- Email: [email protected]
Introduction to the theme issue on women and disabilities
Women’s Health Issues 16 (2006) 283–285
COMMENTARY
INTRODUCTION TO THE THEME ISSUE ON WOMEN AND DISABILITIES Rosemary B. Hughes, PhD* University of Montana Rural Institute on Disabilities, Missoula, Montana Received 18 October 2006; accepted 18 October 2006
A
lthough women’s health has finally achieved its deserved place as a national health priority, relatively little attention has been given to the health of women living with disabilities who comprise 17.6% of the US noninstitutionalized civilian population of women ages 16 – 64 years, and 43% of women ⱖ65 years (Waldrop & Stern, 2000). Despite the fact that approximately 1 of 5 US women has a disability involving a limitation in life activities, the study of health in the context of disability for women is a relatively new field of inquiry. Many women with disabilities are underserved or unserved as a result of racial or ethnic minority status, rural residence, disability type, sexual orientation, and/or economic disadvantage. Healthy People 2010 (US Department of Health & Human Services, 2000) documents tremendous healthrelated disparities between women with disabilities and women without disabilities. Women with disabilities have prominent needs for health services owing to serious disparities such as employment, income, access to health care, overweight, physical activity, stress, depression, and other mental health conditions. The long-held belief that disability and health are mutually exclusive states of being is slowly giving way to an ever-growing appreciation that healthrelated disparities and environmental and other barriers to achieving a state of optimal health are often more limiting than the presence of disability itself. Women with disabilities often experience a lack of access to the disease prevention, health promotion, and health care services necessary for attaining and maintaining optimal health (Thierry & Cyril, 2004).
* Correspondence to: Rosemary B. Hughes, PhD, University of Montana Rural Institute on Disabilities, Missoula, Montana. E-mail: [email protected]. Copyright © 2006 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc.
This theme issue on women and disabilities addresses many of the disparities between women with disabilities and women without disabilities, suggests avenues for eliminating those disparities, and contributes to the growing knowledge base on the healthrelated issues of this largely disadvantaged and underserved population of women. The issue begins with a study by Wei and colleagues, who compared the use of clinical preventive services of women with disabilities and women without disabilities. In the second article, Chevarley and colleagues report on national estimates of the health, preventive health care, and access to health care of women with differing levels of functional limitation. Although many women with physical limitations choose to have children, they also may experience disability-related complications during pregnancy and delivery (Baschat & Weiner, 2004; Jackson, 1996). Gavin and colleagues present findings on the first known study addressing the health service use and outcomes of pregnant women with disabilities under Medicaid. For more than a decade, Margaret Nosek and other investigators at the Center for Research on Women with Disabilities have been conducting cutting edge research on a wide range of issues related to the health and well-being of women with disabilities (e.g., Nosek, 1996; Nosek et al., 1995; Nosek et al., 1996; Nosek et al., 2004; Nosek et al., 2006). In this theme issue, Nosek and her colleagues report on the findings of their investigation into the complex issues surrounding the participation of women with physical disabilities in health-promoting behaviors, specifically in the dietary and physical activity domains. Many women and men with significant disabilities are now living long enough to experience their later years, but serious secondary health conditions can 1049-3867/06 $-See front matter. doi:10.1016/j.whi.2006.10.004
284
R. B. Hughes / Women’s Health Issues 16 (2006) 283–285
threaten their quality of life and well-being (Campbell, Sheets, & Strong, 1999; Nosek, 2000). Robinson-Whelen and colleagues report on the evaluation of an innovative peer-led group program that they designed specifically for the unique health-promotion needs of women aging with physical disability. Aging is the typical context for informal conversations about osteoporosis. Many are surprised when they learn that younger women with disabilities are dealing with the diagnosis of osteoporosis. That phenomenon may be related to the use of certain medications for their underlying disabling health conditions. Watson and colleagues present findings on their study of the incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate and/or anti-epileptic drugs among women and girls with developmental disabilities. Like the early stages of osteoporosis, fibromyalgia is usually invisible; however, the two conditions differ in other ways. Whereas osteoporosis is diagnosed by measuring bone mineral density and using other screening tests, fibromyalgia is diagnosed primarily on the basis of its symptomatology. Without confirming tests for fibromyalgia, people with widespread musculoskeletal pain and its other debilitating symptoms can be left undiagnosed and untreated. Although that situation is slowing changing with advances brought about by clinical research, there are many questions left unanswered. Stuifbergen and colleagues report on cognitive perceptions and emotional responses related to illness in women with fibromyalgia. Many would assume that disability serves as a barrier to the clinical guidelines for diabetes care among women, and that diabetes care among rural women with disabilities would be disproportionately poor. Although that assumption may hold for many women with disabilities, Tseung and colleagues provide unanticipated findings on a retrospective cohort study of diabetes care in veteran women with disabilities. Sexual, physical, and disability-related violence against women with disabilities occurs universally and relentlessly and at alarmingly high rates (Nosek et al., 1997; Nosek et al., 2001; Nosek et al., 2004), but the violence may go unreported owing to various disability-related barriers. In this issue, Nannini reports on her comparative study of the sexual assault patterns among women with disabilities and women without disabilities who sought survivor services and provides findings on the patterns of reporting violence by women with various types of disability. Many studies have shown that women with disabilities experience elevated rates of depression (Hughes, Swedlund, Petersen, & Nosek, 2001; Hughes, Robinson-Whelen, Taylor, Petersen, & Nosek, 2005; Hughes, Nosek, & Robinson-Whelen, in press). Previous research has shown that women with disabilities have a higher prevalence of depression when compared to
men with disabilities (Coyle & Roberge, 1992; Fuhrer, Rintala, Hart, Clearman, & Young, 1993; Turner & Wood, 1985). In this issue, Kalpakjian and Albright reveal findings that contradict many previous findings on depression and gender in the context of disability and specifically spinal cord injury. According to Chapter 6 of Healthy People 2010 (US Department of Health & Human Services, 2000), increased stress represents a health-related disparity between people with and those without disabilities. This preeminent public health agenda also emphasizes the importance of developing health promotion programs to target such health and injury disparities. Hughes and colleagues present the results of a study representing the first of its kind, that is, a randomized, controlled investigation of the efficacy of a peer-led, stress self-management intervention designed specifically for women with physical disabilities. The health of women with disabilities includes psychological, social, and physical domains. Impairment and biology— but mostly—the sociopolitical, environmental, and economic contexts of their lives have tremendous impacts on their health and well-being. These contexts add up to injustices and inequities, including major health-related disparities and a multitude of barriers to accessing services for their health needs. Healthy People 2010 aims to reduce these disparities and promote healthy, long lives. It is time for our nation to attain the goals of that public health agenda and vigorously address its high priority health issues for women with disabilities. Well-designed research initiatives are needed to promote the health of women with disabilities, prevent and reduce the impact of secondary health conditions, and eliminate the disparities between women with and without disabilities. The articles in this theme issue offer important findings on empirically based studies designed to reduce the inequities and improve the health of this underserved and largely disadvantaged population of women. I commend the leadership of the Jacobs Institute of Women’s Health and Women’s Health Issues for their recognition of the importance of disseminating new, empirically based information on the health and wellness of women with disabilities. I acknowledge the efforts of Carol Weisman, Editor, and D. Richard Mauery, Associate Managing Editor, who provided support throughout the development of this issue in the midst of the challenging period of their organizational changes. Again, I am grateful to the terrific group of published researchers who comprised the review panel for this issue. I acknowledge the many authors who committed their time and effort to preparing and submitting manuscripts for this issue. Although some contributed manuscripts that did not meet the journal criteria for acceptance, I appreciate their efforts and wish them well on identifying alternative sources for disseminating their good work. Although I am now working at
R. B. Hughes / Women’s Health Issues 16 (2006) 283–285
the University of Montana Rural Institute on Disability in Missoula, Montana, I contributed a great deal of my efforts related to this theme issue when I was working at the Baylor College of Medicine Center for Research on Women with Disabilities in Houston, Texas. I acknowledge both institutions for their support of my endeavors related to this theme issue on women and disabilities, and I especially thank Margaret Nosek, Founder and Executive Director of the Center for Research on Women with Disabilities, for her mentorship of my own beginnings as a researcher on the health of women with disabilities. Without her mentorship, I would not be in the position of serving as guest editor for a theme issue on women with disabilities. Finally, I extend my highest level of respect and appreciation to the thousands of women who served as our research partners by consenting to become participants in the studies published in this issue.
Acknowledgments As guest editor, I commend the diligent work of the peer review panel that was appointed for this theme issue on “Women with Disabilities.” The members of the panel were Heather Becker, PhD, Timothy R. Elliott, PhD, Katherine Froehlich-Grobe, PhD, Stephen R. McCauley, PhD, Margaret A. Nosek, PhD, Nancy J. Petersen, PhD, Laurie E. Powers, PhD, Susan Robinson-Whelen, PhD, Allison Roller, M.A., Jonelle Rowe, MD, Suzanne C. Smeltzer, EdD, RN, FAAN, and Alexa Stuifbergen, PhD, RN, FAAN. Their expertise and professional commitment to disseminating findings of original research on women’s health contributed greatly to the quality of articles that comprise this issue.
References Baschat, A. A., & Weiner, C. P. (2004). Chronic neurologic diseases and disabling conditions in pregnancy. In S. L. Welner, & F. Haseltine Welner’s Guide to the Care of Women with Disabilities (pp. 145–158) Philadelphia: Lippincott Williams & Wilkins. Campbell, M. L., Sheets, D., & Strong, P. S. (1999). Secondary health conditions among middle-aged individuals with chronic physical disabilities: Implications for unmet needs for services. Assistive Technology, 11, 105–122. Coyle, C. P., & Roberge, J. J. (1992). The psychometric properties of the Center for Epidemiological Studies-Depression Scale (CES-D) when used with adults with physical disabilities. Psychology and Health, 7, 69 – 81. Fuhrer, M. J., Rintala, D. H., Hart, K. A., Clearman, R., & Young, M. E. (1993). Depressive symptomatology in persons with spinal cord injury who reside in the community. Archives of Physical Medicine & Rehabilitation, 74, 255–260. Hughes, R. B., Nosek, M. A., & Robinson-Whelen, S. (in press). Correlates of depression and rural women with physical disabilities. Journal of Obstetric, Gynecologic, and Neonatal Nursing. Hughes, R. B., Robinson-Whelen, S., Taylor, H. B., Petersen, N., & Nosek, M. A. (2005). Characteristics of depressed and nondepressed women with physical disabilities. Archives of Physical Medicine & Rehabilitation, 80, 473– 479. Hughes, R. B., Swedlund, N., Petersen, N., & Nosek, M. A. (2001). Depression and women with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 7, 16 –24.
285
Jackson, A. B. (1996) Pregnancy and delivery. In D. M. Krotoski, M. A. Nosek, & M. A. Turk (Eds.), Women with physical disabilities: Achieving and maintaining health and well-being (pp. 91–99) Baltimore: Paul H. Brooks. Nosek, M. A. (1996). Wellness among women with physical disabilities. Sexuality and Disability, 14, 165– 82. Nosek, M. A. (2000) Overcoming the odds: The health of women with physical disabilities in the United States. The John Stanley Coulter Lecture. Archives of Physical Medicine and Rehabilitation, 81 (2), 135–138. Nosek, M. A., Howland, C. A., & Hughes, R. B. (2001). The investigation of abuse and women with disabilities: Going beyond assumptions. Violence Against Women, 7, 477– 499. Nosek, M. A., Howland, C. A., & Young, M. E. (1997). Abuse of women with disabilities: Policy implications. Journal of Disabilities Policy Studies, 8, 157–176. Nosek, M. A., Hughes, R. B., Howland, C. A., Young, M. E., Mullen, P. D., & Shelton, M. L. (2004) The meaning of health for women with physical disabilities: A qualitative analysis. Family & Community Health, 27, 6 –21. Nosek, M. A., Hughes, R. B., Petersen, N. J., Taylor, H. B., RobinsonWhelen, S., Byrne, M., et al. (2006). Secondary conditions in a community-based sample of women with physical disabilities over a one-year period. Archives of Physical Medicine & Rehabilitation, 87, 320 –327. Nosek, M. A., Hughes, R. B., Taylor, H. B., & Howland, C. (2004). Violence against women with disabilities: The role of physicians in filling the treatment gap. In S. L. Welner, & F. Haseltine, (Eds.), Welner’s guide to the care of women with disabilities (pp. 333–345). Philadelphia: Lippincott Williams & Wilkins. Nosek, M. A., Rintala, D. H., Young, M. E., Howland, C. A., Foley, C.C., Rossi, C.D., et al. (1996). Sexual functioning among women with physical disabilities. Archives of Physical Medicine and Rehabilitation, 77, 107–115. Nosek, M. A., Young, M. E., Rintala, D. H., Howland, C. A., Foley, C. C., & Bennett, J. L. (1995). Barriers to reproductive health maintenance among women with physical disabilities. Journal of Women’s Health, 4, 505–518. Thierry, J. A., & Cyril, J. K. (2004). Health of women with disabilities: From data to action. In S. L. Welner, & F. Haseltine, (Eds.), Welner’s guide to the care of women with disabilities (pp. 373–382). Philadelphia: Lippincott Williams & Wilkins. Turner, R. J., & Wood, D. W. (1985). Depression and disability: The stress process in a chronically strained population. Research in Community and Mental Health, 5, 77–109. US Department of Health and Human Services. (2000). Disability and secondary conditions. Healthy People 2010. Washington, D.C.: Author. Waldrop, J., Stern, S. M. Disability status 2000: Census 2000 brief. Available: www.census.gov/. Accessed October 16, 2006.
Author Description Rosemary B. Hughes, PhD, is Senior Research Scientist at the University of Montana Rural Institute on Disabilities in Missoula, Montana. Dr. Hughes conducted the study reported here while serving as Assistant Professor of the Department of Physical Medicine and Rehabilitation and Director of the Center for Research on Women with Disabilities at Baylor College of Medicine in Houston, Texas. Her research interests include depression, stress, abuse, self-esteem, and health promotion in the context of disability.
COMMENTARY
INTRODUCTION TO THE THEME ISSUE ON WOMEN AND DISABILITIES Rosemary B. Hughes, PhD* University of Montana Rural Institute on Disabilities, Missoula, Montana Received 18 October 2006; accepted 18 October 2006
A
lthough women’s health has finally achieved its deserved place as a national health priority, relatively little attention has been given to the health of women living with disabilities who comprise 17.6% of the US noninstitutionalized civilian population of women ages 16 – 64 years, and 43% of women ⱖ65 years (Waldrop & Stern, 2000). Despite the fact that approximately 1 of 5 US women has a disability involving a limitation in life activities, the study of health in the context of disability for women is a relatively new field of inquiry. Many women with disabilities are underserved or unserved as a result of racial or ethnic minority status, rural residence, disability type, sexual orientation, and/or economic disadvantage. Healthy People 2010 (US Department of Health & Human Services, 2000) documents tremendous healthrelated disparities between women with disabilities and women without disabilities. Women with disabilities have prominent needs for health services owing to serious disparities such as employment, income, access to health care, overweight, physical activity, stress, depression, and other mental health conditions. The long-held belief that disability and health are mutually exclusive states of being is slowly giving way to an ever-growing appreciation that healthrelated disparities and environmental and other barriers to achieving a state of optimal health are often more limiting than the presence of disability itself. Women with disabilities often experience a lack of access to the disease prevention, health promotion, and health care services necessary for attaining and maintaining optimal health (Thierry & Cyril, 2004).
* Correspondence to: Rosemary B. Hughes, PhD, University of Montana Rural Institute on Disabilities, Missoula, Montana. E-mail: [email protected]. Copyright © 2006 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc.
This theme issue on women and disabilities addresses many of the disparities between women with disabilities and women without disabilities, suggests avenues for eliminating those disparities, and contributes to the growing knowledge base on the healthrelated issues of this largely disadvantaged and underserved population of women. The issue begins with a study by Wei and colleagues, who compared the use of clinical preventive services of women with disabilities and women without disabilities. In the second article, Chevarley and colleagues report on national estimates of the health, preventive health care, and access to health care of women with differing levels of functional limitation. Although many women with physical limitations choose to have children, they also may experience disability-related complications during pregnancy and delivery (Baschat & Weiner, 2004; Jackson, 1996). Gavin and colleagues present findings on the first known study addressing the health service use and outcomes of pregnant women with disabilities under Medicaid. For more than a decade, Margaret Nosek and other investigators at the Center for Research on Women with Disabilities have been conducting cutting edge research on a wide range of issues related to the health and well-being of women with disabilities (e.g., Nosek, 1996; Nosek et al., 1995; Nosek et al., 1996; Nosek et al., 2004; Nosek et al., 2006). In this theme issue, Nosek and her colleagues report on the findings of their investigation into the complex issues surrounding the participation of women with physical disabilities in health-promoting behaviors, specifically in the dietary and physical activity domains. Many women and men with significant disabilities are now living long enough to experience their later years, but serious secondary health conditions can 1049-3867/06 $-See front matter. doi:10.1016/j.whi.2006.10.004
284
R. B. Hughes / Women’s Health Issues 16 (2006) 283–285
threaten their quality of life and well-being (Campbell, Sheets, & Strong, 1999; Nosek, 2000). Robinson-Whelen and colleagues report on the evaluation of an innovative peer-led group program that they designed specifically for the unique health-promotion needs of women aging with physical disability. Aging is the typical context for informal conversations about osteoporosis. Many are surprised when they learn that younger women with disabilities are dealing with the diagnosis of osteoporosis. That phenomenon may be related to the use of certain medications for their underlying disabling health conditions. Watson and colleagues present findings on their study of the incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate and/or anti-epileptic drugs among women and girls with developmental disabilities. Like the early stages of osteoporosis, fibromyalgia is usually invisible; however, the two conditions differ in other ways. Whereas osteoporosis is diagnosed by measuring bone mineral density and using other screening tests, fibromyalgia is diagnosed primarily on the basis of its symptomatology. Without confirming tests for fibromyalgia, people with widespread musculoskeletal pain and its other debilitating symptoms can be left undiagnosed and untreated. Although that situation is slowing changing with advances brought about by clinical research, there are many questions left unanswered. Stuifbergen and colleagues report on cognitive perceptions and emotional responses related to illness in women with fibromyalgia. Many would assume that disability serves as a barrier to the clinical guidelines for diabetes care among women, and that diabetes care among rural women with disabilities would be disproportionately poor. Although that assumption may hold for many women with disabilities, Tseung and colleagues provide unanticipated findings on a retrospective cohort study of diabetes care in veteran women with disabilities. Sexual, physical, and disability-related violence against women with disabilities occurs universally and relentlessly and at alarmingly high rates (Nosek et al., 1997; Nosek et al., 2001; Nosek et al., 2004), but the violence may go unreported owing to various disability-related barriers. In this issue, Nannini reports on her comparative study of the sexual assault patterns among women with disabilities and women without disabilities who sought survivor services and provides findings on the patterns of reporting violence by women with various types of disability. Many studies have shown that women with disabilities experience elevated rates of depression (Hughes, Swedlund, Petersen, & Nosek, 2001; Hughes, Robinson-Whelen, Taylor, Petersen, & Nosek, 2005; Hughes, Nosek, & Robinson-Whelen, in press). Previous research has shown that women with disabilities have a higher prevalence of depression when compared to
men with disabilities (Coyle & Roberge, 1992; Fuhrer, Rintala, Hart, Clearman, & Young, 1993; Turner & Wood, 1985). In this issue, Kalpakjian and Albright reveal findings that contradict many previous findings on depression and gender in the context of disability and specifically spinal cord injury. According to Chapter 6 of Healthy People 2010 (US Department of Health & Human Services, 2000), increased stress represents a health-related disparity between people with and those without disabilities. This preeminent public health agenda also emphasizes the importance of developing health promotion programs to target such health and injury disparities. Hughes and colleagues present the results of a study representing the first of its kind, that is, a randomized, controlled investigation of the efficacy of a peer-led, stress self-management intervention designed specifically for women with physical disabilities. The health of women with disabilities includes psychological, social, and physical domains. Impairment and biology— but mostly—the sociopolitical, environmental, and economic contexts of their lives have tremendous impacts on their health and well-being. These contexts add up to injustices and inequities, including major health-related disparities and a multitude of barriers to accessing services for their health needs. Healthy People 2010 aims to reduce these disparities and promote healthy, long lives. It is time for our nation to attain the goals of that public health agenda and vigorously address its high priority health issues for women with disabilities. Well-designed research initiatives are needed to promote the health of women with disabilities, prevent and reduce the impact of secondary health conditions, and eliminate the disparities between women with and without disabilities. The articles in this theme issue offer important findings on empirically based studies designed to reduce the inequities and improve the health of this underserved and largely disadvantaged population of women. I commend the leadership of the Jacobs Institute of Women’s Health and Women’s Health Issues for their recognition of the importance of disseminating new, empirically based information on the health and wellness of women with disabilities. I acknowledge the efforts of Carol Weisman, Editor, and D. Richard Mauery, Associate Managing Editor, who provided support throughout the development of this issue in the midst of the challenging period of their organizational changes. Again, I am grateful to the terrific group of published researchers who comprised the review panel for this issue. I acknowledge the many authors who committed their time and effort to preparing and submitting manuscripts for this issue. Although some contributed manuscripts that did not meet the journal criteria for acceptance, I appreciate their efforts and wish them well on identifying alternative sources for disseminating their good work. Although I am now working at
R. B. Hughes / Women’s Health Issues 16 (2006) 283–285
the University of Montana Rural Institute on Disability in Missoula, Montana, I contributed a great deal of my efforts related to this theme issue when I was working at the Baylor College of Medicine Center for Research on Women with Disabilities in Houston, Texas. I acknowledge both institutions for their support of my endeavors related to this theme issue on women and disabilities, and I especially thank Margaret Nosek, Founder and Executive Director of the Center for Research on Women with Disabilities, for her mentorship of my own beginnings as a researcher on the health of women with disabilities. Without her mentorship, I would not be in the position of serving as guest editor for a theme issue on women with disabilities. Finally, I extend my highest level of respect and appreciation to the thousands of women who served as our research partners by consenting to become participants in the studies published in this issue.
Acknowledgments As guest editor, I commend the diligent work of the peer review panel that was appointed for this theme issue on “Women with Disabilities.” The members of the panel were Heather Becker, PhD, Timothy R. Elliott, PhD, Katherine Froehlich-Grobe, PhD, Stephen R. McCauley, PhD, Margaret A. Nosek, PhD, Nancy J. Petersen, PhD, Laurie E. Powers, PhD, Susan Robinson-Whelen, PhD, Allison Roller, M.A., Jonelle Rowe, MD, Suzanne C. Smeltzer, EdD, RN, FAAN, and Alexa Stuifbergen, PhD, RN, FAAN. Their expertise and professional commitment to disseminating findings of original research on women’s health contributed greatly to the quality of articles that comprise this issue.
References Baschat, A. A., & Weiner, C. P. (2004). Chronic neurologic diseases and disabling conditions in pregnancy. In S. L. Welner, & F. Haseltine Welner’s Guide to the Care of Women with Disabilities (pp. 145–158) Philadelphia: Lippincott Williams & Wilkins. Campbell, M. L., Sheets, D., & Strong, P. S. (1999). Secondary health conditions among middle-aged individuals with chronic physical disabilities: Implications for unmet needs for services. Assistive Technology, 11, 105–122. Coyle, C. P., & Roberge, J. J. (1992). The psychometric properties of the Center for Epidemiological Studies-Depression Scale (CES-D) when used with adults with physical disabilities. Psychology and Health, 7, 69 – 81. Fuhrer, M. J., Rintala, D. H., Hart, K. A., Clearman, R., & Young, M. E. (1993). Depressive symptomatology in persons with spinal cord injury who reside in the community. Archives of Physical Medicine & Rehabilitation, 74, 255–260. Hughes, R. B., Nosek, M. A., & Robinson-Whelen, S. (in press). Correlates of depression and rural women with physical disabilities. Journal of Obstetric, Gynecologic, and Neonatal Nursing. Hughes, R. B., Robinson-Whelen, S., Taylor, H. B., Petersen, N., & Nosek, M. A. (2005). Characteristics of depressed and nondepressed women with physical disabilities. Archives of Physical Medicine & Rehabilitation, 80, 473– 479. Hughes, R. B., Swedlund, N., Petersen, N., & Nosek, M. A. (2001). Depression and women with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 7, 16 –24.
285
Jackson, A. B. (1996) Pregnancy and delivery. In D. M. Krotoski, M. A. Nosek, & M. A. Turk (Eds.), Women with physical disabilities: Achieving and maintaining health and well-being (pp. 91–99) Baltimore: Paul H. Brooks. Nosek, M. A. (1996). Wellness among women with physical disabilities. Sexuality and Disability, 14, 165– 82. Nosek, M. A. (2000) Overcoming the odds: The health of women with physical disabilities in the United States. The John Stanley Coulter Lecture. Archives of Physical Medicine and Rehabilitation, 81 (2), 135–138. Nosek, M. A., Howland, C. A., & Hughes, R. B. (2001). The investigation of abuse and women with disabilities: Going beyond assumptions. Violence Against Women, 7, 477– 499. Nosek, M. A., Howland, C. A., & Young, M. E. (1997). Abuse of women with disabilities: Policy implications. Journal of Disabilities Policy Studies, 8, 157–176. Nosek, M. A., Hughes, R. B., Howland, C. A., Young, M. E., Mullen, P. D., & Shelton, M. L. (2004) The meaning of health for women with physical disabilities: A qualitative analysis. Family & Community Health, 27, 6 –21. Nosek, M. A., Hughes, R. B., Petersen, N. J., Taylor, H. B., RobinsonWhelen, S., Byrne, M., et al. (2006). Secondary conditions in a community-based sample of women with physical disabilities over a one-year period. Archives of Physical Medicine & Rehabilitation, 87, 320 –327. Nosek, M. A., Hughes, R. B., Taylor, H. B., & Howland, C. (2004). Violence against women with disabilities: The role of physicians in filling the treatment gap. In S. L. Welner, & F. Haseltine, (Eds.), Welner’s guide to the care of women with disabilities (pp. 333–345). Philadelphia: Lippincott Williams & Wilkins. Nosek, M. A., Rintala, D. H., Young, M. E., Howland, C. A., Foley, C.C., Rossi, C.D., et al. (1996). Sexual functioning among women with physical disabilities. Archives of Physical Medicine and Rehabilitation, 77, 107–115. Nosek, M. A., Young, M. E., Rintala, D. H., Howland, C. A., Foley, C. C., & Bennett, J. L. (1995). Barriers to reproductive health maintenance among women with physical disabilities. Journal of Women’s Health, 4, 505–518. Thierry, J. A., & Cyril, J. K. (2004). Health of women with disabilities: From data to action. In S. L. Welner, & F. Haseltine, (Eds.), Welner’s guide to the care of women with disabilities (pp. 373–382). Philadelphia: Lippincott Williams & Wilkins. Turner, R. J., & Wood, D. W. (1985). Depression and disability: The stress process in a chronically strained population. Research in Community and Mental Health, 5, 77–109. US Department of Health and Human Services. (2000). Disability and secondary conditions. Healthy People 2010. Washington, D.C.: Author. Waldrop, J., Stern, S. M. Disability status 2000: Census 2000 brief. Available: www.census.gov/. Accessed October 16, 2006.
Author Description Rosemary B. Hughes, PhD, is Senior Research Scientist at the University of Montana Rural Institute on Disabilities in Missoula, Montana. Dr. Hughes conducted the study reported here while serving as Assistant Professor of the Department of Physical Medicine and Rehabilitation and Director of the Center for Research on Women with Disabilities at Baylor College of Medicine in Houston, Texas. Her research interests include depression, stress, abuse, self-esteem, and health promotion in the context of disability.