227910 Geographical equity in chronic disease control: Improving Control with Activity and Nutrition

Tuesday, November 9, 2010

Jacquelyn Smith , Environmental Sciences, Oregon State University, Corvallis, OR
Viktor Bovbjerg, PhD , Public Health, Oregon State University, Corvallis, OR
Nisha Botchwey, PhD , School of Architecture, University of Virginia, Charlottesville, VA
Lydia Abebe , Department of Medicine, Infectious Diseases, University of Virginia, Charlottesville, VA
Jayne Crowther, APRN, MSN , Loudoun Community Health Center, Leesburg, VA
Jerry Nadler, MD , Internal Medicine, Eastern Virginia Medical School, Norfolk, VA
Linda Gonder-Frederick, PhD , Department of Psychiatry, University of Virginia, Charlottesville, VA
Glenn Gaesser, PhD , College of Nursing and Health Innovation, Arizona State University, Phoenix
Kurt Elward, MD , Department of Family Medicine, University of Virginia, Charlottesville, VA
Anne Wolf, MS RD , Public Health Sciences, University of Virginia, Charlottesville, VA
Equal access to effective lifestyle change programs is crucial if we are to achieve chronic disease prevention and control for all. Geographical access may influence program participation. One geographical barrier to sustained participation may be long travel times to program sites. We used data from a multi-site clinical trial of diabetes control among people with obesity to determine whether travel time predicted participant retention over the course of the study. Using geographical information system mapping, we calculated road distance and travel time from participants‘ residences to their clinical sites (one urban, one small city, and two rural sites), and used those data to predict participant retention over the course of the 42-month follow-up. Mean travel time was 22.0 minutes (SD=24.7). In logistic models, travel time was associated with program withdrawal in both adjusted models (odds ratio [OR]=1.012, 95% confidence interval [CI]=1.002-1.021) and after adjustment for hemoglobin A1c, body mass index, age, gender, race, education, income, and clinical site (odds ratio [OR]=1.012, 95% confidence interval [CI]=1.002-1.022). Exponentiating the log odds of withdrawal suggested that 22 minutes of travel time was associated with 30% increased risk of withdrawal from the program. In this setting travel time was predictive of participant retention in the intervention in unadjusted and adjusted analyses. To assure equity of access, chronic disease lifestyle intervention programs should use participant travel time to locate their program sites.

Learning Areas:
Administer health education strategies, interventions and programs
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
1. Explain the association between travel time and participation in lifestyle intervention programs.

Keywords: Access to Care, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator for the project described, and took active roles in the conception and conduct of the analyses that led to this specific abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.