Correlates of physical activity for adults with disability

INTRODUCTION: This study was designed to determine factors that influence the physical activity level of adults with disability as identified in a large representative sample of U.S. adults. METHODS: Data were taken from the District of Columbia and the 12 states that administered the Quality of Life and Caregiving Module of the 2001 Behavioral Risk Factor Surveillance System. Adults with disability (n = 4038) were defined as those who required special equipment because of a health problem or who required the assistance of another person either for their personal care or routine needs. Adequate physical activity was defined as meeting the Centers for Disease Control and Prevention and American College of Sports Medicine recommendation of at least 30 minutes of moderate activity per day at least 5 days per week. Unadjusted and adjusted odds ratios were computed for demographic, health status, health care access, and health behavior variables. RESULTS: Only one fourth of the study population met the recommendation for moderate activity level. African American race, age of 50 years or older, annual income of $50,000 or higher, and being in good, fair, or poor health were all significantly related to activity level; sex, education level, health care access, and years of disability were not. CONCLUSION: Adults with disability are not meeting basic recommendations for physical activity. Some correlates of physical activity found in general populations are also related to activity level for people with disability (age, general health, race), whereas others (sex, education level) are not. These factors should be considered when planning physical activity interventions for people with disability

Cross-sectional and longitudinal risk of physical impairment in a cohort of postmenopausal women who experience physical and verbal abuse.

BackgroundExposure to interpersonal violence, namely verbal and physical abuse, is a highly prevalent threat to women's health and well-being. Among older, post-menopausal women, several researchers have characterized a possible bi-directional relationship of abuse exposure and diminished physical functioning. However, studies that prospectively examine the relationship between interpersonal abuse exposure and physical functioning across multiple years of observation are lacking. To address this literature gap, we prospectively evaluate the association between abuse exposure and physical functioning in a large, national cohort of post-menopausal women across 12 years of follow-up observation.MethodsMultivariable logistic regression was used to measure the adjusted association between experiencing abuse and physical function score at baseline in 154,902 Women's Health Initiative (WHI) participants. Multilevel modeling, where the trajectories of decline in physical function were modeled as a function of time-varying abuse exposure, was used to evaluate the contribution of abuse to trajectories of physical function scores over time.ResultAbuse was prevalent among WHI participants, with 11 % of our study population reporting baseline exposure. Verbal abuse was the most commonly reported abuse type (10 %), followed by combined physical and verbal abuse (1 %), followed by physical abuse in the absence of verbal abuse (0.2 %). Abuse exposure (all types) was associated with diminished physical functioning, with women exposed to combined physical and verbal abuse presenting baseline physical functioning scores consistent with non-abused women 20 years senior. Results did not reveal a differential rate of decline over time in physical functioning based on abuse exposure.ConclusionsTaken together, our findings suggest a need for increased awareness of the prevalence of abuse exposure among postmenopausal women; they also underscore the importance of clinician's vigilance in their efforts toward the prevention, early detection and effective intervention with abuse exposure, including verbal abuse exposure, in post-menopausal women. Given our findings related to abuse exposure and women's diminished physical functioning at WHI baseline, our work illuminates a need for further study, particularly the investigation of this association in younger, pre-menopausal women so that the temporal ordering if this relationship may be better understood

Adverse outcomes and correlates of change in the Short Physical Performance Battery over 36 months in the African American health project

BACKGROUND: The Short Physical Performance Battery (SPPB) is a well-established measure of lower body physical functioning in older persons but has not been adequately examined in African Americans or younger persons. Moreover, factors associated with changes in SPPB over time have not been reported. METHODS: A representative sample of 998 African Americans (49-65 years old at baseline) living in St. Louis, Missouri were followed for 36 months to examine the predictive validity of SPPB in this population and identify factors associated with changes in SPPB. SPPB was calibrated to this population, ranged from 0 (worst) to 12 (best), and required imputation for about 50% of scores. Adverse outcomes of baseline SPPB included death, nursing home placement, hospitalization, physician visits, incident basic and instrumental activity of daily living disabilities, and functional limitations. Changes in SPPB over 36 months were modeled. RESULTS: Adjusted for appropriate covariates, weighted appropriately, and using propensity scores to address potential selection bias, baseline SPPB scores were associated with all adverse outcomes except physician visits, and were marginally associated with hospitalization. Declines in SPPB scores were associated with low falls efficacy (b = -1.311), perceived income adequacy (-0.121), older age (-0.073 per year), poor vision (-0.754), diabetes mellitus (-0.565), refusal to report household income (1.48), ever had Medicaid insurance (-0.610), obesity (-0.437), hospitalization in the prior year (-0.521), and kidney disease (-.956). CONCLUSIONS: The effect of baseline SPPB on adverse outcomes in this late middle-age African American population confirms reports involving older, primarily white participants. Alleviating deterioration in lower body physical functioning guided by the associated covariates may avoid or delay multiple age-associated adverse outcomes

Three-year measured weight change in the African American health study

OBJECTIVE: This study examines 3-year weight change in African Americans. METHOD: Nine hundred and ninety-eight participants 49 to 65 years old were assessed at baseline and 3 years later. Weight was measured, and weight change was defined as clinically meaningful increases or decreases (+/- 5 kg). Potential risk factors were investigated using multinomial logistic regression. RESULTS: In-home measured weights were available for 752 participants (75%): 504 (67%) had stable weights, 131 (17%) gained more than 5 kg, and 117 (16%) lost more than 5 kg. Among all participants, the risks for weight gains were cancer, chronic obstructive pulmonary disease, lower income, and Medicaid status; the risks for weight losses were angina, cancer, high measured systolic blood pressure, asthma, and physical inactivity. Sex-stratified analyses reveal differences involving age, socioeconomic status, cancer, blood pressure, and lower body function. DISCUSSION: Three-year weight changes in middle-aged African Americans were frequent and significantly associated with several risk factors

Observer ratings of neighborhoods: Comparison of two methods

BACKGROUND: Although neighborhood characteristics have important relationships with health outcomes, direct observation involves imperfect measurement. The African American Health (AAH) study included two observer neighborhood rating systems (5-item Krause and 18-item AAH Neighborhood Assessment Scale [NAS]), initially fielded at two different waves. Good measurement characteristics were previously shown for both, but there was more rater variability than desired. In 2010 both measures were re-fielded together, with enhanced training and field methods implemented to decrease rater variability while maintaining psychometric properties. METHODS: AAH included a poor inner city and more heterogeneous suburban areas. Four interviewers rated 483 blocks, with 120 randomly-selected blocks rated by two interviewers. We conducted confirmatory factor analysis of scales and tested the Krause (5-20 points), AAH 18-item NAS (0-28 points), and a previous 7-item and new 5-item versions of the NAS (0-17 points, 0-11 points). Retest reliability for items (kappa) and scales (Intraclass Correlation Coefficient [ICC]) were calculated overall and among pre-specified subgroups. Linear regression assessed interviewer effects on total scale scores and assessed concurrent validity on lung and lower body functions. Mismeasurement effects on self-rated health were also assessed. RESULTS: Scale scores were better in the suburbs than in the inner city. ICC was poor for the Krause scale (ICC=0.19), but improved if the retests occurred within 10 days (ICC=0.49). The 7- and 5-item NAS scales had better ICCs (0.56 and 0.62, respectively), and were higher (0.71 and 0.73) within 10 days. Rater variability for the Kraus and 5- and 7-item NAS scales was 1-3 points (compared to the supervising rater). Concurrent validity was modest, with residents living in worse neighborhood conditions having worse function. Unadjusted estimates were biased towards the null compared with measurement-error corrected estimates. CONCLUSIONS: Enhanced field protocols and rater training did not improve measurement quality. Specifically, retest reliability and interviewer variability remained problematic. Measurement error partially reduced, but did not eliminate concurrent validity, suggesting there are robust associations between neighborhood characteristics and health outcomes. We conclude that the 5-item AAH NAS has sufficient reliability and validity for further use. Additional research on the measurement properties of environmental rating methods is encouraged

Childhood school segregation and later life sense of control and physical performance in the African American Health cohort

BACKGROUND: The association between childhood school desegregation and later life sense of control and physical performance among African Americans is not clear. We hypothesized that childhood school desegregation adversely affected the sense of control of in later life, and that this reduced sense of control accounts in part for reduced physical performance. METHODS: In-home follow-up assessments were completed in 2010 with 582 of the 58–74 year old men and women participating in the on-going African American Health cohort. We used these data to examine the relationship between (a) retrospective self-reports of attending segregated schools during one’s 1(st)-to-12(th) grade education and one’s current sense of control, as well as (b) the association between current sense of control and physical performance. Multiple linear regression analysis with propensity score re-weighting was used. RESULTS: Attending segregated schools for at least half of one’s 1(st)-to-12(th) grade education was significantly associated with higher scores on the sense of control. Adjusting for all covariates and potential confounders, those receiving half or more of their 1(st)-to-12(th) grade education in segregated schools had sense of control scores that were .886 points higher (p ≤ .01; standardized effect size = .22). Sense of control scores were independently (all p < .01) associated with better systolic blood pressure, grip strength, peak expiratory flow, chair stands, balance tests, and the Short Portable Physical Battery even after adjusting for all covariates and potential confounders. Moreover, sense of control scores either partially or fully mediated the statistically significant beneficial associations between childhood school segregation and physical performance. CONCLUSIONS: Childhood school desegregation was adversely associated with the sense of control of African Americans in later life, and this reduced sense of control appears, in part, to account for their poorer physical performance. The etiologic mechanism through which childhood school segregation at the time that this cohort experienced it improved the sense of control in later life, which subsequently led to better physical performance, has not been identified. We suspect, however, that the pathway involves greater exposure to racial solidarity, same-race students as peer role models and same-race teachers and principals as authority role models, the reduced likelihood of exposure to race-based discrimination or antagonism during their formative early lives, and greater exposure to encouragement and support for academic and life success

Predictors of change in grip strength over 3 years in the African American health project

OBJECTIVE: To examine factors associated with change in grip strength. METHOD: Grip strength was measured at baseline and 3 years later. Change was divided into "decreased >/=5 kg," "increased >/=5 kg," and "no change" and analyzed using multinomial multivariable logistic regression. RESULTS: Decline in grip strength was more likely for men, those reporting having cardiovascular disease, and those with instrumental activities of daily living, lower body functional limitations, high diastolic blood pressure, higher physical activity, and greater body mass. Decline was less likely among those ever having Medicaid, those with basic activities of daily living disabilities, and those unable to see a doctor in past year due to cost. Gain in grip strength was more likely for men and those with instrumental activities of daily living disabilities, lower body functional limitations, high diastolic blood pressure, and higher physical activity; it was less likely for older participants. DISCUSSION: Results can be used to design interventions to improve strength outcomes

Rating neighborhoods for older adult health: results from the African American Health study

<p>Abstract</p> <p>Background</p> <p>Social theories suggest that neighborhood quality affects health. Observer ratings of neighborhoods should be subjected to psychometric tests.</p> <p>Methods</p> <p>African American Health (AAH) study subjects were selected from two diverse St. Louis metropolitan catchment areas. Interviewers rated streets and block faces for 816 households. Items and a summary scale were compared across catchment areas and to the resident respondents' global neighborhood assessments.</p> <p>Results</p> <p>Individual items and the scale were strongly associated with both the catchment area and respondent assessments. Ratings based on both block faces did not improve those based on a single block face. Substantial interviewer effects were observed despite strong discriminant and concurrent validity.</p> <p>Conclusion</p> <p>Observer ratings show promise in understanding the effect of neighborhood on health outcomes. The AAH Neighborhood Assessment Scale and other rating systems should be tested further in diverse settings.</p