Cervical Cancer Prevention Behaviors Among Criminal-Legal Involved Women from Three U.S. Cities

Abstract

<b><i>Background:</i></b> This study aims to understand how criminal-legal involved women from three U.S. cities navigate different health resource environments to obtain cervical cancer screening and follow-up care. <b><i>Methods:</i></b> We conducted a cross-sectional study of women with criminal-legal histories from Kansas City KS/MO; Oakland, CA; and Birmingham, AL. Participants completed a survey that explored influences on cervical cancer prevention. Responses from all women with/without up-to-date cervical cancer screening and women with abnormal Pap testing who did/did not obtain follow-up care were compared. Proportions and associations were tested with chi-square or analysis of variance tests. Multivariable regression was performed to identify variables independently associated with up-to-date cervical cancer screening and reported as odds ratios (ORs) with 95% confidence intervals (CIs). <b><i>Results:</i></b> There were <i>n</i> = 510 participants, including <i>n</i> = 164 Birmingham, <i>n</i> = 108 Kansas City, and <i>n</i> = 238 Oakland women. Criminal-legal involved women in Birmingham (71.3%) and Kansas City (68.9%) were less likely to have up-to-date cervical cancer screening than women in Oakland (84.5%, <i>p</i> = 0.01). More women in Birmingham (14.6%) and Kansas City (16.7%) needed follow-up for abnormal Pap than women in Oakland (6.7%, <i>p</i> = 0.003), but there were no differences in follow-up rates. Predictors for up-to-date cervical cancer screening included access to a primary care provider (OR: 3.3, 95% CI: 1.4-7.7), health literacy (OR: 0.3, 95% CI: 0.2-0.7), and health behaviors, including avoiding tobacco (OR: 0.4, 95% CI: 0.1-0.9) and HPV vaccination (OR: 3.4, 95% CI: 1.0-10.9). <b><i>Conclusions:</i></b> Cervical cancer screening and follow-up varied by study site. The results suggest that patient level factors coupled with the complexity of accessing care in different health resource environments impact criminal-legal involved women's cervical cancer prevention behaviors.