• Jacqueline Ellison, Kevin Griffith, Madalyn Thursby, David J G Slusky, and Jacob Bor.
• Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island. Electronic address: jacqueline_ellison@brown.edu.
• Am J Prev Med. 2021 Apr 1; 60 (4): 542-545.

IntroductionPublicly funded family planning clinics provide preventive health services to low-income populations in the U.S. In recent years, several states, including Ohio, have restricted public funds for organizations that provide or refer patients to abortion care, often resulting in clinic closures. This research evaluates the effects of such closures on preventive service use and access to care among female adults in Ohio.MethodsWith data from the 2010 to 2015 Ohio Behavioral Risk Factor Surveillance System, trends in health service use were assessed for female respondents aged 18-45 years with household incomes <$50,000. Clinic locations were combined with restricted-access survey ZIP codes to compute respondents' driving times to the nearest family planning clinic. The association between changes in driving time and the use of routine preventive and unmet care owing to cost were assessed with linear probability models. Analyses took place from March 2019 to February 2020.ResultsEach additional 10 minutes of driving time was associated with an 8.9 percentage point increase in the likelihood of avoided care owing to cost (95% CI=1.7, 16.2), a 10.4 percentage point decrease in the likelihood of mammogram receipt during the past 12 months (95% CI= -22.3, 1.5), and a 12.5 percentage point decrease in the likelihood of ever receiving a clinical breast examination (95% CI= -18.7, -6.3). Driving time had insignificant associations with other utilization outcomes. Similar results were obtained when using driving distance.ConclusionsReduced access to family planning clinics was associated with unmet care due to cost and a reduction in preventive service use among low-income, reproductive-aged females.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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