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

## TL;DR

This study finds that women experiencing homelessness in Indiana have low cervical cancer screening rates, with longer homelessness duration linked to being overdue for screening.

## Contribution

The study identifies sociodemographic and behavioral factors associated with cervical cancer screening delays among homeless populations.

## Key findings

- 35% of participants were overdue for cervical cancer screening.
- Longer homelessness duration was linked to higher odds of being overdue for screening.
- High prevalence of risk factors like smoking and early sexual debut were observed.

## Abstract

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.

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.

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.

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.