Monika Mitra

Disability as a Public Health Issue: Findings and Reflections from the Massachusetts Survey of Secondary Conditions

Public health researchers and practitioners have begun to recognize the dynamic nature of disability, promote the health of people with disabilities, and develop strategies to prevent secondary conditions among them. To understand the epidemiology of secondary conditions, the authors developed the Massachusetts Survey of Secondary Conditions, a longitudinal study of adults with major disabilities (n = 656) based on a conceptual framework linking disability, mediating factors, and health outcomes. This paper reports baseline data on the number of secondary conditions experienced by survey respondents. Respondents experienced a mean of 5.3 of 17 secondary conditions. More numerous secondary conditions were associated with fair or poor general health and number of days unable to do routine activities. Factors amenable to public health interventions included difficulty with weight and exercise maintenance, tobacco and marijuana use, and experiencing assault. Disability should be a focus in all public health research, policy, and programs.

Sexual Violence Victimization Against Men with Disabilities

BACKGROUND Prior research has shown a high prevalence of sexual violence against women with disabilities. However, no previous population-based studies have examined such victimization against men with disabilities. PURPOSE The purpose of this paper is to document the prevalence of lifetime and past-year sexual violence victimization among a representative sample of men with disabilities in Massachusetts and to compare its prevalence among men with disabilities to that of men without disabilities and women with and without disabilities. METHODS Data from the Massachusetts Behavioral Risk Factor Surveillance System, 2005-2009 were analyzed in 2010 using bivariate and multivariate logistic regression. RESULTS Among 25,756 survey respondents, approximately 21.1% of Massachusetts men and 21.0% of women reported a disability. The prevalence of lifetime sexual violence victimization was 13.9% (95% CI=10.7%, 17.1%) among men with disabilities; 3.7% (95% CI=2.9%, 4.5%) among men without disabilities; 26.6% (95% CI=23.4%, 29.7%) among women with disabilities; and 12.4% (95% CI=11.2%, 13.6%) among women without disabilities. Similarly, men with disabilities were more likely than men without disabilities to report lifetime completed and attempted rape and past-year sexual violence victimization. Multivariate analyses controlling for sociodemographic characteristics indicated that men with disabilities were more than four times more likely to report lifetime and past-year victimization than men without disabilities. CONCLUSIONS Men with disabilities are at a heightened risk for lifetime and current sexual violence victimization.

Predictors of Secondary Conditions in a Sample of Independently Living Adults with High-Level Spinal Cord Injury

A sample of 117 Massachusetts adults with predominately high-level spinal cord injuries (SCIs) report a mean of 6.5 (Dž.0) of 17 secondary conditions in the previous year. Hierarchical multiple regression based on a conceptual framework to examine possible contributing factors shows two independent predictors (P h .05) of a greater number of secondary conditions: These predictors are more difficulty with instrumental activities of daily living (IADLs) and more difficulty with accessing medical care. In addition, three variables marginally predicted (P h 0.10) more secondary conditions: inadequate access to transportation, tobacco-smoking, and race (white). The findings highlight the importance of IADL difficulty and access to medical care in relation to secondary conditions among adults with SCI.

Pregnancy outcomes among women with intellectual and developmental disabilities

BACKGROUND There is currently no population-based research on the maternal characteristics or birth outcomes of U.S. women with intellectual and developmental disabilities (IDDs). Findings from small-sample studies among non-U.S. women indicate that women with IDDs and their infants are at higher risk of adverse health outcomes. PURPOSE To describe the maternal characteristics and outcomes among deliveries to women with IDDs and compare them to women with diabetes and the general obstetric population. METHODS Data from the 1998-2010 Massachusetts Pregnancy to Early Life Longitudinal database were analyzed between November 2013 and May 2014 to identify in-state deliveries to Massachusetts women with IDDs. RESULTS Of the 916,032 deliveries in Massachusetts between 1998 and 2009, 703 (<0.1%) were to women with IDDs. Deliveries to women with IDDs were to those who were younger, less educated, more likely to be black and Hispanic, and less likely to be married. They were less likely to identify the father on the infants birth certificate, more likely to smoke during pregnancy, and less likely to receive prenatal care during the first trimester compared to deliveries to women in the control groups (p<0.01). Deliveries to women with IDDs were associated with an increased risk of adverse outcomes, including preterm delivery, very low and low birth weight babies, and low Apgar scores. CONCLUSIONS Women with IDDs are at a heightened risk for adverse pregnancy outcomes. These findings highlight the need for a systematic investigation of the pregnancy-related risks, complications, costs, and outcomes of women with IDDs.

Maternal characteristics, pregnancy complications and adverse birth outcomes among women with disabilities

Objectives:The objective of this study is to describe the maternal characteristics, pregnancy complications, and birth outcomes among a representative sample of Rhode Island women with disabilities who recently gave birth. Methods:Data from the 2002–2011 Rhode Island Pregnancy Risk Assessment Monitoring System survey were analyzed. Results:Approximately 7% of women in Rhode Island reported a disability. Women with disabilities reported significant disparities in their health care utilization, health behaviors, and health status before and during pregnancy and during the postpartum period. Compared with nondisabled women, they were significantly more likely to report stressful life events and medical complications during their most recent pregnancy, were less likely to receive prenatal care in the first trimester, and more likely to have preterm births (13.4%; 95% CI, 11.6–15.6 compared with 8.9%; 95% CI, 8.5–9.3 for women without disabilities) and low–birth-weight babies (10.3%; 95% CI, 9.4–11.2 compared with 6.8%; 95% CI, 6.8–6.9). There was no difference in the rates of cesarean section between women with and without disabilities. Conclusions:These findings support the need for clinicians providing care to pregnant women with disabilities to be aware of the increased risk for medical problems during pregnancy and factors that increase the risk for poor infant outcomes.

Prevalence and correlates of depression as a secondary condition among adults with disabilities

This article examines the associations among environmental factors, healthy behaviors, and depression in a sample of adults with major disabilities. When sociodemographics and type and level of disability were controlled, environmental factors (e.g., access to care, contacts with friends, and experience of assault) and risk behaviors (e.g., tobacco use, marijuana use, and physical exercise) were significant correlates of depression. Public health practice and research implications are discussed.

Pregnancy Outcomes Among U.S. Women With Intellectual and Developmental Disabilities

The existing research on pregnancy outcomes for women with intellectual and developmental disabilities (IDD) is sparse. This study analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and compared deliveries among women with IDD (n = 340) to the general obstetric population. Women with IDD had longer hospital stays and were more likely to have Caesarean deliveries in contrast to other women. Rates of adverse pregnancy outcomes were elevated for women with IDD across a range of measures, including early labor, preterm birth, and preeclampsia, and their infants were more likely to have low birth weight, even after adjusting for age, race, ethnicity, and insurance type. Targeted interventions are needed to address these deleterious outcomes.

Intimate Partner Violence in the Relationships of Men With Disabilities in the United States Relative Prevalence and Health Correlates

Despite the growing literature on intimate partner violence (IPV) victimization against people with disabilities, few studies have examined IPV against men with disabilities. This study uses population-based data to examine the prevalence of past-year and lifetime IPV against men with disabilities in the United States in comparison with men without disabilities and women with and without disabilities, compare the demographic characteristics of men with disabilities who reported IPV to those of other men, and examine associations of IPV and disability status with mental and physical health and other health risks among men. Results indicate that, adjusting for demographic characteristics, men with disabilities were more likely to report lifetime IPV than men without disabilities and, among those reporting any lifetime IPV, men with disabilities were more likely to report past-year IPV than both nondisabled men and women. With few exceptions, comparisons of health indicators revealed that men with disabilities reporting lifetime IPV were more likely than other men to report poor health status and to report engaging in health risk behaviors. Directions for future research and programmatic and policy implications of these results are discussed.

A perinatal health framework for women with physical disabilities

BACKGROUND Studies suggest that women with disabilities experience health and health care disparities before, during, and after pregnancy. However, existing perinatal health and health care frameworks do not address the needs and barriers faced by women with physical disabilities around the time of pregnancy. A new framework that addresses perinatal disparities among women with physical disabilities is needed. OBJECTIVE To propose a framework for examining perinatal health and health care disparities among women with physical disabilities. METHODS We developed a perinatal health framework guided by the International Classification of Functioning, Disability and Health (ICF) and the integrated perinatal health framework by Misra et al. RESULTS The proposed framework uses a life span perspective in a manner that directly addresses the multiple determinants specific to women with physical disabilities around the time of pregnancy. The framework is based on longitudinal and integrated perspectives that take into account womens functional status and environment over their life course. CONCLUSION The perinatal health framework for women with physical disabilities was developed to inform the way researchers and health care professionals address disparities in perinatal health and health care among women with physical disabilities.

Unmet needs for home and community-based services among persons with disabilities in Massachusetts.

BACKGROUND Home and community-based services (HCBS) are vital to the health and well-being of persons with disabilities. However, no previous population-based studies have examined the prevalence of unmet needs for HCBS among working-age persons with disabilities. The purpose of this report is to document the prevalence of unmet need for HCBS among a representative sample of working-age persons with disabilities in Massachusetts. METHODS Data from the 2007 Massachusetts Survey of Unmet Needs of Adults with Disabilities were analyzed. HCBS included in-home help, case-management, information, access to medical care, physical and occupational therapy, prescription drugs, meals, assistive technology, home adaptation, transportation, need for assistance with activities of daily living and instrumental activities of daily living (IADL) services. RESULTS The prevalence of unmet need for HCBS was high, with more than two-thirds of respondents reporting at least 1 unmet need and more than 1 in 4 respondents reporting 4 or more unmet needs. The most prevalent unmet need included the need for information for disability-related services and legal rights, need for primary, specialty, and mental health care, case management services and the unmet need for IADL services. The unmet needs for HCBS were categorized into unmet needs relating to access to information and services and those relating to in-home supports. CONCLUSIONS The study findings support the need to broaden the scope of HCBS for working-age persons with disabilities and to implement community-based programs such as improving access to information for services and benefits and enhancing access to in-home supports.