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Neuroblastoma is a common pediatric cancer, where preclinical studies have suggested chemotherapy resistance is driven by a mesenchymal-like gene expression program. However, the poor clinical outcomes imply we need a better understanding of the relationship between patient tumors and preclinical models. Here, we generated single-cell RNA-seq maps of neuroblastoma cell lines, patient-derived xenograft models (PDX), and a genetically engineered mouse model (GEMM). We developed an unsupervised machine learning approach to compare the gene expression programs found in preclinical models to a large cohort of human neuroblastoma tumors. The dominant adrenergic programs were well preserved in preclinical models, but contrary to previous reports do not unambiguously map to an obvious cell of origin. The mesenchymal-like program was less clearly preserved, and primarily restricted to cancer-associated fibroblasts and Schwann-like cellsin vivo. Surprisingly however, we identified a subtle, weakly expressed, mesenchymal-like program in otherwise adrenergic cancer cells in some high-risk tumors. This program appears distinct from mesenchymal cell lines but was maintained in PDX and a similar program could be chemotherapy-induced in our GEMM after only 24 hours, suggesting an uncharacterized therapy-escape mechanism. Collectively, our findings advance the understanding of neuroblastoma heterogeneity and can inform the development of new treatments.

OBJECTIVE To assess the association between the change in statewide smoke-free laws and the rate of preterm or low birth weight delivery hospitalizations. DATA SOURCE 2002-2013 Healthcare Cost and Utilization Project State Inpatient Databases. STUDY DESIGN Quasi-experimental difference-in-differences design. We used multivariate logistic models to estimate the association between the change in state smoke-free laws and preterm or low birth weight delivery hospitalizations. The analyses were also stratified by maternal race/ethnicity to examine the differential effects by racial/ethnic groups. DATA COLLECTION/EXTRACTION METHODS Delivery hospitalizations among women aged 15-49 years were extracted using the International Classification of Diseases, Ninth Revision, and Diagnosis-Related Group codes. PRINCIPAL FINDINGS Non-Hispanic black mothers had a higher rate of preterm or low birth weight delivery hospitalization than other racial/ethnic groups. Overall, there was no association between the change in smoke-free laws and preterm or low birth weight delivery rate. Among non-Hispanic black mothers, the change in statewide smoke-free laws was associated with a 0.9-1.9 percentage point (P

Introduction Youth cigarette smoking decreased significantly over the last two decades in the United States. This study provides estimates and trends from 2011 to 2018 and factors associated with youth menthol and non-menthol smoking from 2016 to 2018. Methods Using data from the 2011–2018 National Youth Tobacco Surveys, past 30-day (current) menthol and non-menthol cigarette smoking were estimated for all youth (prevalence) and youth smokers (proportions). Trends were examined using Joinpoint regression, calculating the annual percent change (APC). Multivariate logistic regression analyses identified factors associated with menthol smoking. Results From 2011 to 2018, menthol cigarette smoking among current youth cigarette smokers significantly decreased from 57.3% to 45.7% (APC: −3.0%), while non-menthol (38.2% to 47.3% [APC: 2.9%]) and unknown menthol status (not sure\missing) (4.5% to 7.0% [APC: 7.1%]) significantly increased. Menthol cigarette smoking among high school, male, female, and non-Hispanic white current cigarette smokers decreased, but remained unchanged among middle school, non-Hispanic black, and Hispanic smokers. Significantly higher proportions of menthol cigarette smokers smoked on ≥20 days, ≥2 cigarettes per day, and ≥100 cigarettes in their lifetime compared to non-menthol smokers. Among current cigarette smokers, non-Hispanic blacks, Hispanics, flavored non-cigarette tobacco users, frequent smokers (≥20 days), those smoking 2–5 cigarettes per day, and those living with someone who uses tobacco had higher odds of menthol cigarette smoking. Conclusions In 2018, nearly half of current youth cigarette smokers smoked menthol cigarettes. While menthol cigarette smoking declined from 2011 to 2018 among all youth and among youth smokers, there was no change in menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school cigarette smokers. Implications This study finds that overall cigarette and menthol cigarette smoking declined in youth from 2011 to 2018. However, menthol cigarette smoking among non-Hispanic black, Hispanic, and middle school youth cigarette smokers did not change. Information from this study can help inform efforts to reduce menthol cigarette smoking among US youth, particularly racial/ethnic minority populations.

BACKGROUND: Cigarette smoking is the leading cause of preventable disease and death in the United States. The tobacco product landscape has diversified to include electronic cigarettes (e-cigarettes). Adults with disabilities are more likely than adults without disabilities to smoke cigarettes, but within the current body of literature, there is limited information on the use of e-cigarettes among adults with disabilities. OBJECTIVE: To assess overall and state-specific prevalence of current e-cigarette use among adults by disability status, disability type, sex, and age. METHODS: Disability was defined as having serious difficulty with vision, hearing, mobility, cognition, or any difficulty with self-care or independent living. The Behavioral Risk Factor Surveillance System cross-sectional survey data (2016–2018; n = 1,150,775) were used to estimate state and District of Columbia prevalence of current e-cigarette use among adults (aged ≥18 years) with and without disabilities, overall and by disability type, sex, and age group. RESULTS: Median prevalence of current e-cigarette use was higher among adults with than without disabilities (6.5% vs. 4.3%, P < 0.05). Among adults with disabilities, use varied from 2.5% in DC to 10.0% in Colorado; median use was highest among those with cognitive disabilities (10.0%) and those aged 18–24 years (18.7%). CONCLUSIONS: Prevalence of current e-cigarette use was higher among adults with than without disabilities and varied across states by disability status, type, and age group. The findings underscore the need to monitor e-cigarette use among adults with disabilities and specifically include them in tobacco control policies and programs addressing e-cigarette use.

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.

This paper presents the design and development of a two fingered, monolithically designed compliant gripper mounted on a two-link robot. Rigid grippers traditionally designed by rigid links and joints might have low precision due to friction and backlash. The proposed gripper is designed as a single piece compliant mechanism consisted of several flexible links and actuated by wire through a servo motor. The gripper is attached to a two-link arm robot driven by three step motors. An additional servo motor can also rotate the base of the robot. While the robot is 3D printed using polylactic acid (PLA), the gripper is 3D printed in thermoplasticpolyurethane (TPU). Two force sensors are attached to the right and left ends of the gripper to measure grasping force. Experimental testing for grasping various objects having different sizes, shapes and weights is carried out to verify the robust performance of the proposed design. Through the experimentation, it’s been noted that the compliant gripper can successfully lift up objects at a maximum mass of 200 g and have a better performance if the objects’width is closer to the width of the gripper. The presented mechanism can be utilized as a service robot for elderly people to assist them pick and place objects or lift objects if equipped with necessary sensors.

BACKGROUND: Short sleep duration is associated with an increased risk of chronic disease and all-cause death. A better understanding of sleep disparities between people with and without disabilities can help inform interventions designed to improve sleep duration among people with disabilities. OBJECTIVE: To examine population-based prevalence estimates of short sleep duration by disability status and disability type among noninstitutionalized adults aged ≥18 years. METHODS: Data from the 2016 Behavioral Risk Factor Surveillance System were used to assess prevalence of short sleep duration among adults without and with disabilities (serious difficulty with cognition, hearing, mobility, or vision; any difficulty with self-care or independent living). Short sleep duration was defined as

Background: Approximately 30% of children worldwide are infected with gastrointestinal parasites. Depending on the species, parasites can disrupt intestinal bacterial microbiota affecting essential vitamin biosynthesis. Methods: Stool samples were collected from 37 asymptomatic children from a previous cross-sectional Argentinian study. A multi-parallel real-time quantitative PCR was implemented for Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica and Giardia duodenalis. In addition, whole-genome sequencing analysis was conducted for bacterial microbiota on all samples and analyzed using Livermore Metagenomic Analysis Toolkit and DIAMOND software. Separate analyses were carried out for uninfected, Giardia-only, Giardia + helminth co-infections, and helminth-only groups. Results: For Giardia-only infected children compared to uninfected children, DNA sequencing data showed a decrease in microbiota biodiversity that correlated with increasing Giardia burden and was statistically significant using Shannon's alpha diversity (Giardia-only > 1 fg/μl 2.346; non-infected group 3.253, P = 0.0317). An increase in diversity was observed for helminth-only infections with a decrease in diversity for Giardia + helminth co-infections (P = 0.00178). In Giardia-only infections, microbiome taxonomy changed from Firmicutes towards increasing proportions of Prevotella, with the degree of change related to the intensity of infection compared to uninfected (P = 0.0317). The abundance of Prevotella bacteria was decreased in the helminths-only group but increased for Giardia + helminth co-infections (P = 0.0262). Metagenomic analysis determined cobalamin synthesis was decreased in the Giardia > 1 fg/μl group compared to both the Giardia < 1 fg/μl and the uninfected group (P = 0.0369). Giardia + helminth group also had a decrease in cobalamin CbiM genes from helminth-only infections (P = 0.000754). Conclusion: The study results may provide evidence for an effect of parasitic infections enabling the permissive growth of anaerobic bacteria such as Prevotella, suggesting an altered capacity of vitamin B12 (cobalamin) biosynthesis and potential impact on growth and development in children. Fil: Mejia, Rojelio. Baylor College of Medicine; Estados Unidos. Universidad Nacional de Salta; Argentina Fil: Damania, Ashish. Baylor College of Medicine; Estados Unidos Fil: Jeun, Rebecca. Baylor College of Medicine; Estados Unidos Fil: Bryan, Patricia E.. Baylor College of Medicine; Estados Unidos Fil: Vargas, Paola. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Juarez, Marisa del Valle. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Cajal, Silvana Pamela. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Nasser, Julio Rubén. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina Fil: Krolewiecki, Alejandro Javier. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina Fil: Lefoulon, Emilie. New England Biolabs; Estados Unidos Fil: Long, Courtney. New England Biolabs; Estados Unidos Fil: Drake, Evan. New England Biolabs; Estados Unidos Fil: Cimino, Rubén Oscar. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina Fil: Slatko, Barton. New England Biolabs; Estados Unidos

Background: Approximately 30% of children worldwide are infected with gastrointestinal parasites. Depending on the species, parasites can disrupt intestinal bacterial flora affecting nutritional status. We implemented a multi-parallel quantitative real-time PCR and whole-genome sequencing analysis for bacterial microbiota and Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium species, Entamoeba histolytica, and Giardia lamblia. Stool samples were collected from 37 asymptomatic children from rural Argentina. We focused this study on Giardia screening. Separate analyses were done for uninfected, Giardia only, Giardia/helminth coinfections, and helminth only groups.Results: For Giardia only infected children, DNA sequencing data showed a decrease in microbiota biodiversity compared to those uninfected that correlated with increasing Giardia burden. Clustering was statistically significant using Shannon alpha diversity. A non-significant increase in diversity was observed for helminth only infections with a compensatory decrease in Giardia/helminth coinfections. In Giardia only infections, microbiome taxonomy shifted from Firmicutes towards increasing proportions of Prevotella, with the degree of shift related to the intensity of infection compared to uninfected. An abundance of Prevotella bacteria was decreased in the helminths only group but increased for Giardia/helminth coinfections. Metagenomic analysis of the bacterial microbiota showed that the proportion of non-vitamin B12 producing bacteria (Prevotella) was higher in the Giardia group. Total cobalamin synthesis was decreased in the Giardia-infected only group compared to the control and helminth-infected group. Conclusion: Our data provide evidence for an effect of parasitic infections allowing permissive growth of anaerobic bacteria such as Prevotella, suggesting an altered capacity of vitamin B12 biosynthesis and potential impact on growth and development in children.

OBJECTIVE: To assess patterns of contraceptive use at last intercourse among women with physical or cognitive disabilities compared to women without disabilities. STUDY DESIGN: We analyzed responses to 12 reproductive health questions added by seven states to their 2013 Behavioral Risk Factor Surveillance System questionnaire. Using responses from female respondents 18–50 years of age, we performed multinomial regression to calculate estimates of contraceptive use among women at risk for unintended pregnancy by disability status and type, adjusted for age, race/ethnicity, marital status, education, health insurance status, and parity. RESULTS: Women with disabilities had similar rates of sexual activity as women without disabilities (90.0% vs. 90.6%, p=.76). Of 5995 reproductive-aged women at risk for unintended pregnancy, 1025 (17.1%) reported one or more disabilities. Contraceptive use at last intercourse was reported by 744 (70.1%) of women with disabilities compared with 3805 (74.3%) of those without disabilities (p=.22). Among women using contraception, women with disabilities used male or female permanent contraception more often than women without disabilities (333 [29.6%] versus 1337 [23.1%], p

Each year in the United States, about 4000 deaths are attributed to cervical cancer, and over 40,000 deaths are attributed to breast cancer (U.S. Cancer Statistics Working Group, 2015). The purpose of this study was to identify predictors of full, partial, and no screening for breast and cervical cancer among women with and without intellectual disability (ID) who are within the age group for screening recommended by the U.S. Preventive Service Task Force (USPSTF), while accounting for changes in recommendations over the study period. Women with ID and an age matched comparison group of women without ID were identified using merged South Carolina Medicaid and Medicare files from 2000 to 2010. The sample consisted of 9406 and 16,806 women for mammography screening and Papanicolaou (Pap) testing adherence, respectively. We estimated multinomial logistic regression models and determined that women with ID were significantly less likely than women without ID to be fully adherent compared to no screening with mammography recommendations (adjusted odds ratio [AOR]: 0.63, 95% confidence interval [CI] 0.55–0.72), and Pap testing recommendations (AOR: 0.17, 95% CI 0.16–0.19). For the 70% of women with ID for whom we had residential information, those who lived in a group home, medical facility, or supervised community living setting were more likely to be fully adherent with both preventive services than those living alone or with family members. For both outcomes, women residing in a supervised nonmedical community living setting had the highest odds of full adherence, adjusting for other covariates.

Adults with intellectual and developmental disabilities (IDD) are known to experience significant health disparities; however, few studies have described anti-hypertensive medication adherence in this population. Using administrative data from South Carolina from 2000–2014, we evaluated the odds of adherence to anti-hypertensive medication among a cohort of adults with IDD and hypertension. Approximately half (49.5%) of the study cohort were adherent to anti-hypertensive medication. Those who lived in a supervised residence, had a Medicaid waiver, and had more frequent contact with a primary care provider were more likely to be adherent. Organizations that serve people with IDD have an opportunity to increase adherence by educating these individuals, their family members, and caregivers about the importance of adherence to anti-hypertensive medication.

Rotaviruses (RVs) are medically significant gastrointestinal pathogens and are a leading cause of childhood mortality in many countries. The RV RNA-dependent RNA polymerase, VP1, synthesizes RNA during viral replication only in the presence of another RV protein, VP2, which comprises the innermost core shell layer of the virion. Though these VP1-VP2 interactions are essential for RV replication, the mechanism by which the core shell regulates polymerase activity remains incompletely understood. Here, we sought to identify and characterize specific regions of both VP1 and VP2 that are required for core shell dependent polymerase activity. First, we used bioinformatics approaches to analyze VP1 and VP2 sequence diversity across many RV strains and identify positional locations of critical amino acid changes within the context of known structural domains and motifs. We next tested how the identified sequence differences influenced VP2-dependent VP1 activity in vitro. These data revealed that VP1 and VP2 protein diversity correlates with functional differences between avian and mammalian RV strains. Then, we used these sequential and functional incompatibilities to map key regions of VP1 important for mediating RNA synthesis. To pinpoint critical interacting regions of VP1 and VP2, we used site directed mutagenesis to engineer several modified VP1 and VP2 proteins. Then, we employed an in vitro RNA synthesis assay to test how the introduced mutations influenced VP2-dependent VP1 activity. Altogether, our results revealed several functionally important VP1 residues critical for in vitro VP2-dependent VP1 activity, either individually or in combination with neighboring residues, including E265/L267, R614, and D971/S978/I980. Structural analyses show VP2 interactions at these surface-exposed VP1 sites, which altogether supports a direct contact model of core shell dependent RV polymerase activity. Moreover, recombinant VP1 proteins containing multiple mutations at buried residues were incapable of facilitating RNA synthesis in vitro under the assay conditions, indicating that an extensive intramolecular signaling network exists to mediate VP1 activity. Taken together, these results suggest that VP2 binding at the VP1 surface may induce intramolecular interactions critical for VP1 activity. Overall, results from these studies provide important insight into VP1-VP2 binding interface(s) that are necessary for RV replication. Ph. D. Rotaviruses (RVs) are clinically-significant gastrointestinal pathogens that cause severe diarrhea and dehydration in children. RVs encode a specialized polymerase enzyme, called VP1, which functions to synthesize RNA during viral replication. RNA synthesis activities of VP1 are tightly regulated by another RV protein, VP2, which comprises the innermost core shell layer of the virion. Though these VP1-VP2 interactions are essential for viral replication, the mechanism by which the core shell supports polymerase activity remains poorly understood. Here, we sought to identify and characterize specific regions of both VP1 and VP2 that are essential for polymerase activity in a test tube (i.e., in vitro). First, we analyzed VP1 and VP2 sequence diversity across many RV strains. Then, we tested how the identified sequence differences influenced VP2-dependent VP1 activation in vitro. To pinpoint critical regions of VP1 and VP2, we next engineered and assayed several mutant proteins. Altogether, our results revealed several functionally important residues of VP1 and VP2, which raises new ideas about VP1-VP2 binding interface(s) that are important for viral replication. Moreover, results from these studies may provide a scientific platform for the rational design of next-generation RV vaccines or antiviral therapeutics.

Background The Physical Activity Guidelines for Americans, second edition, recommend that all adults participate in moderate-intensity equivalent aerobic physical activity at least 150–300 min/week for substantial health benefits and muscle-strengthening activities involving all major muscle groups 2 or more days a week. The prevalence of the general population meeting the Guidelines and the types of physical activity in which they engage have been described elsewhere. Similar descriptions are lacking for individuals with mobility disability whose physical activity profiles may differ from the general population. Objective This study examined patterns of aerobic and muscle-strengthening physical activity among US adults with mobility disability. Methods We used 2017 Behavioral Risk Factor Surveillance System data from 66,635 adults with mobility disability. We estimated the percentage who engaged in any aerobic physical activity, met the aerobic and/or muscle-strengthening guidelines, and who participated in specific activities. Results Less than half (45.2%) of US adults with mobility disability reported engaging in aerobic physical activity, and 39.5% met one or both components of the physical activity guidelines. Walking was the most commonly reported activity type (34.0%). Conclusions Walking is a common activity type among adults with mobility disability. Efforts to make walking or wheelchair rolling a safe, viable option are important to helping decrease barriers that may limit the ability of those with mobility disability to engage in walking or other physical activity types.

Background Quantifying the number of people with and types of disabilities is helpful for medical, policy, and public health planning. Objective/Hypothesis: To update prior estimates on types, prevalence, and main causes of disability among U.S. adults using the Survey of Income and Program Participation (SIPP) data. Methods We used cross-sectional data from the SIPP 2008 Panel Wave 6 interviews collected May–August 2010. Analyses were restricted to non-institutionalized adults ages ≥18 years (n = 66,410). Disability was ascertained via five non-mutually exclusive components: 1) specific activity difficulties, 2) selected impairments, 3) use of an assistive aid, 4) household work limitations, and 5) paid work limitations. Prioritized main cause of disability was established for the 95% of respondents with a disability type eligible for health condition questions. We generated weighted population estimates (number and percentage, with 95% confidence intervals (CIs)), accounting for the complex sample survey design. Results 50 million U.S. adults (21.8%) experienced a disability in 2010. Mobility-related activity limitations were the most prevalent disabilities across all five components. The most common main causes of disability were arthritis/rheumatism, 9.1 million (19.2%, 95% CI = 18.4–20.0) and back or spine problems, 8.9 million (18.6%, 95% CI = 17.9–19.3). Conclusions A growing population with disabilities has the potential to put considerable and unsustainable demand on medical, public health, and senior service systems. Strengthening clinical community linkages and expanding the availability of existing evidence-based public health interventions to prevent, delay, and mitigate the effects of disability could improve health and outcomes for people with disabilities.

Prevalence of health behaviors among adults with disabilities may vary by disability measure. We used data from the 2011-2015 National Health Interview Survey to estimate prevalence of physical inactivity by disability status using 2 measures of disability: Basic Actions Difficulty questions (BADQ) and a standard 6-question measure (6Q). Disability prevalence (BADQ, 31.1%; 6Q, 17.5%) and inactivity prevalence among adults with disability (BADQ, 42.9%; 6Q, 52.5%) and without disability (BADQ, 24.3%; 6Q, 26.2%) varied by measure; however, both measures highlight inactivity disparities for adults with disability. Disability measures influence physical inactivity estimates and are important for guiding surveillance and health promotion activities for adults with disabilities.

Objective To describe the percentage of US public health schools and programs offering graduate-level courses with disability content as a potential baseline measurement for Healthy People 2020 objective DH-3 and compare the percentage of public health schools that offered disability coursework in 1999 with those in 2011. Design In 2011, using SurveyMonkey.com, cross-sectional information was collected from the deans, associate deans, directors, or chairpersons of master of public health-granting public health schools and programs that were accredited and listed with the Council on Education for Public Health. Two rounds of follow-up were conducted at 4-month intervals by e-mails and phone calls to program contacts who had not responded. The responses from schools and programs were calculated and compared. Results There were 78 responses (34 schools and 44 programs) for a response rate of 63%. Fifty percent of public health schools and programs offered some disability content within their graduate-level courses. A greater percentage of schools than programs (71% vs 34%; P = .003) offered some graduate-level disability coursework within their curricula. The percentage of schools that offered disability coursework was similar in 1999 and 2011. Conclusion This assessment provides a potential baseline measurement for Healthy People 2020 objective DH-3. Future assessments should focus on clarifying disability content within courses and identifying capacity to offering disability training within public health schools and programs.

Understanding the prevalence of disability is important for public health programs to be able to address the needs of persons with disabilities. Beginning in 2013, to measure disability prevalence by functional type, the Behavioral Risk Factor Surveillance System (BRFSS), added five questions to identify disability in vision, cognition, mobility, self-care, and independent living. CDC analyzed data from the 2013 BRFSS to assess overall prevalence of any disability, as well as specific types of disability among noninstitutionalized U.S. adults. Across all states, disabilities in mobility and cognition were the most frequently reported types. State-level prevalence of each disability type ranged from 2.7% to 8.1% (vision); 6.9% to 16.8% (cognition); 8.5% to 20.7% (mobility); 1.9% to 6.2% (self-care) and 4.2% to 10.8% (independent living). A higher prevalence of any disability was generally seen among adults living in states in the South and among women (24.4%) compared with men (19.8%). Prevalences of any disability and disability in mobility were higher among older age groups. These are the first data on functional disability types available in a state-based health survey. This information can help public health programs identify the prevalence of and demographic characteristics associated with different disability types among U.S. adults and better target appropriate interventions to reduce health disparities.

INTRODUCTION Adults with disabilities are more likely to be physically inactive than those without disabilities. Although receiving a health care provider recommendation is associated with physical activity participation in this population, there is little information on factors associated with primary care providers recommending physical activity to patients with disabilities. METHODS We used 2014 DocStyles data to assess primary care provider characteristics and perceived barriers to and knowledge-related factors of recommending physical activity to adult patients with disabilities, by how prepared primary care providers felt in making recommendations. We used log-binomial regression to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) between recommending physical activity at most visits and primary care provider characteristics and preparedness. RESULTS Most primary care providers strongly (36.3%) or somewhat (43.3%) agreed they felt prepared to recommend physical activity to patients with disabilities. We found significant trends between preparedness and primary care provider age (P = .001) and number of patients with disabilities seen per week (P < .001). Half (50.6%) of primary care providers recommend physical activity to patients with disabilities at most visits. Primary care providers who strongly agreed (adjusted PR, 1.74; 95% CI, 1.44-2.09) or somewhat agreed (adjusted PR, 1.36; 95% CI, 1.22-1.65) they felt prepared were more likely to recommend physical activity at most visits compared with those who were neutral or disagreed. CONCLUSION Primary care providers are more likely to recommend physical activity to patients with disabilities regularly if they feel prepared. Understanding factors and barriers associated with preparedness can help public health programs develop and disseminate resources for primary care providers to promote physical activity among adults with disabilities.

INTRODUCTION Many studies on cancer screening among adults with disabilities examined disability status only, which masks subgroup differences. We examined prevalence of receipt of cancer screening tests by disability status and type. METHODS We used 2013 National Health Interview Survey data to assess prevalence of 1) guideline-concordant mammography, Papanicolaou (Pap) tests, and endoscopy and stool tests; 2) physicians' recommendations for these tests; and 3) barriers to health-care access among adults with and without disabilities (defined as difficulty with cognition, hearing, vision, or mobility). RESULTS Reported Pap test use ranged from 66.1% (95% confidence interval [CI], 60.3%-71.4%) to 80.2% (95% CI, 72.4%-86.2%) among women with different types of disabilities compared with 81.4% (95% CI, 80.0%-82.7%) among women without disabilities. Prevalence of mammography among women with disabilities was also lower (range, 61.2% [95% CI, 50.5%-71.0%] to 67.5% [95% CI, 62.8%-71.9%]) compared with women without disabilities (72.8% [95% CI, 70.7%-74.9%]). Screening for colorectal cancer was 57.0% among persons without disabilities, and ranged from 48.6% (95% CI, 40.3%-57.0%) among those with vision limitations to 64.6% (95% CI, 58.5%-70.2%) among those with hearing limitations. Receiving recommendations for Pap tests and mammography increased all respondents' likelihood of receiving these tests. The most frequently reported barrier to accessing health care reported by adults with disabilities was difficulty scheduling an appointment. CONCLUSION We observed disparities in receipt of cancer screening among adults with disabilities; however, disparities varied by disability type. Our findings may be used to refine interventions to close gaps in cancer screening among persons with disabilities.

Nearly 40 million persons in the United States have a disability, as defined by responses to six questions recommended by the U.S. Department of Health and Human Services as the national standard for identifying disabilities in population-based health surveys (1). Although these questions have been used to estimate prevalence of functional disabilities overall, as well as types of functional disabilities (disability type), no study has yet investigated the characteristics of U.S. adults by number of disability types. Knowing the characteristics of persons living with multiple disability types is important for understanding the overall functional status of these persons. CDC analyzed data from the family component of the National Health Interview Survey (NHIS) for the years 2011-2014 to estimate the percentage of adults aged 18-64 years with one, two, three, or four or more disability types, by selected demographic and socioeconomic characteristics. Overall, 22.6 million (11.9%) working-age adults were found to have any disability, and in this population, most (12.8 million) persons had only one disability type. A generally consistent pattern between increasing indicators of low socioeconomic status and the number of disability types was observed. Understanding the demographic and socioeconomic characteristics of working-age adults with disabilities, including those with multiple disability types, might help to further the inclusion of persons with disabilities in public health programs and policies.

Objectives. To estimate the prevalence and causes of functional paralysis in the United States. Methods. We used the 2013 US Paralysis Prevalence & Health Disparities Survey to estimate the prevalence of paralysis, its causes, associated sociodemographic characteristics, and health effects among this population. Results. Nearly 5.4 million persons live with paralysis. Most persons with paralysis were younger than 65 years (72.1%), female (51.7%), White (71.4%), high school graduates (64.8%), married or living with a partner (47.4%), and unable to work (41.8%). Stroke is the leading cause of paralysis, affecting 33.7% of the population with paralysis, followed by spinal cord injury (27.3%), multiple sclerosis (18.6%), and cerebral palsy (8.3%). Conclusions. According to the functional definition, persons living with paralysis represent a large segment of the US population, and two thirds of them are between ages 18 and 64 years. Targeted health promotion that uses inclusion strategies to account for functional limitations related to paralysis can be undertaken in partnership with state and local health departments.