{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:38:04Z","timestamp":1777523884741,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>American Indians and Alaska Natives (AI\/AN) have the highest incidence of cleft lip and palate (orofacial clefts [OFCs]) when compared to other ethnic groups. We aim to determine the AI\/AN populations\u2019 proximity and accessibility to American Cleft Palate-Craniofacial Association accredited centers (ACPA centers) for treatment of OFCs. Our hypothesis is an unacceptable proportion of the AI\/AN population lacks reasonable accessibility to ACPA centers and comprehensive craniofacial care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>A cross-sectional study of ACPA centers and AI\/AN populations were analyzed for possible disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>ACPA centers were mapped using Geographic Information Systems (GIS) and compared with 2018 census population data and 2017 Tribal Census Tract data to visually display possible disparities. Total annual potential pediatric cleft care need for selected high-density AI\/AN populated lands were estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>GIS mapping demonstrates geographical isolation of AI\/AN populations from ACPA centers. Two states with high AI\/AN populated lands (ND, WY) have no ACPA centers. 47.1% of ACPA centers in high AI\/AN populated lands have no craniofacial trained surgeons versus 78.9% craniofacial staffed ACPA centers nationally. The potential unmet cleft and craniofacial care need in selected high-density AI\/AN populated lands is 1042 children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>AI\/AN populations are likely underserved by ACPA centers and by craniofacial fellowship-trained staffed centers. Not addressing OFCs with comprehensive care can lead to worsened outcomes and further marginalization of these children. With future studies, we will be capable of making data-driven, informed decisions to more effectively ensure AI\/AN access to comprehensive cleft and craniofacial care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656221104942","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T01:39:25Z","timestamp":1654047565000},"page":"1376-1384","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["American Indian and Alaska Native Accessibility to Comprehensive Cleft Lip and Palate Treatment"],"prefix":"10.1177","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5782-2134","authenticated-orcid":false,"given":"Erik M.","family":"Wolfswinkel","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna C.","family":"Howell","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beau","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lori K.","family":"Howell","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"bibr1-10556656221104942","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1425.017"},{"key":"bibr2-10556656221104942","unstructured":"U.S. Commision on Civil Rights. A Quiet Crisis: Federal Funding and Unmet Needs in Indian Country. Accessed Jan 10, 2019. https:\/\/www.usccr.gov\/files\/pubs\/na0703\/na0204.pdf."},{"key":"bibr3-10556656221104942","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp048157"},{"key":"bibr4-10556656221104942","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000721"},{"key":"bibr5-10556656221104942","unstructured":"American Cleft Palate- Craniofacial Association. Parameters For Evaluation and Treatment of Patients with Cleft Lip\/Palate or other craniofacial Differences. Accessed Jan 10, 2019b. https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1055665617739564."},{"key":"bibr6-10556656221104942","unstructured":"Seattle Children\u2019s Hospital. Cleft Lip and Palate. Critical Elements of Care. Accessed Jan 10, 2019. https:\/\/www.seattlechildrens.org\/globalassets\/documents\/clinics\/craniofacial\/cleft-lip-and-palate-critical-elements-of-care.pdf."},{"key":"bibr7-10556656221104942","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.07.013"},{"key":"bibr8-10556656221104942","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsurg.2016.08.014"},{"key":"bibr9-10556656221104942","unstructured":"American Cleft Palate- Craniofacial Association. ACPA Approved Teams in the US and Canada. Accessed Jan 10, 2019a. https:\/\/cleftline.org\/find-a-team\/acpa-approved-teams-in-the-us-and-canada\/."},{"key":"bibr10-10556656221104942","unstructured":"U.S. Census Bureau. 2013-2017 American Community Survey 5-Year Estimates, Table DP05 for State-County Census Tracts. Accessed 25 February 2019a from https:\/\/factfinder.census.gov\/faces\/tableservices\/jsf\/pages\/productview.xhtml?pid=ACS_17_5YR_DP05&prodType=table Data now available from https:\/\/data.census.gov\/cedsci\/table?q=&text=DP05&g=0100000US%241400000&y=2018&d=ACS%205-Year%20Estimates%20Data%20Profiles&tid=ACSDP5Y2018.DP05."},{"key":"bibr11-10556656221104942","unstructured":"U.S. Census Bureau. 2018 TIGER American Indian Areas Related National Geodatabase. Accessed 25 February 2019c from https:\/\/www2.census.gov\/geo\/tiger\/TGRGDB18\/."},{"key":"bibr12-10556656221104942","unstructured":"U.S. Census Bureau. 2018 TIGER National Sub-State Geography Geodatabase. Accessed 18 December 2018 from https:\/\/www2.census.gov\/geo\/tiger\/TGRGDB18\/."},{"key":"bibr13-10556656221104942","unstructured":"U.S. Census Bureau. 2013-2017 American Community Survey 5-Year Estimates, Table DP05 for Tribal Census Tracts and AI\/AN\/NH Lands. Accessed 25 February 2019b from https:\/\/factfinder.census.gov\/faces\/tableservices\/jsf\/pages\/productview.xhtml?pid=ACS_17_5YR_DP05&prodType=table. Data now available from https:\/\/data.census.gov\/cedsci\/all?text=DP05&g=0100000US%242500000_2560000US0010T00100,4785T00100,4785T00200&y=2018&d=ACS%205-Year%20Estimates%20Data%20Profiles."},{"key":"bibr14-10556656221104942","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2021.306219"},{"key":"bibr15-10556656221104942","doi-asserted-by":"publisher","DOI":"10.1597\/08-250.1"},{"issue":"5","key":"bibr16-10556656221104942","doi-asserted-by":"crossref","DOI":"10.1097\/SAP.0000000000001046","volume":"78","author":"Schoenbrunner AR","journal-title":"Ann Plast Surg"},{"key":"bibr17-10556656221104942","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620954063"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656221104942","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656221104942","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656221104942","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:22:06Z","timestamp":1777393326000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656221104942"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,31]]},"references-count":17,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1177\/10556656221104942"],"URL":"https:\/\/doi.org\/10.1177\/10556656221104942","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,31]]}}}