RESUMO
BACKGROUND: In California, all four-year public colleges have adopted 100% smoke-/tobacco-free policies (TFP) whereas community colleges (CCs), particularly rural CCs, are less likely to have tobacco-free environments. This raises concerns about health equity, particularly because smoking prevalence is higher in rural areas compared to urban. We examined policy adoption barriers and facilitators for rural California CCs with the aim of providing lessons learned to support TFP adoption by rural CCs and improve conditions for student health and well-being. METHODS: A multiple case study of four CCs in California with (n = 2) and without (n = 2) TFPs was conducted. Semi-structured interviews with 12 campus and community stakeholders, school administrative data, and policy-relevant documents were analyzed at the case level with comparison across cases to identify key barriers, facilitators and campus-specific experiences. RESULTS: All four CCs shared similar barriers to policy adoption including concerns about wildfires, individual rights, and fear of marginalizing people who smoke on campus. These CCs have experienced serious wildfires in the last ten years, have high community smoking prevalence, and fewer school resources for student health. For the two tobacco-free CCs, long-term wildfire mitigation efforts along with leadership support, campus/community partnerships and a collective approach involving diverse campus sectors were essential facilitators in successful TFP adoption. CONCLUSION: Study results underscore contextual pressures and campus dynamics that impact tobacco control efforts at colleges in rural communities. Strategies to advance college TFP adoption and implementation should recognize rural cultural and community priorities.
RESUMO
BACKGROUND: Studies of mental health care received by persons with disabilities who make up a significant group of the U.S. population are limited. OBJECTIVE: This cross-sectional study examined the relationship between disability and non-receipt of past year visits to a mental health professional among individuals with moderate to severe psychological distress. METHODS: Study participants included a nationally representative sample of 5,566 people with moderate to severe psychological distress, extracted from 2011 to 2013 Integrated Health Interview using the 6-item Kessler Psychological Distress Scale. Self-reported disability domains included vision, hearing, mobility, upper body self-care difficulty, learning difficulty, communication difficulty, and cognition difficulty. RESULTS: Sixty-four percent of participants reported a disability. Logistic regression analyses showed that (adjusting for nativity, other mental health conditions, and chronic pain) people aged 18-64 years old with disabilities have significantly lower odds (OR = 0.52, p < 0.001) of unmet mental health care services than people without disabilities. However, foreign-born respondents have significantly higher odds (OR = 2.91; p < 0.001) of unmet mental health care services than U.S. born Americans. After controlling for gender, other mental health conditions and chronic pain, people aged 65 and above with disabilities have higher non-significant odds (OR = 1.34, p = 0.361) of unmet mental health care services than people without disabilities. Additionally, females have significantly higher odds (OR = 1.63, p = 0.039) than males. CONCLUSIONS: Findings indicate the importance of identifying demographic characteristics associated with an increased risk for psychological distress and increased unmet mental health care services among people with and without disabilities.
