Rie Suzuki

Guidelines and Criteria for the Implementation of Community-Based Health Promotion Programs for Individuals with Disabilities:

Health promotion programs for people with disabilities are in the early stages of development. This critical review utilizes a credentialed expert panel to develop a set of guidelines for community-based health promotion programs for individuals with disabilities. The procedures include a review of background material, systematic literature review with drafted guidelines consisting of operational, participation and accessibility recommendations. The role that those with disabilities can play is addressed and includes program planning, implementation and evaluation, physical and programmatic accessibility of programs, and importance of evidence-based practices.

Understanding Health Outcomes: Physical Secondary Conditions in People With Spinal Cord Injury

Objective: To examine the association of predisposing characteristics and enabling characteristics with physical secondary conditions through health practices and health care use in people with spinal cord injury (SCI). Design: Cross-sectional survey mailed to adults in portions of the northeastern and northwestern United States. Participants: Two hundred seventy adults with SCI recruited through durable medical equipment supply companies. Main Outcome Measures: Self-reported health practices, health care use, and physical secondary conditions. Results: In the Andersen behavioral model, F increment tests supported findings that predisposing characteristics accounted for 12% of variance in secondary conditions, enabling characteristics accounted for 16%, and health practices and health care use accounted for another 13%. Path analysis revealed that health care use mediated self-efficacy and interpersonal support. Conclusions: Predisposing characteristics including self-efficacy, enabling characteristics, and health care use are associated with physical secondary conditions in complex ways. More research is needed on measures of health practices and their relation to secondary conditions.

Purposiveness, physical activity, and perceived health in cardiac patients

Purpose. This study examined the relationship of purposiveness, defined as maintaining purpose in life and a sense of personal growth, with physical activity and perceived health in a sample of cardiac outpatients. Method. Participants were 130 outpatients recruited through medical settings serving cardiac patients in a southwestern US community. Participants had an average age of 60 years (SD 12.37). Participants responded to a structured questionnaire at the medical setting. The hypothesized mediational model was tested using Latent Variable Structural Equations Analysis (LISREL) 8. Results. As hypothesized, the results of a LISREL analysis showed that a sense of purposiveness predicted more positive perceived health. Further, as predicted, this relation was mediated by physical activity. Purposiveness was linked to more physical activity, and a high level of physical activity, in turn, predicted better perceived health. A two-group LISREL analysis indicated that the model was equally valid for both sexes. Conclusions. The present results underscore the importance in cardiac rehabilitation of the continued study of factors that foster meaning in life, including a sense of purpose and individual growth, and of their potential to promote recovery of cardiac patients.

Age at disability onset and self-reported health status.

BackgroundThe critical importance of improving the well-being of people with disabilities is highlighted in many national health plans. Self-reported health status is reduced both with age and among people with disabilities. Because both factors are related to health status and the influence of the age at disability onset on health status is unclear, we examined the relationship between disability onset and health status.MethodsThe U.S. 1998–2000 Behavioral Risk Factor Surveillance system (BRFSS) provided data on 11,905 adults with disability. Bivariate logistic regression analysis modeled the relationship between age at disability onset (based on self-report of duration of disability) and fair/poor self-perceived health status, adjusting for confounding variables.ResultsKey variables included demographics and other measures related to disability and general health status. Disability onset after 21 years of age showed significant association with greater prevalence of fair/poor health compared to early disability onset, even adjusting for current age and other demographic covariates. Compared with younger onset, the adjusted odds ratios (OR) were ages 22–44: OR 1.52, ages 45–64: OR 1.67, and age ≥65: OR 1.53.ConclusionThis cross-sectional study provides population-level, generalizable evidence of increased fair or poor health in people with later onset disability compared to those with disability onset prior to the age of 21 years. This finding suggests that examining the general health of people with and those without disabilities might mask differences associated with onset, potentially relating to differences in experience and self-perception. Future research relating to global health status and disability should consider incorporating age at disability onset. In addition, research should examine possible differences in the relationship between age at onset and self-reported health within specific impairment groups.

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

OBJECTIVE To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations. DESIGN Survey responses were analyzed by using partial correlations. SETTING General community. PARTICIPANTS Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE SF-36. RESULTS Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions. CONCLUSIONS Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.

Self-rated health in persons with spinal cord injury: relationship of secondary conditions, function and health status

ObjectiveSelf-rated health is used frequently as a measure of health in the general population, and increasingly with persons with disabilities. However, its meaning and its relationship with other measures of self-reported health (health status and secondary conditions) are not well understood for this group. The purpose of the present study was to use a conceptual model to examine the structure of self-rated health with persons with spinal cord injuries.MethodsA US sample of 270 adults with mobility impairment stemming from spinal cord injury (SCI) provided data on three measures of self-reported health that differ in degree of subjectivity: physical problems common to SCI, four domains of health status from the SF-36, and a single item on self-rated health. Data were compared with the norm sample of the SF-36. The conceptual model was tested using path analyses.ResultsSF-36 scores were lower on three of four domains compared with the norm sample. The conceptual model analyses indicated that 35% of variance in self-rated health is accounted for through direct relationship with physical secondary conditions common to persons with SCI and as mediated through SF-36 domains of Role Physical and Vitality. The SF-36 domain of Physical Function was statistically unrelated to self-rated health.ConclusionThe conceptual model of self-rated health was verified in a sample of persons with SCI. Importantly, the SF-36 domain of Physical Function does not relate to self-rated health for this group. Its inclusion in measures of self-reported for disability populations creates difficulty without apparent benefit.

Motivational Factors in Health Promoting Behavior in Later Aging

Abstract This study investigated motivational factors in health- promoting behavior in later aging. The participants were 162 members of the Terman Study of the Gifted (82 men and 80 women) who responded to a mailout questionnaire in 1999 at a mean age of 86. The motivational variables included questionnaire measures of the goal to be as healthy as possible, purpose in life, and optimism. Seven health promoting behaviors were studied and included exercise and physical recreation, getting enough sleep, getting enough relaxation, good nutrition, controlling weight, accident prevention, and regular checkups. The results showed that all three motivational variables were correlated with positive health behavior, with optimism the strongest predictor. In a multiple regression analysis in which perceived health limitations were controlled, the goal to maintain health and optimism were significant predictors of positive health behavior. The implications of the study results for health promotion in the elderly are discussed.

Regional, Racial, and Gender Differences in Colorectal Cancer Screening in Middle-aged African-Americans and Whites

African-Americans have higher incidence and mortality from colorectal cancer than non-African-Americans. Early detection with colorectal cancer (CRC) screening reduces untimely death because the test can detect abnormalities and precancerous polyps in the colon and rectum. However, African-Americans aged 50 and older continue to have low CRC screening adherence. A retrospective analysis was conducted on data from the 2010 National Health Interview Survey to examine trends in self-reported CRC screening by geographic region, race, and gender. African-Americans, particularly men, were less likely to have been screened for colon cancer compared to all races and genders in this study. Individuals in the south were more likely to receive CRC screening than other regions. Colon cancer education and interventions are needed among low-adherent groups to promote the benefits of early detection with CRC screening.

Improving cancer screening among women with mobility impairments: randomized controlled trial of a participatory workshop intervention.

Purpose. To assess the efficacy of an intervention to promote mammography and Papanicolaou (Pap) testing among women with mobility impairments overdue for screenings Design. Randomized controlled trial. Setting. Urban and suburban Oregon. Participants. Women aged 35 to 64 with mobility impairments who reported not receiving a Pap test in the past 3 years and/or mammogram (if age > 40 years) in the last 2 years were eligible. A total of 211 women were randomized, and 156 completed the study (26% attrition). The majority were not employed and reported annual income <

Structure of health-related quality of life among people with and without functional limitations

10,000. Intervention. The Promoting Access to Health Services (PATHS) program is a 90-minute, small-group, participatory workshop with 6 months of structured telephone support, based on the health belief model and social cognitive theory. Measures. Perceived susceptibility to breast and cervical cancer, perceived benefits of and self-efficacy for screening intention to be screened, and self-reported receipt of mammography and Pap testing. Analysis. Chi-square tests to examine the proportion of women obtaining screening; analysis of covariance to examine change in theoretical mediators. Results. The intervention group received more Pap tests than the control group at posttest (intervention 61 %, control 27%, n = 71, p < .01). No significant group effect was observed for mammography (intervention 49%, control 42%, n = 125, p = .45). Conclusion. Findings indicate that the PATHS intervention promotes Pap testing but not mammography among women with mobility impairments.