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A Conversation With Dr. Brian Armour About Oral Health of People With and Without Disabilities

Patient - teeth checkBrian Armour, PhD is an economist with the Centers for Disease Control and Prevention (CDC). He has spent over 15 years in health services research, including work on helping design the CDC Disability and Health Data. We asked Brian to discuss findings from the study he led, entitled “A Profile of State-level Differences in the Oral Health of People with and Without Disabilities, in the U.S., in 2004” (Armour BS, Swanson M, Waldman HB, Perlman SP. Public Health Rep. 2008 Jan-Feb;123(1):67-75).

Why did you want to study state-level differences in oral health of people with disabilities?

While there have been disability-specific studies about oral health, no state-level analysis of the oral health of people with disabilities was available. We wanted to assess the oral health of people with disabilities in each state.

Oral health is as important as other types of health care; and good oral health improves general health, self-esteem, communication, nutrition, and quality of life.

What did you discover?

In the year we observed, people with disabilities were less likely than people without disabilities to visit a dentist or dental clinic. They were more likely to have experienced tooth loss.

Our study showed very different results among states. People with disabilities from Mississippi were much less likely than people with disabilities in Connecticut to have visited the dentist or dental clinic in the last year. Only four percent of people with disabilities in the District of Columbia reported having tooth loss as opposed to almost 19 percent of people with disabilities in Kentucky.

What does this mean for people with disabilities and their families?

It is important for everyone, especially for people with disabilities, to practice good oral health habits, like brushing their teeth regularly and flossing. People who need help finding good oral health habits can visit the “Oral Health” section of the CDC website.

Sometimes, people with disabilities – particularly intellectual or developmental disabilities – need assistance from their families and caregivers to help them practice good oral health. If caregivers need tips on how to promote good oral heath, they can check out “Dental Care Every Day: A Caregiver’s Guide” from the National Institute on Health.

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A Conversation With Brian Armour About Disability Prevalence Among Healthy Weight, Overweight, and Obese Adults

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Brian Armour, PhD is an economist with the Centers for Disease Control and Prevention (CDC). He has spent over 15 years in health services research, including work on helping design the CDC Disability and Health Data System. We asked Brian to discuss findings from the study he led, entitled Estimating Disability Prevalence Among Adults by Body Mass Index: 2003–2009 National Health Interview Survey” (Armour BS, Courtney-Long E, Campbell VA, Wethington HR. Prev Chronic Dis. 2012; 9: E178. Published online 2012 December 27).

In your article, you assess the number of people who are obese, overweight, or healthy weight and who report having a disability. Why do you think it is important to look at whether people who have weight issues also have disabilities?

This information can help public health programs better recognize the need to design obesity prevention and treatment programs that are inclusive of people with disabilities.

What did you find out?

We found that 41 percent of US adults who are obese also reported having a disability. We also found out that mobility limitation was one of the most frequently reported types of disability among people who are obese.

What does this mean for public health programs?

Public health programs should be considering the needs of those with disabilities when designing their obesity prevention and treatment programs. There are many resources public health organizations can use to help make sure that they are thinking of the needs of people with disabilities. Two good resources include the “Disability Inclusion” section on the CDC’s website as well as the Inclusive Community Health Implementation Package (iChip) program run by the National Center on Health and Physical Activity for People with Disabilities (NCHPAD).

Do you have any recommendations for people with disabilities on how to maintain their weight and avoid becoming obese?

Everyone is different, but it is important that we all are physically active, eat better, and talk to a doctor when not feeling well! People who need help keeping a healthy weight can check out the “Healthy Weight” section of the CDC website for tools to use to help maintain a healthy weight.

Is there anything else you would like to add?

Identifying health issues that people with disabilities experience is important, but we also need to help improve the health of people with disabilities by promoting inclusion. This means making sure that people with disabilities are included in all aspects of community life—in our gyms, healthy eating programs, walking paths, transportation and more.

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Senate Acts on Zika Funding; The Arc Urges House to Step Up

Washington, DC – With a new public health threat on the horizon for our country, yesterday the U.S. Senate finally acted to provide some of the funding necessary to address the Zika virus. With repurposed funding running out and summer quickly approaching, The Arc and our national network of advocates are urging the House to step up and pass a bill that provides funding to address this issue.

“The clock is ticking, and with every passing day, we are less and less prepared to face this impending public health crisis. We have the ability to mitigate the impact of this mosquito- carried virus, with an investment in mosquito reduction, accelerated vaccine development, and better testing. But Congress has been wasting time, playing politics with public health. Thankfully, the Senate’s action yesterday to approve a down payment on addressing this issue is a step in the right direction. We urge the House to follow suit quickly,” said Peter Berns, CEO of The Arc.

In February, the White House asked for $1.9 billion for Zika vaccine development, better testing, and mosquito reduction. With no action taken by Congress, in April the White House transferred $589 million from money set aside to fight Ebola and other problems to work on Zika prevention efforts. But that’s far short of the amount health officials say they need to be effective and that funding will run out at the end of June. Yesterday, the Senate approved $1.1 billion to combat Zika this year and next year.

While Zika is usually harmless to adults, some women infected with Zika while pregnant give birth to babies with severely disabling brain injury, including microcephaly. Many of The Arc’s more than 650 chapters provide supports and services to families and people with a range of disabilities, including severe disabilities.

The Arc has long held a position on the prevention of intellectual and developmental disabilities (I/DD), supporting our national efforts to continue to investigate the causes, reduce the incidence and limit the consequences of I/DD through education, clinical and applied research, advocacy, and appropriate supports. We firmly believe that prevention activities do not diminish the value of any individual, but rather strive to maximize independence and enhance quality of life for people with I/DD.

The Arc advocates for and serves people with intellectual and developmental disabilities (I/DD), including Down syndrome, autism, Fetal Alcohol Spectrum Disorders, cerebral palsy and other diagnoses. The Arc has a network of more than 650 chapters across the country promoting and protecting the human rights of people with I/DD and actively supporting their full inclusion and participation in the community throughout their lifetimes and without regard to diagnosis.

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The Arc Awarded Grant From Amerigroup Foundation for Health and Fitness for All Project

Washington, DC – The Arc is pleased to announce that it has been awarded a $90,000 grant from the Amerigroup Foundation to conduct its Health and Fitness for All project at three chapters of The Arc in Texas and Tennessee. The Health and Fitness for All project utilizes the HealthMatters™ program, which is a training developed by the University of Illinois at Chicago that provides structured information on how to organize and start a tailored physical activity and health education program for people with intellectual and developmental disabilities (I/DD).

With Amerigroup Foundation’s support, three of The Arc’s chapters that are certified in the HealthMatters program, The Arc San Antonio, The Arc Greater Houston, and The Arc Tennessee, will implement the 12-week program to help increase participant’s knowledge about the importance of healthy eating and staying active.

“We are thrilled to be expanding this program with chapters of The Arc that have already demonstrated a commitment to the health and wellness of people with I/DD in their communities. The Amerigroup Foundation’s support will go a long way in supporting people with I/DD to make healthier decisions in their day to day lives,” said Peter Berns, CEO of The Arc.

According to the Centers for Disease Control, adults with disabilities have a 58% higher rate of obesity than adults without disabilities. Since The Arc started using the HealthMatters curriculum in 2012, the program has reached almost 500 participants to help them learn about healthy eating and the importance of staying active. The chapter activities being supported by Anthem, known as Amerigroup in those states, will reach a total of 150 participants.

The Arc advocates for and serves people with intellectual and developmental disabilities (I/DD), including Down syndrome, autism, Fetal Alcohol Spectrum Disorders, cerebral palsy and other diagnoses. The Arc has a network of more than 665 chapters across the country promoting and protecting the human rights of people with I/DD and actively supporting their full inclusion and participation in the community throughout their lifetimes and without regard to diagnosis.

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Learn How HealthMeet® Is Promoting Healthy Lives!

In 2012, The Arc launched the HealthMeet® project because we believe people with intellectual disabilities (ID) should have access to high quality, comprehensive, and affordable health care. HealthMeet® offers free community-based health assessments to people with ID at selected chapters in California, Massachusetts, New Jersey, North Carolina, and Pennsylvania. Over 1,500 people have been assessed through the HealthMeet initiative and 9 percent of those participants reported to have an autism spectrum disorder. At The Arc, we believe that Autism Acceptance is promoting healthy lifestyles.

Overall, HealthMeet® has been a positive experience for participants and chapters of The Arc involved in the project. The health assessments provide an opportunity for participants to be assessed in the areas of vital signs and body composition, respiratory health, vision, hearing, oral health, and foot and mobility issues. Participants also feel empowered to take charge of their health by engaging in dialogue with health assessors about the status of their health and recommendations for follow-up care. As Erika Hagensen of The Arc of North Carolina has noted “health is not a taboo topic, it’s an empowering topic.”

The chapters of The Arc involved in HealthMeet® have leveraged community resources and developed partnerships with local entities such as public health departments, nursing schools, and medical schools. HealthMeet® has also been a learning experience for many of the healthcare professionals that conduct the health assessments because they now feel more equipped to serve people with ID. Through HealthMeet®, healthcare providers have developed better communication skills that will ultimately help them serve the participant’s healthcare needs.

To learn more about how The Arc is increasing health opportunities for people with ID view this video:

If you are a healthcare provider, national organization of healthcare providers, caregiver, chapter of The Arc, or service provider (not affiliated with The Arc), we ask that you join our effort to increase your knowledge of the I/DD community and serve people with I/DD. Learn more by viewing this video:

HealthMeet aims to reduce health disparities experienced by people with intellectual or developmental disabilities (I/DD) so they can live a longer and healthier life. Through free health assessments and training, HealthMeet helps people with I/DD learn about their health needs. HealthMeet also offers training to improve public, health professional, and caregiver awareness of health issues faced by people with I/DD. HealthMeet is supported through at $1 million cooperative agreement with the Centers for Disease Control and Prevention. For more information on the HealthMeet project, contact Jennifer Sladen at sladen@thearc.org.

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Eruption Athletics, an Innovative Approach to Making Fitness Fun

Eruption AthleticsThe Arc recently paired up with the dynamic duo of Chris Engler and Joe Jelinski, the co-owners of Eruption Athletics, to present at the National Down Syndrome Congress Conference. Together, The Arc and EA, presented 3 health and fitness sessions – 1 to the general conference and 2 interactive fitness sessions with their Youth and Adult conference for self-advocates.

Eruption Athletics (EA) was created in 2009 to help prepare individuals competing in Special Olympics’ games. Since then the organization has evolved into an adapted fitness facility designed specifically for individuals with disabilities to come to work out and learn more about health and fitness. Located just outside Pittsburgh Pennsylvania, EA first partnered with The Arc’s Achieva Chapter to help do fitness sessions at their free health assessment events as part of the HealthMeet project.

Joe and Chris help empower their clients with the knowledge of how to be physically active to build strength and endurance while preventing injuries. They provide personal one-on-one or group training sessions. Their program instills in their clients an attitude that there is nothing they can’t do because of their disability and shows them that exercises just need to be modified or adjusted to fit each individual’s specific needs. Spend two minutes in a room with Joe and Chris and you’ll know why they have a dedicated following of clients that continue to come back. Their bright colored clothing matches their high energy vibe and excitement that they bring to each training session.

Individuals that come to their classes are not only becoming more physically active they are also developing socially and cognitively. The group sessions with peers masks working out by providing a fun, social, and supportive environment that makes individuals actually look forward to exercising! It gives them a place to go each week to see old friends, meet new ones, and be part of a group that encourages each person to fulfill their own potential without comparison to others in the program. Their innovative approach to physical activity is helping to improve their clients physically and mentally by not only building muscle, but also self-confidence through proven results.

EA has recently released their new patented Eruption Athletics “Volcano PADD”. The PADD along with the accompanying instruction manuals that vary from beginner to advanced makes exercising easier, fun, and more accessible for individuals with disabilities. To learn more about EA’s Volcano PADD, contact Eruption Athletics.

This isn’t the last you’ll be seeing of Eruption Athletics though. They will be joining us in October down in New Orleans for The Arc’s National Convention. Joe and Chris will be combining forces with the HealthMeet project again to provide morning fitness sessions – so make sure to find out what all the hype is about and join us in New Orleans for our energizing sessions to get your day started right (and make some new friends in the process!).

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HealthMeet: Top 5 Exercises for People With Intellectual and Developmental Disabilities

Guest post by Jared Ciner, Certified Personal Trainer, Disabilities Support Counselor, Founder/Director of SPIRIT Fit & Health

As you may already know, an extremely high percentage of people in America are suffering from obesity. What you may not know is that people with developmental and other disabilities are 58% more likely to be obese than the general population, and they make up roughly 20% of our country’s citizens. As a society, it is our duty to provide the necessary resources and support that enable people with disabilities to be healthy. The purpose of this article is to begin enabling people with intellectual and developmental disabilities to take control of their lives through the practice of health-promoting exercises that are safe, effective and tailored specifically towards their needs.

As a certified personal trainer, I believe that partaking in proper exercise and physical activities empowers us as human beings, and allows us to reach our mental, emotional and physical potential. As a support counselor, I know that people with I/DD often require adapted strategies in order to accomplish certain functional goals. In April of 2013, I teamed up with Sam Smith, certified personal trainer and proud young man with Asperger’s syndrome, to design and implement group health & fitness programs for teens and adults with intellectual and developmental disabilities. Below are five exercises that we encourage all people, including those with an I/DD, to practice in order to maximize their strength, health and independence. Each exercise focuses in improving stability, strength and cardiovascular endurance. (Access a readable file here.)

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Healthy Eating Tips to Help Fight Obesity

Obesity is one of the largest problems facing adults living in the United States. Statistics show that one-third of Americans is considered obese. Thirty-six percent of individuals with disabilities are considered obese as compared to 23% of individuals without disabilities. The best way to fight obesity is by eating healthy and staying active. Unfortunately, for individuals with disabilities there can be physical limitations as to what they can do in regards to physical activity. While most activities can be modified to fit the person’s individual fitness needs, this still puts a greater importance on the necessity to eat healthier. Poor nutrition, which can lead to obesity, can also be a catalyst for many other health related issues too like high blood pressure, diabetes, heart disease, and fatigue.

There are many reasons as to why individuals with disabilities may not eat as healthy as they should – lack of nutritional awareness, limited income, trouble cooking themselves, difficulty chewing or swallowing specific foods, or sensitivity to certain tastes or foods. If a caregiver cooks meals for them, the individual may have limited input as to what types of foods are prepared. Ensuring that the individual has a say in their meal choices and making a few key changes can help tremendously when it comes to healthy eating. A simple change such as drinking more water instead of sugary beverages throughout the day will help keep you hydrated, feeling fuller with no calories, and generally doesn’t cost a thing.

Teaching individuals with disabilities how to save money while at the grocery store will help them pocket some extra cash for other activities or allow them to buy more food. Simple tips such as, using coupons, buying store brand or generic brand versus name brand items, looking for daily specials, and paying attention to expiration dates will help stretch those food dollars. Fresh fruits that are in season usually won’t go bad as quickly and are more cost efficient. Instead of buying yellow bananas that are already ripe (and can go bad quickly) try buying them when they are a little green so that they will last longer. Once bananas ripen, freeze them to make banana bread! Individuals with disabilities who also have mobility issues might have trouble cutting up foods such as, vegetables and fruits. Specially adapted utensils can make this process easier and safer. You can also try purchasing frozen or canned fruits and veggies instead (choose fruit that is canned in 100% fruit juice and vegetables that have “no salt of sodium added” for best options). They will last longer, are already cut up, and are usually a little cheaper. Nutritionists have also shown that there is little difference between the nutrients you receive from fresh and frozen veggies, so go ahead and grab the frozen ones! Large supermarkets and buying in bulk will usually have cheaper prices as opposed to local or specialty shops too.

Planning out weekly meals will also help to know what foods to buy in the grocery store to ensure that individuals are eating healthy every day. When working with the individual with a disability to plan out meals for the week make sure to keep it simple. Recipes that are too difficult or take too long to prepare can be discouraging and may make them not enjoy cooking and avoid it. Recipes should have no more than 5 or 6 ingredients. A good rule of thumb when helping individuals make their meal choices is to make sure that 3 of the 5 food groups are present in each plate. This will help to allow for the individual to choose foods they like, but still keep a balanced plate. Making a larger recipe that can be frozen and eaten again later in the week is also a good idea to have for nights when there is little time to cook instead of running out to a fast food restaurant. Cookbooks for individuals with disabilities, like Cooking By Color, help to clearly illustrate what ingredients are needed and how to prepare simple, yet healthy, meals in smaller portions. To learn more about Cooking By Color’s concept and planning for successful eating, check out author Joan Guthrie Medlen’s, HealthMeet webinar.

Many resources are out there to help teach the importance of keeping a balanced diet. Choosemyplate.gov and the CDC’s new Healthy Weight Issue Briefs provide information on obesity and maintaining a healthier diet.

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Tobacco Cessation Leads to a Healthier Heart

The heart is one of the hardest working muscles in the body, as well as the most important, which is why it’s essential to take good care of it. Cardiovascular disease is the number one cause of death of both women and men in the United States and is the leading cause of disability.

While there are many factors that increase your risk of having cardiovascular disease that you cannot change about yourself – genetics, sex, race, ethnicity, family history, etc. – many deaths from cardiovascular diseases (heart attacks, strokes, and heart disease) can be prevented through healthier habits. Making a few key changes can prolong your life by many years! One large issue that can be easily controlled to help reduce your risk is abstaining from tobacco use. According to the CDC, 25% of adults with ID smoke as opposed to 17% for adults without disabilities.

Smoking is the leading cause of preventable deaths in the US. Smoking tobacco allows for a build-up of plaque and other deposits to gather in the arteries (and lungs), thus blocking part of the artery and slowing the flow of blood to the heart. The heart then has to work harder to push blood through the narrower clogged arteries to the rest of body, which leads to high blood pressure. When the plaque builds up to become a full blockage in an artery is when a heart attack, stroke, or blood clot elsewhere in the body occurs and can be deadly.

Quitting smoking can be difficult for the general population; however when a person with an intellectual disability starts smoking tobacco quitting can be especially difficult. There are fewer programs and resources tailored for individuals with ID that explain the full risks, so they may not understand the importance behind quitting and the range of effects it can have on their bodies. Individuals with ID can also have a harder time controlling nicotine urges. This can cause outbreaks of bad behaviors towards the caregiver, family member, etc. who is trying to help them to quit. Sometimes cigarettes have even been used as a reward with an individual with ID to help reinforce another good behavior, which can lead to more confusion about why smoking is harmful.

Although resources are scarce, there are good tobacco cessation programs out there to help individuals with ID to quit. I Can Quit was developed by Monish University in Australia to help facilitate tobacco cessation sessions with the use of their guidebook and the Michigan Department of Community Health has also worked to create tobacco cessation resources for individuals with disabilities. Learn more about their resources and the effects of tobacco through The Arc’s HealthMeet webinar on tobacco cessation.

Although quitting can be difficult for individuals with ID, starting to smoke hopefully won’t even be considered if the correct information is communicated early on. However, it’s never too late to quit – your heart, arteries and lungs will begin to repair themselves almost immediately after you stop. It only takes about 20 minutes after your last cigarette for your heart rate to start to decrease back to a normal level. Teaching individuals these facts and leading by example will give them the knowledge to know the harmful effects that smoking can have before they begin – which is invaluable to their heart and overall health.

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A Chapter of The Arc Promoting Health and Nutrition in Schenectady County, New York

Know Grow Eat participants A few years ago, Schenectady County Public Health Services and Schenectady Arc formed a unique partnership to address the high rates of chronic disease and obesity among people with I/DD in Schenectady County through the Strategic Alliance for Health. Schenectady Arc a  provider of residential, vocational, clinical, and adult day services in New York State’s Capital Region, recognized that among its 1,480 participants, nearly 10 percent were diagnosed with cardiovascular disease, obesity, or diabetes and wanted to do something to address the needs of those they served.

While nationally-based research showed individuals with I/DD were more prone to incidence of chronic disease, Schenectady Arc had confidence that they could help their participants by improving their diet and educating them about healthy eating habits. Further research found that children who participated in a “seed to table” nutrition education program tended to increase their consumption of fruits and vegetables. Through this program, children participated in a variety of regularly scheduled activities such as vegetable taste-testing, hands-on gardening, and recipe preparation. Based on these studies, Schenectady Arc created Know, Grow and Eat Your Vegetables, a garden-based nutrition education program for people with I/DD. The agency’s horticulture coordinator oversaw the new program which was located at Schenectady Arc’s commercial-sized greenhouse in Rotterdam, NY. The coordinator assessed awareness of and preference for 15 vegetable types and, worked alongside 70 participants to plant and cultivate seedlings.

Know Grow Eat participantsWhile the vegetables were being grown, nutrition educators from Cornell Cooperative Extension of Schenectady County (CCESC) conducted a six-week program adapted to the specific needs of individuals with I/DD. This training provided participants and staff with strategies regarding healthy meal preparation practices and how to incorporate vegetables into daily meals and snacks.

This remarkable program continues to flourish and provide nutrition and education for individuals with I/DD in Schenectady County. Since the program began, participants have harvested approximately 1,000 vegetables. Vegetable packets, along with recipes, were distributed for consumption in group home or family home settings. Last year, this program was named by The National Association of County and City Health Officials (NACCHO) as a model practice and an implementation guide can be found on the U.S. Centers for Disease Control and Prevention website! Also, during The Arc’s National Convention, Schenectady Arc and NACCHO presented together, giving chapters of The Arc the opportunity to learn from the success of this program.