A Driver in Health Outcomes: Developing Discrete Categories of Transportation Insecurity.

Research suggests that transportation is an important social determinant of health, because the ability to get around is consequential for accessing health care and nutritious food and for making social connections. We used an inductive mixed-methods approach and a quantitative k-means clustering approach to identify 5 categories of transportation insecurity using the validated 16-item Transportation Security Index. The resulting 5-category measure distinguished among respondents with qualitatively different experiences of transportation insecurity. Analyzing data from 2018 that were representative of the US adult population aged 25 years or older, we demonstrated a nonparametric association between transportation insecurity and 2 different health measures (self-rated health and depressive symptoms). There was a threshold relationship between self-rated health and any level of transportation insecurity. High transportation insecurity had a very strong relationship with depressive symptoms. The categorical Transportation Security Index will be useful for clinicians who wish to screen for transportation-related barriers to health care. It will also facilitate research investigating the influence of transportation insecurity on health outcomes and provide the basis for interventions designed to address health disparities.

Employers' Perspectives on Accommodating and Retaining Employees with Newly Acquired Disabilities: An Exploratory Study.

Introduction Timely and appropriate accommodations can help employees who experience disabilities stay at work instead of exiting the labor force. Employers can play a critical role in connecting such workers with the accommodations they need. This qualitative study seeks to inform policy makers who want to improve workforce retention outcomes by uncovering factors that affect whether employers provide accommodations to, and ultimately retain, employees with disabilities. Methods We conducted semistructured interviews with a convenience sample of human resources professionals in 14 Arkansas-based employers, yielding detailed information on 50 cases in which an employee developed or disclosed a disability. We analyzed the interviews using a grounded theory approach and compared cases to identify key themes emerging across subgroups of cases. Results Two organization-level factors and four employee-level factors influenced employers' efforts to accommodate and retain employees with disabilities: employer resources; employers' communication with the employee and other stakeholders; employee tenure; employee work performance; active/sedentary nature of employee role; and the severity and type of employees' health conditions. Conclusions Consistent with prior literature, employers with greater access to resources and better ability to communicate generally made greater effort to accommodate and retain employees with disabilities. However, employers in the study did not deploy these resources and processes consistently when making decisions about whether and how to provide accommodations to workers with disabilities; employee-level characteristics affected their actions. Policy makers should consider intervention approaches that reach workers who may be overlooked by employers with scarce resources.