Abstract
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.