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.

Identifying Barriers and Supports to Breastfeeding in the Workplace Experienced by Mothers in the New Hampshire Special Supplemental Nutrition Program for Women, Infants, and Children Utilizing the Total Worker Health Framework.

Variations in the barriers and contributors to breastfeeding across industries have not been well characterized for vulnerable populations such as mothers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Our study used the Total Worker Health Framework to characterize workplace factors acting as barriers and/or contributors to breastfeeding among women participating in the New Hampshire WIC. Surveys were collected from WIC mothers (n = 682), which asked about employment, industry, and workplace accommodation and supports related to breastfeeding in the workplace. We found workplace policy factors supporting breastfeeding (i.e., having paid maternity leave, other maternity leave, and a breastfeeding policy) varied by industry. Women in specific service-oriented industries (i.e., accommodation and retail) reported the lowest rates of breastfeeding initiation and workplace supports for breastfeeding and pumping. Further, how a woman hoped to feed and having a private pumping space at work were significantly associated with industry, breastfeeding initiation, and breastfeeding duration. A substantial portion of women reported being not sure about their workplace environment, policies, and culture related to breastfeeding. Additional studies with larger sample sizes of women participating in WIC are needed to further characterize the barriers to breastfeeding associated with specific industries.

Comparing estimates of disability prevalence using federal and international disability measures in national surveillance.

BACKGROUND: The National Health Interview Survey (NHIS) is changing the annual inclusion of standardized disability identifiers, reinvigorating the priority to examine existing disability question sets. These sets include questions developed by the United States (U.S.) National Center for Health Statistics in conjunction with the U.S. Census Bureau (the American Community Survey questions, ACS) and United Nations (the Washington Group Short Set questions, WGSS), that are policy relevant, comparable across populations, and short enough to be included in censuses and surveys across countries. OBJECTIVE: To compare disability prevalence estimates from federal and international standardized disability questions across demographic factors. METHODS: Bivariate analysis of disability question sets asking adults about vision, hearing, ambulation, cognition, and self-care difficulties and demographic factors using secondary data from supplements in the 2010 and 2013-2015 NHIS. RESULTS: Our study found substantial and statistically significant differences in the percentage of disabilities (overall and by type) based on comparable ACS and WGSS questions across demographic categories. Dependent on response coding, WGSS-based disability prevalence was consistently and significantly larger or smaller than ACS-based disability prevalence. Overall disability prevalence using ACS and two different WGSS response combinations were 16.3% and 9.2% or 39.4%, respectively. CONCLUSION: ACS and WGSS measures identify predictably different sized populations of adults with disabilities. Further, with some exceptions, ACS and WGSS questions identify populations with disabilities with relatively consistent demographic factors. Additional research is recommended to understand the comparability of disability prevalence and health disparities and inequities people with disabilities experience when using these measures.

Assessing the association between mental health and disability indicators among adults living in the United States.

BACKGROUND: Over 40 million people in the U.S. experience mental illness and/or disabilities. However, there has been limited characterization of the relationship between mental health and disability in national surveys. OBJECTIVE: To examine associations between current indicators for psychological distress, serious mental illness, and disability in the National Health Interview Survey (NHIS). METHODS: Secondary analysis (univariate and multivariate log-binomial estimation of relative risk) of non-specific psychological distress, duration of serious mental illness, disability types, and demographic factors in adults from the NHIS. RESULTS: Strong associations between psychological distress, serious mental illness, and disability types were found. After demographic stratifications and adjustment, associations were strongest for cognitive disabilities, compared to other disability types. Adults reporting serious psychological distress or more than 10 years of serious mental illness were 19.7 (17.8, 21.7) and 11.0 (10.2, 12.0) times more likely to report cognitive disabilities, compared to adults reporting no psychological distress or serious mental illness. After sex and race/ethnicity adjustment, individuals ages 35-54 years reporting serious psychological distress or more than 10 years of serious mental illness were 8.6 (6.9, 10.6) and 3.7 (3.3, 4.2) times more likely to report cognitive disabilities, compared to individuals ages 35-54 years reporting no psychological distress or serious mental illness. CONCLUSIONS: There is a robust association between mental health and cognitive disabilities among adults. Our results suggest health agencies and public policy consider addressing the concurrent nature of mental illness and cognitive disabilities in services and programs for adults with disabilities.

Prescription opioid behaviors among adults with and without disabilities - United States, 2015-2016.

BACKGROUND: Prescription opioid use among people with disabilities has not been well characterized. OBJECTIVE: To examine prescription opioid use, misuse, and use disorder, reason and source for last prescription opioid misuse, and receipt of prescription opioid treatment among people with and without disabilities. METHOD: Stratified analysis of prescription opioid use, misuse, and use disorders; primary reason and primary source for last prescription opioid misuse; receipt of prescription opioid treatment; and disability status among civilian, noninstitutionalized adults (ages 18+) using data from the 2015-2016 National Survey on Drug Use and Health. RESULTS: Adults with disabilities were significantly more likely than adults without disabilities to experience past year prescription opioid use (52.3% for those with disabilities compared to 32.8% of those without), misuse (4.4% compared to 3.4%), and use disorders (1.5% compared to 0.5%). People with disabilities were significantly more likely to misuse opioids for pain (Risk Ratio = 1.5, p < 0.001) and to receive opioids from a healthcare provider (Risk Ratio = 2.0, p < 0.001). Among people with opioid use disorder, people with disabilities were less likely to receive treatment for prescription opioid use (Risk Ratio = 0.6, p = 0.067). CONCLUSION: In the U.S., a substantial population with disabilities using and misusing prescription opioids exists that has not been well characterized. Persons with disabilities experience disparities in reason and source for last opioid misuse. Healthcare and substance abuse prevention, intervention and treatment providers must collaborate to address the needs of this population.