Does time pressure create barriers for people to receive preventive health services? Xiaoxi Yao a, ⁎, Allard E. Dembe b , Thomas Wickizer c , Bo Lu d a Mayo Clinic, Center for the Science of Health Care Delivery, USA b The Ohio State University, College of Public Health, Center for Health Outcomes, Policy and Evaluation Studies, USA c The Ohio State University, College of Public Health, Division of Health Services, Management and Policy, USA d The Ohio State University, College of Public Health, Division of Biostatistics, USA abstract article info Available online 12 March 2015 Keywords: Time pressure Preventive health services Mammogram Pap smear Cancer screening Dental check-up Flu vaccination Work hours Overtime Objective. Regular use of recommended preventive health services can promote good health and prevent dis- ease. However, individuals may forgo obtaining preventive care when they are busy with competing activities and commitments. This study examined whether time pressure related to work obligations creates barriers to obtaining needed preventive health services. Methods. Data from the 2002–2010 Medical Expenditure Panel Survey (MEPS) were used to measure the work hours of 61,034 employees (including 27,910 females) and their use of five preventive health services (flu vaccinations, routine check-ups, dental check-ups, mammograms and Pap smear). Multivariable logistic regression analyses were performed to test the association between working hours and use of each of those five services. Results. Individuals working long hours (N 60 per week) were significantly less likely to obtain dental check- ups (OR = 0.81, 95% CI: 0.72–0.91) and mammograms (OR = 0.47, 95% CI: 0.31–0.73). Working 51–60 h weekly was associated with less likelihood of receiving Pap smear (OR = 0.67, 95% CI: 0.46–0.96). No association was found for flu vaccination. Conclusions. Time pressure from work might create barriers for people to receive particular preventive health services, such as breast cancer screening, cervical cancer screening and dental check-ups. Health practitioners should be aware of this particular source of barriers to care. © 2015 Elsevier Inc. All rights reserved. Introduction Regular use of preventive health services has been shown to be an effective way of promoting good health and avoiding disease. However, the inadequate utilization of preventive services has been consistently documented. For example, Americans only receive about half of the recommended preventive health services (McGlynn et al., 2003). In the past, many Americans had difficulty obtaining preventive care because of not having health insurance coverage or having limited health insurance benefits. Under the Patient Protection and Affordable Care Act (ACA), beginning in 2014, nearly everyone is required to be covered by health insurance and most health insurance plans cover a set of important preventive health services at no cost to patients. Although concerns over the cost of care may still present a barrier to care for many people, exploring and understanding the effect of nonfinancial barriers to obtaining preventive health services is especial- ly important in the U.S., as well as in many other countries. Individuals may face many kinds of non-financial barriers to care, including language and cultural issues (Shaw et al., 2009; DuBard and Gizlice, 2008), having no usual source of care (DeVoe et al., 2003), con- straints on physician time, and difficulty in securing transportation to care facilities (Østbye et al., 2005). Individuals may also forgo obtaining health care because they believe it is not important, or because they are busy with other competing activities and commitments. This might be a particularly relevant issue for people who have a considerable amount of time pressure in their lives. Many working adults spend significantly more time at their jobs than at performing other daily activities. In the U.S., 33% of full-time employees work over 40 h per week, and 9% work at least 60 h per week (CPS, 2013). Because work is such an important component in people's lives, time pressure from work can have a significant impact on workers' ability to meet various personal, domestic and civic obligations. Finding time to attend to health care needs may be particularly challenging, because of the complexities in scheduling appointments, locating appropriate medical providers, and dealing with insurance issues. Additionally, it may be especially difficult for employed persons to take time away from their jobs, since working hours often overlap with the hours available at the offices of healthcare providers. Even if an individual makes time to seek treatment for an Preventive Medicine 74 (2015) 55–58 ⁎ Corresponding author at: Research Fellow, Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. E-mail address: yao.xiaoxi@mayo.edu (X. Yao). http://dx.doi.org/10.1016/j.ypmed.2015.03.008 0091-7435/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed