Suicide Rates and Risks Across U.S. Industries: A 29-Year Population-Based Survey.

OBJECTIVE: Suicide rates in the working-age U.S. population have increased by over 40% in the last two decades. Although suicide may be linked with characteristics of workplaces and their industries, few studies have reported industry-level suicide rates. No study has reported suicide rates by industry using nationally representative data. This study estimates suicide risks across industries in the U.S. working population. METHODS: Industry-level estimates of suicide risks require substantial data; we combined 29 years of U.S. suicide data using the National Health Interview Survey (NHIS)-Mortality Linked data from 1986 through 2014, with mortality follow-up through 2015. We conducted survey-weighted Poisson regression analyses to estimate suicide mortality rates and rate ratios across all populations and stratified by gender. All analyses were adjusted first for age, and then for age, employment status, marital status, race/ethnicity, and rurality/urbanicity (demographic-adjusted). Rate ratios compared results for workers in each industry to those for all industries, accounting for the NHIS survey design. RESULTS: A total of 1,943 suicide deaths were recorded. Age-adjusted suicide rates per 100,000 were highest in the furniture, lumber, and wood industry group (29.3), the fabricated metal industry (26.3), and mining (25.8). Demographic-adjusted rates were higher among men than women in most industries. Demographic-adjusted rate ratios were significantly elevated in the furniture, lumber, and wood industries (Rate Ratio, RR = 1.60, 95% confidence interval, CI = 1.18-2.18); chemicals and allied products (RR = 1.49, 95%CI = 1.04-2.13); and construction (RR = 1.21, 95% CI = 1.03-1.41). CONCLUSION: Several industries had significantly high suicide rates. Suicide prevention efforts may be particularly useful for workers in those industries.

Psychological distress is more common in some occupations and increases with job tenure: a thirty-seven year panel study in the United States.

BACKGROUND: Workers in certain occupations may have elevated risks of psychological distress. However, research is limited. For example, researchers often measure distress that may have existed before occupational exposures. We studied occupations and the development of psychological distress using national data from the United States. METHODS: We reviewed relevant research to identify occupations with low and high risks of mental health problems. We confirmed those individual low and high risk occupations using 1981-2017 data from the Panel Study of Income Dynamics (n = 24,789). We measured new cases of distress using the Screening Scale for Psychological Distress (Kessler K6) and compared distress in the low and high risk groups, adjusted for factors associated with occupational selection and non-occupational distress risks. A subset of participants described their jobs (n = 1,484), including factors such as job demands, social support, and control over work. We examined associations of those factors with psychological distress. RESULTS: Workers in high risk occupations had 20% higher adjusted odds of developing distress than those in low risk occupations (odds ratio, OR 1.20, 95% confidence interval, CI 1.13-1.28). Distress increased with time in a high risk occupation: ≥5 years OR 1.38 (CI 1.18-1.62), ≥ 10 years OR 1.46 (CI 1.07-1.99), and ≥ 15 years OR 1.77 (CI 1.08-2.90; p-trend = 0.0145). The most common positive participant descriptions of their jobs indicated social support (34%), sense of accomplishment (17%), and control over work (15%). Participants reporting such descriptions were significantly less likely to have a high risk occupation (OR 0.66, CI 0.46-0.94, p = 0.0195). The most common negative descriptions were excessive job demands (43%), low social support (27%), and lack of control (14%). Participants reporting such descriptions were significantly more likely to have a high risk occupation (OR 1.49, CI 1.03-2.14, p = 0.0331). CONCLUSION: Certain occupations may have high risks of psychological distress, which may be due to characteristics of the occupations rather than employee characteristics, or in addition to them. Results were consistent with theoretical models of psychosocial work environments. Providers of health care and social services should ask patients or clients about work-related distress.

Timing and factors associated with complementary feeding in India.

Introducing complementary feeding at 6 months can reduce premature death. We examined timing and factors associated with complementary feeding using the Indian Human Development Survey II (n = 11,218 women). Only 21% of mothers initiated complementary feeding at 6 months, 42% at 7-9 months, 33% at ≥10 months. In adjusted results, we found mothers with low income, with no formal education, and who had never formally worked were less likely to introduce complementary feeding at 6 months (p > 0.05). Our results indicate women in less advantaged groups are less likely to initiate complementary feeding at recommended age than women in more advantaged groups.

"Eventually I'm gonna need people": Social capital among college students with developmental disability.

BACKGROUND AND AIMS: About 18% of college students have disabilities. Social capital, resources we can tap from relationships, may be particularly valuable for students with disabilities. Yet, disabilities often limit the individual's ability to develop or use social capital. We studied how college students with developmental disabilities understand, develop, and use social capital. METHODS AND PROCEDURES: We conducted in-depth semi-structured Zoom interviews with 10 women with developmental disabilities enrolled at a public university in the southeastern United States early in 2021. We examined the qualitative data with thematic analysis. OUTCOMES AND RESULTS: Participants averaged age 20; 70% reported attention deficit disorder or attention deficit hyperactivity disorder; 90% reported multiple diagnoses. Most participants described COVID-19 pandemic-related isolation and stress, which magnified both the need for relationships and awareness of that need, prompting participants to become proactive in forming and maintaining relationships despite anxiety about them. Themes were: foundational relationships, reciprocity, expanding horizons, a need for new relationships, focus on the future and relationship barriers. CONCLUSIONS AND IMPLICATIONS: Results highlight the importance of social relationships and the resources they provide to students with disabilities, particularly in stressful times. Colleges can help students by connecting them with others and providing strategies for building and maintaining social capital. WHAT THIS PAPER ADDS: College students with developmental disabilities often face challenges developing and maintaining social capital, resources derived from relationships with other people. These resources are key to success in school and after graduation, as students continue into adulthood. We studied how students with developmental disabilities build social capital. The students described their relationships with others and the types of support they contributed to and received from those relationships. We also extended previous research by examining pandemic-related effects, interviewing participants nearly one year into the COVID-19 pandemic. We provide recommendations for further research and ways colleges and universities can encourage social capital development among all students.

Identifying developmental disability in national surveys: Addressing the knowledge gap with special education histories.

BACKGROUND: In the United States nearly 20% of children ages 12-17 have developmental disorders. Some attain population-based developmental milestones after a delay, or increase functioning through special education, medication, technology, or therapy. Others have severe lasting impairments. An indicator identifying those groups in surveys of adults could help shape policies to improve lives. HYPOTHESES: We hypothesized that survey histories of special education could indicate functional status levels. METHODS: Data were from the nationally representative Panel Study of Income Dynamics (1997-2017, n = 2745). With measures of diagnoses, behaviors, functional status, service use, and adult outcomes, we tested three special education groups as indicators of: (1) no impairment (no special education), (2) disorders, developmental diagnoses that adversely affect educational performance, but with development after a period of delay or only moderate disability, indicated by transfer from special education; and (3) severe lasting disability, the diagnoses combined with life-long needs for supports or services, with limitations in areas including self-care, mobility, and capacity for independent living, indicated by special education in the individual's final year of school. RESULTS: Across the special education groups, from no impairment to severe lasting disability, there were trends of: increasing severe and lasting disability (respectively 4.8%, 35.6%, 76.4%); increasing special services use (13.5%, 43.1%, 83.7%); increasing severe emotional disorders (2.3%, 11.3%, 17.9%); lower percentages attaining at least an associate's degree by age 25 (42.1%, 20.7%, and 8.9%); and more chronic diseases. CONCLUSIONS: Special education histories provide a useful indicator of developmental disability impairment levels in adults.

Age of Bottle Cessation and BMI-for-Age Percentile among Children Aged Thirty-Six Months Participating in WIC.

Background: Children's age at bottle weaning typically ranges from 12 to 24 months. The recommended age of bottle weaning varies. The American Academy of Pediatrics recommends weaning by 12 months; The American Academy of Pediatric Dentistry recommends 12-15 months; The US Department of Agriculture recommends 18 months. Prolonged bottle use is associated with dental caries, iron-deficiency anemia, and child overweight or obesity. We examined factors associated with age of bottle cessation, and the association between age of bottle cessation and BMI-for-age percentile at age 36 months among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants. Methods: Data were from the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2). The ITFPS-2, a longitudinal study of WIC participants (mothers and their children) began in 2013. We used Cox proportional hazards models to identify factors associated with bottle cessation and multivariate linear regression to examine the association between age of bottle cessation and BMI. Results: About 34% of children used a bottle longer than 12 months, and 13% longer than 18 months. Bottle cessation at older ages was associated with Hispanic ethnicity, multiparity, low income, low education, higher caregiver weight, and not initiating breastfeeding. The adjusted children's BMI-for-age percentile at age 36 months increased by 0.47 for each additional month of bottle use. Conclusion: Prolonged bottle use was associated with increased children's BMI-for-age percentile. Future research is warranted to determine the optimal age to recommend bottle cessation for WIC participants.

Factors Associated with the Initiation of Added Sugar among Low-Income Young Children Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in the US.

Added sugar intake at a young age is associated with chronic diseases including cardiovascular diseases, asthma, elevated blood pressure, and overweight. The Dietary Guidelines for Americans 2020-2025 and the American Heart Association recommend delaying the introduction of added sugar until age 2. The aims of this study were to identify the timing of added sugar initiation; factors associated with added sugar initiation; and the top five added sugar foods and beverages consumed by infants and children at three age ranges (<7 months, 8-13 months, and 14-24 months). Data were from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2, a longitudinal, national population of WIC participants enrolled in WIC eligible clinics (n = 3835). The Cox proportional hazards model was used to examine the factors associated with introducing added sugar. About 25% of children were given added sugar at or before 7 months. Contributing factors were caregivers' race/ethnicity, education, employment, weight status, parity, child sex, and premature birth (all p < 0.05). The top added sugar foods consumed between 1-24 months were cereal, crackers, apple sauce, dessert, yogurt, sweetened beverages, syrup and preserves, and cookies. Further research to examine the impact of early initiation of added sugar on health outcomes and taste preferences is warranted.

Suicide mortality rates in farm-related occupations and the agriculture industry in the United States.

BACKGROUND: Studies suggest that agricultural workers and rural residents may have an elevated suicide risk. However, suicide is relatively rare, and rural and farming populations have significantly declined, limiting their representation in national surveys. Many studies have inadequate samples for meaningful analysis. METHODS: We pooled 29 years of data from the Mortality-Linked National Health Interview Survey, 1986-2014, then measured suicide mortality in groups including agriculture workers, and variation in suicide across rural and urban areas. Exposure variables indicated whether participants worked in a farm-related occupation or industry, or lived in a rural area. We used survey-weighted Poisson regression to estimate suicide mortality rates and rate ratios. RESULTS: Age-adjusted suicide mortality rate per 100,000 was: 22.3 for farmers and farm managers; 21.6 for farmworkers; 28.7 in farming, forestry, and fishing; 15.3 across all other occupations; 16.1 among rural residents. Among farmworkers, age-adjusted rates were 28.3 in rural areas, 17.1 in urban areas (not significantly different). The age-adjusted suicide mortality rate ratio (RR) comparing workers in the agriculture, forestry, and fishery industries to those in all other industries was 1.34 (95% confidence interval, [CI]: 1.05-1.72) (not statistically significant after further adjustment for demographic characteristics). Age-adjusted results were consistent with a higher suicide risk for workers in forestry and fishing than in all other occupations (RR: 1.88, 95% CI: 0.79-4.46). CONCLUSION: Workers in agriculture, forestry, and fishing may have an elevated suicide risk. National surveys should consider oversampling of rural residents, who have increased morbidity and mortality risks.

Disability in Childhood, Special Education Histories, and Lifetime Health Outcomes in the United States.

Objectives: We evaluated special education as an indicator of childhood disability and used that indicator to estimate lifetime dependency and life expectancy. Methods: Data: Panel Study of Income Dynamics and Health and Retirement Study (n = 20,563). Dependency: Nursing home care or equivalent. Analysis: We first analyzed special education as an indicator of childhood disability; multinomial logistic Markov models and microsimulation then compared populations with and without childhood disability. Results: Special education history was a valid indicator of childhood disability. For example, with parents who did not complete high school, 3.8% with no special education history were dependent at least 5 years of adult life; that result with special education was 15.2%. Life expectancy from age 20 was 58.3 years without special education, 46.0 years with special education (both p < .05). Discussion: Special education history can indicate childhood disability. People with that history had significantly a more dependency than others and significantly shorter lives.

Universal Design for Measurement: Centering the Experiences of Individuals With Disabilities Within Health Measurement Research.

People with disabilities comprise roughly 25% of the U.S. adult population yet remain underrepresented in mainstream public health and evaluation research. The lack of measures of common constructs that are validated in but not specific to this population may impede their inclusion. This article describes the use of Universal Design for Measurement (UDM), a novel method for developing self-report measurement instruments validated among broad populations to minimize the need for scale adaptation. We applied UDM to the development and content validation of a new body image scale. We assessed content validity by surveying subject matter experts (SMEs) and conducted a Delphi panel study to assess consensus about scale items among community women with (n = 18) and without (n = 15) disabilities. Most scale items were found acceptable by SMEs and community women. The Delphi panel study was useful toward evaluating consensus about scale items among women with and without disabilities. Findings support the use of UDM in developing inclusive and psychometrically sound measurement scales to ultimately facilitate the full inclusion of people with disabilities within health research.

Alcohol consumption among older women in the United States.

Few studies have examined alcohol consumption among older women. Using the nationally representative National Survey on Drug Use and Health, we examined binge, moderate, and no alcohol consumption among women ages 50+ (n = 21,178). We calculated population prevalence by age and used multivariate logistic regression, controlling for seven sociodemographic factors. In adjusted results, women ages 65+ were more likely to have moderate or no alcohol consumption than those 50-64; Hispanic and African American women were more likely to engage in binge consumption than whites (all p < .01). More research is needed to understand binge alcohol consumption among older women in racial/ethnic minorities.

Black-white disparities in alcohol consumption trends among women in the United States, 1990-2015.

Alcohol consumption has more adverse consequences among African American women than among white women. Yet little is known about trends in alcohol consumption among African American women. Using the National Survey on Drug Use and Health, we examined trends in alcohol consumption among African American (n = 4,079) and white (n = 17,512) women, 1990-2015. We calculated population prevalence and used the Cochrane-Armitage test to examine trends, controlling for sociodemographic factors. In adjusted analyses, binge consumption increased for African American and white women; not consuming alcohol decreased among African Americans (all p < 0.05). Results highlight the need for culturally sensitive prevention and intervention strategies.

Mental health risks of parents of children with developmental disabilities: A nationally representative study in the United States.

BACKGROUND: Caring for a child with a developmental disability may affect parents' mental health. There are few longitudinal or nationally representative studies, none on new mental health problems. Studies have few young children, and few adult children. OBJECTIVE/HYPOTHESES: We hypothesized that parents of children with developmental disability would be more likely to develop mental health problems than other parents. METHODS: We used the Panel Study of Income Dynamics (PSID, 1997-2017) and its Child Development Supplements, defining developmental disability by diagnoses such as autism spectrum disorder or intellectual disability, and requiring additional evidence of lasting impairment. We linked children's and parents' data spanning 20 years, including 44,264 mental health measurements for 4024 parents of 7030 children. Discrete-time hazard analysis controlled for child and parent characteristics. RESULTS: About 9.4% of children had developmental disability. Parents of children with developmental disability were more likely to develop mental health problems than other parents. The odds of developing anxiety or depression were higher when an adult child with developmental disability lived independently, nearly 3 times higher for mothers (OR 2.89, CI 2.33-3.59) and more than twice as large for fathers (OR 2.35, CI 1.70-3.26). Compared to fathers whose children did not have developmental disability and challenging behaviors, the odds of psychological distress were over 7 times larger (odds ratio, OR 7.18, 95% confidence interval, CI, 5.37-9.61) for those whose children had developmental disability and challenging behaviors. CONCLUSIONS: Parents of children with developmental disability may benefit from increased emotional support, respite, and interventions addressing challenging behaviors.

Work-related asthma in the USA: nationally representative estimates with extended follow-up.

OBJECTIVE: We studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life. METHODS: We used the nationally representative Panel Study of Income Dynamics (1968-2015; n=13 957; 205 498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life. RESULTS: The adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18-65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk. CONCLUSION: Adults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%.

Severe developmental disability and the transition to adulthood.

BACKGROUND: Developmental disabilities are serious and long-lasting. There are few studies of developmental disability in the transition to adulthood, when the programs that provided support in childhood may no longer be available. OBJECTIVE: We studied associations of long-lasting developmental disabilities with health, behaviors, and well-being in adulthood. METHODS: We used the Panel Study of Income Dynamics (1968-2017), its Child Development Supplement (CDS, 1997, 2002, 2007), and its Transition into Adulthood Supplement (TAS, every-other year, 2005-2017) (n = 2702) following a national sample from childhood through age 28, defining serious developmental disabilities using diagnoses and reports from parents, teachers, schools, children, and young adults. We tested differences in proportions using Chi-square tests, estimated differences in least squares means, and used logistic regression to compare results for those with and without developmental disabilities. We adjusted results for age, sex, race, immigrant status, family income, region, metropolitan statistical area, educational attainment, and employment status, accounting for sampling weights and survey design. RESULTS: At ages 18-21, 8.2% had serious developmental disability (95% confidence interval, CI 6.6-9.8). They were more likely to report: no high school graduation (19.3% vs. 4.3%), being assaulted physically (32.1% vs. 20.4%) or sexually (14.4% vs. 6.6%), serious criminal arrests (25.7% vs. 13.2%), smoking (30.8% vs. 12.8%), sedentariness (5.8% vs. 1.1%), obesity (39.2% vs. 23.4%), diabetes (9.1% vs. 2.1%), and work disability (18.7% vs. 4.3%) (all p < 0.01) compared to peers without developmental disability. CONCLUSIONS: Results indicate opportunities to promote education, self-direction, safety, and well-being for people transitioning to adulthood with serious developmental disabilities.

Factors associated with health facility delivery in West and Central Africa: A multilevel analysis of seven countries.

We examined associations between individual and community socioeconomic status (SES) and childbirth in a health facility in West and Central Africa using data from the 2009-2011 United Nations Children's Fund (UNICEF) Multiple Indicator Cluster Survey for women in seven countries (n = 34,487). Individual SES measures were education and wealth; community SES was low or high poverty index. In adjusted results, women residing in communities with high poverty had significantly lower odds of facility delivery than those who lived in more affluent communities in five countries (all p < 0.001). Reducing out-of-pocket healthcare costs may improve women's access to delivery in health facilities.

Factors associated with retinal screening among patients with diabetes in Taiwan.

PURPOSE: The purpose of this study is to explore the factors associated with having a diabetic retinopathy exam (DRE) during the past 2 years among patients with diabetes. METHODS: Patients visiting the eye clinic at Shin-Kong Memorial Hospital in Taipei were enrolled in this study from January to June 2009. A total of 313 patients participated in this study. Excluding patients with missing responses for more than three questions (38) yielded a final sample of 275 participants. Chi-square and Mann-Whitney U-tests were used for bivariate analysis. Multivariable logistic regression examined factors associated with having a DRE controlling for demographic and health factors. RESULTS: Although 83% of participants said that their physician suggested DRE, only 60% were screened during the past 2 years. In response to the question about why patients did not seek a DRE exam, 43.2% reported that they did not know having this exam was necessary. In adjusted results, receiving information about the relationship between diabetes and retinopathy from medical staff and believing that diabetes could damage the vision were associated with having a DRE in the past 2 years (both P < 0.05). CONCLUSIONS: Although most patients indicated that their physician suggested the need for eye care, a substantial percentage of patients with diabetes were not aware of the need for a regular DRE. Information about the relationship between diabetes and retinopathy and concerns about damage to vision were associated with greater likelihood of seeking a DRE. These factors should be considered to promote DR screening.

"It's very valuable to me that I appear capable": A qualitative study exploring relationships between body functionality and appearance among women with visible physical disabilities.

A current hypothesis is that women who learn to focus on their body's functionality versus appearance may experience improved body image outcomes. This research is underdeveloped in considering the perspectives of women with visible physical disabilities (WPD), who have differences in body functionality and appearance that influence their body image. Our study aimed to understand how WPD conceptualize body image and body functionality and to clarify relationships between these constructs. We conducted semi-structured interviews with 15 women representing a range of ages (21-53 years) and disabilities. We used a constructivist grounded theory approach, applying the constant comparative method and engaging in reflexivity throughout the research process. We interpreted themes and subthemes based on their emergence across and explanatory value within cases to develop a conceptual model of the findings. Four major themes emerged: meanings and definitions, body image stability, factors that influence body image, and the interaction of appearance and body functionality. A new concept, "functional-aesthetic body image," emerged describing women's perceptions about the appearance of their body when engaged in functions or activities. Results may stimulate advancements in body image theory and measurement, and guide further exploration of the complex appearance-functionality relationship and its links with holistic health outcomes.

Is having any prenatal care associated with lower infant mortality in West Africa? Evidence from the Demographic and Health Surveys.

Although developing countries may find it difficult to provide adequate prenatal care, it is likely that they can provide at least some. We examined associations of prenatal care with infant mortality in West Africa. We used data from the Demographic and Health Surveys (n = 57,322) and proportional hazards regression models to estimate the risk of infant mortality. Having any prenatal care was associated with lower infant mortality risk in all but the poorest wealth quintile, with 56% lower risk in the wealthiest quintile (95% confidence interval [CI] 0.28-0.69). Even limited prenatal care may significantly reduce infant mortality in developing countries.

An Enduring Health Risk of Childhood Adversity: Earlier, More Severe, and Longer Lasting Work Disability in Adult Life.

Objectives: Childhood adversity has been linked with adult health problems. We hypothesized that childhood adversity would also be associated with work limitations due to physical or nervous health problems, known as work disability. Method: With data from the Panel Study of Income Dynamics (PSID) (1968-2013; n = 6,045; 82,374 transitions; 129,107 person-years) and the 2014 PSID Childhood Retrospective Circumstances Study, we estimated work disability transition probabilities with multinomial logistic Markov models. Four or more adversities defined a high level. Microsimulations quantified adult work disability patterns for African American and non-Hispanic white women and men, accounting for age, education, race, sex, diabetes, heart disease, obesity, and sedentary behavior. Results: Childhood adversity was significantly associated with work disability. Of African American women with high adversity, 10.2% had moderate work disability at age 30 versus 4.1% with no reported adversities; comparable results for severe work disability were 5.6% versus 1.9% (both p < .01). Comparable results for whites were 11.3% versus 4.7%, and 3.5% versus 1.1% (p < .01). The association of childhood adversity with work disability remained significant after adjusting for diabetes, heart disease, obesity, and sedentary behavior (p < .05). Conclusions: Childhood adversity may increase work disability throughout adult life.