Disparities in Tobacco Use by Disability and Type: Findings From the 2019 National Health Interview Survey.

INTRODUCTION: People with disabilities report a higher prevalence of cigarette use than people without disabilities. However, evidence is limited on the relationships between disability type, degree of functional difficulty, and other tobacco product use. METHODS: Data from the 2019 U.S. National Health Interview Survey were used to estimate the prevalence and odds of tobacco product use for 6 disability types and degree of functional difficulty. Bivariate and multivariable analyses conducted in 2021 examined the associations between tobacco product use and disability type. RESULTS: Compared to adults who reported no difficulty, current cigarette use prevalence was higher for adults who reported a lot of difficulty/cannot do at all to vision (21.5% vs 13.1%), hearing (19.6% vs 13.6%), mobility (20.0% vs 12.9%), and cognitive (25.4% vs 12.9%) disability questions. The odds of current cigarette (AOR=1.32), pipe (AOR=1.85), and smokeless tobacco (AOR=1.57) use were significantly higher for adults who reported a lot of difficulty/cannot do at all to any disability question and significantly higher for current cigarette (AOR=1.24), e-cigarette (AOR=1.33), pipe (AOR=1.45), and smokeless tobacco (AOR=1.29) use for adults who reported some difficulty to any disability question than those who reported no difficulty. Pipe use was correlated with mobility difficulty (AOR=1.68), and smokeless tobacco use was correlated with hearing difficulty (AOR=1.95). CONCLUSIONS: People who reported difficulty with vision, hearing, mobility, or cognition had a higher cigarette use prevalence than people without disabilities. Other tobacco use differed by disability type. Future research should tailor tobacco interventions to reduce these disparities.

Barriers to colorectal cancer screening for people with spinal cord injuries and/or disorders: A qualitative study.

BACKGROUND: Limited research has shown people with spinal cord injuries and/or disorders (SCID) are less likely to be up to date with colorectal cancer (CRC) screening and therefore more likely to be diagnosed with advanced stage CRC compared to people without SCID. OBJECTIVE: The aims of this study were to assess knowledge about CRC, CRC screening, and self-reported barriers to CRC screening for people with SCID. METHODS: Interviews with 30 individuals with SCID were conducted using a semi-structured interview guide, audio recorded, and transcribed. Coding was performed using a hybrid approach of inductive and deductive analysis. Thematic analysis was used to identify, review, and modify themes and sub-themes. RESULTS: Themes identified included barriers to CRC screening, such as socioeconomic, health system, transportation, psychological, and environmental or accessibility barriers. While most respondents were able to describe one CRC screening method (usually colonoscopy), knowledge of other screening modalities was limited. Low CRC literacy and misinformation about CRC screening appeared to increase respondent association between CRC screening and colonoscopy. While most respondents associated CRC screening with colonoscopy, almost half reported the colonoscopy preparation was the most substantial barrier to screening. CONCLUSIONS: In addition to addressing identified barriers such as accessibility and transportation, communication, and prevention interventions should be specifically targeted to ensure all people with SCID are informed about appropriate and various modalities and the benefits of screening. Specific, evidence-based guidelines on the use of stool specimens first with follow up direct visualization, if needed, should be developed for this population.

Health Disparities Among Sexual and Gender Minorities with Autism Spectrum Disorder.

We explored the health and health care experiences of people with autism spectrum disorder (ASD) who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) using data from a national, internet-based survey of adults with disabilities supplemented by focused interviews. LGBTQ+ respondents had significantly higher rates of mental illness, poor physical health days per month, and smoking compared to straight, cisgender respondents with ASD. LGBTQ+ respondents also reported much higher rates of unmet health care need, inadequate insurance provider networks, and rates of being refused services by a medical provider. Examining the intersection of LGBTQ+ identity and ASD reveals compounded health disparities that insurers and medical providers are not adequately addressing, particularly as individuals transition to the adult medical system.

Medicaid managed care: issues for enrollees with serious mental illness.

OBJECTIVES: To inform state Medicaid programs and managed care organizations, as well as to build their capacity to serve enrollees with complex needs related to serious mental illness (SMI). STUDY DESIGN: Quantitative and qualitative analyses of survey results from a sample of Medicaid enrollees with SMI in Kansas in 2016 and 2017 (N = 189). METHODS: Surveys were conducted by telephone or in person at community mental health centers. Analyses of descriptive statistics from closed-item responses and coded transcripts were used to identify major themes in open-item responses. RESULTS: Respondents reported high rates of comorbid physical and mental health conditions and current or past tobacco use. Most were unemployed, and some were homeless or living in unstable conditions. Participants indicated a need for better information and communication; improved access to prescriptions, dental care, reliable transportation, medical supplies, and equipment; and a wider physician/provider network. They wanted care coordinators to provide more frequent and responsive contact, better information about benefits and resources, and help navigating the system. CONCLUSIONS: Individuals with chronic and complex conditions can be challenging for managed care organizations to support, especially Medicaid enrollees with SMI, who experience high rates of comorbid physical health conditions and complex healthcare needs. To the extent that managed care organizations can help this population navigate their coverage and use more of the available benefits, barriers to care and unmet needs can be reduced or eliminated and outcomes subsequently improved.

Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness.

INTRODUCTION: Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable. Individuals with mental illness experience multiple risk factors for poor oral health and need targeted intervention. This study investigated experiences of Kansas Medicaid enrollees with serious mental illness in accessing dental services, examined their oral health risk factors, and identified oral health needs and outcomes. METHODS: Survey data were collected from October 2016 through February 2017 from 186 individuals in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively (descriptive and bivariate statistics) and qualitatively (for major themes). RESULTS: Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived need, uncertainty about coverage, difficulty accessing providers, fear of the dentist, and transportation issues. High rates of comorbid physical health conditions, including diabetes and cardiovascular disease, and current or former tobacco use were also observed. CONCLUSIONS: Medicaid dental benefits that cover only dental cleanings and low levels of oral health knowledge create barriers to utilizing needed preventive dental care. Lack of perceived need for preventive dental services and lack of contact with dentists necessitates the development of targeted oral health promotion efforts that speak to the specific needs of this group and are disseminated in locations of frequent contact. The Medicaid population with serious mental illness would be an ideal group to target for the integration of chronic oral, physical, and mental health prevention services and control.

Employment as a health determinant for working-age, dually-eligible people with disabilities.

BACKGROUND: Individuals with disabilities are a health disparity population with high rates of risk factors, lower overall health status, and greater health care costs. The interacting effect of employment, health and disability has not been reported in the research. OBJECTIVE: This study examined the relationship of employment to health and quality of life among people with disabilities. METHODS: Self-reported survey data and secondary claims data analyses of 810 Kansans ages 18-64 with disabilities who were dually-eligible for Medicare and Medicaid; 49% were employed, with 94% working less than 40 hours per week. Statistical analyses included ANOVA for differences between the employed and unemployed groups' health status, risk scores, and disease burdens; chi-square analyses for differences in prevalence of health risk behaviors and differences in quality of life by employment status; and logistic regression with health status measures to determine factors associated with higher than average physical and mental health status. RESULTS: Findings indicated participants with any level of paid employment had significantly lower rates of smoking and better quality of life; self-reported health status was significantly higher, while per person per month Medicaid expenditures were less. Employment, even at low levels, was associated with better health and health behaviors as well as lower costs. Participants reported being discouraged from working by medical professionals and federal disability policies. CONCLUSIONS: Although cause-effect cannot be established from this study, findings strongly support changes to provider practices and federal disability policy to support employment at all levels for people with disabilities.