Substance Misuse among Sexual and Gender Minorities: The Role of Everyday Discrimination and Identity.

BACKGROUND: Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity. METHODS: Data from 1316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation. RESULTS: In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions was significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities. CONCLUSIONS: Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship between SGM identity and substance. Substance use disorder treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance.

Occupational Injustice and the Right to Play: A Systematic Review of Accessible Playgrounds for Children With Disabilities.

IMPORTANCE: Playgrounds facilitate important opportunities for growth and development during childhood. Despite accessibility regulations, these experiences are not afforded to children with disabilities as a result of environmental and societal barriers. OBJECTIVE: To identify and synthesize existing research on the relationship between key areas of development and accessible play settings for children with disabilities to inform evidence-based interventions and advocacy work. DATA SOURCES: The following databases were searched on January 30, 2021: Academic Search Complete/EBSCO, CINAHL/EBSCO, Education Research Complete/EBSCO, ERIC, OTseeker, and PubMed. STUDY SELECTION AND DATA COLLECTION: This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were peer-reviewed, included children with disabilities ages 3 to 12 in an accessible play setting, and had outcomes related to areas of childhood development. Validated tools were used to determine risk of bias and quality of evidence. FINDINGS: Nine articles met inclusion criteria: 1 Level 3b matched case-control study, 4 Level 4 cross-sectional studies, 3 Level 5 qualitative studies, and 1 mixed-methods study with Levels 4 and 5 evidence. Eight of 9 studies reported that social participation, play participation, and motor skills development were negatively affected despite playgrounds being labeled accessible. CONCLUSIONS AND RELEVANCE: Children with disabilities have decreased engagement in activities that provide opportunities for play, social participation, and motor skills development. Practitioners should address occupational injustice in the playground setting by engaging in program development, policy, and playground design to reduce stigma and increase accessibility. What This Article Adds: By addressing play accessibility, occupational therapy practitioners could significantly reduce instances of play inequity. Creating interdisciplinary teams to address accessible playground design locally would allow occupational therapy practitioners the opportunity to make a lasting impact for the children in their community.

Cancer-work management during active treatment: towards a conceptual framework.

PURPOSE: Forward progress in cancer treatment has resulted in fewer adverse consequences of cancer during and after treatment, offering employed cancer patients the possibility of continuing to work during treatment, returning to work after treatment, or implementing a combination of strategies to manage the cancer-work interface. Yet, much of the research on cancer and employment examines return to work as the primary outcome, neglecting to consider the circumstances of survivors who maintain employment while engaged in active treatment. We introduce the Cancer-Work Management Framework (CWMF), a conceptual framework for understanding the cancer and job demands survivors who continue to work during active treatment experience and how cancer and job resources and strategies could promote cancer-work fit and ultimately optimize employment and health outcomes. METHODS: We provide an overview of the research describing the cancer-work management experiences of survivors who maintain employment during active treatment and summarize the theories that informed the CWMF including ecological systems, boundary-spanning, and job demands and resources theories. RESULTS: The paper presents a description of the components of the CWMF which include cancer demands, cancer care resources and strategies, work demands, and workplace resources. We also describe a process-cancer-work fit-that reflects the interplay between demands and resources influence employment and health outcomes. CONCLUSIONS: Future research directions for developing knowledge about the cancer-work management process are proposed with suggestions for study of how cancer and job demands influence cancer treatment and employment decisions.

Analysis of Thoroughbred horse farm workers' compensation insurance claims in Kentucky: Injury frequency, cost, lost time, and associated occupational factors.

BACKGROUND: Thoroughbred horse farm workers self-report a high frequency of work-related injuries and pain. However, an analysis of Thoroughbred horse farm workers' compensation injury claims is absent from the literature, yet may benefit worker safety. METHODS: We analyzed workers' compensation insurance firm data containing 2276 claims filed between 2008 and 2015. Injury frequency, cost, and lost time per cause, nature, and body part injured were examined qualitatively and via univariate tests. Factors associated with high cost and high duration lost time claims were modeled via multivariable logistic regression. RESULTS: The average Thoroughbred worker claim cost $4,198 and accrued 10 days lost time, involving strikes (57% of total claims), sprains/strains (34%), and wrist/hand injuries (18%). Injuries primarily occurred on mornings (54%), weekdays (79%), and during the transition from breeding to sales (23%). Jobs with a high level of horse contact had significantly higher cost ($6,487) and higher duration lost time (16.8 days) claims, with significantly higher cost claims on the weekends ($6,471) and from the oldest workers ($7466), vs reference groups. Logistic models indicate significantly increased odds of a high-cost injury among high horse contact jobs (OR = 1.87; 95% C.I. = 1.53-2.29) and older age tertiles (1.38; 1.08-1.75; 1.70, 1.32-2.18). The odds of a high duration lost time injury are significantly increased among high horse contact jobs (1.91; 1.53-2.39) and males (1.50, 1.13-1.98), with significantly reduced odds among the most tenured workers (0.74; 0.56-0.99). CONCLUSIONS: Our findings elucidate factors to reduce injury frequency, cost, and lost time among Thoroughbred horse farm workers.

Working under conditions of social vulnerability: Depression among Latina/o immigrant horse workers.

OBJECTIVES: The American agricultural industry is heavily reliant on Latina/o workers, yet there is scant understanding regarding the mental health of this population. This gap in the literature is glaring as Latina/o farmworkers are a highly vulnerable group who experience high rates of occupational risks and health hazards. This study is the first, to our knowledge, to examine individual, social and work-related correlates of depression among Latina/o horse workers. METHOD: A community survey (N = 225) administered by lay health workers was implemented with Latina/o horse workers who were employed in thoroughbred horse farms in Kentucky. Study participants were on average 35 years old (9.6), largely male (85.8%), married (67.6%), dominant Spanish speakers (95.1%), born in Mexico (84.4%), made a modal average hourly wage of $10.24, and had spent an average of 14.5 years in the United States. Hierarchical regression analysis was conducted to examine the association between (a) individual and social factors and (b) work factors with depression. RESULTS: Women (ß = .13, p < .04), and those who reported higher job insecurity (ß = .23, p < .001) and number of days missed due to injury (ß = .20, p < .05) were more likely to report higher depressive symptoms. Work discrimination due to race/ethnicity (ß = .26, p < .001) was distinctly associated to depressive symptoms. CONCLUSIONS: Work-related discrimination was uniquely associated with depressive symptoms independent of the effects of occupational risks and stressors. This may be particularly salient in a rising anti-immigrant national context. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Patient-Provider Communication: Experiences of Low-Wage-Earning Breast Cancer Survivors in Managing Cancer and Work.

In 2017, there will be more than 250,000 new diagnoses of invasive breast cancer; most cases will occur in working-age women. The goal of this qualitative study was to explore low-wage-earning breast cancer survivors' experiences communicating with their oncology team about cancer and employment issues. Twenty-four low-wage-earning breast cancer survivors in the USA were interviewed in 2012 using a structured interview protocol. Sociodemographic data, cancer history, and patient-provider communication experiences regarding the management of cancer and work were collected. Interviews were analyzed using grounded theory strategy of constant comparative analysis. Low-wage-earning breast cancer survivors' experiences communicating with their oncology team about employment and cancer focused on three dimensions of patient-provider communication: extent, quality, and content. Over 70% of respondents reported no communication or only routine communication with their providers regarding work; three quarters of women reported poor or standard communication quality, and content of work-related communication covered scheduling issues, work absences, continuing to work during treatment, and financial concerns. Communication between oncology care teams and low-wage-earning cancer patients is critical to the successful management of treatment and work responsibilities given the vulnerable employment situation of these women. There is a need for education of oncology team members about how cancer and its treatment can impact employment for all workers, but especially for low-wage workers, thereby allowing the care team to address these issues proactively and help patients successfully manage both cancer treatment and work responsibilities.

Managing cancer and employment: Decisions and strategies used by breast cancer survivors employed in low-wage jobs.

Advances in breast cancer screening and treatment have led to an overall 5-year survival rate of 90%. Many of these cancer cases are diagnosed in working women. Few studies have explicitly examined the cancer-work interface, as experienced by low-wage earning women with breast cancer. This study uses in-depth, semistructured interviews with 24 low-wage breast cancer survivors to identify employment decisions and factors that influenced or enabled these decisions, and examine the individual strategies and workplace supports used to manage the cancer-work interface among a subset of women (n = 13) who continued to work. Future research areas and clinical implications are discussed.

Cancer and Employment Issues: Perspectives from Cancer Patient Navigators.

Among individuals diagnosed with cancer, 40 % are working-age adults who will face numerous challenges in returning to work, yet oncology providers report limited guidance and uncoordinated communication processes in addressing patients' work-related issues. Cancer patient navigators are uniquely positioned to fill this care and communication gap due to their focus on both practical matters and clinical care. This cross-sectional study utilized survey methodology to collect quantitative and qualitative data from 58 cancer patient navigators to (1) identify patients' cancer and employment issues that commonly challenge navigators and (2) identify the necessary training navigators felt would allow them to more effectively help patients deal with cancer and employment issues. Participants from the southeast USA were invited to complete a paper survey while in attendance at a statewide cancer patient navigator conference or online via the state comprehensive cancer coalition's cancer patient navigator listserv. Results suggest financial burdens, work and treatment conflicts, taking unpaid leave for cancer care, and working through treatment were common concerns among their patients. Navigators also identified employment, legal, government programs, and financial resources as important training and education topics that would help them address their clients' employment and cancer conflicts. Given the fact that employment issues remain one of the most common unmet need of survivors and the increasing presence of navigators across the USA, it is important to address the role of navigators in meeting patients' needs regarding cancer and employment and ensure they are provide with adequate training and resources.

How Does Supervisor Support Influence Turnover Intent Among Frontline Hospital Workers? The Mediating Role of Affective Commitment.

Turnover among frontline hospital service workers can disrupt organizational effectiveness, reduce profitability, and limit the ability to provide high-quality, patient-centered care. This concern is compounded by the increasing reliance on frontline supervisors to manage this workforce, often without necessary training and support. However, research addressing the relationship between frontline supervisor support and intent to turnover among service workers and the process by which these variables are related is limited. By surveying 270 housekeeping and dietary service workers employed at 2 US hospitals, this study examined the relationship between supervisor support and turnover intent and assessed the mediating role of affective commitment between supervisor support and intent to turnover. Turnover intentions were lower for workers who reported greater levels of supervisor support and affective commitment; both supervisor support and affective commitment were significant predictors of turnover intent when tested individually. However, when controlling for affective commitment, supervisor support no longer predicted turnover intent, indicating that affective commitment fully mediated the relationship between supervisor support and intent to turnover. Implications for further research and organizational practice are discussed.

Keeping workers safe: does provision of personal protective equipment match supervisor risk perceptions?

BACKGROUND: Although farm management may understand agriculture's risks, they may not provide personal protective equipment (PPE). This study describes thoroughbred farm management's risk perceptions, provision of PPE, and factors that influence its provision. METHODS: Thirty-five representatives from 26 farms participated in a 1-4hr semi-structured interview covering perceived risks associated with horse work and perspectives and provision of PPE. Interviews were audio-recorded, transcribed, entered into ATLAS.ti, and analyzed by three coders. RESULTS: Management cited horse-related tasks as most dangerous, yet horse-related PPE as least provided because of 1) differences in farm context, 2) the belief that workers were most important agents in their safety, 3) lack of confidence in its effectiveness, and 4) the perception that risk could never be eliminated. CONCLUSIONS: PPE provision was limited by management's poor perceptions of its efficacy relative to other factors. Future research should explore workers' perceptions and PPE's effectiveness in averting horse-related injury.

Individual and occupational characteristics associated with respiratory symptoms among Latino horse farm workers.

BACKGROUND: Latino workers are likely exposed to a variety of respiratory hazards in the horse barn, yet the potential impact of these exposures on respiratory health has not been investigated. METHODS: Using a community-based sample of 225 Latino horse farmworkers we investigated the prevalence of upper and lower respiratory symptoms and occupational characteristics associated with them. Multivariable logistic regression was used to identify factors associated with respiratory symptomology. RESULTS: Upper respiratory symptoms prevalence ranged from 24% to 45%. Half of workers reported lower respiratory symptoms. Workers with symptoms were more likely to be female and have lower levels of English understanding. Workers who never/rarely used dust masks while working in the barn experienced over two times the odds of reporting upper respiratory symptoms. CONCLUSIONS: Many Latino horse workers experienced upper and lower respiratory symptoms. Dust mask use may protect workers in this and other enclosed livestock operations from respiratory symptoms.

The Mental Health Consequences of Losing a Loved One to COVID-19.

OBJECTIVES: This study examined the association between loss of a loved one to COVID-19 and depression, anxiety and suicide ideation among Rhode Island young adults. METHODS: The 2022 Rhode Island Young Adult Survey recruited 1,022 young adults aged 18-25 years who lived in Rhode Island. Logistic regression models were used to estimate the odds of depression, anxiety, and suicide ideation due to experiencing a loss due to COVID-19. RESULTS: The odds of anxiety and suicide ideation were 57% (OR[95% CI] = 1.57 [1.13, 2.18]) and 79% (OR[95% CI] = 1.79 [1.19, 2.70]) greater among participants who lost a close friend or family member due to COVID-19. CONCLUSIONS: Losing a loved one to COVID-19 increases the risk of anxiety or suicide ideation among young adults in RI. Prevention measures such as screening for mental health symptoms and incorporating mental health awareness into college, university and workplace settings should be instituted.

Pornography: A Concealed Behavior with Serious Consequences.

OBJECTIVES: The purpose of the current study was to estimate prevalence of pornography use and addiction in Rhode Island young adults, identify sociodemographic disparities, and determine if use and addiction were associated with mental illness. METHODS: Data from n=1022 participants of the Rhode Island Young Adult Survey were used. Pornography use and addiction, depression, anxiety, and suicide ideation were assessed. Multivariable logistic regressions controlled for age, social status, sex, gender, sexual orientation, and race/ethnicity. RESULTS: 54% indicated pornography use; 6.2% met the criteria for addiction. Odds of pornography use were 5 times higher (95%CI=3.18,7.71), and addiction 13.4 times higher (95%CI=5.71,31.4) among heterosexual cis-males. Pornography addiction was associated with increased odds of depression (OR=1.92, 95%CI=1.04,3.49) and suicide ideation (OR=2.34, 95%CI=1.24,4.43). CONCLUSIONS: Pornography use is highly prevalent, and addiction may be associated with mental illness. New screenings, media literacy training, and developing new therapeutic interventions should be considered.

Brain Injury and Substance Use in Young Adults: The Need for Integrating Care.

OBJECTIVES: This study examined sociodemographic disparities in traumatic brain injury (TBI), and the association between TBI and substance misuse among young adults in Rhode Island. METHODS: Among this sample of N=1,022 from the 2022 Rhode Island Young Adult Survey, multivariable logistic regressions were used to examine both study objectives. RESULTS: Black, Asian, and Hispanic young adults had 77% (95%CI: 26%, 93%), 79% (95%CI: 32%, 94%), and 58% (95%CI: 31%, 75%) lower odds of brain injury, respectively, compared to White, non-Hispanic young adults. Those having experienced brain injury were more likely to engage in hazardous alcohol use (p = 0.003), hazardous marijuana use (p < 0.001), and illicit drug use (p = 0.003), but not OTC or prescription drug misuse. CONCLUSIONS: There is a pressing need for integrated, large-scale, multidisciplinary programs with a well-trained workforce to address TBI and substance misuse in various medical settings for behavioral health and emergency care.

The Mental Health Burden of Racial Discrimination in Young Adults in Rhode Island.

OBJECTIVES: This study examined the association between racial discrimination and depressive symptoms among Rhode Island young adults. METHODS: The 2022 Rhode Island Young Adult Survey recruited 1,022 young adults aged 18-25 years who lived in Rhode Island for at least part of the year. Multivariable logistic regression for depressive symptoms controlled for sexual and gender identity, race/ethnicity, social status, age, employment, and student status. RESULTS: 23.6% of young adults reported experiencing racial discrimination in childhood and/or adulthood. Odds of depressive symptoms increased for experiences of childhood racial discrimination (+70%; 95%CI: 14%, 155%) and any racial discrimination (+56%; 95%CI: 6%, 130%), but not for racial discrimination in adulthood (+38%; 95%CI: -8%, 108%). CONCLUSIONS: Experiences of racial discrimination increase odds of depressive symptoms among young adults. Prevention measures such as universal screening for childhood adversity, incorporating antiracism education into all institutional settings, and continued nondiscrimination policy and enforcement should be employed.

Risk Factors for Suicide Ideation Among Rhode Island College Students.

OBJECTIVES: This study aimed to identify individual and relational risk factors for suicide ideation among students enrolled in 2- and 4-year colleges. METHODS: A cross-sectional analysis was conducted using N=685 college students from the 2022 Rhode Island Young Adult Survey. RESULTS: 13.7% (N = 94) reported suicide ideation, 7.6% (N = 52) reported making a suicide plan, and 3.2% (N = 22) reported at least one suicide attempt. Sexual and gender minorities had 300% (95%CI: 47%, 987%) increased odds relative to cisgender heterosexual males, students living on campus had 56% (95%CI: 79%, 10%) lower odds compared to those living off campus with a parent, and students with insomnia had 156% (57%, 320%) increased odds of suicide ideation. CONCLUSIONS: Interventions to 1) cultivate identity- affirming communities for sexual and gender minority students, 2) create a sense of belonging for students living off campus, and 3) improve sleep health are needed.

Work organization and occupational health: perspectives from Latinos employed on crop and horse breeding farms.

BACKGROUND: Agriculture is hazardous and increasingly dependent on Latino workers, a vulnerable population. However, little research has studied how work organization influences Latino farmworker health. METHODS: Using a work organization framework, this cross-sectional study describes and compares the work organization and occupational health characteristics of a sample of Latino crop (n = 49) and horse production (n = 54) workers in Kentucky. RESULTS: Crop workers experienced more physical demands, work-related and environmental stressors, and musculoskeletal and ill-health symptoms. Significantly more crop workers indicated work-related illness or missed work due to work-related illness/injury, though one-fourth of both groups reported work-related injury in the past year. A majority of both groups cited exposure to toxic chemicals, a minority of whom received training on their use. CONCLUSION: Further surveillance is needed to understand the rate and precursors of illness/injury in these populations, as is research on the relationship between supervisory practices, psychosocial stressors, and occupational health.

Cancer-work management: Hourly and salaried wage women's experiences managing the cancer-work interface following new breast cancer diagnosis.

OBJECTIVE: The purpose of this paper is to report the baseline characteristics of EMPOWER participants-a group of newly diagnosed breast cancer survivors-and describe differences in hourly and salaried wage women's experiences regarding cancer and work management in the three months following breast cancer diagnosis. DESIGN AND SETTING: The EMployment and Potential Outcomes of Working through canceER (EMPOWER) project is a prospective longitudinal, mixed methods pilot study designed to evaluate how employment influences treatment decisions among women diagnosed with breast cancer. Participants were women diagnosed with new breast cancer and treated at one of two clinical sites of the University of Maryland Medical System. Women were enrolled in the study within three months of first breast cancer diagnosis. Study visits occurred every three months for one year. This paper reports data from for the baseline and three-month visit which had been completed by all enrollees. METHODS: Trained research personnel collected demographic information, medical history and health status, social history, employment data, cancer-related data, psychosocial adjustment, and financial wellbeing at the baseline enrollment visit. A semi-structured qualitative interview was administered at the three-month study visit to assess employment decisions and the impact of job demands, cancer care, and cancer-work fit during the three months following diagnosis. RESULT: Fifty women with new, primary diagnosis of breast cancer were enrolled in the study. Mean age of participants was 51 years, and 46% identified their race as Black or other. The majority of women disclosed their diagnosis to their employer and nearly all maintained some level of employment during the first three to six months of treatment. Women with hourly wage jobs were similar to those with salaried wage jobs with respect to demographic and social characteristics. Women with hourly wage jobs were more likely to report working in physically demanding jobs and taking unpaid leave. They were also more likely to experience side effects that required physical restrictions at work, to leave their jobs due to demands of treatment, and to report managing cancer and work concurrently as very difficult. Women in salaried wage jobs were more likely to report falling behind or missing work and working remotely as a cancer-management strategy. Women in hourly jobs more often reported difficulty managing the competing demands of cancer and work. CONCLUSION: While further study is needed, these results suggest that women in hourly and salaried workers reported similar experiences managing cancer and work, with a few key exceptions. These exceptions pertain to the nature of hourly-wage work. Cancer survivors employed in hourly jobs may be more vulnerable to poor employment outcomes due to limited access to paid time off and workplace flexibility, and challenges related to managing physical aspects of cancer and employment.

Psychosocial work environment and depressive symptoms among US workers: comparing working poor and working non-poor.

BACKGROUND: The psychosocial work environment has been associated with mental health outcomes; however, little research has examined this relationship for low-wage workers. The purpose of this study was to investigate the relationship between psychosocial job characteristics and depressive symptoms for US workers using an expanded model of job quality. METHODS: Data were from the 2002 National Study of the Changing Workforce, a nationally representative study of wage and salaried workers in the US. Working poor was defined as households earning <250% of the federal poverty threshold. RESULTS: Multivariate logistic regression models show for working poor employees, job insecurity was the single significant correlate of depressive symptoms after controlling for other demographic and work environment variables. For working non-poor employees, high psychological demands and low supervisor and coworker support were associated with depressive symptoms. CONCLUSIONS: Findings suggest all jobs do not equally affect employees' depressive symptoms. Implications for research that may improve the mental health of the working poor in the US are presented.

Managing the cancer-work interface: the effect of cancer survivorship on unemployment.

OBJECTIVE: This study assessed differences in employment outcomes among cancer survivors using data from a nationally representative sample. METHODS: The 2011 Medical Expenditure Panel Survey (MEPS) data and the 2011 MEPS Experiences with Cancer Survivorship Supplement representing 3,360,465 people in the US population were analyzed to evaluate factors associated with unemployment among cancer survivors during the 5 years following diagnosis and treatment. The sample included adults 1) diagnosed with cancer within 5 years prior to survey completion and 2) engaged in paid employment since diagnosis. Individuals diagnosed with nonmelanoma skin cancer (n=33) were excluded from analyses. RESULTS: Data of 221 cancer survivors were used to identify factors associated with employment status at the time respondents were employed (n=155) vs unemployed (n=66). Results of bivariate analyses indicated that unemployed survivors were older, more likely to be women, more likely to be uninsured at the time of cancer diagnosis, and to report lower incomes than cancer survivors who continue to be employed. Unemployed survivors were more likely than employed survivors to have had anxiety about being forced to retire or quit early when they were employed because of cancer and to report cancer-related interference with physical and mental aspects of their job tasks; unemployed survivors also took less paid time off and were less likely to change to a flexible job schedule when they were employed. In multiple logistic regression analyses, worry about being forced to retire (protective), worry that cancer recurrence will interfere with home or work responsibilities (risk), and change to a flexible work schedule (risk) following cancer diagnosis were associated with unemployment after controlling for demographic differences between employed and unemployed cancer survivors. CONCLUSION: Findings of this study highlight the extent to which the challenges of managing the cancer-work interface create challenges to employment among cancer survivors and may lead to long-term unemployment among cancer survivors. Future studies should evaluate the strategies that the survivors could use to manage the cancer-work interface during cancer treatment to attain medical, psychological, social, and employment outcomes.