Factors associated with cancer screening adherence amongst Latinos in Indiana: Results of an electronic survey.

Abstract

Background: Latinos are the fastest growing ethnic group in the US: cancer is the leading cause of death. Cancer screening is designed to decrease cancer-specific mortality among age- and gender-appropriate populations, but is implemented less frequently among Latino populations. Barriers to screening among Latinos are less well understood. Methods: A crosssectional, online survey was used to assess perspective on cancer information-seeking behavior, demographic, economic, healthcare access and COVID-related factors among Latino adults (>18) living in Indiana able to read and write in Spanish or English. Respondents were recruited using Facebook targeted advertisement and data were collected through Qualtrics. USPSTF recommendations for breast (BC), cervical (CC) and colorectal cancer (CRC) screening were used to evaluate screening adherence. The influence of explanatory variables on cancer-related outcomes was analyzed using univariate chi-squared tests for categorical variables and t-test for scale variables. Following this, significantly influential factors (p < 0.05) were included in multivariate logistic regression models for each response variable. Model selection was performed using stepwise regression. Results: A total of 1624 respondents participated, with 832 (51.2%) completing the survey in Spanish. Median age was 52 years old (range 18-71) for English and 54 (18-77) for Spanish respondents. 80% of respondents were located in urban areas. Cancer screening adherence rates were 45.2% for BC, 61.8% for CC and 68.0% for CRC. The main factor associated with screening adherence across all malignancies (Table) was white self-identification, other factors included having children (OR: 1.79) and having received a COVID test (OR: 1.91) for CRC, having Spanish as chosen language for the survey for CC and BC respectively. Having higher income was associated with less adherence in CRC (OR: 0.50 when expressed as subjective income adequacy, compared with people finding difficult on present income) and CC (OR: 0.18 when expressed as > 75,000 USD annual income, compared with 0- 35,000 USD annual income). Conclusions: In this interim analysis of the largest Latino survey in Indiana, our findings were counter-intuitive regarding the association of income and language with cancer screening adherence. For income, these findings may have been due to lower out-ofpocket costs among vulnerable populations covered by Medicaid or Medicare insurance. For Spanish differences may be explained by increased language specific outreach for certain screening tests but not for others. Overall, these results highlight the necessity for targeted awareness campaigns for the Latino population in Indiana. Multivariate model, odds ratio noting association with cancer screening adherence.