Introduction: Neighborhoods may influence post-stroke recovery. We examined the association betwe... more Introduction: Neighborhoods may influence post-stroke recovery. We examined the association between neighborhood socioeconomic status (nSES) and 90-day post-stroke function, depression, cognition, and quality of life (QoL). Methods: Stroke survivors (N=782) were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project. An nSES index – composite of 2010 census-tract level income, wealth, education, employment – was the exposure; higher values indicate higher nSES (median -4.56; IQR: -7.48 to -0.46). Function was measured with 22 self-reported activities of daily living/instrumental activities of daily living, depression with Patient Health Questionnaire-8, QoL with the Stroke Specific QoL Scale, and cognition with the Modified Mini Mental State Examination. Confounder-adjusted generalized estimating equations were used to estimate associations between nSES (comparing 75 th to 25 th percentile) and 90-day outcomes. We tested for effect modificat...
Objectives: This cross-sectional study examines the association between perceived sidewalk condit... more Objectives: This cross-sectional study examines the association between perceived sidewalk conditions and neighborhood participation among older adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods: Between 2013–2016, 14,233 REGARDS participants completed a second in-home visit. Using logistic regression, we cross-sectionally examined if perceived severity of sidewalk problems was associated with going into the neighborhood less than once compared to 1–7 times per week. Results: The analytic sample included participants ( N = 9863) with nonmissing data. The likelihood of going into the neighborhood less than one time per week was greater among participants who reported minor (OR = 1.15; 95% CI: 1.00, 1.33), somewhat serious (OR = 1.41; 95% CI: 1.17, 1.70), and very serious (OR = 1.65; 95% CI: 1.38, 1.98) sidewalk problems in their neighborhood compared to those reporting no sidewalk problems, independent of demographic, socioeconomic, and im...
PURPOSE: To examine how facets of the home environment and parent perceptions of neighborhood saf... more PURPOSE: To examine how facets of the home environment and parent perceptions of neighborhood safety may be associated with child total PA and moderate-to-vigorous (MVPA) levels in a rural sample. METHODS: Baseline data were analyzed from NU-HOME, a childhood obesity prevention, randomized controlled trial in rural communities. 105 children (age=8.96±1.06 yrs) and their parents (age=37.91±5.42 yrs) reported on sociodemographics and home/neighborhood environments. Child daily PA (total and MVPA) was measured using accelerometers and, using SAS 9.4, associations were examined with home/neighborhood environment variables through multivariate regression models, both unadjusted and adjusted for economic assistance. Normality was not met for child daily MVPA therefore analyses used the log-transformed variable. RESULTS: Mean child total PA was 259.08±58.22 min/day and MVPA was 44.95±18.58 min/day. In unadjusted analyses, access to PA equipment in the home (p=0.037) and neighborhood safety (p=0.049) were associated with total PA; however, no factors were statistically significantly associated with MVPA, although access to PA equipment (p=0.088) and family support for PA (p=0.062) were trending towards significance. For both total PA and MVPA outcomes, the regression models including all variables and accounting for economic assistance were statistically significant (p=0.026 and p=0.034, respectively). For each model, the individual effects of parent PA and PA equipment were statistically significant (p ranges from 0.008 to 0.037). CONCLUSIONS: This study highlights the potential of the home/neighborhood environment as a space for interventions to increase PA in rural children. Only 14% of children in this rural sample met PA recommendations, so interventions to increase PA, particularly MVPA, are needed. Future studies should include multiple levels of a rural child‘s environment (i.e., school, town) to examine which may play the largest role in PA.
Objective: This study examined the environmental barriers and facilitators that hinder or promote... more Objective: This study examined the environmental barriers and facilitators that hinder or promote participation among adults aging with physical disabilities. Method: Data come from an ongoing study of 1,331 individuals aging with long-term physical disability ( M = 65 years). Linear regression examined the association between individual and socioenvironmental factors and participation restrictions in work, leisure, and social activities. Results: Pain, fatigue, and physical functional limitations were significant barriers to participation for individuals aging with physical disability. Barriers in the built environment also reduced participation, net of health and functioning. Poor access to buildings was especially problematic for participation among individuals not using any mobility aid to get around. But for those using wheel or walking aids, environmental barriers had no adverse effect on participation. Discussion: These findings highlight the importance of disentangling the r...
Physical & occupational therapy in pediatrics, Jan 13, 2017
Children with mobility related disabilities often experience limited participation and access to ... more Children with mobility related disabilities often experience limited participation and access to social interactions. An emerging pediatric powered mobility device are modified ride-on cars that provide self-directed mobility experiences to children with disabilities. This study aimed to determine: (1) the feasibility of a modified ride-on car intervention during an inclusive playgroup, (2) the effect of a modified ride-on car intervention on the play behaviors of children with and without mobility related disabilities. A single-subject research design was implemented. Thirteen children participated in a weekly inclusive playgroup. The five children with mobility related disabilities were provided modified ride-on cars during the intervention. Children's play behaviors were classified with Howes' Peer Play Scale. Intervention effects were examined using nonoverlap of all pairs (NAP). The intervention was feasible based on participants' good attendance, retention rates, a...
Services offered through Part C of the Individuals With Disabilities Education Improvement Act im... more Services offered through Part C of the Individuals With Disabilities Education Improvement Act improve cognitive, behavioral, and physical skills for children less than 3 years old at risk for or with a disability. However, there are low enrollment rates into services. Various Lead Agencies oversee services through Part C, and states determine which agency is in charge of administering these services. The objective of this study was to describe odds of enrollment into early intervention services based on the department administering services (Lead Agency). Each state’s Lead Agency (Education, Health, or Other), state population size, narrowness of eligibility criteria, and state-level screening rates were fit into a negative binomial regression model to predict odds of enrollment into Part C services. Results show that state’s reporting from “Health” and “Other” as a Lead Agency had significantly higher odds for Part C services compared with the state Lead Agency of Education (Healt...
Introduction: Neighborhood economic conditions are important predictors of incident stroke. Neigh... more Introduction: Neighborhood economic conditions are important predictors of incident stroke. Neighborhood economic conditions can be characterized differently but studies have not identified which characterizations are most predictive of incident stroke. Previous work has suggested that the income distribution within the population may be more relevant for chronic disease than the absolute value of median income of the population. This project aims to estimate the effects of neighborhood income and neighborhood income inequality on incidence stroke. Hypothesis: Neighborhood income inequality and absolute neighborhood income will predict incident stroke above and beyond demographic characteristics and individual socioeconomic status. Methods: We used data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national longitudinal study of black and white older adults (N=29,443). Baseline median household income and the Gini coefficient of income inequalit...
Introduction: Neighborhoods may influence post-stroke recovery. We examined the association betwe... more Introduction: Neighborhoods may influence post-stroke recovery. We examined the association between neighborhood socioeconomic status (nSES) and 90-day post-stroke function, depression, cognition, and quality of life (QoL). Methods: Stroke survivors (N=782) were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project. An nSES index – composite of 2010 census-tract level income, wealth, education, employment – was the exposure; higher values indicate higher nSES (median -4.56; IQR: -7.48 to -0.46). Function was measured with 22 self-reported activities of daily living/instrumental activities of daily living, depression with Patient Health Questionnaire-8, QoL with the Stroke Specific QoL Scale, and cognition with the Modified Mini Mental State Examination. Confounder-adjusted generalized estimating equations were used to estimate associations between nSES (comparing 75 th to 25 th percentile) and 90-day outcomes. We tested for effect modificat...
Objectives: This cross-sectional study examines the association between perceived sidewalk condit... more Objectives: This cross-sectional study examines the association between perceived sidewalk conditions and neighborhood participation among older adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods: Between 2013–2016, 14,233 REGARDS participants completed a second in-home visit. Using logistic regression, we cross-sectionally examined if perceived severity of sidewalk problems was associated with going into the neighborhood less than once compared to 1–7 times per week. Results: The analytic sample included participants ( N = 9863) with nonmissing data. The likelihood of going into the neighborhood less than one time per week was greater among participants who reported minor (OR = 1.15; 95% CI: 1.00, 1.33), somewhat serious (OR = 1.41; 95% CI: 1.17, 1.70), and very serious (OR = 1.65; 95% CI: 1.38, 1.98) sidewalk problems in their neighborhood compared to those reporting no sidewalk problems, independent of demographic, socioeconomic, and im...
PURPOSE: To examine how facets of the home environment and parent perceptions of neighborhood saf... more PURPOSE: To examine how facets of the home environment and parent perceptions of neighborhood safety may be associated with child total PA and moderate-to-vigorous (MVPA) levels in a rural sample. METHODS: Baseline data were analyzed from NU-HOME, a childhood obesity prevention, randomized controlled trial in rural communities. 105 children (age=8.96±1.06 yrs) and their parents (age=37.91±5.42 yrs) reported on sociodemographics and home/neighborhood environments. Child daily PA (total and MVPA) was measured using accelerometers and, using SAS 9.4, associations were examined with home/neighborhood environment variables through multivariate regression models, both unadjusted and adjusted for economic assistance. Normality was not met for child daily MVPA therefore analyses used the log-transformed variable. RESULTS: Mean child total PA was 259.08±58.22 min/day and MVPA was 44.95±18.58 min/day. In unadjusted analyses, access to PA equipment in the home (p=0.037) and neighborhood safety (p=0.049) were associated with total PA; however, no factors were statistically significantly associated with MVPA, although access to PA equipment (p=0.088) and family support for PA (p=0.062) were trending towards significance. For both total PA and MVPA outcomes, the regression models including all variables and accounting for economic assistance were statistically significant (p=0.026 and p=0.034, respectively). For each model, the individual effects of parent PA and PA equipment were statistically significant (p ranges from 0.008 to 0.037). CONCLUSIONS: This study highlights the potential of the home/neighborhood environment as a space for interventions to increase PA in rural children. Only 14% of children in this rural sample met PA recommendations, so interventions to increase PA, particularly MVPA, are needed. Future studies should include multiple levels of a rural child‘s environment (i.e., school, town) to examine which may play the largest role in PA.
Objective: This study examined the environmental barriers and facilitators that hinder or promote... more Objective: This study examined the environmental barriers and facilitators that hinder or promote participation among adults aging with physical disabilities. Method: Data come from an ongoing study of 1,331 individuals aging with long-term physical disability ( M = 65 years). Linear regression examined the association between individual and socioenvironmental factors and participation restrictions in work, leisure, and social activities. Results: Pain, fatigue, and physical functional limitations were significant barriers to participation for individuals aging with physical disability. Barriers in the built environment also reduced participation, net of health and functioning. Poor access to buildings was especially problematic for participation among individuals not using any mobility aid to get around. But for those using wheel or walking aids, environmental barriers had no adverse effect on participation. Discussion: These findings highlight the importance of disentangling the r...
Physical & occupational therapy in pediatrics, Jan 13, 2017
Children with mobility related disabilities often experience limited participation and access to ... more Children with mobility related disabilities often experience limited participation and access to social interactions. An emerging pediatric powered mobility device are modified ride-on cars that provide self-directed mobility experiences to children with disabilities. This study aimed to determine: (1) the feasibility of a modified ride-on car intervention during an inclusive playgroup, (2) the effect of a modified ride-on car intervention on the play behaviors of children with and without mobility related disabilities. A single-subject research design was implemented. Thirteen children participated in a weekly inclusive playgroup. The five children with mobility related disabilities were provided modified ride-on cars during the intervention. Children's play behaviors were classified with Howes' Peer Play Scale. Intervention effects were examined using nonoverlap of all pairs (NAP). The intervention was feasible based on participants' good attendance, retention rates, a...
Services offered through Part C of the Individuals With Disabilities Education Improvement Act im... more Services offered through Part C of the Individuals With Disabilities Education Improvement Act improve cognitive, behavioral, and physical skills for children less than 3 years old at risk for or with a disability. However, there are low enrollment rates into services. Various Lead Agencies oversee services through Part C, and states determine which agency is in charge of administering these services. The objective of this study was to describe odds of enrollment into early intervention services based on the department administering services (Lead Agency). Each state’s Lead Agency (Education, Health, or Other), state population size, narrowness of eligibility criteria, and state-level screening rates were fit into a negative binomial regression model to predict odds of enrollment into Part C services. Results show that state’s reporting from “Health” and “Other” as a Lead Agency had significantly higher odds for Part C services compared with the state Lead Agency of Education (Healt...
Introduction: Neighborhood economic conditions are important predictors of incident stroke. Neigh... more Introduction: Neighborhood economic conditions are important predictors of incident stroke. Neighborhood economic conditions can be characterized differently but studies have not identified which characterizations are most predictive of incident stroke. Previous work has suggested that the income distribution within the population may be more relevant for chronic disease than the absolute value of median income of the population. This project aims to estimate the effects of neighborhood income and neighborhood income inequality on incidence stroke. Hypothesis: Neighborhood income inequality and absolute neighborhood income will predict incident stroke above and beyond demographic characteristics and individual socioeconomic status. Methods: We used data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national longitudinal study of black and white older adults (N=29,443). Baseline median household income and the Gini coefficient of income inequalit...
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