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AbstractBackgroundThe scientific literature cites wide health disparities for people with intellectual disabilities compared to the general population. This study seeks to gain an understanding of the effects of income status on oral health in a global population of people with intellectual disabilities.MethodsEighty‐two thousand five hundred and seventy Special Olympics athletes were screened and eligible for inclusion in this study. The main exposure (income status) and selected oral health signs and symptoms (missing teeth, untreated decay, injury, gingivitis, and mouth pain) were used to conduct a cross‐sectional analysis. Prevalence odds ratios were obtained through logistic regression.ResultsStudy participants from low‐income countries experienced adverse health outcomes at a lower rate than expected. Study participants from upper middle, lower middle, and low‐income countries had higher odds of mouth pain and untreated decay, yet lower odds of missing teeth, injury, and gingivitis, than participants from high‐income countries. Overall, a great number of individuals from every income group required maintenance or urgent care.ConclusionOral health problems are not exclusive to low‐income study participants. Unexpectedly high odds of missing teeth, injury, and gingivitis in high‐income countries may be attributed to the high proportion of participants from the United States, which is considered a high‐income country but has large income disparities. Health‐determining circumstances in low‐income countries provide some protection from the hypothesized gradient of oral health for all measured outcomes.

Purpose. To determine whether workload, job satisfaction, and flexible schedules are predictive of using time at work to exercise. Design. The study design was the quantitative analysis of the time at work to exercise intervention of a cluster-randomized controlled trial. Setting. The study took place at Emory University, Atlanta, Georgia. Subjects. Subjects comprised 188 full- and part-time faculty and staff (57% female). Intervention. Employees were randomized into different intervention groups, and analysis focused on employees who were provided 30 minutes of time at work to exercise. Measures. Time at work to exercise at was measured 9 months, and work environment characteristics were measured at baseline. Analysis. Logistic regression modeling using generalized estimating equation analysis was used to account for departmental clustering. Results. Time at work to exercise was used by 45% of participants. Participants who felt comfortable taking time off work to exercise were 2.8 times more likely to use time to exercise than those who did not feel comfortable taking time off (95% confidence interval: 1.3 to 6.1). Participants who reported too much work were .3 times less likely to exercise (95% confidence interval: 0.2 to 0.7). Job satisfaction and the ability to take time off for personal matters were not significantly associated with using time to exercise. Conclusion. The results support the hypothesis that individuals with a supportive work environment would be more likely to use time at work to exercise. Workload and having time during the day are more important than job satisfaction.

Purpose: This study aimed to characterize physical activity (PA) environments in Georgia public elementary schools and to identify socioeconomic status (SES) and racial/ethnic disparities in PA environments. Design: A school setting PA survey was launched in 2013 to 2014 as a cross-sectional online survey assessing PA environment factors, including facility access and school PA practices, staff PA opportunities, parental involvement in school PA, and out-of-school PA opportunities. Setting: All 1333 Georgia public elementary schools were recruited. Participants: A total of 1083 schools (81.2%) responded. Survey respondents included school administrators, physical education (PE) teachers, and grade-level chairs. Measures: Physical activity environment factors were assessed via an online questionnaire adapted from school PA surveys and articles. Analysis: The chi-square and Fisher exact analyses were conducted to examine the reporting of PA environment factors overall and by school SES, as measured by free/reduced lunch rate, and/or racial/ethnic composition. Results: Overall, many PA environment factors were widely prevalent (ie, gym [99%] or field [79%] access), although some factors such as some PA-related programs (ie, a structured walk/bike program [11%]) were less widely reported. Disparities in school PA environment factors were largely patterned by SES, though they varied for some factors by racial/ethnic composition and across SES within racial/ethnic composition categories. For example, lower SES schools were less likely to report access to blacktops and tracks ( p-value < .0001), and higher SES schools were less likely to report access to playgrounds ( p-value = .0076). Lower SES schools were also less likely to report "always/often" giving access to PE/PA equipment during recess ( p-value < .01). Lower SES and majority nonwhite schools were less likely to report having joint use agreements with community agencies ( p-value < .0001). Conclusion: This study highlights SES and racial/ethnic disparities in PA environments in Georgia public elementary schools.

Purpose. To evaluate the effectiveness of addressing multiple barriers to physical activity (PA) using interventions at the workplace. Design. The Physical Activity and Lifestyle Study used a randomized controlled trial in which 60 university departments were randomized into five groups. Setting. Large Southeastern university. Subjects. Physically inactive nonfaculty employees in the participating departments (n = 410) were interviewed five times over 9 months, with 82% completing all surveys. Intervention. Departments were randomly assigned to (1) control, (2) gym membership, (3) gym + PA education, (4) gym + time during the workday, and (5) gym + education + time. Measures. PA intensity and quantity were measured using the 7-day Physical Activity Recall instrument, with PA then classified as the number of days meeting Centers for Disease Control and Prevention guidelines. Analysis. The outcome was modeled with generalized linear mixed model methodology. Results. There was no significant improvement when a group received gym alone compared to the control (Rate Ratio [RR]) 1.22 [.90, 1.67]). However, gym + education, gym + time, and gym + education + time were significantly better than the control (RR 1.51 [1.15, 1.98], RR 1.46 [1.13, 1.88], RR 1.28 [1.01, 1.62]), with improvements sustained over the 9 months. Conclusion. Among sedentary adults who had access to indoor exercise facilities, addressing environmental and cognitive barriers simultaneously (i.e., time and education) did not encourage more activity than addressing either barrier alone.

Abstract Background Tuberculosis (TB) in developed countries has historically been associated with poverty and low socioeconomic status (SES). In the past quarter century, TB in the United States has changed from primarily a disease of native-born to primarily a disease of foreign-born persons, who accounted for more than 60% of newly-diagnosed TB cases in 2010. The purpose of this study was to assess the association of SES with rates of TB in U.S.-born and foreign-born persons in the United States, overall and for the five most common foreign countries of origin. Methods National TB surveillance data for 1996–2005 was linked with ZIP Code-level measures of SES (crowding, unemployment, education, and income) from U.S. Census 2000. ZIP Codes were grouped into quartiles from low SES to high SES and TB rates were calculated for foreign-born and U.S.-born populations in each quartile. Results TB rates were highest in the quartiles with low SES for both U.S.-born and foreign-born populations. However, while TB rates increased five-fold or more from the two highest to the two lowest SES quartiles among the U.S.-born, they increased only by a factor of 1.3 among the foreign-born. Conclusions Low SES is only weakly associated with TB among foreign-born persons in the United States. The traditional associations of TB with poverty are not sufficient to explain the epidemiology of TB among foreign-born persons in this country and perhaps in other developed countries. TB outreach and research efforts that focus only on low SES will miss an important segment of the foreign-born population.