BackgroundPoor housing conditions pose significant risks to the health of persons with disabilities. However, it is not well understood how and for whom the relationship between housing conditions and health is more pronounced. ObjectiveThis study aims to estimate the association between poor housing conditions and psychological health, and to explore whether residential characteristics, such as residence type and proximity to community resources, mitigate these risks for community-dwelling adults with disabilities. MethodsData were obtained from three waves of the Disability and Life Dynamic Panel (n = 5,165), a nationally representative study of individuals with disabilities in Korea. Our sample were limited to those aged 20 or older for the purpose of this study. Individual-level fixed effect analyses were conducted to assess the longitudinal association between poor housing conditions and depressive symptoms, accounting for individual-level heterogeneity. We also tested the moderating effects of the residential characteristics, including residence type and proximity to community resources. ResultsPoor housing conditions, characterized by structural unsafety and inadequate ventilation, lighting, and noise protection, were associated with increased depressive symptoms among adults with disabilities. The negative impact of poor housing conditions on depressive symptoms was less pronounced for those living close to community services or in apartment complexes where housing conditions are professionally managed. ConclusionsThe study indicates that the quality of housing and neighborhood environments affects the psychological health of adults with disabilities. These findings support for the need for place-based interventions aimed at improving the residential environments of community-dwelling adults with disabilities.

BackgroundThe growing gap between demand and supply of personal assistance service (PAS) workers presents a significant burden to those who use services. The intensity and duration of hardship is growing, and consumer voices need to be heard and incorporated into the national dialogue. ObjectiveThis paper explores how PAS worker shortages manifest themselves in the daily lives of people with disabilities using or needing PAS services in the United States. MethodsWe used thematic coding of qualitative data from the 2022 National Survey on Health and Disability. Respondents (n = 330) provided open-ended responses to the prompt “Briefly explain the types of problems or issues you have had finding PAS or support workers.” ResultsThree themes emerged regarding consumer perspectives and experiences with worker shortages (1) low pay, few benefits, and undervalued work, (2) demanding working conditions and logistics, and (3) low quality workers. In combination, these themes informed a fourth theme (4) impacts for PAS consumers characterized by substandard care and additional stress and workload for those who direct their own care. ConclusionsAs a society, we have taken steps to increase opportunities for community living and created policies to uphold choice and independence for people with disabilities. In the absence of an adequate workforce to support these policies, however, we convey an empty promise. Without tangible steps to resolve these problems at the policy level, such as improved worker pay and protections, hope for resolution to these issues remains elusive.

BackgroundDuring the COVID-19 pandemic, people with disability had a right and an acute need to access accessible COVID-19 information, in formats such as sign language, Braille, large print and Easy Read/English. Yet such information was not always provided and many people with disability were without sufficient accessible information. ObjectiveThis paper explores the experiences of Australian accessible information provider organizations of producing accessible information during the pandemic. The intent is to understand why insufficient accessible information reached people with disability. MethodsIn-depth interviews were conducted with 17 accessible information provider organizations and one other stakeholder in Australia, and thematically analyzed. ResultsThe findings show that accessible information provider organizations felt an immense depth and breadth of responsibility for providing accessible information to people with disability during the pandemic. However, they were hampered by constantly changing information; workforce challenges; and a lack of financial, logistic and partnership assistance. Other notable difficulties included having no source of clear/accurate information to translate to accessible formats and not having medical/health expertise themselves. ConclusionThe findings have implications for better preparation for accessible information access in future public health crises. There should be greater funding and logistic support for accessible information provider organizations. Provision of clear/accurate information and subject matter checks of accessible products would be helpful. Responsibility for this should be scoped into existing outreach, education and communications roles – for example, in local health services, general practice clinics and government health departments.

Traumatic brain injury (TBI) can come with long term consequences for functional outcome that can complicate return to work. This study aims to make accurate patient-specific predictions on one-year return to work after TBI using machine learning algorithms. Within this process, specific research questions were defined: 1 How can we make accurate predictions on employment outcome, and does this require follow-up data beyond hospitalization? 2 Which predictors are required to make accurate predictions? 3 Are predictions accurate enough for use in clinical practice? This study used the core CENTER-TBI observational cohort dataset, collected across 18 European countries between 2014 and 2017. Hospitalized patients with sufficient follow-up data were selected for the current analysis (N=586). Data regarding hospital stay and follow-up until three months post-injury were used to predict return to work after one year. Three distinct algorithms were used to predict employment outcomes: elastic net logistic regression, random forest and gradient boosting. Finally, a reduced model and corresponding ROC-curve was created. Full models without follow-up achieved an area under the curve (AUC) of about 81%, which increased up to 88% with follow-up data. A reduced model with five predictors achieved similar results with an AUC of 90%. The addition of three-month follow-up data causes a notable increase in model performance. The reduced model - containing Glasgow Outcome Scale Extended, pre-injury job class, pre-injury employment status, length of stay and age - matched the predictive performance of the full models. Accurate predictions on post-TBI vocational outcomes contribute to realistic prognosis and goal setting, targeting the right interventions to the right patients.

BackgroundConversations about prognosis for genetic neurodevelopmental conditions are becoming more frequent; however, there is a lack of evidence and guidance on how to approach these conversations and frame the information being provided. Objective(1) To understand how parents perceive prognostic conversations with healthcare professionals and their preferences for these conversations, (2) To investigate the framing of prognostic information found online. MethodsThis was a mixed-methods study, comprising of (1) a thematic analysis of interviews with parents and (2) a quantification of prognostic information available on the internet that portrayed a negative message. The strategy to classify the framing of prognostic information was defined iteratively, informed by the information found online. ResultsWe interviewed 32 parents from across Australia. Parents had a child with a genetic neurodevelopmental condition, such as Fragile X syndrome (28 %), 22q11.2 deletion syndrome (16 %) or Angelman syndrome (16 %). Parents reported their preference to discuss their child's potential strengths as well as challenges regarding prognosis. They reported that conversations about prognosis often focused on the child's possible deficits and that online information they encountered was similarly framed negatively. Our analysis of online information confirmed parents accounts: 95.3 % was coded as negative, while only 4.7 % was positive/neutral. ConclusionsOur data provide evidence of an over-emphasis of deficit-framed prognostic information about genetic neurodevelopmental conditions. The initial exposure to negative information may adversely affect parents’ psychological well-being and expectations, which future research could address. Health professionals could consider strengths-based framing of prognostic information gained from current and emerging technologies when returning results to families. Findings from this study can help to inform health communication practices as well as online content development.

Three milestone disability health equity related decisions occurred between September 2023 and May 2024. Though each is to be celebrated in its own right, the continued failure to collect and/or limitations with disability data block the path to achieving disability health equity in the US.

BackgroundLittle is known about the prevalence of injection drug use in people with disabilities (PWD) when compared by disability type and to other adults without disabilities. Objective or hypothesisThe prevalence of past-year injection drug use will be higher in adults with a reported disability than adults without any reported disability. MethodsThis study consisted of secondary analyses of data from the 2015–2019 National Survey of Drug Use and Health. The analytic sample comprised 214,505 US adults. Self-reported past-year injection drug use represented the outcome of interest. Disability status and socioeconomic characteristics were conceptualized as predictors, and sex and age were used as controls. ResultsPast-year prevalence of self-reported injection drug use was 0.24 % (95 % CI, 0.22–0.27) in adults without a disability but 0.66 % (95 % CI, 0.59–0.73) in adults with a disability. All disability types examined were associated with increased odds of reporting past-year injection drug use, but the strongest association was observed for disability related to difficulty concentrating (AOR, 4.90; 95 % CI, 3.92–6.14). Adjusted odds of past-year methamphetamine injection were more than three times as high in adults with a disability, compared to those without a disability (AOR, 3.21; 95 % CI, 2.37–4.33) and more than two times as high in adults with a disability for cocaine injection (AOR, 2.77; 95 % CI, 1.84–4.15). ConclusionDisability status is associated with injection of various types of drugs, and a variety of disability types are associated with higher odds of injection drug use.

BackgroundCompanies are increasingly motivated to ensure that they are effective at hiring people with disabilities, but bias in the process remains a challenge. While Diversity, Equity, and Inclusion (DEI) statements are generally crafted as external-facing signaling devices, little is known about their potential effect on the employees themselves with regard to internal decisions, such as hiring. ObjectiveThis study aims to explore whether various DEI statements may encourage more positive hiring decisions for job candidates with both visible and invisible disabilities. MethodsAn experiment with a 2 × 4 × 2 design was used (DEI Language: legal/traditional or heartfelt; Disability Type: none, visible, and two types of invisible disabilities; Candidate's Tone: warm or overconfident). Quantitative and qualitative items measured general reactions to the candidate as well as perceptions about his employability, degree of risk as a new hire, skills at negotiating for his salary, and integrity. Statistical tests include analyses of variance and z-tests for proportions. ResultsHeartfelt statements improved ratings of candidates with disabilities in general, and more so for those with invisible disabilities. In addition, the two types of invisible disability were distinct from each other, with the mental health disability more stigmatized than the neurological one. ConclusionsThese results suggest that the DEI language that a company uses is an important signaling device not just for external constituents but also for internal employees. In addition, it is among the first to demonstrate differences in types of invisible disabilities, indicating that more nuance is needed to understand bias in this context.

BackgroundAdverse childhood experiences (ACEs) confer greater risk for adult traumatic brain injury (TBI), but little is known about their effects on post-injury outcomes. ObjectiveTo determine the prevalence and correlates of conventionally defined ACEs (occurring within household/in private; e.g., physical abuse) and community-level ACEs (e.g., bullying) after TBI. MethodsParticipants were 85 Philadelphia-area TBI Model System participants with chronic (>1 year post-injury) TBI. We examined cross-sectional associations between total conventional and community ACEs reported (out of 21) before age 18, mental health symptoms, and health-related quality of life (HRQoL), as well as relationships between ACEs and neighborhood deprivation (census-derived neighborhood socioeconomic status). ResultsThe median number of total ACEs was 3 (range: 0-17). Emotional abuse, physical abuse, and alcohol abuse in the household were the most common conventional ACEs (each at 36.5%). Witnessing violence (45%) was the most common community ACE. Black individuals (n=32) reported more community ACEs (p<.001) than White individuals (n=45). Community ACEs were significantly associated with greater neighborhood deprivation, though this relationship was confounded by race. Total ACEs was significantly related to more severe mental health symptoms (p<.001) and poorer HRQoL (p=.005), even after covariate adjustment. A fully-adjusted path model supported mental health as a mediator between total ACEs and HRQoL. ConclusionsResults of this preliminary study reveal an appreciable prevalence and potential far-reaching consequences of conventional and community ACEs among those with chronic TBI. The results underscore the value of trauma-informed and life course approaches to research and clinical care in TBI.