Greater engagement in valued activities is associated with less barriers to quitting smoking among smokers with mobility impairments.

BACKGROUND: Individuals with mobility impairments (MI; use equipment to ambulate) have a high prevalence of both smoking and depression. Behavioral activation (BA) purports that depressed mood is remediated through valued activity engagement and may facilitate smoking cessation in MI populations. OBJECTIVE: We examined cross-sectional associations between activity engagement and variables important for smoking cessation among a high-risk group of smokers (people with MIs) and also describe a smoking cessation intervention based on BA, given the lack of studies on smokers with MIs. METHODS: This study used data from a smoking cessation trial enrolling smokers with MIs (n = 263). We assessed valued activities, activity type, activity restriction due to MI, and replacement of restricted activities. Motivation and confidence to quit smoking, number of cigarettes per day, and mood were also assessed. Analysis was performed with generalized linear (or logistic) regression models adjusted for age and physical functioning using aggregated data at baseline. RESULTS: Greater number and frequency of valued activities was associated with less smoking, depression, negative affect, and stress and higher positive affect and self-efficacy to quit. Activity restriction was associated with greater odds of major depression, and activity replacement with lower odds of major depression, lower stress, and higher positive affect and self-efficacy. Strength of associations varied by activity type. CONCLUSIONS: Consistent with our theoretical model, BA activity constructs were associated with several mediators of smoking outcomes in the expected directions. Smokers engaging in valued activities have more favorable profiles for smoking cessation and mood management.

Cancer Disparities Experienced by People with Disabilities.

People with disabilities, who represent a rapidly growing and seriously disadvantaged segment of the U.S. population, face unremitting barriers to equal and accessible healthcare and a high prevalence of chronic health conditions. A slowly growing body of research suggests multiple cancer-related disparities between people with and without disabilities. This commentary identifies multiple aspects of the cancer experience and highlights ways cancer is impacted by disability. This includes vulnerabilities to risk factors, barriers to accessing healthcare, and disparities in screening, diagnosis, and treatment. The authors offer six essential pathways for reducing cancer disparities faced by people with disabilities. It is clear that reducing cancer health disparities experienced by people with disabilities will require the commitment and cooperation of a wide range of stakeholders.

Associations Between Smoking Status and Physical and Mental Health-Related Quality of Life Among Individuals With Mobility Impairments.

BACKGROUND: In the general population, quitting smoking is associated with improved health-related quality of life (QoL), but this association has not been examined in smokers with chronic mobility impairments (MIs). PURPOSE: We examined associations between smoking status and health-related QoL over 6 months, and whether relationships are moderated by depression and MI severity. METHODS: This is a secondary analysis of a smoking cessation induction trial among smokers with MIs (n = 241, 56% female, 36% Black) assessed at baseline, and 4 and 6 months after. Participants were grouped into "Smokers" (smoking at 4 and 6 months), "Abstainers" (quit at 4 and 6 months), "Relapsers" (relapsed at 6 months), and "Late-quitters" (quit at 6 months). Physical and mental health-related QoL was assessed with the Short-Form Health Survey. Depression was defined as scores ≥10 on the Patient Health Questionnaire, and MI severity by the use of skilled care for personal needs. Data were analyzed with linear mixed models. RESULTS: Aggregating across time, among nondepressed participants, compared with "Smokers," the "Abstainer," and "Late-quitter" groups improved their physical health scores. "Late-quitters" also improved compared with "Relapsers." Among the total sample, compared with "Smokers," "Abstainers" showed improvements in mental health scores overtime, whereas "Relapsers" improved their score at 4 months, and "Late-quitters" improved at 6 months. CONCLUSIONS: Quitting smoking is associated with improvements in physical health-related QoL regardless of the severity of MI but only among those without depression at baseline. For mental health-related QoL, associations with quitting smoking were independent of baseline depression and severity of MI.

Facebook usage, participation patterns, and social support from Facebook activity among smokers with mobility impairments.

People with mobility impairments (MIs; use assistive devices to ambulate) have twice the smoking prevalence versus the general population. A Facebook intervention could improve reach to smokers with MIs, but use and patterns of use are unknown. The study examined: (a) Facebook use and relationship with Facebook-based social support and (b) whether Facebook use differs by motivation to quit smoking. Participants (N = 510; 56.3% female, mean age = 42.4 years) were recruited via a recruitment company to complete a one-time online survey assessing motivation to quit within 30 days, Facebook use (Facebook Activities Scale), reasons for use (Facebook Motives Scale), attitudes (Facebook Intensity Scale), and social support (Facebook Measure of Social Support). The vast majority said that Facebook is part of their daily routine (92.9%), 83% checked Facebook >once a day, and 69% spent >30 min/day on Facebook. Facebook was used to connect with similar others (68.4%), participate in groups (72.9%), decrease loneliness (69.2%), and obtain health information (62.5%); 88% said that they would join a Facebook program to help them quit smoking. A greater number of Facebook friends (rs = .18-.22, p < .001) and greater Facebook use (rs = .20 to rs = .59; p < .001) were correlated with greater perceived social and emotional support. Those motivated to quit posted more frequently (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.10, 2.22) and were more likely to indicate that they would join a Facebook group for smoking cessation (OR = 4.15, 95% CI = 2.05, 8.38) than those not motivated. Facebook could circumvent disability and environmental barriers to accessing cessation among this health disparity population.

Improving mammography access for women with disabilities: Outcomes of the CDC's right to know campaign.

Women with disabilities share similar risks for breast cancer as other women yet experience a lack of access to cancer screening and are less likely to receive screening mammograms in accordance with recommended guidelines. The present study evaluated mammography centers across the state of Montana in response to the Centers for Disease Control and Prevention's Right to Know campaign, which focused on addressing barriers to breast cancer screening. Mammography centers were originally evaluated in 2009 and were reassessed in 2011 and 2015 after being given action plans to address accessibility barriers. The current study examined changes in accessibility across time in four priority areas: 1) van and standard parking, 2) exterior and interior routes, 3) mammography rooms, and 4) restrooms. Results indicate all mammography centers had a least one mammography machine that lowered for patients in a seated position and that accessibility of the four priority areas improved over time; however, improvements were still needed to encourage health equity for women with disabilities.

The complex array of antecedents of depression in women with physical disabilities: implications for clinicians.

PURPOSE: This article discusses the complex interrelation of elements of the physical, psychological, social, and environmental life context of women with physical disabilities and the association of these elements with significant disparities in rates of depression and access to mental health care for this population. METHODS: Literature and concept review. RESULTS: High rates of depression in women with physical disabilities are well documented in the literature. Many elements that are disproportionately common in the lives of women with physical disabilities, including socio-economic disadvantage, functional limitations, pain and other chronic health conditions, poor diet, physical inactivity, smoking, violence, low self-esteem, sexuality problems, chronic stress, environmental barriers, and barriers to health care, have also been linked with higher rates of depression and depressive symptomatology. Depression self-management interventions tailored for women with disabilities have been developed and proven effective. CONCLUSIONS: Many women who must deal with the stresses surrounding an array of health problems may experience symptoms of depression without necessarily meeting the criteria for clinical depression. Psychologists, counselors, primary care physicians, specialists, and other medical and rehabilitation professionals are challenged to recognize the symptoms of depression in women with physical disabilities and assist them in obtaining appropriate psychological and pharmacological interventions.

Physical activity and nutritional behaviors of women with physical disabilities: physical, psychological, social, and environmental influences.

INTRODUCTION: We examined predictors of 2 important health behaviors, namely, physical activity and nutritional behaviors, in a sample of community-living women with physical disabilities (N = 386). METHOD: We conducted a cross-sectional survey with regression analysis. RESULTS: Our regression model accounted for 33.5% of the variance in physical activity. Women with joint problems or multiple sclerosis tended to engage in less physical activity than those with stroke-related disabilities. Those who had lived with their disability longer and those experiencing greater pain tended to report less physical activity. Consistent with the literature, women with greater self-efficacy for physical activity tended to engage in more physical activity. The regression model for nutritional behaviors accounted for 37.9% of the variance. Women with better mobility, greater self-efficacy for nutrition, and more vitality had better nutritional behaviors while those who needed assistance with activities of daily living, had lower social functioning scores, and were engaged in more productive activities reported poorer nutritional behaviors. CONCLUSIONS: Our findings highlight the importance of self-efficacy for improving health behaviors. Further research is needed to develop a new paradigm for the measurement of health behaviors, one that focuses on individual improvement rather than comparison to a norm, and health promoting interventions that are responsive to the needs and life circumstances of women with physical disabilities.

Improving the health and health behaviors of women aging with physical disabilities: A peer-led health promotion program.

OBJECTIVE: To examine the efficacy of a health promotion program for women aging with physical disabilities. METHOD: A sample of 137 middle-aged and older women with physical disabilities was randomly assigned to either an 8-week health promotion program or to a wait-list control group. Both groups completed questionnaires before, immediately after, and 3 months after the intervention. RESULTS: Relative to women in the control group, women in the health-promotion program demonstrated improvements in health behaviors, most of which were maintained at follow-up. The intervention group showed some improvements on measures of physical health, but there was little evidence of improvement in psychological health outcomes. Testing our theoretical model, self-efficacy was supported as a mediator of the effect of the intervention on health behaviors, and health behaviors combined with self-efficacy were supported as mediators of the effect of the intervention on physical health outcomes. Contrary to our hypotheses, our measures of social support and social connectedness were not affected by the intervention. CONCLUSIONS: A brief, peer-led, group health promotion program resulted in improved scores on measures of self-efficacy, increased health behavior, and physical health. Self-efficacy, which was supported as a mediator in the effect of the intervention on behaviors and health outcomes, should remain an important focus of future interventions with this population.