Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Introduction: People with disabilities experience multiple barriers to health promotion opportunities. This is especially true for adults with disabilities who are members of minority groups. When access to timely health promotion opportunities and community supports is unavailable, excluded individuals become more vulnerable to developing potentially preventable chronic conditions that can needlessly intensify the disablement process.

Methods: The purpose of our study was to identify areas of health vulnerability that can be reduced or eliminated with multi-disciplinary collaboration. We combined and analyzed 8 years of data from the National Health Interview Survey (1997-2004) with bivariate and multivariate statistical procedures, using the SUDAAN computer software package. Our sample included 258,279 self-responding adults with and without lower-extremity mobility limitations. We examined health disparities among African-Americans and non-Hispanic whites with lower-extremity mobility limitations in 4 different areas: health status, chronic conditions, health risks, and community participation. Comparison groups included working-age (18-64 years) and elderly (65 years and older) African-American and white non-Hispanic adults with and without lower-extremity mobility limitations.

Results: African-Americans with lower extremity mobility limitations were significantly more likely to experience worsening health (58.3%) and to have diabetes (15.7% for working-age adults, and 29.9% for older adults), hypertension (46.2% for working-age adults, and 74.3% for older adults), and stroke (5.6% for working-age adults, and 14.1% for older adults), compared with mobility limited whites. Mobility limited whites experienced the highest rates for breathing problems, cancer, heart problems, joint pain and swelling, and low back pain. They were also significantly more likely to be current drinkers. Results on current smoking were mixed, but mobility limited adults were the most likely group to be current smokers. African-Americans with mobility limitations were the most likely to be obese and morbidly obese, compared with their white counterparts. African-Americans with mobility limitations were the least likely to meet nationally established exercise criteria and the most likely to report never exercising at all during the week. They also experienced the most difficulty with shopping and socializing and the lowest rate of workforce participation.

Conclusions/Implications: African-Americans with mobility limitations emerged as a very vulnerable group to further disablement, poorer health, and isolation within their communities. Health care providers, social workers, and community support programs should vigorously address environmental, attitudinal, economic, and transportation barriers to timely preventive care and community support services that are targeted toward the prevention of chronic secondary conditions and preventable health risk behaviors in this population. Social workers, with their person-in-environment perspective can play a critical role in bringing together other professionals and community supports to facilitate health promotion efforts and enhance the quality of life for minorities with disabilities.