title: Factors associated with distance and time traveled to cleft and craniofacial care.
abstract: BACKGROUND
  Information on travel distance and time to care for children with birth defects is lacking. We examined factors associated with travel distance and time to cleft care among children with orofacial clefts.
  
  
  METHODS
  In 2006, a mail/phone survey was administered in English and Spanish to all resident mothers of children with orofacial clefts born 2001 to 2004 and identified by the North Carolina birth defects registry. We analyzed one-way travel distance and time and the extent to which taking a child to care was a problem. We used multivariable logistic regression to examine the association between selected sociodemographic factors and travel distance (≤60 miles and >60 miles) and time (≤60 min and >60 min) to cleft care.
  
  
  RESULTS
  Of 475 eligible participants, 51.6% (n = 245) responded. Of the respondents, 97.1% (n = 238) were the child's biological mother. Approximately 83% (n = 204) of respondents were non-Hispanic White; 33.3% (n = 81) were college educated; and 50.0% (n = 115) had private health insurance. One-way mean and median travel distances were 80 and 50 miles, respectively (range, 0-1058 miles). One-way mean and median travel times were 92 and 60 min, respectively (range, 5 min to 8 hr). After adjusting for selected sociodemographics, travel distance varied significantly by maternal education, child's age, and cleft type. Travel time varied significantly by child's age. Approximately 67% (n = 162) reported taking their child to receive care was not a problem.
  
  
  CONCLUSIONS
  Approximately 48% of respondents traveled > 1 hr to receive cleft care. Increasing access to care may be important for improving health outcomes among this population.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Cassell
authors.forename: Anne
authors.initials: A
authors.lastname: Krohmer
authors.forename: Dara D
authors.initials: DD
authors.lastname: Mendez
authors.forename: Kyung A
authors.initials: KA
authors.lastname: Lee
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Strauss
authors.forename: Robert E
authors.initials: RE
authors.lastname: Meyer
mesh_terms: D000328:Adult; D002648:Child; D002971:Cleft Lip / Q000191:economics* / Q000628:therapy; D002972:Cleft Palate / Q000191:economics* / Q000628:therapy; D005260:Female; D040362:Geographic Information Systems; D062305:Geographic Mapping; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009657:North Carolina; D012042:Registries; D013997:Time Factors
keywords: barriers to care; cleft lip; cleft palate; health care accessibility; orofacial clefts; travel distance; travel time
references.citation: Cleft Palate Craniofac J. 2012 May;49(3):262-9
references.pmid: 21740175
references.citation: Arch Pediatr Adolesc Med. 1995 May;149(5):553-8
references.pmid: 7735412
references.citation: Birth Defects Res A Clin Mol Teratol. 2008 Nov;82(11):795-8
references.pmid: 18985692
references.citation: Health Serv Res. 1974 Fall;9(3):208-20
references.pmid: 4436074
references.citation: J Rural Health. 2007 Spring;23(2):150-7
references.pmid: 17397371
references.citation: Acad Pediatr. 2009 Nov-Dec;9(6):427-32
references.pmid: 19945078
references.citation: Cleft Palate Craniofac J. 1995 Nov;32(6):495-9
references.pmid: 8547290
references.citation: J Community Health. 2011 Dec;36(6):933-42
references.pmid: 21461957
references.citation: Environ Res. 2007 Mar;103(3):405-12
references.pmid: 17046743
references.citation: Ambul Pediatr. 2004 Jul-Aug;4(4):323-31
references.pmid: 15264959
references.citation: Pediatrics. 2004 May;113(5 Suppl):1538-44
references.pmid: 15121923
references.citation: Birth Defects Res A Clin Mol Teratol. 2003 Sep;67(9):643-6
references.pmid: 14703787
references.citation: Med Care. 1981 Dec;19(12 Suppl):4-27
references.pmid: 7339313
references.citation: Child Care Health Dev. 2012 Jan;38(1):6-20
references.pmid: 21623872
references.citation: Can Med Assoc J. 1980 Jan 12;122(1):19-24
references.pmid: 6988061
references.citation: Cleft Palate J. 1981 Apr;18(2):116-21
references.pmid: 6939506
references.citation: Pediatrics. 2012 Jun;129(6):1118-24
references.pmid: 22566422
references.citation: J Am Dent Assoc. 2004 Apr;135(4):490-5
references.pmid: 15127874
references.citation: Oral Dis. 2010 Jan;16(1):3-10
references.pmid: 19656316
references.citation: Pediatr Dent. 2011 Jan-Feb;33(1):29-36
references.pmid: 21406145
references.citation: Med Care. 1981 Feb;19(2):127-40
references.pmid: 7206846
references.citation: Pediatrics. 2009 Jun;123(6):e996-1004
references.pmid: 19482751
references.citation: Birth Defects Res A Clin Mol Teratol. 2010 Dec;88(12):1008-16
references.pmid: 20878909
references.citation: J Rural Health. 2009 Fall;25(4):366-71
references.pmid: 19780916
references.citation: Pediatrics. 2009 Dec;124 Suppl 4:S352-60
references.pmid: 19948599
references.citation: Matern Child Health J. 2009 Jul;13(4):445-56
references.pmid: 18546066
references.citation: Cleft Palate Craniofac J. 2007 Jul;44(4):351-7
references.pmid: 17608558
references.citation: Arch Pediatr Adolesc Med. 2005 Jan;159(1):10-7
references.pmid: 15630052
references.citation: Pediatr Cardiol. 2012 Feb;33(2):229-38
references.pmid: 21956401
references.citation: Cleft Palate Craniofac J. 2009 Nov;46(6):588-97
references.pmid: 19860509
references.citation: Arch Pediatr Adolesc Med. 2005 Feb;159(2):167-72
references.pmid: 15699311
references.citation: Nat Rev Genet. 2011 Mar;12(3):167-78
references.pmid: 21331089
references.citation: Cleft Palate Craniofac J. 1999 May;36(3):189-95
references.pmid: 10342606