Differences in social connectedness and perceived isolation among rural and urban adults with disabilities

BackgroundSocial isolation has been compared to smoking in terms of risk to public health. Some groups are at particularly high risk for these feelings, including people with disabilities and rural residents. Few studies have considered the potentially compounding effects of disability status and rural residency.ObjectiveTo evaluate how reported satisfaction with social participation and perceived isolation relate to the health of rural and urban people with disabilities, and to consider whether number of disabilities, living arrangement, and employment status were associated with differences in reported satisfaction with social participation and perceived isolation.MethodsThis observational, cross-sectional analysis utilized data from working-age adults with disabilities (n = 1246) collected by the Collaborative on Health Reform and Independent Living (CHRIL).ResultsThere were significant associations between reported health and measures of satisfaction with social participation and perceived isolation (all ps < .001). Increased number of disability issues, not being employed, and living with at least one other person were associated with reduced satisfaction with social participation (ps < .01), and number of disability issues and not being employed were associated with increased perceived isolation (ps < .01). Urban residents reported feeling more isolated (ps < .05) and there were multiple predictor x geographic residency (rural versus urban) interactions.ConclusionThese results underscore the importance of considering geography as a factor in understanding satisfaction with social participation and perceived isolation and how these factors relate to health in people with disabilities.     

Determinants of use of smoking cessation aids in 27 European countries

ObjectiveTo identify determinants of use of smoking cessation aids among current and former smokers in the European Union (EU).MethodsData from n = 9921 current and ex-smokers from 27 European countries (Eurobarometer 77.1, February–March 2012) were analysed. Multivariate binary logistic regression was used to assess for correlates of use of any recommended aid with proven efficacy, defined as use of pharmacotherapy or psychosocial counselling (p < 0.05). The regression analyses assessed for socio-demographic characteristics, EU region, as well as scope of national smoking cessation policies.ResultsAmong current smokers who had made a quit attempt and ex-smokers, 19.9% had used any recommended aid with proven efficacy. Respondents from Northern (adjusted odds ratio [aOR] = 1.90), Western (aOR = 3.21) and Eastern Europe (aOR = 1.69) were more likely to have used an efficacious smoking cessation aid compared to respondents from Southern Europe (all p < 0.05). Respondents in countries with comprehensive tobacco cessation programmes that offered cost-covered national quit lines, medication, and other cessation services had increased likelihood of using efficacious cessation aids (OR = 1.29; 95% Confidence Interval: 1.07–1.55).ConclusionsThese findings underscore the need for enhanced and sustained efforts to ensure increased access to cessation services and aids as part of a comprehensive tobacco control programme.     

A curriculum on care for people with disabilities: Effects on medical student self-reported attitudes and comfort level

BackgroundEarly, frequent encounters with people with disabilities may improve medical students' knowledge, attitudes and skills regarding their care. We developed and implemented a longitudinal four-year curriculum addressing caring for people with disabilities.Objectives/hypothesisTo test differences in mean scores between intervention and control groups on individual post-survey items regarding attitudes toward people with disabilities, and to conduct exploratory procedures to examine individual factors that may account for group differences.MethodsStudents at two U.S. medical schools, one with the new curriculum, and one with no specific disabilities curriculum, were surveyed in Year 1 of medical school, prior to curriculum introduction, and again at the end of Year 3, using a validated 30-item instrument measuring medical students' self-reported attitudes and comfort toward people with disabilities. We compared mean item ratings between the two groups using χ² and ANOVA. Principal components analysis was then used to construct linear composite variables that were then regressed on potential predictors of attitudes and comfort level.ResultsThe intervention led to significant or near-significant improvement in several factors. However, male students in the intervention group, particularly those who encountered people with disabilities in a clinical context, had a tendency to more frequently agree with negative statements (β = .628, p = .005).ConclusionsExposure of medical students to a longitudinal curriculum for caring for people with disabilities led to significant improvement in several factors related to comfort and attitudes. The gender-related reinforcement of some negative attitudes merits further investigation and caution when implementing the curriculum in the future.     

The relation of tobacco use during hospitalization to post-discharge smoking cessation among US veterans

ObjectiveThe objective of this study was to determine if tobacco use while in the hospital was associated with post-discharge cessation rates.MethodsDuring 2006–2008, smokers from three Veterans Affairs hospitals (n = 354) were surveyed during their hospitalization and again 6 months later. Data analysis was conducted in 2009.ResultsWhile veterans smoked an average of 19 cigarettes per day, prior to admission, the average was 6–7 cigarettes per day during hospitalization. About 40% (n = 140) were able to quit smoking for more than 24 h and the median days quit was 29. The 6-month self-reported quit rate was 15% (n = 53). Multivariate analyses showed that veterans who quit tobacco use during their hospitalization had nearly 4 times increased odds of quitting smoking for more than 24 h and 2.7 times increased odds of quitting at 6 months post-hospitalization as compared to veterans that did not quit using tobacco during hospitalization.ConclusionMany veterans quit tobacco use during hospital admissions and those who do not quit, tended to decrease their use. Veterans who quit tobacco use were more likely to be abstinent at 6-month follow-up. State-of-the-art cessation interventions need to be provided to smokers hospitalized in Veterans Affairs hospitals.     

Disparities in mental health,social support and coping among individuals with mobility impairment

BackgroundCDC estimated that 19.4 million (7.8%) US adults are living with mobility impairment, who are unable to walk a quarter mile. Individuals with physical disability reported greater depression and, in some cases, insufficient social support.ObjectivesThis study explores the extent of disparities in psychological health, social support, and coping mechanisms among those with mobility impairment as compared to those without such impairment, and the longitudinal effect of onset of mobility impairment on subsequent psychosocial health and coping.MethodsIndividuals with mobility impairment were matched to controls from a nationally representative sample, using the propensity score method. The final sample included 345 matched pairs. Regression models with robust standard errors were used to assess disparities in outcomes by mobility status. Autoregressive models were used to assess the longitudinal effect of the onset of mobility limitation on these outcomes.ResultsThose with impaired mobility fared significantly higher on negative affect (p < .05) and pessimism (p < .05), and significantly lower on life satisfaction (p < .05) and positive affect (p = .001). In terms of coping, they showed disparities in health locus of control (self) (p < .05), planning (p < .05), active coping (p < .05), and problem-focused coping (p < .05), as compared to those without mobility limitation. The onset of mobility impairment had significant effects in similar psychological and coping domains.ConclusionOur work revealed a piece of reality of individuals living with mobility impairment and will inform designing effective interventions to mitigate psychosocial health disparities in this population.     

The role of pre-treatment proactive coping skills in successful weight management

ObjectivesProactive coping encompasses future-oriented self-regulatory skills that help people prepare for future difficulties before they occur, such as planning and monitoring. The aim of the present study was to examine the interplay between pre-treatment proactive coping skills and expected difficulties during weight loss in determining successful weight management.MethodObese and overweight Dutch adults (N = 119) who enrolled in a weight management intervention reported their level of proactive coping skills and expected difficulties at the start of intervention. Two months later, weight loss was assessed via self-report.ResultsThe results show that the detrimental effects of a low level of proactive coping skills were compensated by the expectation that many difficulties would accompany the weight loss attempt. Also, pre-treatment proactive coping skills did not predict weight loss success above and beyond self-efficacy and socio-demographic factors (e.g., gender).ConclusionIt is concluded that future-oriented self-regulatory skills and beliefs about impending difficulties at the start of intervention may have predictive value for subsequent success in weight management.     

State-specific prevalence of current e-cigarette use by disability status and disability type—United States,BRFSS 2016–2018

BackgroundCigarette smoking is the leading cause of preventable disease and death in the United States. The tobacco product landscape has diversified to include electronic cigarettes (e-cigarettes). Adults with disabilities are more likely than adults without disabilities to smoke cigarettes, but within the current body of literature, there is limited information on the use of e-cigarettes among adults with disabilities.ObjectiveTo assess overall and state-specific prevalence of current e-cigarette use among adults by disability status, disability type, sex, and age.MethodsDisability was defined as having serious difficulty with vision, hearing, mobility, cognition, or any difficulty with self-care or independent living. The Behavioral Risk Factor Surveillance System cross-sectional survey data (2016–2018; n = 1,150,775) were used to estimate state and District of Columbia prevalence of current e-cigarette use among adults (aged ≥18 years) with and without disabilities, overall and by disability type, sex, and age group.ResultsMedian prevalence of current e-cigarette use was higher among adults with than without disabilities (6.5% vs. 4.3%, P < 0.05). Among adults with disabilities, use varied from 2.5% in DC to 10.0% in Colorado; median use was highest among those with cognitive disabilities (10.0%) and those aged 18–24 years (18.7%).ConclusionsPrevalence of current e-cigarette use was higher among adults with than without disabilities and varied across states by disability status, type, and age group. The findings underscore the need to monitor e-cigarette use among adults with disabilities and specifically include them in tobacco control policies and programs addressing e-cigarette use.     

Physical activity and motor skill outcomes of a 10-week intervention for children with intellectual and developmental disabilities ages 4–13: A pilot study

BackgroundChildren with intellectual and developmental disabilities (IDD) often experience increased barriers to engaging in physical activity (PA) which can stem from lack of gross motor function (GMF) development. Intervening on GMF at an early age can create better opportunities for children with IDD to engage in regular PA. In turn, increased PA can improve health outcomes and increase social skills.ObjectiveThe primary objective of this pilot study was to explore the effectiveness of a community-based GMF-focused PA intervention for improving overall motor skills and PA for children with IDD.MethodsAll study participants (n = 24) engaged in 10 weeks of programming for 1 h each week. A convenience sample was utilized.ResultsResults indicated no statistically significant changes pre to post for motor skill scores. However, a visual analysis of mean changes showed a consistent pattern of increased scores from pre to post on most skills. Additionally, we found that a change in participant locomotor skills significantly predicted change in Moderate to Vigorous Physical Activity (MVPA), F (1,11) = 5.16, Adj R² = .26, p = .04.ConclusionsThese results suggest individualized attention on GMF may help to increase motor skills for children with IDD. This study adds to the small but growing amount of research examining the efficacy of community based adapted PA interventions. Further, study results should support continued exploration of effective approaches to address the motor delays experienced by children with IDD.     

Abstinence rates among college cigarette smokers enrolled in a randomized clinical trial evaluating Quit and Win contests: The impact of concurrent hookah use

ObjectiveTo examine baseline characteristics and biochemically verified 1-, 4-, and 6-month tobacco quit rates among college students enrolled in a Quit and Win cessation trial, comparing those who concurrently smoke both hookah and cigarettes with those who deny hookah use.MethodsAnalyses were conducted on data from 1217 college students enrolled in a Quit and Win tobacco cessation randomized clinical trial from 2010–2012. Multivariable logistic regression (MLR) analyses examined group differences in baseline characteristics and cotinine verified 30-day abstinence at 1, 4, and 6-month follow-up, adjusting for baseline covariates.ResultsParticipants smoked 11.5(± 8.1) cigarettes per day on 28.5(± 3.8) days/month, and 22% smoked hookah in the past 30 days. Hookah smokers (n = 270) were more likely to be male (p < 0.0001), younger (p < 0.0001), report more binge drinking (p < 0.0001) and score higher on impulsivity (p < 0.001). MLR results indicate that hookah users, when compared to non-users, had a 36% decrease in odds of self-reported 30-day abstinence at 4-months (OR = 0.64, 95% CI = 0.45–0.93, p = 0.02) and a 63% decrease in odds in biochemically verified continuous abstinence at 6-months (OR = 0.37, CI = 0.14–0.99, p = 0.05).ConclusionCollege cigarette smokers who concurrently use hookah display several health risk factors and demonstrate lower short and long-term tobacco abstinence rates.     

Acute classroom exercise breaks improve on-task behavior in 4th and 5th grade students: A dose–response

This study was the first to directly compare the acute effects of 5, 10, and 20 min of classroom exercise breaks on on-task behavior.MethodsIn this within-subject experiment, 96 4th and 5th grade students, in 5 classroom groups, participated in each of four conditions: 10 min of sedentary classroom activity and 5, 10, 20 min of classroom exercise breaks led by research staff. On-task behavior was directly and systematically observed from videotapes before and after each condition. The post-test time-on-task scores were compared using a repeated measures mixed ANCOVA, adjusted for age, classroom, and the time-varying pre-test time-on-task.ResultsTime-on-task was significantly higher in students after 10 min of classroom exercise breaks compared to a sedentary attention control (87.6% vs 77.1%, d = .45, p = .004).ConclusionsTen minutes of classroom exercise breaks improved on-task behavior in children.     

Smoking behaviors among people with disabilities in Korea

BackgroundMost reports concerning smoking behaviors in people with disabilities have been from Western societies; knowledge of smoking behaviors in Asian countries, including Korea, is insufficient.ObjectivesThis study investigates the smoking behaviors of people with a disability compared to the general population in Korea.MethodsWe compared the smoking behaviors of people with a disability with the general population by using datasets from the 2011 National Survey of Disabled People and an age- and sex-matched random sample from the 5th Korean National Health and Nutrition Examination Survey. Random samples of people 18 years of age and older with disabilities (n = 5636) and of the general population were used (n = 5636). The main outcome measures include smoking behaviors by type, severity, and age at disability onset.ResultsPeople with a mental or physical impairment have higher current smoking rates (38.1% and 26.3%, respectively) than the general population (23.3%). In particular, current smokers with psychiatric impairment were more likely to smoke more than 20 cigarettes a day (61.2%). People with a disability, regardless of severity or age at onset, were less likely than the general population to have attempted to quit smoking.ConclusionsSmoking behaviors differed according to the type of disability. These results suggest that interventions for smoking prevention and cessation need to be tailored according to disability characteristics.     

Coping strategy mediates the relationship between body image evaluation and mental health: A study with Chinese college students with disabilities

BackgroundFor students with disabilities, evidence exists of significant links between body image evaluation and mental health status, and between coping strategies and mental health status, yet few investigations have tested body image evaluation, coping strategies and mental health status in one study to reveal their complicated relationships.ObjectiveThe present study investigated the mediation role of coping strategy between body image evaluation and mental health and its variations among Chinese university students with three types of disabilities, physical disability, visual disability and hearing disability.MethodTwo hundred and fifty-five Chinese college students (166 males and 89 females) with disabilities completed a battery of self-report questionnaires, including Multidimensional Body-Self Relations Questionnaire (MBSRQ), Coping Style Questionnaire (CQS) and Symptom Checklist 90 (SCL-90). Mediation analyses were conducted in AMOS.ResultsIn students with physical disabilities, positive coping strategies played a role in mediating the relation between body image evaluation and mental health (β = −0.190, p < 0.05). In students with hearing disabilities, negative coping strategies played the mediation role (β = −0.089, p < 0.05). No significant mediation effect was found in students with visual disabilities. Meanwhile, the mental health status of all of the three groups were significantly lower than the Chinese norm (M = 129.96; SD = 38.76) (all ps < 0.01).ConclusionsIn Chinese college students with disabilities, in bridging the link between their body image evaluation and mental health status, coping strategies played a central role and its specific role varied depending upon the type of disability. Practical implications are discussed.     

Park-based afterschool program to improve cardiovascular health and physical fitness in children with disabilities

BackgroundChildren with disabilities are more likely to be overweight or obese and less likely to engage in physical activities versus their peers without disabilities.ObjectiveThe effect of a structured afterschool program housed in a large county parks system on several obesity-related health outcomes among children with disabilities was examined.MethodsChildren/adolescents with a developmental and/or intellectual disability ages 6–22 (N = 52, mean age 13.7 years) who participated in an afterschool (either 2010–2011 or 2011–2012 school year) health and wellness program called Fit-2-Play™ were assessed. Pre-post comparison of outcome variables (mean height, weight, waist/hip/midarm circumference, fitness tests, and a 9-item health and wellness knowledge assessment) via general linear mixed models analysis was conducted to evaluate the effectiveness of the program for normal and overweight/obese participants.ResultsNormal weight participants significantly improved pre-post mean number of push-ups (9.69–14.23, p = 0.01) and laps on the PACER test (8.54–11.38, p < 0.01) and the overweight/obese group significantly improved the number of sit ups (7.51–9.84, p < 0.01) and push ups (4.77–9.89, p < 0.001). Pre-post mean health and wellness knowledge composite scores significantly improved for all participants (p < 0.01).ConclusionsParks-based afterschool programs can be effective community resources for instilling physical health in both normal weight and overweight/obese children with disabilities. More studies are needed to ascertain whether community-based afterschool health and wellness programs can be implemented and sustained across this population.     

Theory of planned behavior to promote physical activity of adults with physical disabilities: Meta-analytic structural equation modeling

BackgroundAdults with physical disabilities experience lower physical activity (PA) engagement. The theory of planned behavior (TPB) has been one of dominant theories in understanding and promoting PA. There is no previous meta-analysis examining the use of the TPB on PA of adults with physical disabilities.ObjectiveThe purposes of this review were 1) to conduct meta-analysis to examine predictive effects of TPB on PA behavior of adults with physical disabilities and 2) to investigate a possible moderator among components of TPB.MethodsOne-stage meta-analytic structural equation modeling was used to conduct meta-analysis. Type of physical disability was examined as a moderator.ResultsIntention had moderate effect on PA (β = 0.37, p < .001), attitude had a moderate effect on intention (β = 0.30, p < .001), SN had a non-significant effect on intention (β = 0.03, p = .75), and PBC had a moderate effect on intention (β = 0.43, p < .001) and a non-significant direct effect on PA (β = 0.09, p = .18). The studies conducted with only participants with SCI lowered the predictive effect (β = ?0.12, p = .02) of PBC on PA.ConclusionsPredictive effects of component of TPB were slightly different from those of individuals without disabilities. Type of physical disability can be a critical factor determining the impact of perceived control on PA behavior. Attitude and PBC can be targets for promoting PA of adults with physical disabilities.     

The role of physical activity enjoyment on the acute mood experience of exercise among smokers with elevated depressive symptoms

ProblemDepressive symptoms are consistently shown to be related to poor smoking cessation outcomes. Aerobic exercise is a potential treatment augmentation that, given its antidepressant and mood enhancing effect, may bolster cessation outcomes for smokers with elevated depressive symptoms. Lower enjoyment of physical activity may inhibit the acute mood enhancing effects of aerobic exercise. The current study investigated the associations between depressive symptoms, physical activity enjoyment and the acute mood experience from exercise among low-active smokers with elevated depressive symptoms.MethodDaily smokers with elevated depressive symptoms (N = 159; M_age = 45.1, SD = 10.79; 69.8% female) were recruited for a randomized controlled exercise-based smoking cessation trial. Participants self-reported levels of depressive symptoms, physical activity enjoyment, and rated their mood experience (assessed as “mood” and “anxiety”) before and after a standardized aerobic exercise test.ResultsHierarchical regression analysis revealed that depressive symptom severity accounted for significant unique variance in physical activity enjoyment (R² = 0.041, t = −2.61, p = 0.010), beyond the non-significant effects of gender and level of tobacco dependence. Additionally, physical activity enjoyment was a significant mediator of the association between depressive symptom severity and acute mood experience (“mood” and “anxiety”) following the exercise test.ConclusionsPhysical activity enjoyment may explain, at least in part, how depressive symptom severity is linked to the acute mood experience following a bout of activity. Interventions that target increasing physical activity enjoyment may ultimately assist in enhancing the mood experience from exercise, and therefore improve smoking cessation likelihood, especially for smokers with elevated depressive symptoms.     

Contraceptive use at first sexual intercourse among adolescent and young adult women with disabilities: The role of formal sex education

ObjectivesThis study examines receipt of formal sex education as a potential mechanism that may explain the observed associations between disability status and contraceptive use among young women with disabilities.Study designUsing the 2011?2017 National Survey of Family Growth, we analyzed data from 2861 women aged 18 to 24 years, who experienced voluntary first sexual intercourse with a male partner. Women whose first intercourse was involuntary (7% of all women reporting sexual intercourse) were excluded from the analytic sample. Mediation analysis was used to estimate the indirect effect of receipt of formal sex education before first sexual intercourse on the association between disability status and contraceptive use at first intercourse.ResultsCompared to nondisabled women, women with cognitive disabilities were less likely to report receipt of instruction in each of 6 discrete formal sex education topics and received instruction on a fewer number of topics overall (B = ?0.286, 95% CI = ?0.426 to ?0.147), prior to first voluntary intercourse. In turn, the greater number of topics received predicted an increased likelihood of contraceptive use at first voluntary intercourse among these women (B = 0.188, 95% CI = 0.055?0.321). No significant association between noncognitive disabilities and receipt of formal sex education or contraceptive use at first intercourse was observed.ConclusionsGiven the positive association between formal sex education and contraceptive use among young adult women with and without disabilities, ongoing efforts to increase access to formal sex education are needed. Special attention is needed for those women with cognitive disabilities.     

Peer Reviewed: State-Level Prevalence of Cigarette Smoking and Treatment Advice, by Disability Status, United States, 2004

Introduction

To our knowledge, no study has determined whether smoking prevalence is higher among people with disabilities than among people without disabilities across all U.S. states. Neither do we know whether people with disabilities and people without disabilities receive the same quality of advice about tobacco-cessation treatment from medical providers.

Methods

We analyzed data from the 2004 Behavioral Risk Factor Surveillance System to estimate differences between people with and people without disabilities in smoking prevalence and the receipt of tobacco-cessation treatment advice from medical providers.

Results

We found that smoking prevalence for people with disabilities was approximately 50% higher than for people without disabilities. Smokers with disabilities were more likely than smokers without disabilities to have visited a medical provider at least once in the previous 12 months and to have received medical advice to quit. More than 40% of smokers with disabilities who were advised to quit, however, reported not being told about the types of tobacco-cessation treatment available.

Conclusion

Ensuring that people with disabilities are included in state-based smoking cessation programs gives states an opportunity to eliminate health disparities and to improve the health and wellness of this group. Ways to reduce unmet preventive health care needs of people with disabilities include provider adoption of the Public Health Service''s clinical practice guideline for treating tobacco use and dependence and the provision of smoking cessation services that include counseling and effective pharmaceutical treatment.     

Incidence,risk, and associated risk factors of stroke among people with different disability types and severities: A national population-based cohort study in Taiwan

BackgroundThe number of people with disabilities is increasing. People with disabilities are more likely to be physically inactive, which can lead to chronic diseases, including stroke. Stroke is a leading cause of illness and death worldwide, but little is known regarding stroke among people with disabilities.ObjectiveTo evaluate the incidence density rate, relative risk, and associated risk factors of stroke and measure the risk of death due to stroke among people with disabilities in Taiwan.MethodsThis retrospective cohort study used nationwide data from the National Health Insurance Research Database, National Disability Registry Database, and Cause of Death File. Incidence density rates of stroke were estimated as new cases per 1000 person-years. Cox proportional hazard models were used to estimate the relative risk of stroke, adjusted survival curves, and adjusted cumulative incidence curves.ResultsA total of 670,630 people with disabilities were included in our analyses. The average person-years of observation was 9.43 ± 5.31, with a yearly rate of 16.72 new cases of stroke per 1000 person-years. The highest risk of stroke was found among people with balance disorder (hazard ratio [HR] = 2.27, 95% confidence interval [CI] = 2.00–2.57) and intractable epilepsy (HR = 1.85, 95% CI = 1.56–2.19). The highest risk of death due to stroke was found among people with dementia and multiple disabilities.ConclusionsStroke rates were higher among people with disabilities than among the general population, and certain disabilities were associated with a higher stroke risk and death rate.