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IntroductionWe examined geographic and social factors associated with participation in the Chronic Disease Self-Management Program (CDSMP) and the Diabetes Self-Management Program (DSMP) implemented at 144 sites in Illinois.MethodsPrograms were delivered by trained facilitators, once per week, during 6 weeks to 1,638 participants aged 50 or older. Of the 1,638 participants, we included in our analysis 1,295 participants with complete geographic information and baseline data on demographic characteristics, health history, and health behaviors. We assessed the following program data: program type (CDSMP or DSMP), workshop location, class size, and number of sessions attended by participants. We geocoded each participant’s home address, classified the home address as rural or urban, and calculated the distance traveled from the home address to a workshop. We used linear and logistic regression analyses to examine the associations between participant and program factors with number of sessions attended and odds of program completion by whether participants lived in an urban or rural county.ResultsAverage program attendance was 4.2 sessions; 71.1% (1,106 of 1,556) completed 4 or more sessions. Most participants enrolled in CDSMP (59.6% [954 of 1,600]), but DSMP had greater completion rates. Less than 7% (85 of 1,295) of our sample lived in a rural county; these participants had better completion rates than those living in urban counties (89.4% [76 of 85] vs 75.6% [890 of 1,178]). Traveling shorter distances to attend a workshop was significantly associated with better attendance and program completion rates among urban but not rural participants. The number of sessions attended was significantly higher when class size exceeded 16 participants. Not having a high school diploma was significantly associated with lower levels of attendance and program completion.ConclusionParticipation in CDSMP and DSMP was associated with distance traveled, program type, class size, and education. Increasing participation in self-management programs is critical to ensure participants’ goals are met.

Background and Objectives This study introduces a theoretical framework for assessing age inclusivity in higher education environments and describes the Age-Friendly Inventory and Campus Climate Survey (ICCS). The ICCS measures age-friendly campus practices as reported by administrators, perceptions of age friendliness by campus constituents, and the fit between objective practices and subjective perceptions as an overall indicator of age inclusivity. Research Design and Methods The ICCS was administered at a public university in the northeastern United States. Administrators completed the Inventory of potential age-friendly campus practices associated with their units. Campus constituents (n = 688) completed the online Campus Climate Survey to assess subjective awareness of these practices, perceived age-friendliness, and personal beliefs about age inclusivity. Results The Inventory yielded a score of 66% of potential age-friendly practices in place as reported by administrators. The Campus Climate Survey showed low overall perceptions of age-friendliness and varied beliefs about age inclusivity on campus. Fit was measured by comparing the Inventory practices and Campus Climate Survey awareness of the existence of 47 of 73 potential practices. Convergence on this campus showed an awareness of 36% of age-friendly practices. Discussion and Implications Based on the proposed theoretical framework for age inclusivity, the ICCS offers a way of assessing the age-friendliness of the objective environment across campus functions, the subjective environment across campus constituents, and the fit between subjective and objective environments on campuses. The ICCS will help higher education institutions identify strengths and challenges for advancing age inclusivity.

What is already known on this topic? Chronic lung diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, are among the top preexisting conditions identified by the Centers for Disease Control and Prevention that increase the risk for severe COVID-19 illness and death. What is added by this report?Town-level factors (African American race and Hispanic ethnicity, age ≥65 y, and low educational attainment) were significant predictors of COVID-19 death rates, adding to the current understanding of the impact of social determinants of health on outcomes.What are the implications for public health practice? Public health policy makers could focus on communities reporting high rates of chronic lung conditions among the older adult population to provide more testing and access to vaccinations.

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