Disability and Health Journal

Author Information

2012-01-01

Longitudinal changes in psychosocial constructs and physical activity among adults with physical disabilities

Maria Kosma, Rebecca Ellis, Jeremy J. Bauer — 2011-11-07

Abstract: Background: Given the importance of physical activity (PA) and the low activity levels among adults with physical disabilities, it is important to understand how temporal changes in psychosocial constructs affect PA changes over time.Objective/Hypothesis: Examine if changes in the transtheoretical model (TTM) constructs affected changes in PA levels over time.Methods: One hundred thirty-two adults with physical disabilities, such as multiple sclerosis and spinal cord injuries, completed a web-based survey once every 4 months, for a total of 3 time points, to assess the TTM constructs and PA. Six latent growth curve analyses were conducted using Mplus5 to examine if longitudinal changes in the TTM constructs affected temporal changes in PA levels.Results: All six hypothesized models fit the sample data well (e.g., χ2 = NS; RMSEA = <.001-.06). In a descending order of significance, the best predictors of the initial levels of PA were the stages of change, the behavioral processes of change, the cognitive processes of change, self-efficacy, and perceived pros. The meaningful predictors of PA changes over time were the initial levels and the slopes of the cognitive processes of change, perceived pros, and the behavioral processes of change. Although the slopes of the stages of change and perceived cons did not have a statistically significant effect on PA changes, their effects approached a medium size (.33 and .38, respectively).Conclusions: In order to reassure the maintenance of an exercise program, interventionists need to first emphasize cognitive, motivational strategies (cognitive processes of change), such as the importance of PA and positive thoughts about exercise participation as well as exercise benefits (pros) before they implement behavioral strategies (behavioral processes of change), such as social support, goal setting, and self-rewarding.

A comparison of Autism Spectrum Disorder DSM-IV criteria and associated features among African American and white children in Philadelphia County

2011-10-31

Abstract: Background: Racial differences are documented in the timing and type of autism spectrum disorder (ASD) diagnosis among white and African American children. Differences in clinical presentation by race may contribute to these disparities. This study explores documented differences in core ASD symptoms and associated behavioral features among African American and white children.Methods: This project is a secondary data analysis from the Pennsylvania Autism and Developmental Disabilities Surveillance Program and utilized methodology that evaluates existing records, reviews, and codes for DSM-IV criteria for ASD and 12 associated behavioral features. The sample comprised 343 children meeting surveillance case definition for ASD, from 3 population-based cohorts of children in Philadelphia County.Results: A higher frequency of white children compared to African American children with ASD have documented DSM-IV criteria of inflexible adherence to nonfunctional routines/rituals (92% vs 81%; p = .005) and persistent preoccupation with parts of objects (67% vs 50%; p = .002). A higher frequency of white children with ASD compared to African American children with ASD have documented abnormal motor development (74% vs 60%; p = .008) and odd responses to sensory stimuli (76% vs 51%; p < .001). There were no significant differences in externalizing behaviors or reciprocal social interaction.Conclusions: This study suggests differences in the types of ASD symptoms and associated behavioral features exhibited by African American as compared to white children with ASD. Further research is needed to determine if these differences contribute to disparities in the timing or type of ASD diagnosis.

Association between parental nativity and autism spectrum disorder among US-born non-Hispanic white and Hispanic children, 2007 National Survey of Children’s Health

2011-11-04

Abstract: Background: Limited studies suggest the prevalence of autism spectrum disorders (ASD) varies by whether maternal and child birth country are discordant.Objective/Hypothesis: We explored associations between ASD and maternal and paternal nativity in a sample of US-born non-Hispanic white (NHW, n = 37,265) and US-born Hispanic (n = 4,690) children in the 2007 National Survey of Children’s Health (NSCH).Methods: We assessed ASD prevalence within race-ethnicity and parental nativity subgroups. Prevalence ratios (aPR), comparing each group to NHW children with 2 US-born parents, were adjusted for child age, sex, and receipt of care in a medical home. Estimates were weighted to reflect US noninstitutionalized children. Standard errors were adjusted to account for the complex sample design.Results: In NHW children with 2 US-born parents, ASD prevalence was 1.19%; estimates were similar for NHW children with a foreign-born mother or father. There was a striking heterogeneity between Hispanic children with 2 US-born versus 2 foreign-born parents (ASD prevalence 2.39% versus 0.31%, p = .05). Even after adjustment, PRs comparing ASD prevalence in Hispanic versus NHW children were vastly different for Hispanic subgroups, suggesting a substantially lower prevalence for Hispanic children with both parents foreign-born (aPR 0.2, 95% confidence interval 0.1-0.5) and a higher prevalence for Hispanic children with both parents US-born (aPR 2.0 [0.8-4.6]).Conclusions: Previous studies comparing ASD prevalence between NHW and Hispanic children based on a composite Hispanic grouping without consideration of parental nativity likely missed important differences between these racial-ethnic groups. Continuing efforts toward improving early identification in Hispanic children are needed.

“He only takes those type of patients on certain days”: Specialty care access for children with special health care needs

Rebecca Feinstein Winitzer, Joanna Bisgaier, Colleen Grogan, Karin Rhodes — 2012-01-01

Abstract: Background: Expansions to public and private coverage opportunities under the Affordable Care Act and the Children’s Health Insurance Program are meant to provide greater access to medical services, particularly for the 10 million US children with special health care needs (CSHCN).Objective/Hypothesis: We used qualitative methods to explore the nuanced processes of obtaining access to specialty care for publicly and privately insured CSHCN.Methods: From May 2009 to February 2010, 30 in-depth qualitative interviews (60-90 minutes in length) were conducted with English-speaking family caregivers of CSHCN covered by public insurance (n = 15), private insurance (n = 6), or both (n = 9) in Cook County, IL. We used purposive quota sampling techniques to recruit parents from a group of 102 respondents from a related telephone survey who agreed to follow-up contact. All audio transcriptions and field notes were entered into Atlas-Ti software and analyzed by the authors through a thematic coding scheme.Results: Respondents varied in their success in obtaining requested specialty care. Several themes emerged that shape access to specialty care for CSHCN in this study: marked differences based upon insurance type, the acuity of a child’s health condition, and the presence of language and cultural barriers in scheduling and attending appointments.Conclusions: Qualitative interviews with families illuminated current perceptions of inequities in access to outpatient specialty care for CSHCN. Such findings generate questions and concerns about parity across public and private coverage systems for vulnerable children and suggest areas for future research and policy consideration for ensuring access to both primary and specialty care.

Quality of diabetes care for adults with physical disabilities in Kansas

Amanda Reichard, Hayley Stolzle, Ana Carolina Sella, Theresa I. Shireman — 2012-01-01

Abstract: Background: Similar to health disparities found among racial and ethnic minority groups, individuals with physical disabilities experience a greater risk for diabetes than those without disabilities.Objective: The purpose of this works was to assess Kansas Medicaid data to determine the quality of diabetic care and the level to which individuals with physical disabilities' prevention and diabetes management needs are being met.Methods: We selected a continuously eligible cohort of adults (ages 18 and older) with physical disabilities who had diabetes and received medical benefits through Kansas Medicaid. We examined their quality of care measures (screening for HbA1c/glucose, cholesterol, and eye exams; and, primary care visits) in the succeeding year. Using unconditional logistic regression, we assessed the measures for quality of care as they related to demographic variables and comorbid hypertension.Results: Thirty-nine percent of the 9,532 adults with physical disabilities had diabetes. They had the following testing rates: HbA1c, 82.7%; cholesterol, 51.5%; and eye examinations, 86.8%. Females, those with dual eligibility, and those with comorbid hypertension had higher rates for all types of screenings and primary care visits. Those living in MUAs had a higher screening rate for cholesterol.Conclusions: Adults with physical disabilities supported by Kansas Medicaid received diabetes quality indicator screenings have better diabetes quality of care rates for 3 out of 4 measures than nationally published figures for Medicaid. These findings point to a strong quality of care programs in Kansas for this population; however an imperative next step is to determine how effectively this population is managing their blood sugar levels day-to-day.

Availability of physical activity resources in the environment for adults with intellectual disabilities

2011-11-18

Abstract: Background: Adults with intellectual disabilities (ID) have high rates of physical inactivity, yet little is known about the prevalence of facilitators and barriers in the built environment contributing to these high rates.Objective: To describe the physical activity resources available to adults with ID in both the home and day programs outside of the home.Methods: Demographic information was collected on a sample of adults with ID. A survey checklist of the physical activity environment at the participants’ home and the facility or workplace where the participant spent his/her weekdays was collected by trained research staff. Differences in the prevalence of environmental resources between those living in group homes and those living alone or with family were tested using χ2 tests.Results: A total of 103 participants had complete demographic and environmental data. Of these, only 37.9% had exercise equipment available, 39.8% had sports equipment, and 15.5% had a bicycle in the home environment. At the facility where the individual attended a day program or where the individual was employed, 55.4 had sports equipment, 50.5% had an outdoor recreation area, 41.8% had an indoor recreation area, and 41.8 had organized physical activities. Those who lived in group homes were more likely to have access to basketball hoops, sports fields, and recreation centers than those who lived alone or with family (p < .01).Conclusions: Adults with ID have few physical activity environmental resources and opportunities available to them, especially those not living in group homes. Future interventions are needed to increase physical activity opportunities in this underserved population.

Disability and home hazards and safety practices in US households

2012-01-01

Abstract: Background: Individuals with disabilities have an elevated risk of residential injury. However, the prevalence of home hazards and safety practices among households where an individual with a disability resides is unknown.Methods: This study examined patterns of home hazards and safety practices among 1003 households across the United States in 2002.Results: Households with at least 1 resident with a disability had a lower prevalence of household hazards than those without a resident with a disability, including living in a 2-story dwelling (34.6% vs 50.7%) and having stairs inside the home (48.1% vs 58.4%). They were more likely to implement fall prevention strategies, such as handrails or grab bars in the bathroom (40.4% vs 21.8%) and mats or nonskid strips in the tub or shower (71.7% vs 61.5%).Conclusion: There is room for improvement in safety practices among households where an individual with a disability resides.

Enhancing early identification and coordination of intervention services for young children with autism spectrum disorders: Report from the Act Early Regional Summit Project

Georgina Peacock, Sue C. Lin — 2012-01-01

Abstract: Background: Increasing prevalence of autism spectrum disorders (ASD) and the merits of early intervention support the importance of early identification and detection. The Act Early Initiative attempts to address the states' capacity to support this process of early identification and early intervention.Objective: The Centers for Disease Control and Prevention (CDC) Health Resources and Services Administration (HRSA) collaborated with the Association of University Centers on Disabilities (AUCD) to develop strategies that will address state capacity for responding to the increasing demand for earlier identification, earlier diagnoses, and coordination of service systems for children with ASDs and other developmental disabilities (DD).Methods: Act Early regional summits were held to engage stakeholders from the early detection and intervention community including parents, state agencies, provider groups, autism and related disability organizations, and academia. The stakeholders then used the Logic Model to facilitate the teams' planning process. The Logic Model enables teams to understand the strengths and gaps within their state resources and plan specific activities to achieve concrete outcomes.Results: States identified opportunities and challenges in early identification of children with delay. One of the particular challenges identified were low income, rural and non-English speaking populations encountering more challenges than others in accessing diagnosis and early intervention services.Conclusions: The Summits are a unique model that demonstrates the importance of developing comprehensive state plans to advance the collaboration and coordination of early detection and intervention service systems for children with ASDs and related DDs from all racial, ethnic, geographical, and socioeconomic backgrounds.

Discrepancy among Behavioral Risk Factor Surveillance System, Social Security, and functional disability measurement

Jean P. Hall, Noelle K. Kurth, Emily C. Fall — 2011-11-07

The Affordable Care Act (ACA) of 2010 (P.L. 111-148) Section 4302 requires the development of federal standards for the measurement of disability status in order to monitor health disparities and quality of care among this population. These new data will contribute to policy, research, and funding decisions. Therefore, the validity and reliability of disability measurement instruments are important to all those who will use these data.

Editorial Board

2012-01-01

Disability and Health Journal

Author Information

Longitudinal changes in psychosocial constructs and physical activity among adults with physical disabilities

A comparison of Autism Spectrum Disorder DSM-IV criteria and associated features among African American and white children in Philadelphia County

Association between parental nativity and autism spectrum disorder among US-born non-Hispanic white and Hispanic children, 2007 National Survey of Children’s Health

“He only takes those type of patients on certain days”: Specialty care access for children with special health care needs

Quality of diabetes care for adults with physical disabilities in Kansas

Availability of physical activity resources in the environment for adults with intellectual disabilities

Disability and home hazards and safety practices in US households

Enhancing early identification and coordination of intervention services for young children with autism spectrum disorders: Report from the Act Early Regional Summit Project

Discrepancy among Behavioral Risk Factor Surveillance System, Social Security, and functional disability measurement

Editorial Board

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