Cost-Related Barriers, Mental Distress, and Cervical Cancer Screening Adherence: A BRFSS 2024 Analysis

ObjectivesTo examine associations of a general cost-related barrier to medical care and BRFSS-defined poor mental health-day categories with cervical cancer screening adherence among U.S. female respondents.MethodsWe conducted a cross-sectional analysis of female BRFSS respondents. The primary outcome (_RFPAP37) identified Pap testing within the past 3 years among respondents aged 21-65 years with an intact cervix; the sensitivity outcome (_PAPHPV1) additionally incorporated HPV testing within the past 5 years for those aged 30-65 years. MEDCOST1 measured inability to see a doctor because of cost during the previous 12 months. _MENT14D classified respondents by 0, 1-13, or 14-30 poor mental health days. Survey-weighted adjusted logistic regression incorporated BRFSS weights, strata, and clustering.ResultsThe primary analytic sample included 101,580 female respondents; survey-weighted complete-case models included 84,705. Pap adherence was lower among respondents reporting a general cost-related barrier to medical care than among those without the barrier (54.5% vs 68.6%). In survey-weighted adjusted models, the barrier remained associated with lower Pap adherence (OR 0.79, 95% CI 0.65-0.95). Formal interaction terms were not statistically significant, and the ordinal poor mental health-day trend was attenuated (OR 1.02, 95% CI 0.97-1.07). Findings for Pap+HPV adherence were directionally similar but weaker.ConclusionsA general cost-related barrier to medical care was consistently associated with lower cervical cancer screening adherence. BRFSS-defined poor mental health days may indicate a co-occurring vulnerability, but adjusted interaction evidence was limited. Access-focused and mental health-informed strategies warrant evaluation in future intervention studies.