Cervical Cancer Screening Rates and Associated Sociodemographic and Behavioral Factors among People Experiencing Homelessness in Indiana.

OBJECTIVE

To estimate cervical cancer screening rates, prevalence of risk factors, and factors associated with being overdue for screening among people experiencing homelessness in two Indiana cities.

METHODS

Rapid assessment surveys were conducted at two large homelessness service agencies in Indianapolis and Lafayette, Indiana (November 2023 to November 2024). Participants were aged 21-69 years, assigned female at birth, and currently experiencing homelessness. Screening status was categorized as up-to-date (screened within 5 years) or overdue (more than 5 years or never screened). Descriptive statistics and multivariable logistic regression examined predictors of being overdue.

RESULTS

Among n = 212 participants, 35% were overdue and 49% had not been screened within 3 years. Prevalence of risk factors was high, including smoking (74%), sexual debut before age 18 (73%), and no HPV vaccination (75%). Older age and having experienced homelessness for 5 years or more were associated with higher odds of being overdue.

CONCLUSIONS

Longer duration of homelessness significantly increased the likelihood of being overdue for cervical cancer screening, underscoring the cumulative disadvantage of chronic housing instability. Cervical cancer prevention is a critical unmet need among women experiencing homelessness, and findings highlight the importance of developing targeted interventions to improve screening access in this population.