{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:57:55Z","timestamp":1793167075723,"version":"4.5.0"},"reference-count":33,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T00:00:00Z","timestamp":1717545600000},"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":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluates the geospatial distribution of cleft lip and\/or cleft palate (CL\/P) care in the United States, assesses disparities between families with and without one-hour proximity to CL\/P care, and recommends interventions for improving access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We identified American Cleft Palate Craniofacial Association-approved CL\/P teams and calculated a one-hour driving radius around each clinic. We then used census data to compare risk factors for developing cleft (i.e., incidence risk factors) and obstacles to care (i.e., access risk factors) between counties with and without one-hour proximity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 187 CL\/P teams in 45 states. Most were in the South (n\u2009=\u200960, 32.0%), though children in the Middle Atlantic had the greatest access to care. Alabama, Mississippi, Tennessee, and Kentucky had the least access. Children without access were 39% more likely to have gestational tobacco exposure, 8% more likely to have gestational obesity exposure, and 28% less likely to have health insurance (p\u2009&lt;\u20090.01). Children without access in the South were 29% more likely to have a low birth weight and 46% more likely to be living below the poverty line (p\u2009&lt;\u20090.01). Children with access were twice as likely to live in immigrant families and 7-times more likely to speak English as a second language.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pronounced disparities affect patients with and without one-hour access to CL\/P care. Interventions should address care costs for patients living furthest without access and language barriers for patients with access that speak English as a second language.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656241259883","type":"journal-article","created":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T04:21:20Z","timestamp":1717561280000},"page":"1478-1488","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["A Geospatial Analysis of Barriers to Cleft Lip and Palate Care in the United States"],"prefix":"10.1177","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7578-8053","authenticated-orcid":false,"given":"Matthew J.","family":"Heron","sequence":"first","affiliation":[{"name":"Department of Plastic &amp; Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siam K.","family":"Rezwan","sequence":"additional","affiliation":[{"name":"Department of Plastic &amp; Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine J.","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Plastic &amp; Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Gornitsky","sequence":"additional","affiliation":[{"name":"Department of Plastic &amp; Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Redett","sequence":"additional","affiliation":[{"name":"Department of Plastic &amp; Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Plastic &amp; Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,5]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-925900"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665621990174"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211035253"},{"issue":"3","key":"e_1_3_3_5_2","article-title":"Number of surgical procedures for patients with cleft lip and palate from birth to 21 years old at a single children\u2019s hospital","volume":"76","author":"McIntyre JK","year":"2016","unstructured":"McIntyre JK, Sethi H, Sch\u00f6nbrunner A, Proudfoot J, Jones M, Gosman A. Number of surgical procedures for patients with cleft lip and palate from birth to 21 years old at a single children\u2019s hospital. Ann Plast Surg. 2016;76(Suppl 3):S205-S208. doi:https:\/\/doi.org\/10.1097\/SAP.0000000000000765","journal-title":"Ann Plast Surg"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12122089"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1044\/2019_JSLHR-19-00162"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620956873"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221093174"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.coms.2020.01.001"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000009863"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221150291"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/27325016231203517"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221078488"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2021.02.043"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008636"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000006900"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003038"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656231189940"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620949119"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620949119"},{"key":"e_1_3_3_22_2","unstructured":"Find a care team. American Cleft Palate Craniofacial Association. Accessed March 22 2024. https:\/\/acpacares.org\/find-a-care-team\/."},{"key":"e_1_3_3_23_2","unstructured":"Standards for approval of cleft palate and craniofacial teams. Published online November 2022. Accessed March 22 2024. https:\/\/acpacares.org\/standards-of-approval-for-team-care\/."},{"key":"e_1_3_3_24_2","volume-title":"The Integration of Immigrants into American Society","author":"Waters MC","year":"2016","unstructured":"Waters MC, Pineau MG. The Integration of Immigrants into American Society. 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