Birth intentions among US fathers with disabilities

BackgroundMen’s birth intention is an indicator of their sexual health and plays an important role for their child’s health and development; however, birth intendedness in fathers with disabilities has been unknown.ObjectiveThis study examines disparities in birth intendedness among fathers with and without disabilities and explores whether the differences vary by marital status or race/ethnicity.MethodsData from the 2011–2017 National Survey of Family Growth (NSFG) were used to examine pregnancy intendedness for fathers with (n = 380) and without disabilities (n = 1,324) about their last birth in the five years preceding the interview. Multinomial regression models estimated the odds ratios of fathers’ disability status on birth intention controlling for covariates. Interaction effects of disability status by marital status or race/ethnicity were also tested.ResultsFathers with disabilities were 1.89 (95% CI = 1.21, 2.95) times as likely to report their last birth as unwanted versus intended compared to those without disabilities after adjusting for covariates. Although married fathers without disabilities were less likely to report unintended birth than their unmarried counterparts, the protective effect of marriage was not evident among fathers with disabilities.ConclusionsDisabled fathers are at a higher risk of unintended birth compared to nondisabled fathers. These findings highlight the need to increase access to family planning services for disabled men. Further research is needed to better understand the risk factors that contribute to disabled fathers’ unintended birth and how these are linked to their child and family well-being.     

Sexual Partner Accumulation From Adolescence to Early Adulthood in Populations With Physical Disabilities in the U.S.

PurposeThis study aimed to examine the lifetime and pre-18 sexual partnering patterns of populations with physical disabilities from adolescence to early adulthood and how these patterns further vary by biological sex, race/ethnicity, and sexual orientation.MethodsData were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Poisson regression models were used to assess differences in pre-18 and lifetime sexual partner counts among populations with physical disabilities compared with those without disabilities. Moderation analyses by biological sex, race/ethnicity, and sexual orientation were used to consider further differences among minority subgroups.ResultsThe results indicated more similarities than differences in sexual partnering patterns across disability severity groups. Specifically, populations with disabilities had just as many pre-18 and lifetime sexual partners as peers without disabilities. There was variation by biological sex, race/ethnicity, and sexual orientation, although this was not tied to disability status.ConclusionsThese results fill an important gap in the literature by considering the sexual partnering behaviors of populations with physical disabilities in the U.S. over the life course. Future research should continue to include populations with disabilities and other minority groups to ensure that their experiences are represented in sexual health policies and programs.     

Disparities in influenza vaccination for U.S. adults with disabilities living in community settings by race/ethnicity, 2016–2021

BackgroundThere is a paucity of data examining disparities in influenza vaccination at the intersection of disability and race.ObjectiveTo compare the prevalence of influenza vaccination between U.S. adults (≥18 years) with and without disabilities living in community settings, and to examine changes in influenza vaccination over time by disability status and race/ethnicity groups.MethodsWe analyzed cross-sectional data from the Behavioral Risk Factor Surveillance System (2016–2021). We calculated the annual age-standardized prevalence of influenza vaccination (last 12 months) in individuals with and without disabilities (2016–2021), and examined percentage changes (2016–2021) by groups of disability status and race/ethnicity.ResultsFrom 2016 to 2021, the annual age-standardized prevalence of influenza vaccination was consistently lower in adults with disabilities as compared to those without disabilities. In 2016, 36.8% (95%CI: 36.1%–37.4%) of adults with disabilities had an influenza vaccine versus 37.3% (95%CI: 36.9%–37.6%) of those without disabilities. In 2021, 40.7% (95%CI: 40.0%–41.4%) and 44.1% (95%CI: 43.7%–44.5%) of adults with and without disabilities had an influenza vaccine.The percentage change in influenza vaccination from 2016 to 2021 was lower among people with disabilities (10.7%, 95%CI: 10.4%–11.0%; vs. no disability: 18.4%, 95%CI: 18.1%–18.7%). Among adults with disabilities, Asian adults reported the largest percentage increase in influenza vaccination (18.0%, 95% CI: 14.2%, 21.8%; p: 0.07), and Black, Non-Hispanics adults reported the lowest (2.1%, 95% CI: 1.9%, 2.2%; p: 0.59).ConclusionsStrategies to increase influenza vaccination in the U.S. should address barriers faced by people with disabilities, particularly the intersectional barriers faced by people with disabilities from racial and ethnic minority groups.     

Preconception Health Risks Among U.S. Women: Disparities at the Intersection of Disability and Race or Ethnicity

IntroductionPrior research has found that some preconception health risks are more prevalent among women in historically minoritized racial and ethnic groups. Preconception health risks are also increased among women with disabilities. Risks could be even greater among women who both have a disability and belong to a minoritized racial or ethnic group. The purpose of this study was to assess preconception health at the intersection of disability and race or ethnicity.MethodsWe analyzed data from the 2016 Behavioral Risk Factor Surveillance System to estimate the prevalence of health behaviors, health status indicators, and preventive healthcare receipt among nonpregnant women 18–44 years of age. We used modified Poisson regression to compare non-Hispanic White women with disabilities and women with and without disabilities in three other race/ethnicity groups (non-Hispanic Black, Hispanic, other race) to a reference group of non-Hispanic White women without disabilities. Disability status was defined based on affirmative response to at least one of six questions about difficulty with seeing, hearing, mobility, cognition, personal care, or independent living tasks. Multivariate analyses adjusted for other sociodemographic characteristics such as age and marital status.ResultsIn every racial and ethnic group, women with disabilities had a significantly higher prevalence of most preconception health risks than their counterparts without disabilities. The disparity in obesity for Black women with disabilities was additive, with the adjusted prevalence ratio (PR, 1.77; 95% confidence interval [CI], 1.57–2.00) equal to the sum of the prevalence ratios for disability alone (PR, 1.29; 95% CI, 1.19–1.41) and Black race alone (PR, 1.47; 95% CI, 1.36–1.58).ConclusionsWomen at the intersection of disability and minoritized race or ethnicity may be at especially high risk of adverse outcomes. Targeted efforts are needed to improve the health of women of reproductive age in these doubly marginalized populations.     

Temporal trends in disability evaluation and retirement in the Army,Navy, and Marine Corps: 2005–2011

BackgroundSurveillance of trends in disability is necessary to determine the burden of disability on the U.S. military, the most common types of disability conditions, and the prevalence of combat exposures in the disability population. Previous studies of disability in the U.S. military have focused on a particular service or condition rather than examining the epidemiology of disability in the military overall.ObjectiveThis study's objective is to describe rates of disability evaluation and retirement in U.S. Army, Navy, and Marine Corps.MethodsA cross-sectional study of 126,170 service members evaluated for disability discharge from the U.S. military in fiscal years 2005–2011 was conducted. Crude and standardized rates of disability evaluation and retirement were calculated per 10,000 service members by year of disability, demographic characteristics, and type of disability evaluation or retirement. Temporal trends in the prevalence of combat-related disability in the disability evaluated and retired population were also examined.ResultsRates of disability evaluation and retirement were highest among female, enlisted, and active duty service members. Overall rates of disability evaluation significantly decreased, while rates of disability retirement increased. Rates of psychiatric disability evaluation and retirement significantly increased in all services during the same time period from 2005 to 2011. Combat-related disability evaluations and retirements have substantially increased in all services particularly among psychiatric disability cases.ConclusionsPsychiatric disability, combat-related disability, and disability retirement continue to increase in the military, despite observed decreases in the rates of disability the Department of Defense since 2005.     

The effect of body mass index on adequacy of serum 25-hydroxyvitamin D levels in US adults: the National Health and Nutrition Examination Survey 2001 to 2006

PurposeTo investigate the relationship between body mass index (BMI) and vitamin D adequacy among US adults.MethodsWe used data for US adults aged 18 years or older (n = 12,927) who participated in the 2001 to 2006 United States National Health and Nutrition Examination Survey. Log-binomial regression was used to estimate the strength of association between BMI categories and the prevalence of serum 25-hydroxyvitamin D [25(OH)D] greater than or equal to 20 ng/mL before and after controlling for selected characteristics. An interaction term between race or ethnicity and BMI categories was tested.ResultsAmong US adults, 67.2% had serum 25(OH)D greater than or equal to 20 ng/mL, a cut point suggested by the Office of Dietary Supplements for adequate bone and general health. Overweight and obese adults were 8% (95% confidence interval, 0.89–0.95) and 26% (95% confidence interval, 0.71–0.78), respectively, less likely to have serum 25(OH)D greater than or equal to 20 ng/mL than their normal weight counterparts after controlling for age, gender, race/ethnicity, nativity and marital status, as well as education and income. No heterogeneity of the association between BMI categories and the prevalence of 25(OH)D greater than or equal to 20 ng/mL was observed by race or ethnicity.ConclusionsThe low prevalence of 25(OH)D greater than equal to 20 ng/mL among overweight and obese adults in the US population underscores the need to comparatively assess vitamin D intakes across different BMIs.     

Trends and predictors of HPV vaccination among U.S. College women and men

BackgroundHPV vaccination was recommended by the Advisory Committee on Immunization Practices for young adult females in 2006 and males in 2011 to prevent HPV-related cancers and genital warts. As this prevention mechanism continues to disseminate, it is necessary to monitor the uptake of this vaccine. College students represent an important population for HPV vaccination efforts and surveillance due to increased risk for HPV infection and representing a priority population for catch-up HPV vaccination. The purpose of this study was to assess the trends in HPV vaccination among U.S. college females and males from 2009 to 2013, and to examine whether predictors for HPV vaccination differ between males and females.MethodsThe National College Health Assessment-II (Fall 2009–2013) was used to assess trends in HPV vaccination using hierarchical logistic regression across genders and demographics. Data from 2013 were used to assess demographic variables associated with HPV vaccination for males and females, respectively. The analysis was conducted in 2015.ResultsFemales had nearly double the rates of HPV vaccination compared to males over time. All demographic sub-groups had significant increases in vaccine rates over time, with select male sub-groups having more accelerated increases (e.g., gay). Young age (18–21 vs. 22–26 years) was a significant predictor for HPV vaccination among males and females, while race/ethnicity was a predictor of vaccination among females only.ConclusionsThese findings identified specific demographic sub-groups that need continued support for HPV vaccination. Campus health centers may be rational settings to facilitate clinical opportunities for HPV vaccination among unvaccinated college students.     

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.     

Cigarette smoking among college students with disabilities: National College Health Assessment II,Fall 2008–Spring 2009

BackgroundPeople with disabilities are 1.5 times more likely to smoke than their peers without disabilities, intensifying risk of health related disparities and further loss of function. When compared with the general population, college students also have a higher smoking prevalence. This study explores smoking rates among college students with disabilities.Objective/hypothesisCollege students with disabilities have an increased likelihood of smoking, as compared with students without disabilities. Type of disability also influences smoking rates.MethodsThis study explores the association between smoking and disability using multiple regression analyses and data from the National College Health Assessment II (NCHA II), Fall 2008–Spring 2009 (N = 79,915). People with disabilities comprised 15.6% of the total sample: 3.4% reported a physical disability, 8.3% reported a mental disability, 2.5% reported a sensory disability, and 3.7% reported a learning disability.ResultsSmoking prevalence among those reporting disabilities was 23.1% versus 15% in those without disabilities. Those reporting mental disabilities had the highest rates (29.9%), followed by those with learning disabilities (23.7%), sensory disabilities (19.8%), and physical disabilities (16.4%). Students with disabilities were 1.23 times more likely to report current smoking than those without any disabilities, controlling for other factors (OR 1.23, 95% CI 1.16–1.30).DiscussionResults are consistent with previous research regarding the general adult population. Epidemiologic data demonstrating differences in risk behaviors for young adults with disabilities are important in allocation of resources. Findings of this study highlight the need for tailored smoking cessation programs for college students with disabilities.     

Social inequalities and the early provision and dispersal of COVID-19 vaccinations in the United States: A population trends study

BackgroundIn December 2020 the U.S. began a massive COVID-19 vaccination campaign, an action that researchers felt could catalyze inequalities in COVID-19 vaccination utilization. While vaccines have the potential to be accessible regardless of social status, the objective of this study was to examine how and when socioeconomic status (SES) and racial/ethnic inequalities would emerge in vaccination distribution.MethodsPopulation vaccination rates reported at the county level by the Centers for Disease Control and Prevention across 46 states on 3/30/2021. Correlates included SES, the share of the population who were Black, Hispanic, Female, or aged ≥65 years, and urbanicity (thousands of residents per square mile). Multivariable-adjusted analyses relied on zero-inflated negative binomial regression to estimate the odds of providing any vaccine, and vaccination rate ratios (aVRR) comparing the distribution rate for vaccinations across the U.S.ResultsAcross the U.S., 16.3 % of adults and 37.9 % of adults aged 65 and older were vaccinated in lower SES counties, while 20.45 % of all adults and 48.15 % of adults aged 65 and older were vaccinated in higher SES counties. Inequalities emerged after 41 days, when < 2 % of Americans were vaccinated. Multivariable-adjusted analyses revealed that higher SES was associated with improved vaccination distribution (aVRR = 1.127, [1.100–1.155], p < 1E−06), while increases in the percent reporting Black or Hispanic race/ethnicity was associated with lower vaccination distribution (aVRR = 0.998, [0.996–0.999], p = 1.03E−04).ConclusionsSocial inequalities in COVID-19 vaccines reflect an inefficient and inequitable distribution of these technologies. Future efforts to improve health should recognize the central role of social factors in impacting vaccine delivery.     

Tobacco use in Florida: Comparisons between adults living with and without disabilities

BackgroundFlorida has the third largest population in the U.S. of persons living with disabilities, making optimizing health outcomes for this population paramount. Though the state has a long-standing and robust program to reduce tobacco use, prevention efforts do not specifically target persons with disabilities.ObjectiveTo compare rates of tobacco use behaviors and second hand smoke exposure between adults living with and without disabilities.MethodsSecondary analysis of 2007–2009 Florida BRFSS data. The proportions of persons with disabilities who were cigar or cigarette smokers, quit smoking, were exposed to secondhand smoke, or had an interest in calling a Quit Line were compared for persons with and without disabilities. Weighted proportions and accompanying 95% confidence intervals were calculated, with proportions adjusted for age, gender, race, and education.ResultsAdult Floridians with a disability were more likely to report being a current cigarette smoker and being exposed to secondhand smoke, yet were also more likely to report quitting smoking for at least one day than were persons without a disability. No differences were found for cigar smoking, age at smoking initiation, or interest in the Quit Line.ConclusionsFindings suggest persons with disability are disproportionately burdened by tobacco use, yet are more likely to attempt to quit, suggesting a need for targeted interventions to assist persons with a disability in smoking cessation and reducing tobacco use and exposure. This has important implications for the future health of a group at greater risk of chronic disease.     

Social inequities in the distribution of COVID-19: An intra-categorical analysis of people with disabilities in the U.S.

BackgroundWhile recent reports suggest that people with disabilities (PwDs) are likely to be adversely impacted by COVID-19 and face multiple challenges, previous research has not examined if COVID-19 burdens are unequally distributed with respect to the disability characteristics of the U.S. population.ObjectiveThis article presents the first national scale study of the relationship between COVID-19 incidence and disability characteristics in the U.S. The objective is to determine whether COVID-19 incidence is significantly greater in counties containing higher percentages of socio-demographically disadvantaged PwDs, based on race, ethnicity, poverty status, age, and biological sex.MethodsThis study integrates county-level data on confirmed COVID-19 cases from the Johns Hopkins Center for Systems Science and Engineering database with multiple disability variables from the 2018 American Community Survey. Statistical analyses are based on bivariate correlations and multivariate generalized estimating equations that consider spatial clustering in the data.ResultsGreater COVID-19 incidence rate is significantly associated with: (1) higher percentages of PwDs who are Black, Asian, Hispanic, Native American, below poverty, under 18 years of age, and female; and (2) lower percentages of PwDs who are non-Hispanic White, above poverty, aged 65 or more years, and male, after controlling for spatial clustering.ConclusionsSocio-demographically disadvantaged PwDs are significantly overrepresented in counties with higher COVID-19 incidence compared to other PwDs. These findings represent an important starting point for more detailed investigation of the disproportionate impacts of COVID-19 on PwDs and highlight the urgent need for COVID-19 data collection systems to incorporate disability information.     

Total body skin examination for skin cancer screening among U.S. adults from 2000 to 2010

ObjectiveMelanoma incidence and mortality are increasing among United States adults. At present, routine skin cancer screening via total body skin examinations (TBSEs) by a physician is not recommended by the United States Preventive Services Task Force (USPSTF); while organizations such as the American Cancer Society recommend screening. Currently, there are limited data on the prevalence, correlates, and trends of TBSE among United States adults.MethodsWe analyzed data by race/ethnicity, age, and skin cancer risk level, among other characteristics from three different National Health Interview Survey (NHIS) cancer control supplements conducted every five years since 2000 in random United States households. High-risk status and middle-risk status were defined based on the USPSTF criteria (age, race, sunburn, and family history).ResultsPrevalence of having at least one TBSE increased from 14.5 in 2000 to 16.5 in 2005 to 19.8 in 2010 (P < 0.0001). In 2010, screening rates were higher among the elderly, the fair-skinned, those reporting sunburn(s), and individuals with a family history of skin cancer. Approximately 104.7 million (51.1%) U.S. adults are at high-risk for developing melanoma, of which 24.0% had at least one TBSE.ConclusionsTBSE rates have been increasing since 2000 both overall and among higher-risk groups. Data on screening trends could help tailor future prevention strategies.     

Disparities in chronic conditions and health status by type of disability

BackgroundPrior research has established health disparities between people with and without disabilities. However, disparities within the disability population, such as those related to type of disability, have been much less studied.ObjectiveTo examine differences in chronic conditions and health status between subgroups of people with different types of disability.MethodsWe analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses considered disparity from three perspectives: 1) basic differences, unadjusted for other factors; 2) controlling for key demographic and health covariates; and 3) controlling for a larger set of demographic variables and socioeconomic status as well as health and access to healthcare.ResultsIndividuals with vision, physical, cognitive, or multiple disability types fared worse than people with hearing impairment on most health outcomes. This was most consistently true for people with multiple disabilities. Even when all covariates were accounted for, people with multiple types of disability were significantly more likely (p < 0.05) than those with hearing impairment (reference group) to report every poor health outcome with the exception of BMI ≥ 25 and lung disease.ConclusionsWhile many of the differences between disability types were reduced when controlling for other factors, some differences remained significant. This argues for a more individualized approach to understanding and preventing chronic conditions and poor health in specific disability groups.     

Co-occurring risk factors for current cigarette smoking in a U.S. nationally representative sample

IntroductionRelatively little has been reported characterizing cumulative risk associated with co-occurring risk factors for cigarette smoking. The purpose of the present study was to address that knowledge gap in a U.S. nationally representative sample.MethodsData were obtained from 114,426 adults (≥ 18 years) in the U.S. National Survey on Drug Use and Health (years 2011–13). Multiple logistic regression and classification and regression tree (CART) modeling were used to examine risk of current smoking associated with eight co-occurring risk factors (age, gender, race/ethnicity, educational attainment, poverty, drug abuse/dependence, alcohol abuse/dependence, mental illness).ResultsEach of these eight risk factors was independently associated with significant increases in the odds of smoking when concurrently present in a multiple logistic regression model. Effects of risk-factor combinations were typically summative. Exceptions to that pattern were in the direction of less-than-summative effects when one of the combined risk factors was associated with generally high or low rates of smoking (e.g., drug abuse/dependence, age ≥ 65). CART modeling identified subpopulation risk profiles wherein smoking prevalence varied from a low of 11% to a high of 74% depending on particular risk factor combinations. Being a college graduate was the strongest independent predictor of smoking status, classifying 30% of the adult population.ConclusionsThese results offer strong evidence that the effects associated with common risk factors for cigarette smoking are independent, cumulative, and generally summative. The results also offer potentially useful insights into national population risk profiles around which U.S. tobacco policies can be developed or refined.     

Cardiovascular health: associations with race–ethnicity,nativity, and education in a diverse,population-based sample of Californians

PurposeThis study examined how race–ethnicity, nativity, and education interact to influence disparities in cardiovascular (CV) health, a new concept defined by the American Heart Association. We assessed whether race–ethnicity and nativity disparities in CV health vary by education and whether the foreign-born differ in CV health from their U.S.-born race–ethnic counterparts with comparable education.MethodsWe used data from the 2009 California Health Interview Survey to determine the prevalence of optimal CV health metrics (based on selected American Heart Association guidelines) among adults ages 25 and older (n = 42,014). We examined the interaction between education and ethnicity–nativity, comparing predicted probabilities of each CV health measure between U.S.-born and foreign-born White, Asian, and Latino respondents.ResultsAll groups were at high risk of suboptimal physical activity levels, fruit and vegetable and fast food consumption, and overweight/obesity. Those with greater education were generally better off except among Asian respondents. Ethnicity–nativity differences were more pronounced among those with less than a college degree. The foreign-born respondents exhibited both advantages and disadvantages in CV health compared with their U.S.-born counterparts that varied by ethnicity–nativity.ConclusionsEducation influences ethnicity–nativity disparities in CV health, with most race–ethnic and nativity differences occurring among the less educated. Studies of nativity differences in CV health should stratify by education in order to adequately address SES differences.     

The effect of body mass index on optimal vitamin D status in U.S. adults: The National Health and Nutrition Examination Survey 2001–2006

ObjectivesTo investigate the relationship between body mass index (BMI) and optimal vitamin D status in U.S. adults.MethodsData on 12,927 adults 18 years and older participating in National Health and Nutrition Examination Surveys 2001–2006 were used. Serum levels of 25-hydroxy vitamin D 30 ng/mL or greater was used as a measure of vitamin D sufficiency. Log-binomial regression was used to estimate the strength of the association between BMI categories and the prevalence of vitamin D sufficiency before and after adjusting for selected characteristics.ResultsAfter adjustment, overweight and obese individuals were 24% and 55%, respectively, less likely to have a 25-hydroxy vitamin D level of 30 ng/mL or greater compared with their normal-weight counterparts.ConclusionsOur findings call attention to the importance of identifying individuals at risk for vitamin D insufficiency and its potential adverse health outcomes because the latter may increase health disparities in the U.S. population. If vitamin D insufficiency is implicated for chronic diseases such as cardiovascular diseases and diabetes, a vitamin D supplementation regimen would need to be readdressed, especially for segments of the U.S. population with greater BMIs.     

Which one? What kind? How many? Types,causes, and prevalence of disability among U.S. adults

BackgroundQuantifying the number of people with and types of disabilities is helpful for medical, policy, and public health planning.Objective/Hypothesis: To update prior estimates on types, prevalence, and main causes of disability among U.S. adults using the Survey of Income and Program Participation (SIPP) data.MethodsWe used cross-sectional data from the SIPP 2008 Panel Wave 6 interviews collected May–August 2010. Analyses were restricted to non-institutionalized adults ages ≥18 years (n = 66,410). Disability was ascertained via five non-mutually exclusive components: 1) specific activity difficulties, 2) selected impairments, 3) use of an assistive aid, 4) household work limitations, and 5) paid work limitations. Prioritized main cause of disability was established for the 95% of respondents with a disability type eligible for health condition questions. We generated weighted population estimates (number and percentage, with 95% confidence intervals (CIs)), accounting for the complex sample survey design.Results50 million U.S. adults (21.8%) experienced a disability in 2010. Mobility-related activity limitations were the most prevalent disabilities across all five components. The most common main causes of disability were arthritis/rheumatism, 9.1 million (19.2%, 95% CI = 18.4–20.0) and back or spine problems, 8.9 million (18.6%, 95% CI = 17.9–19.3).ConclusionsA growing population with disabilities has the potential to put considerable and unsustainable demand on medical, public health, and senior service systems. Strengthening clinical community linkages and expanding the availability of existing evidence-based public health interventions to prevent, delay, and mitigate the effects of disability could improve health and outcomes for people with disabilities.     

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.