Julia A. Rivera Drew

Disability and Pap Smear Receipt Among U.S. Women, 2000 and 2005

CONTEXT Sexually experienced women are at risk of cervical cancer, one of the most common female reproductive cancers. Nearly 20% of U.S. women aged 18-64 have a disability, and disability is associated with health care access; however, the relationship between disability and Pap smear receipt remains underexplored. METHODS Data on 20,907 women aged 21-64 from the 2000 and 2005 National Health Interview Surveys were used to investigate the relationship between disability and cervical cancer screening. Logistic regression analyses were conducted to assess the association between disability and both womens receipt of a Pap smear and their receipt of a doctors recommendation for a Pap smear in the past year. RESULTS Having a disability was negatively associated with Pap smear receipt (odds ratio, 0.6). Compared with women with no disabilities, those with mobility limitations and those with other types of limitations had reduced odds of having received a Pap smear (0.5-0.7). Disability was positively associated with having received a recommendation for a Pap smear (1.2); however, among women who had received a recommendation, those with disabilities had reduced odds of having received a Pap smear (0.5). Among women who had not received a Pap smear, 31% of those with disabilities and 13% of others cited cost or lack of insurance as the primary reason. CONCLUSIONS The negative relationship between Pap smear receipt and multiple types of disability suggests barriers beyond the human-made physical features of the environment. Efforts to reduce inequalities in reproductive health care access should consider the needs of women with disabilities.

Making Full Use of the Longitudinal Design of the Current Population Survey: Methods for Linking Records Across 16 Months.

Data from the Current Population Survey (CPS) are rarely analyzed in a way that takes advantage of the CPSs longitudinal design. This is mainly because of the technical difficulties associated with linking CPS files across months. In this paper, we describe the method we are using to create unique identifiers for all CPS person and household records from 1989 onward. These identifiers-available along with CPS basic and supplemental data as part of the on-line Integrated Public Use Microdata Series (IPUMS)-make it dramatically easier to use CPS data for longitudinal research across any number of substantive domains. To facilitate the use of these new longitudinal IPUMS-CPS data, we also outline seven different ways that researchers may choose to link CPS person records across months, and we describe the sample sizes and sample retention rates associated with these seven designs. Finally, we discuss a number of unique methodological challenges that researchers will confront when analyzing data from linked CPS files.

Disability and the self-reliant family: Revisiting the literature on parents with disabilities

An estimated 8.4 million adults with disabilities have children under age 18 living with them. Despite the large number of adults with disabilities engaged in parenting, studies of parents with disabilities have been relatively scarce, though the number is growing. This article reviews the literature on parents with disabilities as a whole and elaborates three themes relevant to parental support and care: parental capacity, “young carers,” and social networks. Also discussed are key concepts from the feminist and disability studies literature that can form the basis for a theoretical framework to guide research on parents with disabilities.An estimated 8.4 million adults with disabilities have children under age 18 living with them. Despite the large number of adults with disabilities engaged in parenting, studies of parents with disabilities have been relatively scarce, though the number is growing. This article reviews the literature on parents with disabilities as a whole and elaborates three themes relevant to parental support and care: parental capacity, “young carers,” and social networks. Also discussed are key concepts from the feminist and disability studies literature that can form the basis for a theoretical framework to guide research on parents with disabilities.

Human capital, gender, and labor force incorporation: The case of immigrants from the Former Soviet Union

Women immigrating to the United States from the Former Soviet Union (FSU) were expected to incorporate seamlessly into the US labor force because of their strong educational and professional backgrounds. Using 2000 Census data, we find that FSU women were less successful than both FSU men and other non-Hispanic white female immigrants. After controlling for other factors, FSU women were more likely to rely on public assistance and less likely to be employed. If employed, they worked in less prestigious occupations and earned much less.These findings draw attention to the particular difficulties of incorporation of this wave of relatively advantaged immigrants.

Hysterectomy and disability among U.S. women

Approximately 600,000 hysterectomies are performed annually in the United States, and this surgery is the second most common—after cesarean section—among women of reproductive age.1 Hysterectomy is a major operation, involving the removal of the uterus, cervix, fallopian tubes or ovaries, and can lead to serious complications.2,3 Nevertheless, about 90% of hysterectomies are performed for elective reasons.*1 When reviewed by a panel of physician experts, about 70% of elective hysterectomies were found to carry at least as many risks as benefits.4 Hysterectomy receipt is socially patterned. Women with a high school education or less undergo hysterectomies at much higher rates than women with more education.5–7 In addition, women reporting relatively lower levels of income and those working in low-status occupations are far more likely to have hysterectomies than are their counterparts with higher incomes or better jobs.5–7 Whites and blacks have an identical risk of getting a hysterectomy, whereas Hispanics and women of other races or ethnicities have a lower risk of having one.5–8 The association between disability and having a hysterectomy has not been thoroughly considered in previous research. The health of women with disabilities in general has received relatively little attention,9,10 even though these women may be more vulnerable than others to adverse consequences of inadequate health care access.11–13 Indeed, they frequently face multiple forms of inequality that put them at a health disadvantage relative to other women—like low socioeconomic status and depression.14,15 Evidence suggests that women with varied types of disability are at heightened risk of having a hysterectomy, and that they may have a relatively high risk of hysterectomy at young ages. In 2001, Nosek and colleagues16 found that women with mobility limitations have hysterectomies at higher rates than women without such disabilities. Findings from their in-depth interviews suggest that some women with mobility limitations face pressure from family members and medical professionals to undergo elective hysterectomy, even if they wish to have children someday. Although the Nosek et al. study provides the best evidence to date on the relationship between disability and risk of hysterectomy, it has several shortcomings: Hysterectomy rates were calculated from a national convenience sample; the focus was exclusively on women with mobility limitations; and the analysis did not adjust for potentially confounding variables, like education and income. Historically, institutionalized women with disabilities and women with cognitive or multiple disabilities have been frequent targets of eugenics campaigns. The majority of women who involuntarily underwent hysterectomies at the height of the U.S. eugenics movement were institutionalized women who had disabilities.17–19 Medical ethics controversies in the past decade suggest that some young women with severe cognitive disabilities still have hysterectomies at the request of their parents to eliminate menstruation and ease caregiving burdens.20–23 This study sought to expand our understanding of the relationship between disability and hysterectomy in several ways. First, it used data from the National Health Interview Survey (NHIS), the only nationally representative survey to include retrospective measures of the timing and type of disability, as well as the timing of hysterectomy. Second, it employed multivariate regression analysis to explore the relationship between disability and having a hysterectomy, and to assess whether the risk of hysterectomy varies by disability type. Third, it used a series of event history regressions to investigate whether the risk of undergoing a hysterectomy faced by women with disabilities, and by women with multiple disabilities in particular, changes over the life course.CONTEXT Hysterectomies are the second most common surgery performed on women in the United States, and most are done for elective reasons. Although women with disabilities appear to have an increased risk of undergoing the procedure, little research has evaluated the relationship between disability and hysterectomy. METHODS Data on 42,842 women aged 18 or older from the 2000, 2005 and 2010 National Health Interview Surveys were used to evaluate the relationship between disability and the risk of having a hysterectomy over the life course. Piecewise exponential event history models were estimated to identify associations between timing of disability onset, type of disability, and the occurrence and timing of hysterectomy. RESULTS Women with multiple disabilities experienced a higher risk of undergoing a hysterectomy than women with no disability (hazard ratio, 1.3), and this heightened risk was concentrated at younger ages. During their 20s, 30s and early 40s, women who had multiple disabilities were more likely to have had a hysterectomy than were their same-age counterparts with no or one disability (1.3-2.4). Women with a single type of disability, as well as most women who had multiple disabilities and were aged 46 or older, were not at increased risk of having had a hysterectomy. CONCLUSIONS Additional research is needed to investigate why young women with multiple disabilities appear to face an increased risk of having a hysterectomy, especially because it is major surgery that can carry significant health risks.

The Developmental Epidemiology of Mental Retardation and Developmental Disabilities

Publisher Summary This chapter provides an overview of developmental epidemiology as a powerful research tool with unique perspectives for investigators studying mental retardation and developmental disability. The chapter reviews the major population‐based developmental epidemiology studies. It discusses the insights provided in understanding mental retardation and developmental disabilities in community, school, family contexts, and the life course of children with mental retardation or developmental disabilities. A detailed description of the major conceptual and theoretical models of disability is advocated for use in population‐based studies. The advantage of developmental epidemiology studies is described in the chapter.

Cause, nature and care-seeking behaviour for injuries among community-dwelling older adults, USA, 2004-2013

Objective To describe the cause and nature of injuries, and care-seeking behaviour following injury, among community-dwelling older adults. Methods We used 10 years of the nationally representative Integrated Health Interview Series data, providing information on individual characteristics, cause and nature of injuries, and care-seeking behaviour for 3074 adults 65 years of age and older. Univariate and bivariate analyses were used to evaluate overall patterns and test for group-level differences. Results Approximately 40% of injuries were characterised as hip fracture, head injury and/or other fracture, with the remaining 60% consisting of other, milder types of injuries like bruises, strains and sprains. Fifty-eight per cent of injuries required a visit to the emergency room or transportation via an emergency vehicle, and 19% required hospitalisation. Injuries sustained in a fall were more likely to be serious than those due to other reasons. Older women, those ages 80+, those living with others with no spouse or partner present and those with activities of daily living/instrumental activities of daily living disabilities were more vulnerable to serious injuries and serious injury consequences relative to other older adults. Conclusions Our results suggest that injuries, especially falls, are a pressing public health concern for the growing population of older adults. Injury prevention outreach should take extra measures to reach certain subgroups of older adults that have been identified as especially vulnerable. Because so many injuries are due to reasons other than falling and/or do not result in hospitalisation, more interventions should be designed for general injury prevention and outpatient settings.

What Doesn’t Kill You Doesn’t Make You Stronger: The Long-Term Consequences of Nonfatal Injury for Older Adults

Purposey The majority of research efforts centering on injury among older adults focus on fall-related injuries and short-term consequences of injury. Little is known about the long-term consequences of all-cause nonfatal injuries, including minor injuries. Using a recent, large, and nationally representative sample of the U.S. non-institutionalized civilian population, the current study examines whether older adults who sustained a nonfatal injury (serious and minor) have higher risk of long-term morbidity and mortality outcomes compared with noninjured seniors. Methods Linked National Health Interview Survey-Medical Expenditure Panel Survey (NHIS-MEPS) data were used to fit logistic and 2-part models to estimate associations between injury incidence and later injury, hospitalization incidence, and length of hospital stay during the 2.5 years following the NHIS interview among 16,109 older adults. Data from the linked National Health Interview Survey-National Death Index (NHIS-NDI) files were used to estimate a Cox proportional hazards model to examine the association between injury incidence and mortality for up to 11 years after the initial interview among 79,504 older adults. Results Relative to no injury, serious nonfatal injury was significantly associated with increased risk of another injury, hospitalization, and mortality. Minor injuries were significantly related to higher risk of later injury and mortality. Implications Because even minor injuries are strongly associated with increased risks of later injury and mortality, preventing injury among seniors may be an effective way to improve quality of life and reduce declines in functional capacity.

Changes to the Design of the National Health Interview Survey to Support Enhanced Monitoring of Health Reform Impacts at the State Level

Pursuant to passage of the Patient Protection and Affordable Care Act, the National Center for Health Statistics has enhanced the content of the National Health Interview Survey (NHIS)-the primary source of information for monitoring health and health care use of the US population at the national level-in several key areas and has positioned the NHIS as a source of population health information at the national and state levels. We review recent changes to the NHIS that support enhanced health reform monitoring, including new questions and response categories, sampling design changes to improve state-level analysis, and enhanced dissemination activities. We discuss the importance of the NHIS, the continued need for state-level analysis, and suggestions for future consideration.