Women with criminal justice histories persist as one of the groups most affected by cervical cancer, with 4-
5 times the rates of cancer compared to other women. Our research team has spent the last 8 years
investigating the factors that account for this disparity. We have found that abnormal Pap tests are high, with
sexual health risk, trauma, women's life circumstances, and low cervical health literacy as facilitators of risk
and barriers to care. But questions remain about justice-involved women's screening trajectories over time
given complex cervical screening recommendations and the difficulty of interfacing with health systems and
navigating complex health insurance environments. Thus, there is insufficient information available to inform
interventions that address justice-involved women's cervical cancer prevention needs in the community.
The specific objective of this study is to develop a better understanding of the natural history of cervical
cancer risk and prevention behaviors among community-based justice-involved women. The long-term goal of
this study is to identify strategies for where and how to intervene to change the factors and environments that
structure women's cervical health risk.
We have a unique opportunity to conduct a natural history study of cervical health risk and screening
among community-based justice-involved women in three geographically and demographically diverse cities.
We plan to leverage three existing samples of community-based, justice-involved women – in Kansas City,
MO, Birmingham, AL, and Oakland, CA – to become one of the first long-term cancer prevention studies of
high-risk women across cities in the U.S. By studying three geographically and demographically diverse cities,
we can draw conclusions about factors at each level of inquiry across study sites, accounting for variation in
cities and increasing our ability to generalize findings. By leveraging samples generated by our ongoing
projects in each city, we also offer a cost-effective and feasible way to engage in long-term follow-up of hard to
reach women, with whom we've already established trust and rapport.
In our first aim, we use the Behavioral Model for Vulnerable Populations (BMVP) to explain the natural
history of cervical health risk behaviors, screening, and treatment among community-based justice-involved
women (N~600) over a 5-year period in three cities. In the second aim, we use a mixed methods approach to
unpack the ways in which significant domains of the BMVP operate in the daily lives of a subsample of women
(N~60) recruited from the larger sample.
Public health significance of this study centers on two products: 1) Development of a multi-level
conceptual framework that explains the environment in which justice-involved women engage in cervical
cancer prevention. 2) Creation of intervention models that address “upstream” determinants of health in
clinical and service settings, while addressing justice-involved women's unique needs.