Health behaviors among American Indians with spinal cord injury: comparison with data from the 1996 Behavioral Risk Factor Surveillance System

COVID-19-Induced Inequalities and Mental Health: Testing the Moderating Roles of Self-rated Health and Race/Ethnicity

This study examines the relationship among COVID-19-induced social, economic, and educational inequalities on mental health (i.e., anxiety and depression). This study also examines if levels of self-rated health (SRH) moderate the relationship (i.e., COVID-induced inequalities [CII] and mental health), as well as examines the racial/ethnic group differences among 567 young adults in the mid-Atlantic region. Using a moderation model, results indicate that CII were significantly related to depression (b = .221, t(554) = 4.59, p = .000) and anxiety (b = .140, t(555) = 3.23, p = .001). SRH and race/ethnicity also moderated both relationships. At above-average SRH (i.e., moderator), higher CII were also significantly related to lower anxiety (Asian young adults only) and lower depression (Asian and White young adults only). Overall, SRH and race/ethnicity are important factors in the mental health impact of COVID-19 on young adults.

Health-related behaviors and multiple chronic health conditions among persons with traumatic spinal cord injury

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

The purposes of this study were to assess (i) prevalence of self-reported multiple chronic conditions (MCC) in a population-based cohort of persons with traumatic spinal cord injury (TSCI) and (ii) the association between health-related behaviors and MCC.

SETTING

Population-based TSCI cohort.

METHODS

Participants included 716 adults with TSCI of at least 1-year duration who were identified through a population-based TSCI surveillance system. Standard questions from the Behavioral Risk Factor Surveillance System measured cigarette smoking, binge drinking, planned exercises, and 10 chronic health conditions (CHC), including diabetes, heart attack, angina (or coronary artery disease), stroke, cancer, asthma, kidney disease, arthritis, depressive disorder, chronic obstructive pulmonary disease. MCC was defined as having two or more CHCs in this study. Multivariate logistic regression models were used to assess the association between health-related behaviors and MCC.

RESULTS

Almost half (45%) of the study sample had MCC. After controlling for demographic and injury characteristics, participants with smoking history of at least 100 cigarettes were 59% more likely to develop MCC, and those who had planned exercises at least three times a week were 36% less likely to have MCC.

CONCLUSIONS

We found MCC prevalence was high among people with TSCI, and MCC was associated with cigarette smoking and planned exercise.

Changes in alcohol use after the onset of spinal cord injury

OBJECTIVE

Identify the prevalence of alcohol consumption and binge drinking at time of spinal cord injury (SCI) onset, compare these rates to data from the general population, and identify changes in alcohol use at an average of 17 months post-injury.

DESIGN

Cross sectional, mailed self-report assessment.

SETTING

A specialty hospital in the southeastern United States.

PARTICIPANTS

Five hundred sixty-six inpatients completed the baseline measure. After eliminating those under age 18, there were 524 participants at baseline. 410 were approached for follow-up, with 201 of those responding.

INTERVENTIONS

N/A.

OUTCOME MEASURES

Self-reported assessments were completed during inpatient rehabilitation and at follow-up approximately 17 months later. The two primary outcomes were the number of days consuming 5 or more drinks (binge drinking) and the number of days consuming any alcoholic beverages within the 30 days prior to the assessment. Comparison data were taken from the Behavioral Risk Factor Surveillance System.

RESULTS

At SCI onset, the prevalence of alcohol use, particularly binge drinking, was substantially higher than the general population (SCI = 44.9%; general population = 13%). Drinking rates decreased by 17 months post-injury.

CONCLUSION

Alcohol use and binge drinking are elevated over the general population at the time of injury. Drinking patterns reflect a decrease following injury but remain slightly elevated, signifying a need for interventions to minimize long-term health consequences.

Rasch analysis of alcohol abuse and dependence diagnostic criteria in persons with spinal cord injury

STUDY DESIGN

Cross-sectional.

OBJECTIVE

The objective of the study is to examine whether alcohol use disorders should be conceptualized categorically as abuse and dependence as in the 'Diagnostic and Statistical Manual of Mental Disorders' 4th edition or on a single continuum with mild to severe category ratings as in the 'Diagnostic and Statistical Manual of Mental Disorders' 5th edition in people with spinal cord injury (SCI).

SETTING

United States of America.

METHODS

Data from 379 individuals who sustained SCI either traumatically or non-traumatically after the age of 18 and were at least 1 year post injury. Rasch analyses used the alcohol abuse and dependence modules of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Non-patient Edition (SCID-I/NP).

RESULTS

Fifty-seven percent (n=166) of the entire sample endorsed criteria for alcohol abuse, and 25% (n=65) endorsed criteria for alcohol dependence. Fit values were generally acceptable except for one item (for example, alcohol abuse criterion 2), suggesting that the items fit the expectation of unidimensionality. Examination of the principal components analysis did not provide support for unidimensionality. The item-person map illustrates poor targeting of items.

CONCLUSIONS

Alcohol abuse and dependence criterion appear to reflect a unidimensional construct, a finding that supports a single latent construct or factor consistent with the DSM-5 diagnostic model.

Exploring Barriers of the Health System to Rehabilitation Services for People with Disabilities in Iran: A Qualitative Study

INTRODUCTION

The United Nations (UN) identified health as a basic human right, but, unfortunately, the evidence shows that people with disabilities (PWD) often have lower levels of health than the general population. This can be associated with problems in access to the services and programs. The aim of this study was to explore barriers of the health system to rehabilitation services for PWD in Iran.

METHODS

This was a qualitative study conducted on 21 participants using semi-structured, in-depth interviews and content analysis from June 2014 to July 2015. Data analysis was performed by MAXQDA version 10.

RESULTS

"Barriers" were the most prominent challenge of people with disabilities that needed access to rehabilitation services. These barriers were categorized into eight concepts of deficiency in the system that provides rehabilitation services, defect of education, deficiency in detecting and screening of people with disability, defect of stewardship in rehabilitation, ignoring socio-cultural factors, accessibility hardships, lack of identification, and financial hardships in rehabilitation.

CONCLUSIONS

An efficient rehabilitation plan requires a common understanding, considering the long-term complications involved in addressing the barriers. Understanding the barriers of the health system to rehabilitation services requires comprehensive management that first should be familiar with all of PWD, providers, policy makers, and other beneficiaries. It also is necessary for policy makers to consider rehabilitation services as a main part of the health plan; especially, they must change their oversight of rehabilitation services and programs. Thus, policy makers should have need comprehensive management and recommended further research.

Lifetime prevalence of chronic health conditions among persons with spinal cord injury

OBJECTIVE

To assess lifetime prevalence of 7 chronic health conditions (CHCs) among a cohort of adults with chronic traumatic spinal cord injury (SCI).

DESIGN

Cross-sectional.

SETTING

Rehabilitation hospital.

PARTICIPANTS

Adults with SCI who were ≥18 years of age, were ≥1 year postinjury, and had residual neurologic effects impeding full recovery (n=1678).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

CHCs were measured using questions from the Behavioral Risk Factor Surveillance System for diabetes (not including gestational), heart attack (also called a myocardial infarction), angina or coronary artery disease, stroke, hypertension (not including during pregnancy), high blood cholesterol, or cancer.

RESULTS

Of participants, 49.5% reported having at least 1 CHC, with 23.2% reporting ≥2 CHCs. The most frequently reported CHC was high cholesterol (29.3%) followed by hypertension (28.7%) and diabetes (11.8%). Although the prevalence of CHCs significantly increased with increasing age, only hypertension and cancer were significantly associated with years postinjury. Four CHCs (diabetes, coronary artery disease, hypertension, high cholesterol) were significantly related to mobility status as measured by injury level and ambulatory status. However, after controlling for age, years postinjury, sex, and race, mobility status became nonsignificant in relation to coronary artery disease, but it remained significantly associated with diabetes, hypertension, and high cholesterol.

CONCLUSIONS

Clinicians should be aware of the risk of CHCs in persons with SCI and should screen for these conditions and regular maintenance activities related to SCI.

Leisure time physical activity of people with spinal cord injury: mainly with clubs of spinal cord injury patients in busan-kyeongnam, Korea

Objective

To estimate hours of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA of people with chronic SCI.

Method

Seventy nine persons with SCI living in Busan and Gyongsangnam-do were recruited. They completed a self-administered questionnaire, which consisted of items about personal characteristics, type of LTPA, hours of LTPA, LTPA intensity, and LTPA satisfaction.

Results

Most participants (92.4%) did not work. The respondents reported a daily mean of 3.13 hours (±1.47) of LTPA; however, 3.8% reported no LTPA whatsoever. Years post-injury, income sources, and type of medical payment emerged as a predictors of LTPA. Years post-injury were positively correlated with amount of leisure activity. In the case of self income, LTPA was longer than for groups with different income sources (e.g.partner, parents). For patients receiving workers' compensation insurance, LTPA was longer than for patients receiving non-WC insurance. Most LTPA was done at a moderate intensity. The three most frequently reported types of LTPA were wheeling (26%), sports (19%), and stretching exercise (15%). There was overall dissatisfaction with LTPA.

Conclusion

Daily LTPA hours were longer than previously reported, but wheeling accounted for a large part of the activity. Intensity of activity was generally moderate. The employment rate was very low. Clearly, participating in regular LTPA for health purposes is very important to people with chronic SCI, but it is also important for them to have jobs.

A structural analysis of health outcomes after spinal cord injury

OBJECTIVE

To develop and validate a latent model of health outcomes among persons with spinal cord injury.

METHODS

Survey data were collected at a large specialty hospital in the southeastern USA from 1,388 adult participants with traumatic spinal cord injury of at least 1 year's duration. Multiple indicators of health outcomes were used, including general health ratings, days adversely affected by poor health and poor mental health, treatments and hospitalizations, depressive symptoms, symptoms of illness or infection (eg, sweats, chills, fever), and multiple individual conditions (eg, pressure ulcers, subsequent injuries, fractures, contractures).

RESULTS

We performed exploratory factor analysis on half of the sample and confirmatory factor analysis on the other. A 6-factor solution was the best overall solution, because there was an excellent fit with the exploratory factor analysis (root mean square error of approximation = 0.042) and acceptable fit with the confirmatory factor analysis (root mean square error of approximation = 0.065). Four of the factors were types of secondary conditions, including symptoms of illness or infection, orthopedic conditions, pressure ulcers, and subsequent injuries. The 2 remaining factors reflected global health and treatment. Gender, race-ethnicity, age, injury severity, and years of education were all significantly related to at least 1 factor dimension, indicating variations in health outcomes related to these characteristics.

CONCLUSION

Identification of the 6 factors represents an improvement over the utilization of multiple individual indicators, because composite scores generated from multiple individual indicators provide more informative and stable outcome scores than utilization of single indicators.

Disparities between persons with and without disabilities in their participation rates in mass screening

OBJECTIVES

The purpose of this study was to determine the number of persons with and without disabilities who participated in the National Health Insurance (NHI) chronic disease mass screening programs in South Korea.

METHODS

The data were obtained from mass screening claims submitted to the NHI and National Disability Registry. Factors affecting the participation rate included demographic variables, socioeconomic status, residential region, and disability type and severity. A multiple logistic regression analysis was used to evaluate the relationship between participation rates and disability type and severity adjusted for confounding factors.

RESULTS

The analysis revealed that persons with a disability were less likely to participate in mass screening programs than those without a disability (35.8% vs. 40.2%). Multiple logistic regression analysis indicated that persons with severe disabilities had lower participation rates than those without disabilities [adjusted odds ratio (aOR): 0.64, 95% confidence interval (CI): 0.63-0.64]. In particular, persons with severe disabilities such as limb, brain, visual and internal organ impairment, were less likely to participate in the mass screening programs. However, persons with mild disability had higher participation rates than those without disabilities (1.03, 1.02-1.03).

CONCLUSIONS

Although the prevalence rates of chronic diseases are higher among persons with disabilities, various types of impairments such as limb, brain, visual and internal organ impairment, hinder participation in mass screening programs for chronic diseases. The reasons for this disparity must be investigated and health policies must be altered to make preventative treatments more accessible to persons with disabilities.

Disability and receipt of clinical preventive services among women

BACKGROUND

More individuals are surviving catastrophic injuries and living longer with persistent disability; however, their receipt of clinical preventive services is not well understood as compared with those without disabilities given the dual focus of care on both primary prevention and the prevention of secondary complications related to their disabilities.

METHODS

Longitudinal analyses of 1999-2002 Medical Expenditure Survey (MEPS). Study sample consisted of 3,183 community-dwelling women aged 51-64 years and followed for 2 full years. Women with disabilities were defined as having reported any limitation in any area of activity of daily living in 2 years. Recommended clinical preventive services were defined as receiving the following at the recommended intervals: colorectal, cervical, and breast cancer; cholesterol screening; and influenza immunization. chi(2) tests and multiple logistic regressions were used to examine variations in use of clinical preventive services.

RESULTS

Overall, 23% of the women in the study (n = 835) were disabled. Disabled women, however, were less likely to receive mammography and Pap smears within the recommended intervals. However, disabled women were more likely to receive influenza immunization, cholesterol screening, and colorectal screening within the recommended intervals. Among the disabled, usual source of care and health insurance remained significant predictors of receipt of clinical preventive services across all types,

CONCLUSIONS

Disabled women were less likely to receive some of the cancer screening services, suggesting a need for targeted interventions to promote breast cancer and cervical cancer screening. Increased access to health care insurance and health care providers may also help.

Patterns of alcohol and substance use and abuse in persons with spinal cord injury: risk factors and correlates

OBJECTIVE

To investigate patterns of alcohol consumption and abuse and substance use among persons with spinal cord injury (SCI), relating these patterns to demographic and injury-related characteristics, as well as to key medical and psychosocial outcomes.

DESIGN

Retrospective cross-sectional.

PARTICIPANTS

Subjects with traumatic SCI (N=3041) with dates of injury between June 6, 1975, and June 23, 2002, who were interviewed between November 2000 and March 2003.

SETTING

Sixteen Model Spinal Cord Injury Systems participating in this collaborative study during the 2000-2005 grant cycle.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Alcohol consumption, substance use, CAGE questionnaire, Satisfaction With Life Scale, Craig Handicap Assessment Reporting Technique, and pain. Data were analyzed using chi-square tests, analysis of variance, analysis of covariance, and logistic regression models.

RESULTS

Fourteen percent of the subjects were classified as likely to have an alcohol abuse issue, based on the CAGE, and 11% reported using illegal drugs or prescription medications for nonmedical reasons. Demographic and injury characteristics were associated with alcohol consumption patterns, abuse, and substance use. At-risk drinkers and substance users tended to be younger, single, male, and less educated. Those who were CAGE positive and substance users reported more pain and lower satisfaction with life. Persons who drank without indication of problem drinking had superior occupation outcomes. Pressure ulcers were associated with substance use.

CONCLUSIONS

Alcohol abuse and substance use were related to a number of adverse outcomes. The specific role of drinking with increased work activity deserves further exploration.

Relationships between level of disability and receipt of preventive health services

OBJECTIVES

To examine relationships between level of disability and receipt of certain preventive health services, including demographic and systems variables that may explain or confound these relationships.

DESIGN

Analysis of recent (1998 and 2000) data from the Behavioral Risk Factor Surveillance System, a nationwide telephone survey.

SETTING

States reporting data on disability (13 in 1998, 18 in 2000).

PARTICIPANTS

Noninstitutionalized persons living in the community.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Frequency of receipt of recommended preventive health services, including colorectal, cervical, and breast cancer screening, and influenza and pneumococcal vaccination. An ordinal index of disability severity was constructed from questions on activity limitations.

RESULTS

In 2000, people with mild and moderate disability received influenza and pneumonia vaccinations somewhat more frequently than people without disabilities, but people with the most severe disabilities least frequently received vaccinations that year. Disabled women received fewer Papanicolaou tests and clinical breast examinations, but significant differences did not occur for mammograms in 2000. Fewer differences as a function of disability level were apparent in 2000 than 1998. Demographic variables affected receipt of most preventive services. Access to routine checkups affected all preventive services independent of disability level in both years.

CONCLUSIONS

Severity of disability is related to receipt of certain preventive services but not necessarily in a simple or unidirectional way. Regardless of disability, receipt of a checkup was an important determinant of receipt of preventive health services. For almost all services and groups studied, preventive care remained below targeted goals for Healthy People 2010.

International differences in ageing and spinal cord injury

DESIGN

The present study is part of a programme of longitudinal research on ageing and spinal cord injury involving three populations - American, British and Canadian. The design was multivariate.

OBJECTIVE

To identify international differences in outcomes associated with ageing and spinal cord injury.

SETTING

A sample of 352 participants was assembled from five large, well-established databases. The Canadian sample was derived from the member database of the Canadian Paraplegic Association (Ontario and Manitoba divisions). The British sample was recruited from Southport Hospital's Northwest Regional Spinal Injuries Centre and Stoke-Mandeville Hospital's National Spinal Injuries Centre. The American sample has been recruited through Craig Hospital in Denver, Colorado.

METHODS

The sample included individuals who had incurred a spinal cord injury at least 20 years previously; were admitted to rehabilitation within 1 year of injury; were between age 15 and 55 at the time of injury. Data were collected using a combination of self-completed questionnaires and interviews. Data included medical information, general health, hospitalisations, and changes in bladder and bowel management, equipment, pain, spasticity, the need for assistance, and other health issues.

RESULTS

Clear international differences existed between the three samples in the three different countries. After controlling for sampling differences (ie, differences in age, level of lesion, duration of disability, etc.), the following differences were seen: (1) American participants had a better psychological profile and fewer health and disability-related problems; (2) British participants had less joint pain and less likelihood of perceiving they were ageing more quickly; (3) Canadians had more health and disability-related complications (particularly bowel, pain and fatigue problems).

CONCLUSION

These differences are discussed in terms of socio-political, health care system and cultural factors that might be used to explain them, and to generate hypotheses for future research.

Health outcomes among American Indians with spinal cord injury

OBJECTIVE

To identify factors related to risk for poor health outcomes and secondary conditions in a sample of American Indians with spinal cord injury (SCI).

DESIGN

Interviews were conducted by telephone with most participants; those who did not have telephones returned materials by mail.

SETTING

A large rehabilitation hospital in the Western/ Mountain region of the United States.

PARTICIPANTS

Ninety-seven American Indians with SCI completed a comprehensive health interview. All participants were adults with traumatic SCI and were at least 1 year postinjury.

MAIN OUTCOME MEASURES

Selected items from the Behavioral Risk Factor Surveillance System were used to assess health behaviors and general health outcomes. Two secondary conditions were also investigated as outcome measures: pressure sores and post-SCI injuries.

RESULTS

Multiple linear regression was used to predict seven health-related outcomes. Depressive symptomatology and post-SCI injuries were the primary predictors of the majority of health outcomes. Alcohol consumption was associated with a greater risk for post-SCI injuries, and being older at injury was associated with poorer health outcomes.

CONCLUSIONS

Interventions to reduce depression, injuries, and alcohol misuse have potential for improving health among American Indians with SCI.