ACCESS Miami, a comprehensive resource guide for the physically disabled

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Abstracts / Disability and Health Journal 2 (2009) e1ee15

A Systematic Review of Exercise Interventions and Their Relationship to Secondary Condition Reduction in People with Disabilities Ming-De Chen, Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL James Rimmer, PhD, Disability and Human Development, University of Illinois at Chicago, Chicago, IL

Health professionals and researchers have strived to develop strategies for mitigating secondary conditions among populations with disabilities, including the use of exercise. However, limited research has focused on developing an evidence base for examining the effects of exercise on reducing secondary conditions. We conducted a systematic literature review of 139 exercise trials for six secondary conditions on 11 disability groups. The strength levels of evidence are categorized as: Strongdtwo or more randomized controlled trials (RCTs) with positive results and no studies reported significant negative effects; Moderatedone RCT with positive results and no studies reported significant negative effects; Limiteddat least one Non-RCT with positive results and no studies with significant negative effects. There was strong evidence suggesting the use of exercise for decreasing Pain in individuals with Spinal Cord Injury (SCI); Fatigue in Multiple Sclerosis (MS); and Depression in Alzheimer’s Disease (AD) and Mental Illness. There was moderate evidence for the use of exercise in decreasing Pain in Intellectual Disability (ID); Fatigue in Muscular Dystrophy; Depression in MS, SCI, Stroke, and ID; reducing Overweight in Stroke, ID, and Mental Illness; improving Quality of Sleep in SCI and AD; and improving Interpersonal Relationships in Stroke and Mental Illness. There was limited or no evidence on the remaining disabilities. It is important to have more studies targeting the use of exercise on reducing certain secondary conditions, especially in populations with limited findings. Using media approaches to translate disability research into practice Elaine T. Jurkowski, MSW, PhD, School of Social Work, Southern Illinois University Carbondale, Carbondale, IL

Introduction: Funding mechanisms and funding agents are increasingly seeking translational research, or research which translates its findings into the hands of consumers. This presentation will showcase various media strategies which can be used to translate research pertaining to adults who are aging, to the consumer. Methods: Specific case study examples of how theoretical research can be translated to consumers aiming at a secondary educational level will be illustrated. These case studies using media strategies will include media artifacts (various creative materials such as bumper stickers, reminder cards, t-shirts sun visors etc.), press releases, letters to the editor and infomercials. Case studies were also analyzed for impact that made use of various health behavior models in this process of translational research. Findings: Findings suggest that users suggest that creative media strategies can be an effective mechanism to bring cutting edge research to the broader consumer community, and to promote health and well being. Specific strategies will be addressed and ways to infuse these into the hands of people with disabilities will be addressed as a result of the findings. Comorbidities and Health Risks among Minorities with Sensory Impairments: Need for Public Health Intervention Gwyn C. Jones, PhD, MSW, MEd, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA

Objective: To identify comorbid conditions and health risks among minorities with vision and/or hearing (sensory) impairments that should be addressed in the public health arena. Methods: We back-coded questions from the 2000-2006 National Health Interview Survey, to the International Classification of Functioning, Disability and Health framework to identify comorbidities and health

risks among minorities with visual impairments (trouble seeing, even with corrective lenses) and/or hearing impairments(a little trouble, some trouble, a lot of trouble hearing, deaf) among racial/ethnic minorities and non-minority whites. In the logistic regression models we controlled for the effects of age, sex, income, education and marital status. Findings were significant at p!.001 with non-minority whites having no sensory impairments as our reference group. Results: Compared with non-impaired, non-minority whites, minorities with sensory impairments were more likely to have fair/poor health (36.3% v. 7.9%, AOR 5 6.19), diabetes (18.0% v. 9.6%, AOR 5 3.00), hypertension (43.5% v. 20.8%, AOR 5 2.01), problems with ADLs (6.3% v. 1.0%, AOR 5 4.14) and IADLs (13.7% v. 2.4%, AOR 5 3.75), obesity (29.7% v. 20.6%, AOR 5 1.49), and not exercising weekly (53.8% v. 34.5%, AOR 5 1.59). Minority adults with sensory loss also had higher odds of having low educational attainment (AOR 5 1.96), income below $20,000 (AOR 5 2.27) and not working (AOR 5 1.73). Conclusions: Adults in racial/ethnic minorities who have visual and/or hearing impairments face health threats that may lead to further disability and health decline without timely interventions. Public health measures must address the intersection of minority cultures and disabilities in both service delivery and provision of information in alternative formats that accommodate significant sensory loss. Health Risks across the Lifespan among Adults with Mobility Limitations: Challenges for Public Health Practice Gwyn C. Jones, PhD, MSW, MEd, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA

Objective: To investigate disparities in health risks among adults with mobility limitations across the lifespan. Methods: We back-coded questions from the 2000-2006 National Health Interview Survey to the international Classification of Functioning, Disability and Health framework to investigate disparities in health risks across the lifespan for adults with lower-extremity mobility limitations (difficulties with changing and maintaining body position and difficulties with walking and moving around). In the logistic regression models we controlled for race/ethnicity, sex, income, education and marital status. Our reference group for all comparisons was adults age 65+ years without mobility limitations. Findings were statistically significant at p!.001. Results: Among adults under age 65, obesity rose 15.5% for mobility-limited adults, compared with 6.8% for non-limited adults. A similar pattern emerged for diabetes. Smoking declined for all groups but adults under age 65 with mobility limitations were significantly more likely to smoke. The odds of having fair/poor health for adults with mobility limitations increased (age 1824, AOR 5 1.78; age 25-44, AOR 5 2.96; age 45-64, AOR 5 6.89; age 65+ years, AOR 5 8.07.). Risk for depression declined by age group but remained higher for adults with mobility limitations (age 18-24, AOR 5 13.5; age 2544, AOR 5 9.9; age 45-54, AOR 5 6.4; age 65+ years, AOR 5 3.4). Conclusions: Adults with mobility limitations face substantial health risks at every age, compared with their non-limited counterparts, Public health interventions should begin early in the lifecycle and be sustained over time to minimize future disability and health decline. Longitudinal data are needed to track health risks among adults with mobility limitations as they age. ACCESS Miami, a comprehensive resource guide for the physically disabled Rochelle Baer, LCSW, Jay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of Medicine, Miami, FL Sonjia Kenya, EdD, Jay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of Medicine, Miami, FL Katie Houghton, Jay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of Medicine, Miami, FL

In 2003 Miami had one of the largest populations of people with disabilities in the U.S. and was without a comprehensive resource guide

Abstracts / Disability and Health Journal 2 (2009) e1ee15 detailing agencies and venues accessible to disabled individuals. Following the footsteps of Washington D.C. and many other American cities that provide a resource guide for the physically disabled, we developed ACCESS MIAMI to offer disabled residents with information about a myriad of resources. Potential businesses that were reviewed for inclusion were identified through positive recommendations from disabled residents, a resource hotline and the local telephone directory. Over 40 businesses and agencies met selection criteria and the comprehensive guide was divided into 16 categories, including arts, education, wheelchair rentals, employment, equipment, home modification and online resources. Development occurred over 8 months and 500 copies of an inaugural guide were printed with support from the Dade Community Foundation. Funding was secured from the Allegheny Foundation to print a second edition in 2007. Barriers to physical activity and exercise for adults with intellectual disabilities Amy E. Bodde, MPH, Department of Applied Health Science, Indiana University, Bloomington, IN Dong-Chul Seo, PhD, Applied Health Science, Indiana University, Bloomington, IN Georgia C. Frey, PhD, Department of Kinesiology, Indiana University, Bloomington, IN

There is a higher prevalence of sedentary behavior among adults with intellectual disability (ID) compared to the general population. The majority of research on this topic has focused on assessing physical activity (PA) levels and there are few studies addressing barriers to activity in this population segment. If these barriers are not clearly understood, it will be difficult to develop and implement intervention programs. A systematic research review on these barriers was conducted using combinations of the following search terms: intellectual disabil*, mental retard*, exercise and physical activity in the databases EBSCO, PsycINFO, Social Science Citation Index, CINAHL Plus, and SPORTDiscus. Reference lists from each reviewed article were also examined. Original research articles published after 1997 with primary intention of identifying PA determinants that included age 18+ adults with ID were included. In total, 388 citations were returned, after screening for repeated articles and inclusion criteria, 6 were included in the analysis. The primary barriers that reoccurred throughout the papers were transportation issues, financial limitations and lack of awareness of options. Other salient barriers included negative supports from caregivers and authority figures (e.g. teachers, coaches and parents) and lack of clear policies for engaging in regular activity in residential and day service programs. Although the research is limited, there are clear barriers to PA to target. Of primary importance is the development of policies among agencies that serve individuals with ID that could help minimize transportation, financial and educational barriers, which are more modifiable than negative supports.

Disability beyond borders: New approaches to understanding children’s special health care needs and maternal mental health Betty G. Brown, PhD, MPH, RN, Department of Health Sciences, Northern Arizona University, Flagstaff, AZ

The impact of children’s special health care needs on maternal mental health has been the subject of considerable research, but to examine this relationship, many have focused on specific childhood diagnoses. Extending public health understandings beyond the borders of diagnostic categories requires an alternative view. Using the National Survey of Children’s Health, 2003, this study assessed the broader implications of mothers’ caregiving for children with special needs. Screening questions from the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services, piloted for the first time in

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this national sample, formed the basis of special needs criteria. The relationships among special needs and mothers’ mental health and anxiousness about their child’s outcomes were assessed within the framework of the stress process using multiple regression and simple slopes analyses. Results of this study not only indicate that children’s special needs e beyond diagnoses e are significantly associated with mothers’ mental health but also suggest that a broader view of maternal stressors contributes to our understanding of at-risk families with disabled children. In this sample, mothers’ perceived coping, a child’s regular source of care, and neighborhood support either mediated or buffered the effects of maternal caregiver stress. The significant effects of structural environments and contexts of social stress on maternal well-being underscore the importance of viewing a disability within the context of environmental limitations rather than that of individual capabilities. This important shift in perspective can form the basis for stronger and more effective family public health interventions.

Personalized injury risk assessment for children with special needs Catherine Frentz, BS, Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, OH Huiyun Xiang, MD, MPH, PhD, Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, OH

Objective: Personalized injury risk assessment would enhance injury prevention interventions targeting children. Our goal was to develop a basic model for assessing risk of injury in children (ages 5-17) with disabilities. Methods: We used the 2000-2003 National Health Interview Survey (NHIS) data to build the model. Potential injury risk variables were first fitted into univariate logistic regression models to evaluate medically treated injuries during the three months prior to the interview. A multivariate logistic regression model was fitted to obtain odds ratios (ORs) for injuries at each level of the significant variables. These ORs were then multiplied by 10 and rounded to create individual weighting factors. An injury risk score was calculated for each child based on the significant variables and the associated weighting factors. To test the model, median injury scores were plotted against observed injury incidence for children who participated in the 2004-2005 NHIS. Results: The injury risk assessment model was built using data from 79,378 children and was tested with data from 13,580 children. Nine variables were determined to be significant for predicting injury: sex, age, U.S. citizenship status, household family size, highest level of education in the household family, yearly household income, presence or absence of health insurance, presence or absence of depression, and disability status. Median injury scores were highly correlated with the observed injury rates with a correlation coefficient of 0.924. Conclusions: Our preliminary results suggest that personalized injury risk assessments are a feasible tool for assessing risk of injury among children with disabilities.

Photo-Mapping: Women with physical disabilities visually capture and relay to others the factors that influence breast health screening during a health care visit Ellen Lopez, PhD, MPH, University of Florida, Gainesville, FL Eva Egensteiner, University of Florida, Gainesville, FL Elena Andresen, PhD, Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL Lisa Hannold, Rorc, VA, Gainesville, FL Melissa Lanzone, University of Florida, Gainesville, FL Vijay Vasudevan, Department of Behavioral Science and Community Health, University of Florida, Gainesville, FL