Marital Status and Cervical Screenings Among a Vulnerable Population

Introduction: The CDC’s Healthy People 2020 goal is that 93% of eligible women receive a cervical cancer screening by 2020. Evidence based strategies for increasing completion rates include doctor recommendation and reminders by telephone and mail. Other strategies such as educating husbands on the importance of cervical cancer screenings for their wives has had success in underserved, vulnerable populations, such as refugees. However, there is little evidence whether these strategies work among women at highest risk of cervical cancer as they move in and out of the criminal justice system and sell sex for mere survival needs. Given the political and social dynamics on the street, we hypothesized that marital status would not have the same positive effect that we observe in the general population or in other underserved populations. Methods: We performed a cross-sectional analysis on data collected from 1172 women who were in substance abuse treatment at Nexus Recovery Center from 2012–2016 and participated in the CPRIT funded Sound Mind, Sound Body Project. Women who received a well-woman exam through this cancer prevention project and declared a marital status at enrollment (married, divorced, widowed, in a relationship, single) were included in the final study population (n=744). Outcomes assessed were high-risk HPV screening results and STI results. Bivariate analysis was performed using Statistical Analysis Software to calculate chi-square p values (α Results: Our study population had an average age of 33.4 years; 37% minority race; 26% with less than a high school diploma. Nearly half were currently (n=85) or previously (n=253) married. The odds ratios for cervical HPV and cervical chlamydia were close to the null (AOR=1.02, 95% CI:0.60-1.74; AOR=0.77, 95% CI:0.23-2.56, respectively). Similarly, the association between marriage and anal screenings was also statistically insignificant (anal HPV: AOR=0.69, 95% CI:0.41-1.19; anal chlamydia: AOR=1.20, 95% CI:0.45-3.21). Conclusion: Marriage did not offer positive benefits in cervical cancer screenings among vulnerable populations with complex needs and addictions. Findings serve to highlight both the need for multi-sector strategies that could ensure adherence to needed cancer screenings and a critical need to inform healthcare providers how self-reported marital status is determined on the street, in order to provide best cancer prevention recommendations.