Abstract A167: Screened out: Citizenship, disparities, and the puzzle of cancer prevention across citizenship lines

Abstract Introduction: Structural barriers to cancer preventive services contribute to delays in cancer diagnosis and poor outcomes in non-US citizen populations. The potential role of modifiable cancer risk factors and perceived discrimination on cancer disparities in non-US citizens is unclear. Understanding whether and how citizenship status is related to cancer risk factors and screening behaviors is crucial for informing targeted interventions to address disparities. Thus, we assessed whether citizenship status is independently associated with cancer risk factors and screening behaviors. Methods: Using cross-sectional National Health Interview Survey (NHIS) data from 2023, we included adult participants with no prior cancer diagnosis. Citizenship status was defined based on self-report. We examined differences in sociodemographic factors, healthcare access indicators, modifiable cancer risk factors (body mass index (BMI), smoking, and diet), perceived everyday discrimination, and cancer screening behaviors (colorectal, prostate, and cervical) according to citizenship status using chi-square tests or t-tests. Multivariable logistic regression assessed the independent association between citizenship status and cancer risk factors and screening. Results: Among the 24, 584 eligible participants, 92.5% were U.S citizens and 7.5% were non-U.S. citizens. Compared to U.S citizens, non-U.S. citizens were slightly younger (43.4 vs. 51.7 years), were more likely to be living below the poverty threshold (11.9% vs. 5.8%), and to not have health insurance (31.6% vs. 5.6%; all p-values <0.001). A lower proportion of non-US citizens reported a family history of cancer (23.8% vs. 42.7%) and perceived discrimination (32.6% vs. 46.3%) compared to U.S citizens (all p-values <0.001). Non-US citizens exhibited lower rates of smoking (23.4% vs. 36.1%), and obesity (25.1% vs. 33.9%); although they also reported lower access to healthy diets (84.1% vs. 89.6%); all p-values <0.001) compared to U.S. citizens. Notably, non-U.S. citizens consistently had lower screening rates for colorectal (24.6% vs. 61.3%), cervical (63.6% vs. 80.8%), and prostate cancer (25.5% vs. 44.7%). In multivariable models, non-U.S. citizens had lower odds of smoking (AOR (95% CI): 0.59 (0.53, 0.67) and obesity (AOR (95% CI): 0.65 (0.58, 0.73) compared to US citizens. Additionally, Non-U.S citizens were less likely to undergo colorectal (AOR (95% CI): 0.46 (0.39, 0.54) and cervical (AOR (95% CI): 0.59 (0.50, 0.69) cancer screening, but not prostate screening (AOR (95% CI): 1.08 (0.81, 1.32)). Conclusion: These findings suggest a complex association between citizenship status and cancer-related health behaviors. Despite facing greater socioeconomic and healthcare access barriers, non-US citizens exhibited healthier cancer risk factor profiles but significantly lower rates of colorectal and cervical cancer screening. These disparities underscore the need for targeted and culturally appropriate strategies to improve access to cancer screening among non-citizen populations. Citation Format: Jonathan O. Odingo, Kelly A. Hirko. Screened out: Citizenship, disparities, and the puzzle of cancer prevention across citizenship lines [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A167.