Abstract
PURPOSE: Preliminary studies have suggested child caregivers ('caregivers') may experience childcare barriers to cancer screening. The objective of this study was to compare cancer screening adherence among caregivers and non-caregivers in a nationally representative sample. METHODS: This cross-sectional analysis used 2021-2023 Behavioral Risk Factor Surveillance System survey data. Caregivers were defined as adults 18-65 employed as a 'homemaker' with child(ren) in the home. The primary outcome was colorectal cancer screening adherence, and secondary outcomes were breast and cervical cancer screening adherence. Relative risks (RR) of screening adherence were estimated using regression models adjusting for age, sex, race and ethnicity, income, education, payer status, marital status, employment, language, self-rated health, and year. Models used survey standard error estimation and sampling weights. Sensitivity analyses tested two alternative caregiver definitions: adults 18-65 with child(ren) and employed adults 18-65 with child(ren). RESULTS: There were 1,317,148 participants (weighted: 255,041,726); 2.9% of the weighted sample were caregivers, 95.3% of whom were women. Most caregivers were married or partnered, identified as non-white, and reported <$50,000 for household income. In adjusted analyses, caregiver status was associated with significantly lower rates of colorectal (aRR 0.92, 95% CI 0.85-0.98) and breast (aRR 0.90, 95% CI 0.82-0.98) cancer screening adherence, but not cervical cancer screening adherence (aRR 1.01, 95% CI 0.95-1.09). Sensitivity analyses with alternative caregiver definitions similarly showed lower rates of colorectal and breast cancer screening adherence but not for cervical cancer screening. CONCLUSION: Caregivers had lower adherence to colorectal and breast cancer screening but not cervical cancer screening, consistent across multiple exposure definitions. Child caregiving may pose barriers to cancer screening.