title: Spatial heterogeneity in repeated measures of perceived stress among car commuters in Scania, Sweden.
abstract: Long commutes by car are stressful. Most research studying health effects of commuting have summarized cross-sectional data for large regions. This study investigated whether the levels of stress and individual characteristics among 30-60 min car commuters were similar across different places within the county of Scania, Sweden, and if there were changes over time.
  
  
  
  The study population was drawn from a public health survey conducted in 2000, with follow-ups in 2005 and 2010. The study population was selected from the 8206 study participants that completed the questionnaire at all three time points. Commuting questions in the 2010 questionnaire assessed exposure concurrently for that year and retrospectively for 2000 and 2005. In total, 997 persons aged 18-65 and working 15-60 h/week had commuted by car 30-60 min at least at one time point. Geographically weighted proportions of stress among 30-60 min car commuters were calculated for each year and classified into geographically continuous groups based on Wards algorithm. Stress levels, sociodemographic characteristics and commuting characteristics were compared for areas with high and low stress in relation to the rest of the county. This novel methodology can be adapted to other study settings where individual-level data are available over time.
  
  
  
  Spatial heterogeneity in stress levels was observed and the locations of high and low stress areas changed over time. Local differences in stress among participants were only partly explained by sociodemographic characteristics. Stressed commuters in the high stress area in 2000 were more likely to maintain their commuting mode and time than those not stressed. Stressed commuters in the high stress area in 2000 were also more likely to have the same workplace location in 2010, while stressed commuters in the high stress area in 2010 were more likely to have the same residential location as in 2000.
  
  
  
  The relationship between commuting mode and time and stress is variable in place and time. Better understanding of commuting contexts such as congestion is needed in research on the health effects of commuting.
authors.affiliation: Department of Occupational and Environmental Medicine, Lund University, 221 85, Lund, Sweden. kristoffer.mattisson@med.lu.se.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Mattisson
authors.affiliation: Department of Occupational and Environmental Medicine, Lund University, 221 85, Lund, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Jakobsson
authors.affiliation: Department of Occupational and Environmental Medicine, Lund University, 221 85, Lund, Sweden.
authors.forename: Carita
authors.initials: C
authors.lastname: Håkansson
authors.affiliation: Department of Occupational and Environmental Medicine, Lund University, 221 85, Lund, Sweden.|Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, MC 6325, Farmington, CT, 06030-6325, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Cromley
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001334:Automobile Driving / Q000523:psychology* / Q000706:statistics & numerical data*; D001336:Automobiles; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D013315:Stress, Psychological / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014186:Transportation / Q000379:methods*; D055815:Young Adult
keywords: Commuting; Cross-sectional; Geographically weighted proportions; Repeated measures; Spatial heterogeneity; Stress; Sweden