There is recent concern that caregivers are less likely than non-caregivers to practice health-promoting behaviors [1
], which may include seeking cancer screening tests. Caregivers are generally defined as persons who provide unpaid assistance or supervision with personal or instrumental activities of daily living (i.e., bathing, eating, dressing, medication management, handling finances) to a relative or friend who cannot perform these tasks due to cognitive, physical, or psychological impairments [4
]. The increasing number of older caregivers in the United States [5
], and their chronically high levels of self-reported stress and potential for adverse health consequences [6
], underscores the importance of health maintenance and disease prevention in this population. Receipt of appropriate cancer screening tests is an important component of health maintenance, yet little is known about the cancer screening practices of caregivers as compared to non-caregivers.
Of the estimated 43.5 million U.S. caregivers in 2009, 54% were aged 50 years or older, and 26% spent ≥20 hours/week performing caregiving activities [5
]. As the majority (67%) of caregivers are female [5
], the health effects of caregiving are an increasingly important women’s health issue. Caregivers consistently report more psychological distress, such as depressive symptoms and anxiety, as well as self-reported stress than non-caregivers [6
]. According to the Caregiver Stress Process model, stress may result from characteristics of the caregiving situation, including the care recipient’s condition, level of care required, the necessity to balance caregiving responsibilities with other employment and family responsibilities, and the availability of social support and other factors that may reduce caregiving-related stress, leading to adverse effects on psychological or physical health [7
]. As a result of this stress, or a way to cope with caregiving demands, caregivers may engage in risky health behaviors, such as cigarette smoking and alcohol consumption. Likewise, they may neglect health promotion activities, such as regular cancer screening, due to feeling stressed or the time constraints of caregiving [1
]. However, there is conflicting evidence that caregivers have an increased risk of physical health decline or mortality [4
]. In fact, older women caregivers had fewer medical conditions and functional limitations than their non-caregiver peers [4
], suggesting that older caregivers may attempt to maintain good health in order to continue providing care to their care recipient.
Scant research has examined the association between caregiving and modifiable health behaviors related to cancer risk or utilization of cancer screening. The results of existing studies are inconsistent [2
], with caregivers having some better health habits [2
] and pro-active cancer screening practices [1
] as well as some poorer health habits [8
]. Likewise, of studies comparing breast and cervical cancer screening behaviors, one reported increased utilization among caregivers [3
], while the other reported no association [1
]. Most studies to date have been limited by focusing on spousal caregivers [1
], restriction to persons older than age 50 [1
] or 65 [2
], not stratifying by gender [1
], and lack of adjustment for covariables [2
]. Thus, the results of these studies may not relate to cancer-screening guidelines that are generally gender- and age-specific.
Effective screening methods are widely available for breast and cervical cancers, two of the most common cancers among middle-aged and older women. Among U.S. women, an estimated 209,060 incident cases of breast cancer and 12,200 incident cases of cervical cancer were expected in 2010 [12
], with the highest incidence rates among women age ≥40 [7
]. Though cervical cancer guidelines have recently been revised [13
], the American Cancer Society (ACS) previously recommended Pap tests either yearly or every two to three years depending on personal history of Pap test results for women age ≥21 to screen for cervical cancer and annual clinical breast exams (CBE) and mammograms for women age ≥40 to screen for breast cancer [12
Given the increases in the aging population and resultant need for informal caregiving, it is important to understand whether caregiving is associated with cancer risk and screening behaviors, especially among women. Therefore, we used data from female respondents to the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine the association between caregiving and modifiable health behaviors known to affect overall cancer risk, such as smoking, alcohol use, obesity, physical activity, and fruit/vegetable consumption, and on breast and cervical cancer screening. We hypothesized that caregivers would engage in more negative health behaviors and be less likely to receive recommended cancer screenings as compared to non-caregivers. We additionally sought to examine if associations between caregiving and health behaviors and cancer screening differed by age or race. If caregiving is associated with poorer health behaviors or lack of screening utilization, this might identify an opportunity for intervention, as caregivers are likely to have frequent contacts with the health care system due to their caregiving responsibilities.