Civic engagement and breast cancer screening participation among US citizens

Civic engagement may influence health behavior, but little is known about its relation to the use of preventive care services like cancer screening. This study examined relationships between civic engagement and breast cancer screening, overall and stratified by age, education, income, and race/ethnicity.

Data were from the 2023 National Health Interview Survey. Measures of civic engagement included binary (yes/no) indicators of participation in the most recent local election, past-year public meeting attendance, and past-year volunteering. The dependent variable was past-year mammogram use. Associations were evaluated using survey-weighted logistic regression models with adjustment for multiple sociodemographic characteristics, health insurance status, and self-rated health.

Analyses included 5733 respondents eligible for breast cancer screening. In adjusted models, the prevalence of past-year screening was higher among those who voted (adjusted prevalence ratio [aPR], 1.18; 95% confidence interval [CI], 1.12-1.24), attended a public meeting (aPR, 1.08; 95% CI, 1.01-1.16), or volunteered (aPR, 1.11; 95% CI, 1.06-1.16) relative to those who did not. Associations were strongest for those who participated in two or more measures of civic engagement relative to none (aPR, 1.26; 95% CI, 1.18-1.35). In stratified models, associations were generally positive across subgroups and were consistently stronger in magnitude for those with a high school education or less than those with higher educational attainment.

Breast cancer screening is higher in civically engaged adults. More research is needed to understand the social mechanisms that underlie this relationship, but the findings support efforts to advance cancer control through paired public health and civic health programming.