Brian S. Armour

Cigarette Smoking and Food Insecurity Among Low-Income Families in the United States, 2001

Purpose. To quantify the association between food insecurity and smoking among low-income families. Design and Setting. A retrospective study using data from the 2001 Panel Study of Income Dynamics (PSID), a longitudinal study of a representative sample of U.S. men, women, and children and the family units in which they reside. Subjects. Low-income families. Measures. Family income was linked with U.S. poverty thresholds to identify 2099 families living near or below 200% of the federal poverty level. Food insecurity (i.e., having insufficient funds to purchase enough food to maintain an active and healthy lifestyle) was calculated from the 18-core-item food security module of the U.S. Department of Agriculture. Current smoking status was determined. Results. Smoking prevalence was higher among low-income families who were food insecure compared with low-income families who were food secure (43.6% vs. 31.9%; p < .01). Multivariate analysis revealed that smoking was associated with an increase in food insecurity of approximately six percentage points (p < .01). Conclusions. Given our finding that families near the federal poverty level spend a large share of their income on cigarettes, perhaps it would be prudent for food-assistance and tobacco-control programs to work together to help low-income people quit smoking.

State-Level Differences in Breast and Cervical Cancer Screening by Disability Status: United States, 2008

INTRODUCTION AND BACKGROUND Despite reported disparities in the use of preventive services by disability status, there has been no national surveillance of breast and cervical cancer screening among women with disabilities in the United States. To address this, we used state-level surveillance data to identify disparities in breast and cervical cancer screening among women by disability status. METHODS Data from the 2008 Behavioral Risk Factor Surveillance System were used to estimate disability prevalence and state-level differences in breast and cervical cancer screening among women by disability status. RESULTS Overall, modest differences in breast cancer screening were found; women with a disability were less likely than those without to report receiving a mammogram during the past 2 years (72.2% vs. 77.8%; p < .001). However, disparities in breast cancer screening were more pronounced at the state level. Furthermore, women with a disability were less likely than those without a disability to report receiving a Pap test during the past 3 years (78.9% vs. 83.4%; p < .001). DISCUSSION This epidemiologic evidence identifies an opportunity for federal and state programs, as well as other stakeholders, to form partnerships to align disability and womens health policies. Furthermore, it identifies the need for increased public awareness and resource allocation to reduce barriers to breast and cervical cancer screening experienced by women with disabilities.

Estimates of state-level health-care expenditures associated with disability.

Objectives. We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. Methods. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002–2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. Results. The DAHE for all U.S. adults totaled

Are adolescent girls with a physical disability at increased risk for sexual violence

397.8 billion in 2006, with state expenditures ranging from

Factors Associated with Self-Reported Mammography Use for Women With and Women Without a Disability

598 million in Wyoming to

A profile of state-level differences in the oral health of people with and without disabilities, in the U.S., in 2004.

40.1 billion in New York. Of the national total, the DAHE were

Estimates of National Health Care Expenditures Associated With Disability

118.9 billion for the Medicare population,

Hospitalization for urinary tract infections and the quality of preventive health care received by people with spina bifida

161.1 billion for Medicaid recipients, and

The Influence of Year-end Bonuses on Colorectal Cancer Screening

117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. Conclusions. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

Estimating disability prevalence among adults by body mass index: 2003-2009 National Health Interview Survey.

BACKGROUND The purpose of this study was to investigate whether US female adolescents who self-reported having a physical disability or long-term health problem were more likely to report having been physically forced to have sexual intercourse than US female adolescents without a physical disability or long-term health problem. METHODS Using data from the 2005 U.S. National Youth Risk Behavior Survey (YRBS), we employed logistic regression analyses to estimate the association between physical disability (and other variables) and the risk for sexual violence among US high school girls. RESULTS Female high school students who reported a physical disability or long-term health problem were more likely to report having been physically forced to have sexual intercourse than those who did not (19.6% vs 9.4%; chi(2) = 14.51, p = .003). Results from our multivariate analysis reveal that this association remained significant (adjusted odds ratio [AOR], 1.57; 95% confidence interval [CI], 1.10-2.23) after adjusting for certain demographic characteristics, physical health problems, behavioral health risks, and violent conduct. CONCLUSIONS Our findings suggest that adolescent girls in the United States with a physical disability or long-term health problem may be at increased risk for sexual violence. It is important that national efforts to reduce sexual violence consider how to address the unmet needs of children and adolescents with disabilities. As most adolescent girls spend the majority of their time in a school setting, it is of particular importance that school health professionals are aware of the current findings.