It takes a village: The impact of social and environmental factors on cervical cancer screening.
Authors: Ahsan Muhammad Danyal , An Anjile , Keenahan Laura , Morley Faith , Tamimi Rulla M. , Lin Jeff Feng-Hsu , Cantillo Evelyn , Frey Melissa Kristen , Holcomb Kevin , Kensler Kevin , Chapman-Davis Eloise 
Published: June 2024

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Background: Neighborhood and societal factors can influence individuals’ cancer screening behaviors. We evaluated the influence of neighborhood factors on adherence to cervical cancer screening. Methods: Data from the NIH All of Us Research Program were used. Electronic health records were used to assess compliance with United States Preventative Services Task Force (USPSTF) recommendations for cervical cancer screening: 1) Participants aged 21–29 with a cervical cytology within 3 years; 2) Participants aged 30–65 with cervical cytology alone within 3 years; 3) Participants aged 30–65 with high-risk HPV testing alone within 5 years; 4) Participants aged 30–65 with cervical cytology and high-risk HPV co-testing within 5 years. Neighborhood deprivation index (NDI) was assessed using census data from zip code of residence, perceived neighborhood disorder (PND) was self-reported using the Ross-Mirowsky Perceived Neighborhood Disorder Scale, and neighborhood social cohesion (NSC) self-reported using the Neighborhood Social Cohesion Scale. Associations between quartiles of NDI, PND, and NSC (defined based on the distribution in the entire cohort) with cervical cancer screening guideline adherence were evaluated in multivariable logistic regression models with 1) age and race, and 2) socioeconomic status (SES) with age, race, insurance, education, income, employment, home ownership, and census region. Results: 21,083 eligible participants had a mean age of 45 (SD 12); 15,276 (72%) self-identified as Non-Hispanic White, 2555 (12%) as Hispanic, 1807 (9%) as Non-Hispanic Black, and 1091 (5%) as Other. Of these, 6166 (30%) were adherent with screening recommendation, 14,917 (70%) were not adherent. Among the non-adherent group, 4114 (20%) self-identified as racial/ethnic minorities, 4695 (32%) had annual income ≤ $50,000, 2337 (16%) had Medicaid/Medicare insurance, and 1934 (13%) had a high-school degree or less. Adjusting for age and race, participants with highest quartile PND scores were less likely than those with lowest quartile scores to be adherent to screening (OR 0.84, 95% CI: 0.76, 0.92); however, this difference was not significant in the SES-adjusted model (OR 0.97, 95% CI: 0.88, 1.07). Adjusting for age and race, participants with highest quartile NDI scores were less likely than those with lowest quartile scores to be adherent (OR 0.68, 95% CI: 0.61, 0.75), consistent with the SES-adjusted model (OR 0.61, 95% CI: 0.54, 0.68). Adjusting for age and race, participants with highest quartile NSC scores were less likely than those with lowest quartile scores to be adherent (OR 0.83, 95% CI: 0.76, 0.90), but not in the SES-adjusted model (OR 0.92, 95% CI: 0.84, 1.01). Conclusions: Neighborhoods may influence cervical cancer screening adherence. Targeted interventions to tackle specific neighborhood and societal challenges may reduce disparities in cervical cancer screening.