Breast and cervical cancer screening among women in metropolitan areas of the United States by county-level commuting time to work and use of public transportation, 2004 and 2006

Background. Commuting times and behaviors have been associated with a variety of chronic disease outcomes and health behaviors. We examined the relationships between ecologic measures of commuting time and use of public transportation in relation to breast and cervical cancer screening among women in U.S. metropolitan areas who participated in the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Methods. Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas (MSAs). Only BRFSS respondents who resided in the 39 MSAs with a population of 1.5 million in 2007 - representing a total of 337 counties - were included in this analysis. A total of 76,453 women aged 40 years were included in analyses on mammography. Analyses on Pap testing were limited to women aged 18 years with no history of hysterectomy (n = 80,959). Area-based measures of socio-economic status (SES) were obtained by utilizing county-level information from the 2000 U.S. Census. Results. With adjustment for age, no important associations were observed between receipt of a recent mammogram and either a county-level measure of commute time or residence in an area where more residents had access to a car. Similarly, women living in counties where at least four percent of the residents used public transportation were as likely to have had a recent mammogram or Pap test compared with women in areas where less than four percent of residents used public transportation. However, women living in counties where < 2% of residents had no access to a car were somewhat more likely to have had a Pap test in the past 3 years than women in areas where 3% of the residents had no access to a car (87.3% versus 84.5%; p-value for test for trend < 0.01). In multivariate analysis, living in a county with a median commute time of at least 30 minutes was not significantly associated with having had a Pap test in the past 3 years (adjusted odds ratio (OR) = 1.1, 95% CI 0.9-1.2, p = .50), or with having had a mammogram in the past 2 years (adjusted OR = 0.9, 95% CI 0.9-1.1, p = .28). A weak positive association was observed between residence in a county with less use of public transportation and having had a Pap test in the past 3 years, which was of borderline significance (adjusted OR 1.2, 95% CI 1.0-1.4, p = .05). Conclusions. In large U.S. metropolitan areas, transportation issues may play a role in whether a woman obtains cancer screening along with other factors (e.g., Hispanic ethnicity, low income, and no physician visit in the past year). In this contextual analysis, a longer commute time was not associated with breast and cervical cancer screening.