Employment as a health determinant for working-age,dually-eligible people with disabilities

BackgroundIndividuals with disabilities are a health disparity population with high rates of risk factors, lower overall health status, and greater health care costs. The interacting effect of employment, health and disability has not been reported in the research.ObjectiveThis study examined the relationship of employment to health and quality of life among people with disabilities.MethodsSelf-reported survey data and secondary claims data analyses of 810 Kansans ages 18–64 with disabilities who were dually-eligible for Medicare and Medicaid; 49% were employed, with 94% working less than 40 hours per week. Statistical analyses included ANOVA for differences between the employed and unemployed groups' health status, risk scores, and disease burdens; chi-square analyses for differences in prevalence of health risk behaviors and differences in quality of life by employment status; and logistic regression with health status measures to determine factors associated with higher than average physical and mental health status.ResultsFindings indicated participants with any level of paid employment had significantly lower rates of smoking and better quality of life; self-reported health status was significantly higher, while per person per month Medicaid expenditures were less. Employment, even at low levels, was associated with better health and health behaviors as well as lower costs. Participants reported being discouraged from working by medical professionals and federal disability policies.ConclusionsAlthough cause–effect cannot be established from this study, findings strongly support changes to provider practices and federal disability policy to support employment at all levels for people with disabilities.     

Unable to work? Characteristics of people with blindness and low vision who are out of the labor force

BackgroundApproximately half of the people who are blind or have low vision in the U.S. are not in the labor force, yet we know little about their characteristics or reasons for being out of the labor force.Objective/HypothesisThe objective of this study was to compare people with blindness or low vision who reported being unable to work to those out of the labor force for other reasons, unemployed, and employed, and investigate characteristics that differentiate these groups.MethodsOur sample of people with blindness or low vision was selected from the Behavioral Risk Factor Surveillance System to compare people who reported being unable to work to those in other employment groups utilizing multinomial logistic regression.ResultsThe majority of people out of the labor force reported they were unable to work. People unable to work were likely to have low income, more chronic health conditions, days with poor physical health, and functional disabilities than all other groups. They were also more likely to have access to health care than other groups and were more likely to be male and uncoupled compared to those out of the labor force for other reasons.ConclusionsPeople who reported being unable to work had more chronic health and functional disability issues. Because being out of the labor force puts one at economic risk, further research is indicated to assess policy issues and strategies that might identify employment options that accommodate people with blindness or low vision and additional health issues and disabilities.     

Supporting the diffusion of healthy public policy in Canada: the Prevention Policies Directory

Healthy public policy plays an essential role in a comprehensive public health approach to preventing cancer and chronic disease. Public policies spread through the ‘policy diffusion’ process, enabling governments to learn from another’s enacted policy solutions. The Prevention Policies Directory (the Directory), an online database of municipal, provincial/territorial, and federal cancer and chronic disease prevention policies from across Canada, was developed to facilitate the diffusion of healthy public policies and support the work of prevention researchers, practitioners, and policy specialists. This information technology solution was implemented, through a participatory engagement approach, as a communication channel or policy knowledge transfer tool. It also addressed the intrinsic shortcomings of environmental scanning for policy surveillance and monitoring. A combination of quantitative web metrics and qualitative anecdotal evidence have illustrated that the Directory is becoming an important tool for healthy public policy surveillance and policy diffusion in Canada.     

Factors Affecting Employment Outcomes for People with Disabilities Who Received Disability Employment Services in Taiwan

Purpose. One of the most important rehabilitation goals is to return people with disabilities to paid employment. The purposes of this study were (1) to explore employment status and (2) to identify factors that may affect the employment outcomes of people with disabilities who received Disability Employment Services (DES). Methods. A retrospective study was conducted on clients who commenced and closed DES between January 2008 and December 2010 in a metropolitan city in Taiwan, using the files from the National Vocational Rehabilitation Services Documentary System. Results. Sixty-nine percent (1,684 out of 2,452) of the clients in this study were engaged in paid employment after receiving DES. Logistic regression analyses indicated that clients with no psychiatric disability or mild impairment and with useful vocational qualifications, typical work experience, more post-employment services, and less pre-employment services were associated with a higher rate of successful employment outcomes. Conclusion. This study provides empirical evidence of the association between person- and DES-related factors and the employment outcomes of people with disabilities. Future improvements in health, school-to-work transition services, and vocational rehabilitation for people with disabilities should place more emphasis on providing work-based work experience, professional vocational training, access to college/professional education, career exploration, effective supported employment services, and other post-employment services.     

Disability and voting

BackgroundFor millions of people with disabilities in the United States, exercising the fundamental right to vote remains a challenge. Over the last few decades, the U.S. government has enacted several pieces of legislation to make voting accessible to individuals with disabilities.ObjectiveWe examine trends in self-reported voting rates among people with and without disabilities to uncover evidence for the effects of these policies on political participation. We also explore what policy change is necessary to encourage people with disabilities to vote by investigating whether the participation rates vary by the types of disabilities.MethodsWe analyze the Current Population Survey (CPS) data in the years of presidential elections for the period of 1980–2008.ResultsOur analysis shows that the population aged 18–64 with work-preventing disabilities has been persistently less likely to vote compared to the corresponding population without such disabilities. In addition, individuals with cognitive and mobility impairments have the lowest rates of electoral participation. The gap in the likelihood of voting in-person between people with and without disabilities is considerably larger than the gap in the likelihood of voting by-mail, regardless of the types of impairments that they have.ConclusionsThe participation gap between people with and without disabilities did not decrease over the last three decades despite the presence of federal laws that aimed at removing barriers for voting.     

How has COVID-19 impacted disability employment?

BackgroundWhile the COVID-19 public health emergency has had disastrous health impacts for people with disabilities, it remains unclear what impact the associated economic recession and subsequent recovery have had on disability employment.ObjectiveWe evaluated employment trends for people with and without disabilities over the course of the COVID-19 recession and subsequent economic recovery, both overall and by occupational category (essential, non-essential, teleworkable, non-teleworkable, frontline, non-frontline).MethodsWe made use of data from the nationally representative Current Population Survey. Linear probability models were used to estimate percent changes in employment-to-population ratios and identify differences between disabled and non-disabled employment in each quarter broadly and within specific occupational categories.ResultsAs the COVID-19 recession began in Q2 2020, people with disabilities experienced employment losses that were proportionately similar to those experienced by people without disabilities. However, during the subsequent economic recovery, the employment rate of people with disabilities grew more quickly in Q4 2021 through Q2 2022, driven by increased labor force participation. These employment gains have been concentrated in teleworkable, essential, and non-frontline occupations.ConclusionOur findings suggest that people with disabilities are disproportionately benefiting from the rapid recovery from the initial economic contraction at the start of the pandemic.     

Canadian school-based HPV vaccine programs and policy considerations

BackgroundThe National Advisory Committee on Immunization in Canada recommends human papillomavirus (HPV) vaccination for females and males (ages 9–26). In Canada, the HPV vaccine is predominantly administered through publicly funded school-based programs in provinces and territories. This research provides an overview of Canadian provincial and territorial school-based HPV vaccination program administration and vaccination rates, and identifies foreseeable policy considerations.MethodsWe searched the academic and grey literature and contacted administrators of provincial and territorial vaccination programs to compile information regarding HPV vaccine program administration and vaccination rates in Canada’s 13 provincial and territorial jurisdictions.ResultsAs of October 2016, all 13 Canadian jurisdictions vaccinate girls, and six jurisdictions include boys in school-based publicly funded HPV vaccination programs. Eleven jurisdictions administer the HPV vaccine in a two-dose schedule. The quadrivalent vaccine (HPV4) has been the vaccine predominantly used in Canada; however, the majority of provinces will likely adopt the nonavalent vaccine in the future. According to available data, vaccination uptake among females ranged between 46.7% and 93.9%, while vaccination uptake among males (in programs with available data to date) ranged between 75.0% and 87.4%.ConclusionsFuture research and innovation will beneficially inform Canadian jurisdictions when considering whether to administer the nonavalent vaccine, whether to implement a two or one-dose vaccination schedule, and how to improve uptake and rates of completion. The usefulness of standardizing methodologies for collecting and reporting HPV vaccination coverage and implementing a national registry were identified as important priorities.     

Housing, income support and mental health: Points of disconnection

There exists a disconnection between evolving policies in the policy arenas of mental health, housing, and income support in Canada. One of the complexities associated with analysing the intersection of these policies is that federal, provincial, and municipal level policies are involved. Canada is one of the few developed countries without a national mental health policy and because of the federal policy reforms of the 1970s, the provincial governments now oversee the process of deinstitutionalization from the hospital to the community level. During this same period the availability of affordable housing has decreased as responsibility for social housing has been transfered from the federal government to the provincial and/or municipal levels of government. Canada also stands alone in terms of being a developed nation without national housing policy instead what is considered "affordable" housing is partially dependant upon individuals' personal economic resources. As well, over the past decade rates of income supports have also been reduced. Psychiatric survivors have long been identified as being at risk for homelessness, with the disconnection existing between housing, income and mental health policies and the lack of a national policy in any of these policies areas further contributing to this risk.     

Telework during the pandemic: Patterns,challenges, and opportunities for people with disabilities

BackgroundTelework has benefits for many people with disabilities. The pandemic may create new employment opportunities for people with disabilities by increasing employer acceptance of telework, but this crucially depends on the occupational structure.ObjectiveWe compare people with and without disabilities in the expansion of telework as the pandemic began, and the evolution of telework during the pandemic.MethodsWe use U.S. data from the American Community Survey from 2008 to 2020 and the Current Population Survey over May 2020 to April 2022 period. Prevalence and trends are analyzed using linear probability and multinomial logit regressions.ResultsWhile workers with disabilities were more likely than those without disabilities to telework before the pandemic, they were less likely to telework during the pandemic. The occupational distribution accounts for most of this difference. Tight labor markets, as measured by state unemployment rates, particularly favor people with disabilities obtaining telework jobs. While people with cognitive/mental health and mobility impairments were the most likely to telework during the pandemic, tight labor markets especially favored the expansion of telework for people with vision impairments and difficulty with daily activities inside the home.ConclusionsMany people with disabilities benefit from working at home, and the pandemic has increased employer acceptance of telework, but the current occupational distribution limits this potential. Tighter labor markets during the recovery offer hope that employers will increasingly hire people with disabilities in both telework and non-telework jobs.     

Australian federal,state and territory policy on the health and wellbeing of young people: A scoping review

BackgroundThe health and wellbeing of young people are critical for the future of society but the extent to which they are addressed by overarching Australian Federal, State and Territory health policy is difficult to determine. Analysing high-level youth health policy will help establish how Australian governments are articulating and prioritising issues and may guide local and international health agendas.MethodsThis scoping review aimed to determine the extent, range and nature of Australian high-level government policy focused on the general health and wellbeing of the general population of young people. Policies published by Australian Federal, State, or Territory government departments between 2008 and 2019 were thematically analysed employing Braun and Clark's six-step recursive framework.FindingsTwelve policy documents met inclusion criteria. Three meta-themes emerged, comprising policy development, youth health challenges, and policy goals. Policy goals fell into three ubiquitous and overarching categories focused on supporting public health, promoting equity, and improving the health system for young people.ConclusionsA number of youth-specific health policies have been developed by Australian governments in recent years. Whilst goals and strategies are clearly articulated, more can be done to ensure a youth voice in policy development. The policy goals of supporting public health, promoting equity and improving the health system deserve consideration from other countries developing youth health policies.     

Incorporation of health economic evaluation into immunization policy-making in Canada: Barriers and facilitators

IntroductionDespite the WHO recommendation that economic evidence be considered in national vaccine recommendations, this element of decision-making has been lacking or not done routinely in Canada. This study aimed to investigate barriers and facilitators to using economic evaluations in public health immunization programs decision-making across Canadian jurisdictions.MethodsThis mixed methods study consisted of a cross-sectional survey and semi-structured interviews of national, provincial and territorial public health level key informants, and of members of the national immunization research network in Canada. Barriers were categorized according to accessibility (e.g. access to human resources to conduct the evaluation) and acceptability (e.g. political resistance to using the evaluation).ResultsOf 63 survey participants, 12 were federal, provincial or territorial key informants (response rate 12/31, 39%) and 51 were members from the research network (response rate 51/214, 24%). Eleven stakeholders gave semi-structured interviews. All respondents support increased use of economic evaluation and of it becoming a routine part of immunization policy-making. However, 70% of the survey respondents identified limited resources (human and financial) to perform economic evaluations, and 39% reported lack of expertise to interpret economic evidence. Vaccine effectiveness and the burden of disease were seen as more important than cost-effectiveness by survey respondents and interviewees. Potential facilitators were for economic evaluations to either be conducted at the national level, or through a collaboration between provinces and territories with capacity to address shared needs so that evaluations occurred in a co-ordinated but distributed way.Recommendations:Barriers to incorporation of economic evaluation in immunization policy-making in Canada include lacking human and financial resources to conduct them and understanding of economic evidence. National, provincial and territorial public health actors reported that facilitators to incorporating economic evidence include developing increased capacity to conduct and use economic evaluations and establishing inter-jurisdictional systems to share the work of conducting economic evaluation and/or by national leadership.     

Which one to follow? Service animal policy in the United States

BackgroundService animals are an invaluable resource to improving health among individuals with disabilities, and their use is steadily growing. Yet, United States’ current federal and state policies surrounding service animals are contradictory and burdensome, and often do not adequately protect the rights of service animal handlers.ObjectiveTo review each state’s service animal policies surrounding criminal interference, misrepresentation of a service animal, and public accessibility. To also identify inconsistencies among states’ individual policies, between state policies, and between state and federal policies, and discuss the implications of these inconsistencies.MethodsWestlaw legal research database was used to comprehensively review each state’s policies regarding the use of a service animal.Results26 states have one or more policies that are incongruous with the Americans with Disabilities Act. Further, 34 states have contradictions within their own policies and between other states. 31 states provide protections against fraudulent service animals, and there are variations in the degree of protection and ability to enforce these laws.ConclusionsBecause service animals are a vital resource to this particularly vulnerable population, it is imperative that our policies encourage their use and protect the rights of handlers. Yet, inconsistencies among current policies create confusion and ultimately deter individuals with disabilities from taking full advantage of their service animal. We are in need of clear, cohesive policy at all levels of government in order to improve health literacy and ensure that those with disabilities are able to benefit from the positive health impacts of a service animal.     

Health characteristics and outcomes of caregivers in the United States: An Analysis of the 2017 Health Information National Trends Survey (HINTS)

BackgroundCaregivers are essential for assisting people with disabilities to fully participate in their communities. Past research has primarily focused on family caregivers in the U.S. providing care to older adults rather than children and adults with disabilities.ObjectiveThis paper examines the demographic and health characteristics of caregivers of children and adults with disabilities across the lifespan using data from the 2017 Health Information National Trends Survey (HINTS).MethodsChi square, t-test, linear and logistic regression analyses show differences between caregivers and non-caregivers related to gender, age, employment, and specific health outcomes.ResultsOf 3285 respondents, 18% self-identified as caregivers of children or adults with disabilities (n = 546). Almost one-third of all caregivers reported being diagnosed with depression or an anxiety disorder as compared to one-fifth of non-caregivers. Psychological distress was associated with an increased risk for a diagnosis of depression/anxiety. We also found that distress decreased with age when controlling for other factors.ConclusionThis paper increases knowledge of a growing segment of family caregivers providing care for members with disabilities across the lifespan. Research and policy needs are discussed.     

A Socio-Ecological Approach to Understanding the Perinatal Care Experiences of People with Intellectual and/or Developmental Disabilities in Ontario,Canada

BackgroundAccessible and quality care during the perinatal period is critical for optimal maternal and neonatal health. Using the socio-ecological model, the purpose of this study was to explore barriers and facilitators that shape the perinatal care experiences of people with intellectual and/or developmental disabilities (IDD).MethodsSemi-structured interviews were conducted with 10 individuals with IDD in Ontario, Canada, who had given birth within the past 5 years. Interviews focused on care experiences before, during, and after pregnancy. Data were analyzed using a directed content analysis approach, and the socio-ecological model guided analysis.ResultsBarriers at the societal (e.g., cultural norms of motherhood), policy/institutional (e.g., child protection policies and practices), interpersonal (e.g., inadequate formal and informal support), and intrapersonal levels (e.g., internalized stigma) contributed to participants having negative perinatal care experiences. Conversely, we identified facilitators on the interpersonal level (e.g., positive interactions with perinatal care providers and familial and social service supports) as positively shaping participants’ perinatal care experiences.ConclusionsFindings reveal that the perinatal care experiences of people with IDD are shaped by several interrelated factors that largely stem from societal-level barriers, such as dominant (stigmatizing) discourses of disability. To improve the perinatal care experiences of people with IDD, there is a need for interventions at multiple levels. These include the development of policies to support perinatal care for diverse populations and training care providers to enact policies at the institutional and interpersonal levels.     

Future Directions in Employment,Occupational Rehabilitation,and Disability: Introduction to the Special Section

Purpose From an array of disciplinary perspectives, the articles in this special section examine opportunities and challenges in the economic, social, and civic participation of individuals across the spectrum of disabilities. Methods At multiple levels of analysis, the contributors consider employment law and policy frameworks, occupational and vocational rehabilitation strategies, and corporate practices in support of the full and equal inclusion of people with disabilities in society. Results and Conclusions The implications for policymakers, public and private sector stakeholders, and occupational rehabilitation professional are presented to help inform future policies, practices, and strategies to improve employment outcomes for people with disabilities.     

Lesbian,gay, bisexual and transgender youth: Victimization and its correlates in the USA and UK

Research on lesbian, gay and bisexual young people in the USA and UK has provided an important tool for advocacy and for developing appropriate public policy. Studies suggest that lesbian, gay and bisexual youth are more frequently victims of discrimination as a result of actual or perceived sexual orientation than adults, and anecdotal information suggests that transgender young people may be particularly vulnerable. During the past decade, high rates of victimization, particularly in school and community settings, has paralleled increased visibility. Increased media attention has focused on gay youth in schools, highlighting the need for support, appropriate policies and intervention. This paper reviews research and policy needs related to sexual minority youth in the USA and the UK and identifies strategies and approaches for reducing victimization and harassment and providing safer communities and school environments for lesbian, gay, bisexual and transgender young people.     

Emerging electronic cigarette policies in European member states,Canada, and the United States

BackgroundIncreased electronic cigarette (ECIG) use has motivated new regulations to address the changing landscape of tobacco use and promote public health.MethodThis policy scan compares ECIG prevalence and regulations in the European Union (EU), Canada, and the United States (US) at the federal- and local-level to foster a policy dialogue around modern tobacco prevention and control regulations.ResultsAmong young adults, 40 % in the US, 29 % in Canada, and 28 % in the EU report ever using an ECIG. Results from the policy scan find significant variation in approach to regulating ECIGs. EU member states are subject to the most stringent requirements regarding nicotine concentration regulations, and several member states have also opted to ban flavors and/or require plain packaging or out of sight retail sales. Among EU and US states, taxation is a popular strategy, though taxing strategies vary widely. Regarding youth use, US states have led the way for increasing the legal age of sale to 21 at the federal level, and in Canada recent federal regulations are innovative in their approach to banning advertising that may appeal to youth.ConclusionStrategies to achieve public health goals related to ECIGs vary widely, with federalism playing an important role in policy innovation, offering opportunities to evaluate their effectiveness and inform future regulations.     

The Kansas Medicaid Buy-In: Factors influencing enrollment and health care utilization

BackgroundMedicaid Buy-Ins are optional programs states may implement to create work incentives for people with disabilities. These programs allow participants to increase earnings without losing Medicaid eligibility—potentially moving them out of poverty without risking loss of health care coverage. They also provide the opportunity for beneficiaries to offset some of their medical costs to the federal and state governments through premiums for coverage and increased taxes paid. State and federal policy makers and administrators have speculated about who might enroll, how they might use the benefits, and whether positive health outcomes for persons with disabilities would result.ObjectiveWe compared characteristics and health care utilization of 184 enrollees and 158 eligible nonenrollees in Kansas' Medicaid Buy-In.ResultsEnrollees were older and significantly more likely to have more than one disability, with mental illness being more prevalent than physical disabilities, and to have both higher Social Security and earned income. A majority of the sample was dually eligible for Medicare and Medicaid with Medicaid paying most costs. Home health service costs were the primary difference between enrollee and nonenrollee expenditures.ConclusionsIncreased Medicaid Buy-In enrollment could prevent long-term dependence on federal disability benefits.     

Parental leave: Policy issues

Pregnant women and mothers with infants and young children are increasingly visible in the labor market. Their employment rate currently approaches 50 percent. This historical review examines current policies related to pregnancy and parental leaves and concludes that ambiguity and discontinuity characterize American maternity benefits.     

Trajectories of disability throughout early life and labor force status as a young adult: Results from the Longitudinal Study of Australian Children

ObjectivesYoung people with disabilities have poorer labor force outcomes than their peers without disabilities. These understandings, however, are largely based on research assessing disability at one time point only, an approach that potentially obscures variation in disability over time. We aimed to identify trajectories of disability during childhood/adolescence and assess associations between trajectory membership and labor force status in young adulthood.MethodsWe conducted group-based trajectory modeling of disability status information from six waves [waves 2–7 (age 4/5 to 16/17 years)] of the Longitudinal Study of Australian Children. The trajectories were used to predict labor force participation (employed, unemployed, not in the labor force) at wave 8 (18/19 years), adjusted for confounders.ResultsWe identified four trajectory groups of the prevalence of disability: low (75.5% of cohort), low increasing (9.7%), high decreasing (10.9%), and consistently high (3.9%). Individuals in the low increasing trajectory were nearly three times as likely to be unemployed at age 18/19 years compared to individuals in the low trajectory [risk ratio (RR) 2.96, 95% confidence interval (CI) 1.94–4.53]. Individuals in the consistently high trajectory had a greater RR of not being in the labor force at age 18/19 years compared to individuals in the low group (reference) (RR 3.65, 95% CI 2.21–6.02).ConclusionsResults suggest that prolonged and increasing experiences of disability among young Australians may be differentially associated with future labor force outcomes. Additional support to prepare young people for the labor force should focus on individuals who consistently or increasingly report a disability.