According to current estimates, more than 54 million Americans live with some type of long lasting condition or disability [1]. While these conditions are diverse and some are due to trauma (e.g., spinal cord injury), many are the result of common chronic diseases such as arthritis, heart disease, emphysema, and multiple sclerosis [2]. In an effort to influence the trajectory of functional limitations, disability, and quality of life in persons with chronic disabling conditions, a number of investigators and clinicians have begun to develop and test innovative interventions to promote the health (rather than control the disease or condition) of persons with chronic disabling conditions [3]. Some interventions have focused on a single behavior such as exercise or stress management, while others have taken a more comprehensive "lifestyle" approach [4,5]. As a group, these interventions clearly reflect the philosophical perspective of the International Classification of Functioning, Disability and Health that individuals with chronic and disabling conditions (e.g. multiple sclerosis, spinal cord injury) are fully capable of being healthy and experiencing a good quality of life [6}. The purpose of this study was to review and evaluate existing evidence supporting the use of wellness/health promotion interventions in persons with chronic disabling conditions. Health Promotion within the Context of Chronic Disabling ConditionsIn the U.S. Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities [7], one of the four broad program statements to be achieved is "Persons with disabilities can promote their own good health by developing and maintaining healthy lifestyles" [7, p2]. Health promotion, activities "motivated by the desire to increase well-being and actualize human potential ' [8, p.7], encompasses a number of self-initiated health behaviors and emphasizes the need to enhance each person's responsibility and commitment to a healthy lifestyle. A variety of health promoting behaviors such as physical activity, stress © 2009 Elsevier Inc. All rights reserved. ** Corresponding Author: Alexa Stuifbergen, The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, TX 78701-1499, Phone: 512-232-4764, Fax: 512-475-8755, astuifbergen@mail.utexas.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. It is important to differentiate conceptually between health promotion/wellness interventions and the disease and symptom management interventions for persons with varied chronic conditions commonly described in the literature. Pen...

There is a well-established link between educational attainment and health. Alternative high schools (AHSs) serve students who are at risk for school dropout. Health-related research conducted in AHSs has been sparse. Achieving high participation rates is critical to producing generalizable results and can be challenging in research with adolescents for reasons such as using active consent. These challenges become greater when working with vulnerable populations of adolescents. In this systematic review, we examined health-related studies conducted in AHSs between 2010 and 2015. Results indicated that (1) health-related research in AHSs has increased over the past 5 years, (2) AHS students continue to experience significant disparities, (3) active consent is commonly used with AHS students, (4) 42% of studies reported participation rates or provided enough information to calculate participation rates, and (5) school nurses are missing from health-related research conducted in AHSs. Implications for future research and school nursing are discussed.Keywords integrative reviews, high school, alcohol/tobacco/drug use prevention, exercise, mental health, nutrition Each day in the United States, over 2,300 students drop out of high school and over 18,000 are suspended (Children's Defense Fund, 2008;Smaller, 2012). School dropout is increasingly recognized as an important public health issue owing to the link between educational attainment and health (Freudenberg & Ruglis, 2007). Rigorous research documenting disparities and impacts of interventions can play a crucial role in monitoring and addressing health disparities among young people. Alternative high schools (AHSs) frequently serve students who are at risk for dropping out of school. The same factors that place AHS students at risk for school dropout (e.g., adverse childhood experiences and homelessness) also increase their risk for poor mental health outcomes and involvement in health-risk behaviors such as substance use and high-risk sex. Yet the AHS setting has typically been underutilized for health-related research and presents unique challenges to producing rigorous and generalizable results. For example, AHS students are a highly mobile population and have high rates of chronic truancy; this instability can present challenges to obtaining active parental consent for participation in research and determining accurate participation rates. In this article, we present an updated systematic literature review of health-related studies conducted in the AHS setting between May 2010 and June 2015 (the last systematic review covered literature published between 1997 and April 2010; Johnson & Taliaferro, 2012). In addition, we take this review one step further by exploring important methodological issues that may impact the quality and generalizability of research conducted with AHS students. These issues include consent procedures used by researchers (i.e., active vs. passive) and reporting practices for consent rates and participation rates.

Alternative high school (AHS) students are at-risk for school dropout and engage in high levels of health-risk behaviors that should be monitored over time. They are excluded from most public health surveillance efforts (e.g., Youth Risk Behavior Survey; YRBS), hindering our ability to monitor health disparities and allocate scarce resources to the areas of greatest need. Using active parental consent, we recruited 515 students from 14 AHSs in Texas to take a modified YRBS. We calculated three different participation rates, tracked participation by age of legal consent (≥18 and <18 years), and identified other considerations for obtaining quality data. Being required to use active consent resulted in a much lower cooperation rate among students <18 years (32%) versus those who were ≥18 years and could provide their own consent (57%). Because chronic truancy is prevalent in AHS students, cooperation rates may be more accurate than participation rates based off of enrollment or attendance. Requiring active consent and not having accurate participation rates may result in surveillance data that are of disparate quality. This threatens to mask the needs of AHS students and perpetuate disparities because we are likely missing the highest-risk students within a high-risk sample and cannot generalize findings.

Background Multiple sclerosis (MS) is a debilitating, progressive disease with no known cure. Symptoms vary widely for persons with MS and measuring levels of fine motor, gross motor and cognitive function is a large part of assessing disease progression in both clinical and research settings. While self-report measures of function have advantages in cost and ease of administration, questions remain about the accuracy of such measures and the relationship of self-reports of functioning to performance measures of function. Objective The purpose of this study was to compare scores on a self-report measure of functional limitations with MS with a performance-based measure at five different time points. Methods Sixty participants in an ongoing longitudinal study completed two measures of function annually over a five-year period - the self-report Incapacity Status Scale and the MS Functional Composite (MSFC), a performance test. Pearson correlations were used to explore the association of self-report and performance scores. Results There were moderate to strong correlations among the ISS total (r= −.53 to −.63, p<.01) and subscale scores of gross (r=.79 to .87; p<.01)) and fine (r= .47 to .69; p<.01) motor function and the corresponding MSFC performance measure. The pattern of change over time in most scores on self-report and performance measures was similar. Conclusion Findings suggest that the self-report measure examined here, which has advantages in terms of feasibility of administration and patient burden, does relate to performance measurement, particularly in the area of gross motor function, but it may not adequately reflect cognitive function.

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