Targeted restriction on abortion provider (TRAP) laws and breast and cervical cancer screening in low-income women.

164 Background: TRAP laws impose unnecessary rules on abortion providers, hindering care like cancer screening for low-income women. This study examines TRAP laws' impact on breast and cervical cancer screening (BCS and CCS) rates in this group. Methods: We identified low-income women (≤$35,000 annual income) from the 2012-2018 Behavioral Risk Factor Surveillance System survey. States were grouped by TRAP law status: 1) existing, 2) new in 2017, 3) without. Outcomes were self-reported BCS via mammography for women aged 40 and above, and CCS via Pap test for women aged 21-65 without a history of hysterectomy, in the past year. Multivariate logistic regression estimated adjusted screening prevalence (aSP) and adjusted prevalence ratios (aPR), comparing 2012-2016 and 2018 screening rates by TRAP law. We also performed difference-in-difference (DiD) analysis on screening rates in TRAP vs. non-TRAP states between 2012-2016 and 2018. Results: From 2012 to 2016, BCS and CCS prevalence rates were similar between states with TRAP laws (BCS: 56.44%, CCS: 54.26%) and those without (BCS: 56.77%, CCS: 54.12%), with aPR of 1.08 for BCS and 0.91 for CCS. In 2018, BCS rates increased in states with existing TRAP laws (56.44% to 56.98%) but decreased in states with new TRAP laws (56.96% to 55.02%) and states without TRAP laws (56.77% to 54.36%). The aPR for BCS and CCS in states with new 2017 TRAP laws were 0.95 and 1.04, while states without TRAP laws had aPRs of 0.93 for BCS and 0.88 for CCS. All results were statistically significant at alpha = 0.05. The DiD analysis indicated a significant BCS increase in TRAP states compared to non-TRAP states from 2012-2016 to 2018, with a DID estimate of 0.0288 (p-value <0.001). The DID estimate for CCS was 0.0158 (p-value 0.126), indicating no significant change. Conclusions: Overall, BCS rates increased in states with longstanding TRAP laws but decreased in states with new or no TRAP laws, suggesting a positive association between TRAP laws and BCS. However, no significant impact was observed for CCS, highlighting a more definite effect of TRAP laws on BCS among low-income women. Targeted restriction on abortion provider (TRAP) laws and breast and cervical cancer screening in low-income women. aSP* aPR* 2012-2016 2018 2012-2016 vs 2018 States with existing TRAP law Breast 56.44% 56.98% 1.08 Cervical 54.26% 48.44% 0.91 States with new TRAP law in 2017 Breast 56.96% 55.02% 0.95 Cervical 54.79% 56.51% 1.04 States without TRAP laws Breast 56.77% 54.36% 0.93 Cervical 54.12% 50.89% 0.88 Models adjusted for age, race, body mass index, marital status, education, insurance status, general health status, state, and year. *All results were statistically significant at alpha = 0.05.