Reasons for Not Working During the Coronavirus Pandemic Among Working-Age Persons With and Without Disabilities in the US.

OBJECTIVE: To provide new information about the reasons why persons with and without disabilities were not working during the coronavirus pandemic. DESIGN: Secondary analysis of the Household Pulse Survey conducted between April 14, 2021, and May 9, 2022. SETTING: The United States. PARTICIPANTS: 876,865 people with and without disabilities aged 18-64 years (N=876,865). INTERVENTION: N/A. MAIN OUTCOME MEASURES: Reasons for not working such as "Sick with coronavirus symptoms or caring for someone who was sick with coronavirus symptoms", "Concerned about getting or spreading the coronavirus", "Sick (not coronavirus related) or disabled", "Laid off or furloughed due to coronavirus pandemic", "Employer closed temporarily due to the coronavirus pandemic", "Caring for children not in school or daycare", "Caring for an elderly person", "Retired", "Did not have transportation to work", and "other" reasons. RESULTS: The number of people with disabilities and people without disabilities in the sample was 82,703 and 794,162, respectively. People with disabilities were more likely to report that they were laid off or furloughed and less likely to report that they did not want employment than people without disabilities. Working-age adults with disabilities were more likely to report health or disability reasons not related to coronavirus than working-age adults without disabilities as a reason for not working. Caring for children not in school or daycare was 1 of the most cited reasons for both people with and without disabilities. Women, among both the groups, were more likely to not work primarily due to caregiving responsibilities. People with disabilities were more likely to report getting or spreading the coronavirus and less likely to report being retired as a reason for not working than people without disabilities. CONCLUSION: Analyzing reasons why people with disabilities were not working during the pandemic is crucial for successful employment policymaking in a post-pandemic world.

Mental health experiences in 2021 for adults with disabilities who are lesbian, gay, bisexual, or transgender.

PURPOSE/OBJECTIVE: Examine the prevalence of mental health issues, receipt of mental health treatment, and self-reported unmet need for mental health treatment among U.S. adults with and without disabilities by lesbian, gay, bisexual, or transgender (LGBT) status during the pandemic. RESEARCH METHOD/DESIGN: Logistic regression and predicted probabilities using nationally representative, cross-sectional, household survey data from the U.S. Census Bureau's weekly Household Pulse Survey conducted during the COVID-19 pandemic (July 21, 2021-October 11, 2021). RESULTS: Controlling for age, educational attainment, employment, health insurance coverage, and race/ethnicity, adults with disabilities, regardless of LGBT status, had statistically significantly increased odds of having mental health issues, receiving mental health treatment, and reporting the unmet need for mental health treatment compared to adults without disabilities who were not LGBT. Adjusted rates of receipt of mental treatment ranged from a low of 9% for persons without disabilities who were not LGBT to 27% for persons with disabilities who were LGBT, a gap of 18 percentage points. An even larger percentage point gap (22 percentage points) was noted in the unmet need for treatment between persons without disabilities who were not LGBT (9%) and persons with disabilities who were LGBT (31%). CONCLUSIONS/IMPLICATIONS: These results highlight the need for expansions of the mental health service delivery system in the United States as well as a prioritization of accessibility and inclusiveness practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring Acceptability of Employment Interventions to Support People Living With Cancer: Qualitative Study of Cancer Survivors, Health Care Providers, and Employers.

BACKGROUND: Employment contributes to cancer survivors' quality of life, but this population faces a variety of challenges when working during and after treatment. Factors associated with work outcomes among cancer survivors include disease and treatment status, work environment, and social support. While effective employment interventions have been developed in other clinical contexts, existing interventions have demonstrated inconsistent effectiveness in supporting cancer survivors at work. We conducted this study as a preliminary step toward program development for employment support among survivors at a rural comprehensive cancer center. OBJECTIVE: We aimed (1) to identify supports and resources that stakeholders (cancer survivors, health care providers, and employers) suggest may help cancer survivors to maintain employment and (2) to describe stakeholders' views on the advantages and disadvantages of intervention delivery models that incorporate those supports and resources. METHODS: We conducted a descriptive study collecting qualitative data from individual interviews and focus groups. Participants included adult cancer survivors, health care providers, and employers living or working in the Vermont-New Hampshire catchment area of the Dartmouth Cancer Center in Lebanon, New Hampshire. We grouped interview participants' recommended supports and resources into 4 intervention delivery models, which ranged on a continuum from less to more intensive to deliver. We then asked focus group participants to discuss the advantages and disadvantages of each of the 4 delivery models. RESULTS: Interview participants (n=45) included 23 cancer survivors, 17 health care providers, and 5 employers. Focus group participants (n=12) included 6 cancer survivors, 4 health care providers, and 2 employers. The four delivery models were (1) provision of educational materials, (2) individual consultation with cancer survivors, (3) joint consultation with both cancer survivors and their employers, and (4) peer support or advisory groups. Each participant type acknowledged the value of providing educational materials, which could be crafted to improve accommodation-related interactions between survivors and employers. Participants saw usefulness in individual consultation but expressed concern about the costs of program delivery and potential mismatches between consultant recommendations and the limits of what employers can provide. For joint consultation, employers liked being part of the solution and the possibility of enhanced communication. Potential drawbacks included additional logistical burden and its perceived generalizability to all types of workers and workplaces. Survivors and health care providers viewed the efficiency and potency of peer support as benefits of a peer advisory group but acknowledged the sensitivity of financial topics as a possible disadvantage of addressing work challenges in a group setting. CONCLUSIONS: The 3 participant groups identified both common and unique advantages and disadvantages of the 4 delivery models, reflecting varied barriers and facilitators to their potential implementation in practice. Theory-driven strategies to address implementation barriers should play a central role in further intervention development.

Referral networks for pediatric patients with genetic conditions: The perspective of occupational therapists.

Families of children with developmental delays but no diagnosed genetic condition may benefit from connection to genetic systems of care. This work examines the role of occupational therapy as a space for families of pediatric patients to gain access to genetic services. Between September 2021 and February 2022, we interviewed 20 occupational therapists in New England who work primarily with pediatric patients. We transcribed the interviews and used a grounded theory approach to identify and code recurring themes. The data reveal several barriers to linking pediatric patients to genetic systems of care, including lack of insurance coverage, wait times for appointments and test results, hesitant primary care providers, and familial and cultural stigma of disability. We discuss the unique role of occupational therapists as professionals who spend substantial time with patients, often in their everyday environments, to bridge these barriers. We also address challenges associated with occupational therapists facilitating connections to genetics services, including their lack of specialized knowledge of genetics and barriers fully integrating with others on the medical team.

Comparing effects of question set order and location within a survey instrument of two commonly used disability question sets among a U.S. population of adults.

BACKGROUND: In nationally representative household surveys conducted in the United States (U.S.), two distinct sets of questions are commonly used to identify persons with disabilities. The six-question sequence (6QS) measures, in a yes/no fashion, limitations in cognition, hearing, independent living, self-care, vision, and walking. The Washington Group Short Set (WG-SS) captures more nuanced yet similar information, although instead of including a measure of independent living asks about communication. To date, research has not estimated, among the same set of survey respondents, variations in disability prevalence using these two sets of questions nor how prevalence estimates vary by question set order and placement of these questions at the beginning or end of a survey. OBJECTIVE/HYPOTHESIS: The objective was to examine adjusted differences in disability prevalence among three measures of disability based on the 6QS and the WG-SS question sets, controlling for differences in question set order and placement within a survey. METHODS: We fielded an Internet survey (N = 13,277) in September 2020 that included these questions, but varied question set order and placement among respondents, using four different versions of the survey. We first tested for bivariate differences by survey design between an "any disability" measure as well as between specific types of limitations using Chi square. Finally, we examined pairwise adjusted differences in prevalence estimates. RESULTS: The 6QS provided the most consistent prevalence estimates (26%-28%) (p < .05), regardless of survey design. Estimates varied more widely for the WG-SS measures, ranging from 43 to 60% for WG-SS1 and from 10% to 15% for WG-SS2, among survey versions. CONCLUSIONS: Question set order and placement was not associated with differences in prevalence for the 6QS but was associated with differences in estimates from the WG-SS. Further research is needed to understand the possible survey priming effects that might influence estimates from the WG-SS.

Work limitations as a moderator of the relationship between job crafting and work performance: results from an SEM analysis of cross-sectional survey data.

PURPOSE: Job crafting is an incremental, employee-initiated job design process used to achieve a better fit between job demands and worker skills. Persons with work limitations face multiple barriers to optimal work performance. Some persons with work limitations may innately use job crafting as a strategy to achieve better alignment with their job tasks and demands, however the extent to which job crafting may be helpful in improving work performance and engagement is unknown. The purpose of this study is (1) to examine the moderating role of work limitations in the relationship between job crafting and work performance and (2) to understand the complex relationship between job crafting, work limitations, work engagement, work performance, readiness to change, and worker characteristics. METHODS: We conducted an online survey of workers with and without disabilities (final N = 742) in 2020-2021. Our sample included workers aged 18 and older. Descriptive statistics, bivariate statistics, and Partial Least Squares-Structural Equation Modeling (PLS-SEM) were used to assess the relationships among job crafting, work limitations, work engagement, work performance, readiness to change, and worker characteristics. RESULTS: Work limitation moderates the relationship between job crafting and work performance by weakening the impact of innate job crafting on work performance. Worker characteristics such as education and years of work experience predict crafting behaviors and work engagement mediates the relationship between job crafting and work performance. CONCLUSIONS: Work limitation weakens the relationship between job crafting and work performance. Workers with limitations may benefit from job crafting interventions to increase work engagement and performance.

Linking job duties, functioning, and employment status using the Work-Disability Functional Assessment Battery (WD-FAB): An expert coding and quantitative analysis.

BACKGROUND: An understanding of the link between specific occupational demands and individual worker functioning is limited, although such information could permit an assessment of the fit between the two in a manner that would inform national and state disability programs such as vocational rehabilitation and Social Security disability programs. OBJECTIVE: Our goal was to examine the utility of assessing physical and mental functioning relative to self-reported job duties to identify the domains of worker functioning most likely to create barriers to fulfilling an occupation's specific requirements. METHODS: Through primary survey data collection, 1770 participants completed the Work-Disability Functional Assessment Battery (WD-FAB) instrument after reporting details on their occupations (or most recent occupation if not working). Expert coders evaluated the level of function expected to successfully carry out each self-reported job duty with respect to six scales of physical and mental function. Quantitative analysis is used to examine the relationship between functioning and job duties. RESULTS: Those not working due to disability were more likely to fall short of the threshold of the physical and mental functioning requirements of their last job's three main job duties compared to those currently employed. Mental function scales were most likely to be the area experiencing a shortfall. CONCLUSIONS: Functional difficulties impede the ability to continue working in particular jobs that require that ability. This points to a need for specific accommodations to be implemented to bridge the gap between job requirements and functional capacity so that workers may remain engaged in their current work.

The association of disability status with job tenure for U.S. workers.

BACKGROUND: Job tenure is a useful economic indicator. To employees, longer job tenure creates higher rewards in pay, promotion opportunities, and job security. For employers, there are fewer costs in recruitment and retraining when job turnover is low. Marginalized populations, such as persons with disabilities, may find work in various economies, but retention is more difficult. They are often the first to be laid off in struggling economies. OBJECTIVE: The purpose of this study is to highlight differences in individual and employment-related factors associated with job tenure for American workers with and without disabilities. METHODS: Using newly available survey data (N = 1,538), OLS regression is used to estimate job tenure for workers with and without disabilities, controlling for worker sociodemographic characteristics, a job quality index, and job characteristics. All disability types are examined. RESULTS: Multivariate results show that workers with disabilities have shorter job tenure than others when controlling for job quality, individual characteristics and job characteristics. CONCLUSION: Employees with disabilities have shorter job tenure than those without. Given the benefits of lengthened job tenure, further efforts should be made to explore this issue and to develop effective strategies that help those with disabilities retain jobs long term.

Food sufficiency and the utilization of free food resources for working-age Americans with disabilities during the COVID-19 pandemic.

BACKGROUND: Working-age people with disabilities are an economically disadvantaged population more likely than those without disabilities to live in food insecure households. OBJECTIVE/HYPOTHESIS: Compare rates of food sufficiency and utilization of free food sources between working-age persons with and without disabilities in the US during the COVID-19 pandemic. METHODS: In September 2020, an online survey was conducted with n = 13,270 working-age individuals with and without disabilities to gather information about food sufficiency prior to COVID-19 (i.e., in March 2020) and within the last seven days as well as receipt of free groceries or meals, use of food programs or pantries, and concerns with using free food sources over the past week. Descriptive and multivariate statistics were used to compare these measures for persons with and without disabilities. RESULTS: Controlling for sociodemographic characteristics, the proportion of working-age persons who were food sufficient decreased from March 2020 to September 2020 for persons with disabilities (59%-53%, a six-percentage point decrease) and for persons without disabilities (77%-73%, a four-percentage point decrease). The rates of change were not significantly different between groups. In September 2020, higher proportions of persons with disabilities (57%) used free food resources in the past week than persons without disabilities (41%). CONCLUSIONS: The low rate of food sufficiency, the high rate of free food resource utilization, and the concerns noted by working-age persons with disabilities in using these sources suggest a need for continuing nutrition assistance policy and program development targeted towards the needs of persons with disabilities.

Midlife Work Limitations are Associated with Lower Odds of Survival and Healthy Aging.

OBJECTIVES: Health conditions that limit work are associated with myriad socioeconomic disadvantages and around half of Americans could face a work limitation at some point in their working career. Our study examines the relationship between midlife work limitations and two aging outcomes: longevity and healthy aging. METHODS: Using longitudinal data from the Panel Study of Income Dynamics and restricted mortality data, multivariate logistic regressions estimate the odds of desirable aging outcomes around age 65 for individuals with various midlife work limitation histories in samples of around 2,000 individuals. RESULTS: Midlife work limitations are consistently linked with a lower likelihood of desirable aging outcomes. Temporary limitations are associated with 59% and 69% lower survival and healthy aging odds, respectively. Chronic limitations are associated with approximately 80% lower survival odds and 90% lower healthy aging odds at age 65. DISCUSSION: Even temporary work limitations can be highly disadvantageous for aging outcomes, emphasizing the need to understand different work limitation histories. Future research should identify underlying mechanisms linking midlife work limitations and less desirable aging outcomes.

Examining differences in prescription opioid use behaviors among U.S. adults with and without disabilities.

We aimed to identify differences in prescription opioid-related behaviors between adults with and without disabilities in the U.S. We analyzed data from the 2015-2017 National Survey on Drug Use and Health (128,740 individuals; weighted N of 244,831,740) to examine disability-based differences in (1) reasons and sources of last prescription opioid misuse and, in multivariate models overall and stratified by disability, the likelihood of (2) prescription opioid use, and if used, (3) misuse and prescription opioid use disorder (OUD), overall and stratified by disability. Adults with disabilities were 11% more likely than adults without disabilities to report any past-year prescription opioid use, adjusted for sociodemographic, health, and behavioral health characteristics. However, among adults with any prescription opioid use, which is more common among people with disabilities, likelihood of prescription OUD did not vary by disability status. Pain relief as the reason for last misuse was associated with 18% increased likelihood of prescription OUD, if any use. To reduce risk of opioid misuse among people with disabilities, accessible and inclusive chronic pain management services are essential. Further, the substance use treatment field should provide accessible and inclusive services, and be aware of the need for pain management by many people with disabilities, which may include the use of prescription opioids. These findings highlight essential opportunities for public health and policies to improve access, accommodations, and quality of health and behavioral health care for people with disabilities, and to encourage a holistic perspective of people with disabilities and their needs.

Food sufficiency and the utilization of free food resources for working-age Americans with disabilities during the COVID-19 pandemic.

BACKGROUND: Working-age people with disabilities are an economically disadvantaged population more likely than those without disabilities to live in food insecure households. OBJECTIVE/HYPOTHESIS: Compare rates of food sufficiency and utilization of free food sources between working-age persons with and without disabilities in the US during the COVID-19 pandemic. METHODS: In September 2020, an online survey was conducted with n = 13,277 working-age individuals with and without disabilities to gather information about food sufficiency prior to COVID-19 (i.e., in March 2020) and within the last seven days as well as receipt of free groceries or meals, use of food programs or pantries, and concerns with using free food sources over the past week. Descriptive and multivariate statistics were used to compare these measures for persons with and without disabilities. RESULTS: Controlling for sociodemographic characteristics, the proportion of working-age persons who were food sufficient decreased from March 2020 to September 2020 for persons with disabilities (65%-57%, an eight-percentage point decrease) and for persons without disabilities (78%-73%, a five-percentage point decrease). The rates of change were not significantly different between groups. In September 2020, higher proportions of persons with disabilities (58%) used free food resources in the past week than persons without disabilities (41%). CONCLUSIONS: The low rate of food sufficiency, the high rate of free food resource utilization, and the concerns noted by working-age persons with disabilities in using these sources suggest a need for continuing nutrition assistance policy and program development targeted towards the needs of persons with disabilities.

Health disparities among Social Security Disability Insurance and Supplemental Security Income beneficiaries who participate in federal rental housing assistance programs.

BACKGROUND: Approximately 1.2 million non-elderly adults jointly participate in U.S. Department of Urban Development (HUD) rental housing assistance and Social Security Administration (SSA) disability programs (Social Security Disability Insurance (DI) and Supplemental Security Income (SSI), yet information about the health of these program participants is limited. OBJECTIVE: /Hypothesis. Non-elderly DI and/or SSI participants participating in HUD-assisted rental housing programs face unique health disparities. METHODS: Using newly available 2013-2016 National Health Interview Survey (NHIS) data linked with U.S. Department of Housing and Urban Development (HUD) administrative records on public and assisted housing programs, multivariate analyses were used to highlight differences in health status, health behaviors, health care utilization, and financial worry about health and housing costs between non-elderly persons participating in HUD rental housing assistance programs who were and who were not also participating in DI and/or SSI. RESULTS: The focal population had higher predicted probabilities of fair or poor health status, chronic condition diagnoses (hypertension, asthma, diabetes), and obesity than others but a lower probability of smoking (p < .05). Engagement with the health care system is high, yet 32% needed but could not afford services in the past year. CONCLUSIONS: Opportunities for joint intervention between HUD and SSA to improve the health of their program participants are discussed.

Changes in the Employment Status of People With and Without Disabilities in the United States During the COVID-19 Pandemic.

OBJECTIVE: Using data from the monthly Current Population Survey, this paper provides monthly employment and unemployment statistics for people with and without disabilities in the United States before and during the coronavirus disease 2019 pandemic to date (January 2021). DESIGN: Cross-sectional analysis of the Current Population Survey. SETTING: The United States. PARTICIPANTS: People with and without disabilities ages 16-64 years. INTERVENTION: N/A MAIN OUTCOME MEASURES: Percentage employed, percentage unemployed, percentage not in labor force, percentage on temporary layoff, percentage looking for work. RESULTS: Estimates show that, like workers without disabilities, workers with disabilities experienced increases in unemployment at the beginning of the pandemic but continued to remain engaged in the labor force. Our analysis finds that employment rates dropped from 74.8% to 63.2% for those without disabilities and from 31.1% to 26.4% for those with disabilities between February 2020 and April 2020 but gradually improved in the succeeding months. CONCLUSIONS: As the pandemic continued, the percentage of unemployed people with and without disabilities on temporary layoff decreased and those looking for work increased.

Wellbeing at older ages: Towards an inclusive and multidimensional measure.

BACKGROUND: With population aging, there is a growing need to measure and monitor the wellbeing of older people, including older people with disabilities. OBJECTIVE: To estimate the extent of wellbeing for individuals age 60+ in the U.S. overall and across disability status, this paper develops a measure of wellbeing at older ages that is multidimensional and disability inclusive. METHODS: Rates of multidimensional wellbeing among American older adults overall and among older adults with disabilities were estimated using multivariate regression analysis and data from the Panel Study of Income Dynamics matched with the 2013 Disability and Use of Time Supplement. Multidimensional wellbeing was defined as the simultaneous achievement of outcomes in five dimensions: material wellbeing, health status, personal activities, social connections/relationships, and economic security. RESULTS: Among all older adults, 33% experience multidimensional wellbeing. However, only 4-18% of older adults with disabilities experience wellbeing. Wellbeing varies across the dimensions of wellbeing for this subpopulation. Persons with disabilities experience as much wellbeing as persons without disabilities in terms of health insurance status and social connections/relationships. In contrast, for material wellbeing, health status and personal activities, older persons with disabilities less often experience wellbeing. DISCUSSION: This paper brings to light a disability gap in the experience of wellbeing among older adults in the U.S. There is a need for research which can inform the development of policies and practices that will enhance wellbeing for older people with disabilities, including material wellbeing, health and personal activities.

Disability and aging: From successful aging to wellbeing through the capability and human development lens.

This commentary explores the use of the capability approach and one of its recent applications, the human development model of disability, health and wellbeing, as a lens that can guide aging-related research as well as policy and practice in ways that are inclusive of older persons who have health conditions and impairments. As an alternative to biomedical theories of aging, the capability and human development lens includes human diversity and agency at its core while also reconsidering success to be the practical opportunities that older people value. The practical opportunities that older people value, including older people with disabilities, are what research, policy and practice should aim to expand.

Job Crafting Among American Workers with Disabilities.

Purpose Job crafting is an informal, employee-initiated approach to job re-design that has not been tested among people with disabilities, thus far. The purpose of this study is to examine crafting behaviors of workers with disabilities and individual factors associated with crafting behaviors. Methods We conducted a survey of employees with disabilities who were 18-64 years old and had at least 1 year of work experience. Bivariate and multivariate methods were used to: (1) compare the use of job crafting behaviors between our sample and published results from a sample of the general population; (2) identify individual characteristics associated with job crafting for workers with disabilities. Results Persons with disabilities engage in job crafting behaviors, albeit at lower levels than that reported in a broader sample (Int J Wellbeing, https://doi.org/10.5502/ijw.v3i2.1 , 2013). Education, and disability type (visual and mobility impairment) were associated with certain types of crafting behaviors. Conclusions As job crafting can be associated with higher levels of engagement and career growth among persons without disabilities, findings from this research can be utilized to design programs and policies that support the career goals of people with disabilities beyond labor force participation.

Health, Health Behaviors, and Health Care Utilization Among Adults with Serious Psychological Distress Who Receive Federal Housing Assistance.

Using newly available U.S. Department of Housing and Urban Development (HUD) administrative data linked with National Health Interview Survey (NHIS) data, this study estimates the prevalence of serious psychological distress (SPD) among non-elderly HUD-assisted adults and examines differences in health, health behaviors, and health care utilization for this population. The linked data estimate that 13% of HUD-assisted adults experience SPD. Controlling for individual characteristics and HUD program type, assisted housing residents who had SPD experienced higher rates of self-reported fair or poor health, chronic disease, and cigarette smoking than HUD-assisted adults without SPD. Adults with SPD had more frequent use of emergency rooms and were more likely than residents without SPD to have more frequent contact with specialists, general doctors, and mental health providers, although they also reported increased levels of unmet health care needs due to affordability. Policy implications are discussed.

Community mental health center staff attitudes about employment for persons with serious mental illness.

OBJECTIVE: To measure community mental health agency staff attitudes about employment for persons with serious mental illness. METHODS: An online survey was developed and sent to 2,218 staff at 4 community mental health centers (CMHC) in 1 New England state. The survey collected quantitative and qualitative data about staff attitudes about employment for persons with serious mental illness. Descriptive statistics and qualitative results are provided. Results from analysis of variance are provided as well, assessing differences in staff views by staff characteristics. RESULTS: A mix of clinical and administrative staff participated in the survey (N = 221). Staff views on the benefits of work, the ability of clients to handle the demands of the worker role, and client motivation to work were mixed. Staff with higher levels of education held significantly more supportive views than those with less education. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: CMHC staff need to consistently convey supportive attitudes about employment to their clients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).