk Factor Surveillance System (BRFSS), Visual Impairment and Access to Eye Care Module and Diabetes Module in 2007. The second and third papers examined three years of BRFSS data from the 11 states that implemented both modules in order to predict non-use of eye care based upon vision loss, diagnosed eye disease, and social demographic characteristics including possession of eye health insurance; however, the third paper focused on the subpopulation of people with diabetes by including diabetes management habits as an additional predictor of eye-care use. Results from the first paper indicate variations in prevalence of eye disease and visual impairment and use of eye care by age and race with rates of eye disease increasing with age; glaucoma and diabetic retinopathy most prevalent in blacks and Hispanics; macular degeneration most prevalent in whites; and use of eye care increasing with diagnosis of eye disease, possession of eye-care insurance, and increasing income. Results from the second study indicate that the strongest predictor of non-use was having no history of diagnosed eye disease, followed closely by not having insurance, and then by having a mid-range household income ($25,000-$35,000). Similar results were revealed for the subpopulation of people with diabetes, with certain positive diabetes management behaviors aiding the prediction of non-use. Implications for public health practice, health policy reform, public policy development, and educational programs are discussed.

Access Setting

Dissertation-Open Access