Determinants of Adherence to Cervical Cancer Prevention Strategies Among Socially Diverse Middle-Aged Women

Abstract Despite the availability of vaccinations and screenings, cervical cancer (CC) remains a major global health challenge. Understanding the factors influencing adherence to CC prevention strategies is essential, particularly among overlooked groups such as middle-aged and/or underprivileged women. For this purpose, a cross-sectional study was conducted in a population comprising 379 women (aged 37–64 years, recruitment: 2019–2023) from Valencia (Spain), representing diverse socioeconomic profiles, including female sex workers (FSWs; n = 46). Data were analysed using multivariate logistic regression models. Overall, 88.65% of participants adhered to CCS recommendations and 22.16% reported past-year condom use, compared with 86.96% and 76.09%, respectively, among FSWs. In the overall population, CCS adherence was significantly associated with higher education and marginally associated with a history of candidiasis, non-condom contraceptive use in the past year, and having more children and sexual partners. Higher condom use was associated with lower alcohol consumption, being single, non-Spanish origin, not being postmenopausal, use of vaginal health products, and not previous recurrent urinary tract infections. Marginally significant positive associations were also observed for the absence of chronic disease and a history of sexually transmitted infections. Among FSWs, earlier menarche age and lower gravidity were marginally associated with higher CCS adherence, while older age at entry into prostitution and earlier sexual debut were associated with condom use, the latter marginally significant. Overall, our findings highlight the importance of further research into underprivileged groups such as midlife women across socioeconomic strata. Novelty and Impact First study to assess 28 determinants of CC prevention in middle-aged women from diverse socioeconomic backgrounds, an often overlooked group. Key factors were education, alcohol consumption, relationship status, birth country, menopausal status, vaginal product use, and recurrent UTIs. Weaker associations were found for candidiasis history, non-condom contraception, number of children and sexual partners, STI history, and chronic disease. Our findings underscore the need for targeted public-health interventions to support the WHO strategy to eliminate CC.