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Perceived interpersonal and institutional discrimination among persons with disability in the U.S.: Do patterns differ by age?
Abstract
Rationale:
One-third of U.S. adults have an activity-limiting health condition and this proportion increases with age. However, it is unclear whether functional limitation renders one vulnerable to institutional and interpersonal discrimination, and whether this vulnerability differs over the life course. Stigma theories suggest disability would be more discrediting to younger persons relative to older adults, as it violates cultural norms and expectations regarding able-bodied working-age adults.
Objective:
We evaluate whether U.S. adults with functional impairment report higher levels of perceived interpersonal mistreatment and institutional discrimination relative to persons without impairment, and whether these patterns differ across age groups.
Method:
We use data from the second wave of the National Survey of Midlife Development in the United States (MIDUS II), collected between 2004 and 2006 (n = 3931). We estimate OLS and logistic regression models to predict interpersonal and institutional discrimination, respectively.
Results:
Persons with impairment report more frequent encounters of disrespectful treatment, insults, and being treated as if they have a character flaw, and elevated odds of workplace- and service-related discrimination, net of sociodemographic, and physical and mental health characteristics. Effects are significantly larger among early (age 40-49) and late (age 50-64) midlife versus older (age 65+) adults.
Conclusions:
We discuss implications for policy and practice, and underscore that stigmatization processes may further amplify health and socioeconomic disparities between those with versus without functional limitations.
... Modsat kan der også vaere mennesker med et laengerevarende helbredsproblem eller handicap, eller en psykisk lidelse, som ikke selv oplever, at de har et handicap, eller ikke ønsker at oplyse om det. Eksempelvis har undersøgelser vist, at unge med handicap oplever et større stigma, idet et handicap i højere grad overtraeder kulturelle normer og forventninger til, hvad en ung person "skal kunne" (Namkung & Carr, 2019). Det er derfor muligt, at unge med handicap i lavere grad end aeldre identificerer sig som et menneske med handicap, hvilket kan medføre, at vi undervurderer antallet af unge med handicap. ...
... 10 Diskrimination og vold Forskning viser, at mennesker med fysisk og psykisk handicap ofte oplever stigma eller at blive diskrimineret på grund af deres handicap (Erler & Garstecki, 2002;Russinova et al., 2011). Mennesker med handicap oplever fx oftere at blive behandlet respektløst eller at blive fornaermet, og de har forhøjet risiko for at blive udsat for beskaeftigelsesrelateret diskrimination samt diskrimination i forbindelse med forskellige typer af service, herunder fra bank, sundhedspersonale og håndvaerkere (Namkung & Carr, 2019). Der er en aldersgradient i oplevelsen af diskrimination således, at yngre mennesker i højere grad oplever at blive diskrimineret på grund af handicap end aeldre mennesker (Erler & Garstecki, 2002;Namkung & Carr, 2019). ...
... Mennesker med handicap oplever fx oftere at blive behandlet respektløst eller at blive fornaermet, og de har forhøjet risiko for at blive udsat for beskaeftigelsesrelateret diskrimination samt diskrimination i forbindelse med forskellige typer af service, herunder fra bank, sundhedspersonale og håndvaerkere (Namkung & Carr, 2019). Der er en aldersgradient i oplevelsen af diskrimination således, at yngre mennesker i højere grad oplever at blive diskrimineret på grund af handicap end aeldre mennesker (Erler & Garstecki, 2002;Namkung & Carr, 2019). Dette kan skyldes forventninger til og fordomme om, at unge mennesker i højere grad end aeldre skal vaere fysisk og mentalt sunde og raske (ibid. ...
This report describes and compares living conditions, such as education, employment, health, family situation, discrimination and violence among people with and without disabilities.
... For college students with disabilities, subjective well-being also has a profound impact on their academic and social skills 7 . However, physical impairments can lead to negative psychological experiences, such as discrimination perceptions and psychological stress, to which individuals are particularly susceptible 8 . These experiences continuously undermine their subjective well-being 9 . ...
... At present, how to cope with the generally low subjective well-being of college students with disabilities has become an urgent issue for colleges and universities. Although there have been studies focusing on the relationship between discrimination perceptions and the subjective well-being of college students with disabilities 8 , there is still a lack of in-depth research on the mechanisms of the specific effects of discrimination perceptions on the subjective well-being of college students with disabilities. Therefore, actively studying the mechanism of discrimination perceptions' influence on the subjective well-being of college students with disabilities can help to improve their subjective well-being level, which in turn improves their mental health. ...
Exploring the relationship between discrimination perceptions and subjective well-being among college students with disabilities and the chain-mediated effects of psychological resilience and positive coping styles. Questionnaires were administered to 528 college students with disabilities using the Discrimination Perceptions Scale, Index of Well-Being Scale, Psychological Resilience Scale, and Simple Coping Styles Scale. SPSS 24.0 and Amos 26.0 were used to analyze chained mediation effects and construct structural equation modeling tests. ①Discrimination perception was significantly negatively correlated with subjective well-being (r = -0.294, p < 0.01), psychological resilience(r = -0.427, p < 0.01) and all 3 of its dimensions, and positive coping styles (r = -0.328, p <0.01); subjective well-being was significantly positively correlated with psychological resilience (r = 0.334, p < 0.01) and all 3 of its dimensions, and positive coping styles (r = 0.363, p<0.01); and positive coping styles was significantly positively correlated with psychological resilience(r = 0.433, p < 0.01) and all 3 of its dimensions.② The direct effect of discrimination perceptions on college students with disabilities was significant, and the mediating effect value was-0.191.③Psychological resilience and positive coping styles not only play a significant separate mediating role between discrimination perceptions and subjective well-being of college students with disabilities, with mediation effect values of -0.138 (49.11%) and − 0.087 (30.96%), respectively but also play a significant chain mediating role between discrimination perceptions and subjective well-being, with an effect value of -0.056 (19.93%). Discrimination perceptions can directly affect the subjective well-being of college students with disabilities, and can also indirectly affect the subjective well-being of college students with disabilities through the separate and chain-mediated effects of psychological resilience and positive coping styles.
... Perceived discrimination also contributes to these differences. Experts report that PWD experience higher rates of perceived discrimination in healthcare settings relative to their non-disabled peers and may avoid healthcare appointments due to experiences of unfair or disrespectful treatment by their healthcare providers (Namkung & Carr, 2019;Sharby et al., 2015). Further, researchers who examined survey responses among PWD in Peru found an association between perceived Abbreviations: People with disabilities, PWD. ...
... Differences in intent to receive the COVID-19 vaccine also varied by age group, with non-intent highest among adults 18-64 years (with or without underlying medical conditions) relative to older cohorts (Nguyen et al., 2021). Notably, researchers found a significant relationship between age and perceived institutional discrimination, including at healthcare facilities for PWD in their 40's through mid-60's, but did not find significant relationships among the very young and very old age groups relative to the non-disabled (Namkung & Carr, 2019). These findings highlight the importance of stratifying groups by age to understand differences more fully in preventative healthcare trends, including vaccine uptake. ...
Improving vaccination rates among marginalized populations is an important priority among public policy makers and healthcare providers in the United States of America (U.S.). Racial/ethnic minorities have a long history of reduced vaccination rates relative to white Americans (Khan, Hall, Tanner, & Marlow, 2018), while people with disabilities (PWD) have varied rates of vaccine use (Diab & Johnston, 2004; O’Neill, Newall, Antolovich, Lima, & Danchin, 2019). Yet, little is known about vaccine use among individuals who belong to both groups. This study examines the intersectional effects of race/ethnicity and disability on flu vaccine use. We used the 2015–2018 National Health Interview Survey to examine the odds of flu vaccine use by race/ethnicity, disability, and their interaction among adults aged 18+ in the U.S. non-institutionalized, civilian population stratified by age groups. For each unit increase in disability scores, we found a significant race-by-disability interaction for young black adults (18–39 years) who had higher odds of getting the flu vaccine compared to white adults in the same age group. A significant interaction occurred for middle-aged Hispanic vs. white adults (40–64 years) who had higher odds of getting the flu vaccine as their disability scores increased. Black vs. white adults were less likely to get the flu vaccine across all age groups irrespective of disability and other covariates, while results were more mixed among other racial/ethnic groups. Additionally, people with disabilities had higher odds of flu vaccination. Further, race/ethnicity had a moderating effect on the relationship between disability and flu vaccination and an interaction effect occurred between disability and certain racial/ethnic groups when stratified by age.
... They also may feel their independence and autonomy are threatened, abandon activities that were once a source of enjoyment, and struggle to live independently and maintain social relationships . Consequently, difficulties with physical mobility and ADLs are associated with heightened depressive symptoms, with studies documenting the direction of effects going both from physical to mental health Kelley-Moore & Ferraro, 2005;Namkung & Carr, 2019;Schieman & Plickert, 2007), and vice-versa (Friedrich, 2017). ...
... Response categories were "not at all," "a little," "some," and "a lot" (Ware & Sherbourne, 1992). We indicated the presence of a limitation if a respondent indicated at least "some" difficulty with an activity, consistent with previous MIDUS analyses (Namkung & Carr, 2019). HRS participants were asked whether they had any difficulty performing each of 11 similar activities because of health problems: dressing; eating; bathing; walking several blocks; walking one block; walking across a room; climbing several flights of stairs without resting; getting up from a chair after sitting for long periods; stooping, kneeling, or crouching; pushing or pulling large objects like a living room chair; and getting in and out of bed. ...
Objectives
We examined the extent to which optimism buffers the effects of physical limitations on depressive symptoms, across four mid- and later-life age groups (ages 40-49, 50-64, 65-74, 75+ at baseline). Analyses are motivated by stress theories, which hold that the protective effects of coping resources are evidenced only at high levels of stress. We further explore whether these purportedly protective effects diminish with age, as health-related stressor(s) intensify and become irreversible.
Methods
We use data from two waves (2004-06 and 2013-14) of the Health and Retirement Study (HRS, n = 4,515) and Midlife in the United States (MIDUS, n = 2,138). We estimate OLS regression models with three-way interaction terms to examine prospectively the benefits of optimism as a coping resource for persons with physical limitations across four age groups. Physical limitations are assessed with a composite measure encompassing mobility and activity of daily living (ADL) limitations.
Results
In HRS and MIDUS, persons with 3+ limitations reported significantly more depressive symptoms than persons with 0-2 limitations, yet these disparities diminished at higher levels of optimism. Buffering effects of optimism vary by age. For midlife and young-old persons with 3+ limitations, optimism is strongly and inversely related to depressive symptoms at follow-up. Comparable protective effects are not evident among oldest sample members.
Discussion
Stress and coping models should consider more fully factors that limit older adults’ capacity to deploy purportedly protective personal resources. Investments in structural or institutional supports may be more effective than interventions to enhance positive thinking.
... We conducted sensitivity analysis in which we used three subscales of perceived mistreatment, consistent with MIDUS analyses showing three conceptually and statistically distinct subtypes of perceived discrimination (Carr et al. 2008;Namkung and Carr 2019). Lack of respect (α = 0.91) indicates the frequency with which one was treated with less courtesy or respect than other people; received poorer service than other people; treated as if not smart or not as good as other people. ...
... First, the stronger mediation effects detected among midlife versus older persons may reflect cohort rather than age effects, such that members of the Baby Boom and Generation X cohorts are more sensitive to experiences of discrimination, relative to older cohorts. However, while there is evidence that cohort membership may affect one's awareness of and willingness to report discrimination (Namkung and Carr 2019), it is less clear that cohort membership would affect emotional responses to this discrimination among persons with impairment. Given compelling literature on age differences in emotional responses to difficult interpersonal encounters (Charles and Carstensen 2010), we find age moderation arguments more persuasive, although these contrasts could be further fleshed out in future analyses. ...
We examine whether perceived interpersonal discrimination mediates the association between disability and psychological well-being (depression, negative and positive affect) and how these processes differ across the life course. Data are from two waves (2004–2006; 2013–2014) of the Midlife in the United States (MIDUS; N = 2,503). Perceived discrimination accounts for 5% to 8% of the association between disability and the three mental health outcomes. Moderated mediation analyses reveal significant age differences; perceived discrimination is a stronger explanatory mechanism among midlife (ages 40–64) relative to older (age 65+) adults. Disability stigma takes a heightened psychological toll at midlife, a life stage when adults are expected to be able-bodied and interact with a diverse social network, which may be a source of interpersonal mistreatment. Among older adults, for whom impairment is expected and common, the psychological impact of disability may operate through other pathways. We discuss implications for research and practice.
... Barriers to accessing quality leisure may also be agegraded, particularly for individuals who are younger and for whom disability is less prevalent among age peers (Taylor, 2018). Namkung and Carr (2019), for example, find that people with disabilities in early midlife (age 40-49) reported higher perceived lack of respect, harassment, and service discrimination than those in young adulthood (30-39) and in late midlife (50-64) and older age (age 65+). Additionally, younger people without disabilities perceive disability as more stigmatizing than older people without disabilities (Erler & Garstecki, 2002). ...
... Yet the greatest disparities in passive leisure by disability occur during 40-49 years of age. This age category, in particular, may reflect a period in which people with disabilities are less connected to age-graded institutions like employment and the linked lives of spouses and children than their age peers without disabilities (Bureau of Labor Statistics, 2018; Clarke & McKay, 2014) and more susceptible to experiences of stigma and discrimination (Namkung & Carr, 2019). Midlife is also an important window for health-promoting leisure interventions among disabled populations. ...
Objectives:
Patterns of healthy leisure are dependent upon age, but people with disabilities are particularly susceptible to passive and disengaged types of activities. This study evaluates how individuals with disabilities spend their time in passive, active, social, and isolated forms of leisure over the life course, and how these patterns vary by age.
Methods:
I analyze nationally representative data from 70,165 respondents in the 2008, 2010, and 2012-2016 American Time Use Survey. Linear regression models estimate the association between disability and leisure time, net of self-rated health and sociodemograhic controls. Interactions between age and disability are also evaluated.
Results:
People with disabilities report significantly more, and poorer quality, leisure than people without disabilities. The isolated leisure time of people with disabilities is most different from people without disabilities in later life-whereas differences in total and passive leisure time, by disability status, are greatest in midlife.
Discussion:
People with disabilities spend less time in health-promoting forms of leisure at all ages, but these patterns are unique across midlife and older age.
... Discrimination can be recognised as being treated unfairly or differently because of one's colour, religion, gender, sexual orientation, or other personal traits. According to Namkung & Carr (2019), individuals with disabilities report higher rates of workplace and service-related discrimination, net of sociodemographic and physical and mental health characteristics, as well as more frequent experiences of insults, disrespect, and being treated as though they have a character flaw. It can be direct or indirect discrimination. ...
Discrimination has a significant impact on individuals, particularly those from marginalised groups such as people with disabilities. It is important to know the level of the discrimination that employees face and the barriers that affect the effectiveness of the employees. The research delves into how discriminatory practices in the workplace can hinder job satisfaction. The study involves 242 respondents from the banking sector, including employees from various categories of disability, such as those with visual, hearing, and mobility impairments. The study employed a convenience sampling method to choose participants, with questionnaires used for data collection, followed by analysis. The study investigated the perceived discrimination, job satisfaction, and also basic demographic profile of the respondents. The result reveals that the means of job satisfaction vary significantly between different categories of disability. The result of the study identifies an association between job satisfaction and perceived and has a significant role in predicting the job satisfaction of employees with disabilities.
... Previous studies indicate a significant disparity in the utilization of invasive therapies for these patients, coupled with poorer short and long-term outcomes [35,36]. This gap in care, potentially exacerbated by interpersonal and institutional biases [37], underscores the urgent need for research into the in-hospital outcomes of NSTEMI patients with NDDs, hypothesizing that these patients face higher mortality rates and reduced access to invasive treatments compared to their neurotypical counterparts. 1 2 1 2 1 2 2 3 2 ...
Patients with neurodevelopmental disorders (NDDs) encounter significant barriers to receiving quality health care, particularly for acute conditions such as non-ST segment elevation myocardial infarction (NSTEMI). This study addresses the critical gap in knowledge regarding in-hospital outcomes and the use of invasive therapies in this demographic. By analyzing data from the National Inpatient Sample database from 2011 to 2020 using the International Classification of Diseases, Ninth Edition (ICD-9) and Tenth Edition (ICD-10) codes, we identified patients with NSTEMI, both with and without NDDs, and compared baseline characteristics, in-hospital outcomes, and the application of invasive treatments. The analysis involved a weighted sample of 7,482,216 NSTEMI hospitalizations, of which 30,168 (0.40%) patients had NDDs. There were significantly higher comorbidity-adjusted odds of in-hospital mortality, cardiac arrest, endotracheal intubation, infectious complications, ventricular arrhythmias, and restraint use among the NDD cohort. Conversely, this group exhibited lower adjusted odds of undergoing left heart catheterization, percutaneous coronary intervention, or coronary artery bypass graft surgery. These findings underscore the disparities faced by patients with NDDs in accessing invasive cardiac interventions, highlighting the need for further research to address these barriers and improve care quality for this vulnerable population.
... At the interpersonal level, articles used measures of everyday discrimination (related to disability status). The two articles that added measures at the institutional level studied major instances of discrimination in the workplace (87) or across multiple institutional domains (86). ...
Over the past three decades, health equity has become a guiding framework for documenting, explaining, and informing the promotion of population health. With these developments, scholars have widened public health’s aperture, bringing systems of oppression sharply into focus. Additionally, some researchers in disability and health have advocated for utilizing socially grounded frameworks to investigate the health of disabled people. Yet, naming ableism, much less operationalizing it for the empirical study of health, remains scant. This paper critically reviews the study of ableism as a social determinant of disabled people’s health within population health research. First, we provide an orientation to the present state of this literature by looking to the past. We briefly trace a history of traditional approaches to studying disability and health and alternatives that have emerged from critiques of the individualized lens that has dominated this work. Next, we delineate the operation of ableism across social levels. We characterize how ableism has been studied in population health in terms of levels of analysis (intrapersonal, interpersonal, institutional, and structural) and measures of interest. To conclude, we discuss hinderances to and promising avenues toward population health research that advances health equity for disabled people.
... Demographic characteristics such as citizenship status, asset ownership status, health, culture, and language play a critical role in financial access (Blanco et al., 2019;Namkung & Carr, 2019). Racial minorities, disabled individuals, and those with lower levels of education are more likely to be unbanked and underbanked (Berre et al., 2021;FDIC, 2022). ...
Universal financial access, or the ability for all to open, afford, and continuously use beneficial and affordable financial products and services, eludes the USA. The Consumer Financial Protection Bureau (CFPB) has an important role to play in facilitating financial access through its regulatory function. This paper investigated the policy goals pursued by the CFPB proposed and final rules related to basic financial products and services. The paper also examined the products and services, providers, and populations targeted. Rules proposed through its independent authority were also examined. Researchers conducted a policy mapping content analysis of all CFPB proposed and final rules from 2011 to 2023. Two researchers independently coded basic characteristics, and policy goals and illustrative mechanisms. Researchers compared codes and addressed discrepancies through consensus, and created new codes as needed. The policy goals that appeared most often were increasing consumer protection and promoting the functioning of the financial marketplace. Out of 24 proposed or final rules, the most common financial products or services addressed were remittances and debt collection, with their providers being the most commonly targeted providers by new rules. Few populations were specifically targeted by proposed or final rules. The CFPB independently proposed or finalized 16 new rules, most of which addressed the same policy goals. Rules finalized by the CFPB since its inception address some of the key financial access challenges. However, the CFPB could exercise its independent rule-making authority to further address financial access issues, particularly for financially vulnerable populations.
... Reports of perceived discrimination and disrespectful treatment also vary based on age/cohort. Although older adults are vulnerable to ageism, current cohorts of young and midlife adults are more sensitive to mistreatment by service providers, given rising levels of awareness of microaggressions among more recent birth cohorts [35]. Racial and ethnic groups differ with respect to marital status, where Blacks and Native Americans are less likely than whites, Hispanics, and Asians to be currently married, and a higher proportion of men than women tend to be married across all racial and ethnic groups [36]. ...
Race and gender differences in the quality of one’s health care encounters are widely documented, but few studies explore the multiplicative impacts of race and gender. Drawing on intersectionality frameworks, we contrast white, Black, Hispanic, Asian, and Native American men’s and women’s perceptions of disrespectful treatment from health care providers and staff (e.g., receptionists, clerks) in low-income health settings. Data are from the 2014 Health Center Patient Survey (N = 5385), a nationally representative survey of community-dwelling patients receiving care at health centers funded through Section 330 of the Public Health Service Act. Our results show race and sex differences in the study outcomes, yet weak support for intersectional effects. Asian and Native American patients report more disrespectful treatment from providers, relative to other ethnic groups. Women are more likely than men to report disrespectful treatment from staff. Asians also report disrespectful treatment from staff. Health care providers and staff may require training focused on the distinctive needs of Asian patients, for whom “saving face” may be a salient goal. Structural changes to reduce wait times and employ medical interpreters to ensure clear communication, and staff training focused on verbal and nonverbal communication may mitigate against actions perceived as disrespectful in low-income health settings.
... Consider, for example, disability status. Those with a disability do suffer from mistreatment at work, including lack of respect, hostility, and economic consequences, but this mistreatment is less for low-onset controlled disabilities (i.e., due to factors beyond their control such as heredity or an accident), for those that can conceal the disability, and those older in age (Bogart et al., 2019;Lyons et al., 2017;Namkung & Carr, 2019;Richard & Hennekam, 2021). For example, individuals with disabilities for which they are not responsible are served by distancing themselves from the disability, as it reduces pity and improves manager hiring intentions (Lyons et al., 2017). ...
Popular and influential social commentators have called organizations complicit in perpetuating weight-based bias and mistreatment. Although our field has advanced our understanding of the economic consequences of being fat at work (e.g., salary; job performance; and promotions), we urgently need more research on the interpersonal experiences of this swath of workers so that we can appropriately advise organizations. In this article, we describe how organizational psychology researchers can answer this call to do more research on weight at work (a) even while feeling uncomfortable with a topic that can feel personal, medicalized, and/or overly intertwined with other DEI-based topics; (b) by incorporating insightful research from outside disciplines that centers weight controllability and weight-based mistreatment deservedness; and, critically, (c) while approaching weight at work research with a respectfulness that conveys an understanding of the complexities intertwining weight, health, and personal agency. In culmination, this article offers to our field a flexible, living document entitled Best Practices for Weight-Based Research in Organizational Studies.
... Much focus has been placed on intentional discrimination and implicit bias in administrative decision-making. Survey research shows that transgender people and people with disabilities face considerable difficulties in accessing administrative goods and services (James et al., 2016;Namkung & Carr, 2019). While scholars conventionally interpret these findings as evidence of intentional discrimination, our data suggests a different possible mechanism (see Doan and Grace, 2022). ...
Scholars have revealed how moral evaluation is woven into formal administrative processes. While research examining these dynamics tends to assume that a person’s naturalized identity (such as race and gender) precedes administrative processing, we argue that social categorization by administrators is the tacit precondition upon which further processing takes place. We make this argument by looking at a set of unusual cases: parole hearings where prisoners fall outside of, conflict with, or move between categories of gender, sexuality, race, and ability. We find that categorization acts as a prerequisite to moral evaluation. When administrators cannot easily categorize a prisoner, they resolve this uncertainty by denying parole. Yet, social categorization can also serve as a pathway to moral approval and administrative allocation. In certain situations, administrators encourage prisoners’ identification with a new social category as proof that they are deserving of parole. In both cases, successful administrative categorization occurs through a combination of what we call narrativization, or crafting a narrative around one’s identity that aligns with administrators’ presumptions, and authorization, or marshalling official evidence from prior classification moments to support identity claims. These insights extend our understanding of classification, moral evaluation, and the administrative reproduction of inequality.
... We included sociodemographic variables such as sex (male and female), age (age groups), education (no education/preschool/primary, secondary, or higher), and marital status (married, cohabiting, widowed/divorced/separated, or single). We also included variables related to not seeking medical care, such as health insurance (no or yes) [ [17], and perception of discrimination because of nationality ["Have you felt discriminated against for being a Venezuelan since you arrived in Peru?" (no or yes)] [18], and length of stay in Peru (months). ...
Background
Currently, there are more than six million Venezuelan immigrants worldwide. This study aimed to estimate the association between disability and failure to seek medical care among Venezuelan immigrants in Peru.
Methods
A cross-sectional study was conducted using secondary data of the Encuesta Dirigida a la Población Venezolana que Reside en el País (ENPOVE) 2018. We developed four Poisson regression models and calculated prevalence ratios (PR) with their 95% confidence intervals (95% CI).
Results
After adjusting for multiple confounding variables, we found that immigrants who reported having only one type of disability were 78% more likely not to seek medical care compared with immigrants without disability (PR = 1.78; 95% CI 1.15–2.76).
Conclusions
Venezuelan immigrants with disabilities in Peru seek less medical care than those without disabilities.
... Particularly, as the survey items with the low ICC values (i.e., respondents' perception to discrimination, stress from disabilities, and leisure satisfaction) asked the participants to rate their past experience, their evaluations might have been affected by their positive or negative experience near the data collection. Given the vulnerability of this study's sample (Namkung & Carr, 2019;Rasch et al., 2008), their life events pertinent to discrimination, stress, and leisure near the survey might have resulted in the large variations of their responses over the year. These limitations result from using a national panel study with secondary data where researchers cannot manipulate measures. ...
Leisure is considered an effective means to relieve stress. However, limited research has explored its roles in the stress-coping processes of people with disabilities, especially those living in non-western contexts. This study explores the relationship between leisure time (LT) and leisure repertoire (LR) and perceived stress from disability (PSD) through leisure satisfaction (LS), while using perceived discrimination (PD) as a moderator. Data were collected from the 2016 and 2017 Panel Survey of Employment for the Disabled created by a Korean government agency. A total of 1,443 respondents with physical disabilities were selected. The results showed LT and LR have somewhat different associations with LS and PSD. Moreover, PD was only a moderator of the relationship between LT, LS, and PSD. The present study emphasizes the importance of quality of leisure experiences, rather than simply engaging in leisure, and the efficacy of LR as a stress coping skill.
... Daily experiences of discrimination have remained relevant for many people with disabilities despite the passage of the Americans with Disability Act (ADA) in 1990 (Brown, 2017;Erler & Garstecki, 2002;Kilpatrick & Taylor, 2018;LaVeist et al., 2003;McMahon & Shaw, 2005;Namkung & Carr, 2019Schur et al., 2009). Experiences of interpersonal discrimination in the context of disability may be particularly problematic when considering the public devaluation associated with safety net program participation (Oemichen & Smith, 2016). ...
The COVID-19 pandemic has amplified the need for nutritional assistance among many households, but prior research suggests that people with disabilities and other marginalized groups have been less likely to seek needed assistance due to perceived discriminatory experiences. We examined variation in the use of food assistance programs during the pandemic using data from a community survey of working-age adults with a sizeable subsample of people with disabilities in the Intermountain West region of the United States (N = 1,745). Study findings revealed that having a self-reported disability was associated with greater participation in food assistance programs, which was driven by higher rates of food insecurity. However, the mediated association between disability and nutritional assistance was reduced for food insecure adults who reported greater experiences of perceived daily discrimination. The implication is that perceived discriminatory experiences have diminished the benefits of health-promoting social services during the pandemic. Ways in which the findings extend previous literature on disability, social marginalization, and health disparities is also discussed.
... [8][9][10] However, research on potential contributions and challenges faced by disabled trainees in medical education is still scarce. 11 Patients with disabilities encounter high rates of mistreatment, 1,12,13 discrimination [14][15][16][17][18][19] and communication difficulties 17,20-24 that point to diminished provider empathy as a potential contributor to health inequities faced by this population. Conversely, anecdotal reports and qualitative research suggest that one of the valuable contributions that physicians and medical students with disabilities bring to the medical workforce is the highly empathic way they approach patient care. ...
Objective:
To investigate whether self-disclosed disability and self-reported program access are associated with measures of empathy and burnout in a national sample of US medical students.
Methods:
The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students) and empathy (Interpersonal Reactivity Index), and disability-related questions, including self-reported disability, disability category, and program access. Associations between disability status, program access, empathy, and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal-related, and learning environment measures.
Results:
Overall, 23,898 (54.2%) provided disability data and were included. Of those, 2,438 (10.2%) self-reported a disability. Most medical students with disabilities (SWD) self-reported having program access through accommodations (1,215 [49.8%] or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared to students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95%CI, 1.34 - 1.69] and 2.59 [95%CI, 1.93 - 3.49], respectively) and lower odds of low empathy (.75 [95%CI, .67 - .85] and .68 [95%CI, .52 - .90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95%CI, 1.09 - 1.87], while SWD with program access did not (1.09 [95%CI, .97 - 1.22]).
Conclusions:
Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians.
... In this intersectional sense, the mechanics of oppression appear quasiuniversal. However, many experiences are unique to Disabled people, including those related to sensory and processing needs and physical access barriers (Namkung & Carr, 2019). While there are debates about the best ways to operationalize disability in research, there is a nascent body of research for social work researchers to delve into and build on (Mathematica, Inc., 2021). ...
In the United States and Canada, the adult disability community numbers 27 percent and 16 percent to 33 percent of the population, respectively (Statistics Canada, 2017; Varadaraj et al., 2019). Despite decades of advocacy, Disabled people continue to experience ableism—such as inaccessibility, stigma, and exclusion—in all realms of social work (Slayter & Johnson, 2022). In this Commentary, we use a mix of identity-first disability language and person-first disability language. In keeping with the guidelines of the American Psychological Association (APA) guidelines, we acknowledge that different members of the disability community may have different choices about how they wish to be referred to; APA (n.d.) offers a discussion on the subject. Additionally, when we speak of “Disability culture,” it is inclusive of neurodivergence, chronic illness, chronic pain, mental illness, madness, and so forth. As Disabled social work professionals and accomplices, we call on our nondisabled colleagues to develop their Disability cultural competence and to make inclusion and antiableism priorities in our field.
... Regarding the negative impact caused by social media, as stated in a study conducted by Namkung (2019), people with disabilities are more vulnerable and more often experience disrespectful treatment, ridicule, and unpleasant treatment that is carried out as if they have a bad character, commit crimes and have a tendency to experience discrimination in the workplace and public services, socio-demographic, as well as physical and mental health characteristics. These negative effects were significantly greater in the teenage years than in middle-aged (ages 40-49) and late (ages 50-64) versus older adults (ages 65 and older). ...
Studies on liquid identity have been done by many previous researchers. However, this article sees it differently where liquid identity is experienced by adolescents with disabilities who basically have many difficulties, obstacles in interacting with society in general. This study aimed to look at the process, intention, and purpose of the liquid identity experienced by adolescents with disabilities on social media. This study used a virtual ethnographic method with informants who are members of the Facebook community named “Indonesian Association of People with Disabilities.” The number of informants is 23 adolescents with disabilities who are users of social media. The findings of this study showed that adolescents with disabilities take various ways to get recognition and acceptance by a wide audience according to their type and characteristics. This is done by using social media called liquid identity. To get recognition and acceptance on social media, the practice of liquid identity of adolescents with disabilities was shown by hiding their real identity, having multiple accounts, and sharing positive things on social media. This study concluded that support from various parties is needed, either from the community, parents, friends, schools, and the environment. The role of these parties is important to provide motivation, enthusiasm, and encouragement so that adolescents with disabilities can show value on social media with their identity that is recognized by the public as a positive identity.
... Our findings align with the prior studies we identified [3,[35][36][37]. Drawing from a secondary data analysis, Namkung and Carr examined perceived mistreatment in interpersonal interactions and identified three types of mistreatments, those involving disrespect, insults, and harassment [38]. Our participant narratives provided a far broader range of individuals, contexts, and forms of treatment through which they perceived ableist attitudes. ...
Adults with physical disabilities experience a continuum of enabling and disabling attitudes in the environment. This study identified where adults with physical disabilities experience the attitudinal environment, the continuum of those attitudes, and how they impact emotional and psychological health and well-being. Focus groups and interviews were conducted in 2019 and 2020 with adults with physical disabilities in southeastern Michigan in the United States. Participants discussed environmental factors that impact healthy aging. From an initial thematic coding of narratives, the attitudinal environment was identified. Transcripts were recoded and analyzed focusing on societal attitudes. Qualitative analyses revealed that participants did not experience societal attitudes as simply positive or negative, and that the contexts in which these attitudes were expressed were not limited to interpersonal interactions. Rather, these attitudes were also experienced in the built environment and through social institutions and organizations and their programs, systems, and structures that provide or deny needed accommodations, resources, and support. The spectrum of overlapping attitudes that participants articulated ranged from understanding and supportive, to not understanding, to being viewed and treated as less than human. Societal structures reflect and influence societal attitudes and have material consequences on the lives of adults with physical disabilities.
... Age groups above 20-24 years appear in the analysis as protective factors, with a more pronounced emphasis for (Badu et al., 2016). Other studies have noted that disability can be more devaluing to young adults because it impedes their independence, physical and economic development (McPherson, 1994;Namkung & Carr, 2019). Since functional impairment is less common among young people (30-39 years) and middle-aged adults (40-64 years) than in older people (65 years and older). ...
People with disability face stigmatization in most of African countries. The objective of this study was to determine the prevalence and the factors associated with stigma among people living with a disability in Niger. This is a secondary analysis of data from a cross sectional study on disability and HIV conducted in Niger from June to November 2018. People with disabilities in grades 3 and 4 identify with Washington Group Short Set of Questions, aged 15-60, were included. Factors associated with stigma were identified by a binary multilevel regression model. A total of 820 participants were included. The prevalence of stigma was 18%. People with intellectual (adjusted odds ratio [aOR]: 1.89; 95% Confidence interval [95%CI] [1.58-5.03]) and cognitive (aOR:2.82; 95%CI 1, 14-3.13]were more likely to experience stigma than other types of disabilities. People with disabilities over the age of 20 were 57% to 71% less likely to be stigmatized than people with disabilities aged 15-19. Living in the same accommodation with other people with disabilities was also a protective factor against the experience. There is a need to implement interventions to reduce the stigmatization of people with disabilities in Niger.
... In this intersectional sense, the mechanics of oppression appear quasiuniversal. However, many experiences are unique to Disabled people, including those related to sensory and processing needs and physical access barriers (Namkung & Carr, 2019). While there are debates about the best ways to operationalize disability in research, there is a nascent body of research for social work researchers to delve into and build on (Mathematica, Inc., 2021). ...
... Youth with disabilities have lower employment rates than youth without disabilities (Bureau of Labor Statistics, 2020). Workers with disabilities, in general, report greater levels of workplace discrimination (Namkung & Carr, 2019) and lower participation in workplace decision-making, teamwork, and informal training from co-workers (Schur et., 2009). All of these factors may constrain opportunities for social contact with coworkers. ...
Youth with disabilities may experience unequal patterns of social contact, compared to youth without disabilities. This study uses a nationally representative sample of youth (ages 15–19; N = 6,803) from the American Time Use Survey (2008–2019) to evaluate if and how social contact—defined as time spent with relatives and nonrelatives—differs by youth disability status. Outside the family context, youth with disabilities spent less time with nonrelatives compared to youth without disabilities. Lower social contact with nonrelatives was offset by increased social contact with relatives. Limited social contact outside a youth’s family context has implications for adolescent development. Social contact, and family social contact specifically, may be important forms of developmental support for youth with disabilities.
... More than the functional limitation as such, culture and other social factors also influence the experience. For example, in the U.S. it has been found that older people with functional limitations perceive less interpersonal and institutional discrimination than younger equivalents [22]. Social factors include for example the perceived "right" to the public environment and the respect for older people in particular. ...
Older people and people with functional limitations are recognized as vulnerable groups when it comes to evacuation. Previous studies have focused mostly on the quantitative aspects of their physical characteristics, such as movement speeds. This study explores the perspectives on egressibility of older people with functional limitations. This was achieved by reflexive thematic analysis of semi-structured interviews with 28 older people with functional limitations. Participants were recruited based on voluntary participation mainly from senior citizen organizations. Inspired by The International Classification of Functioning, Disability and Health, a questionnaire was developed to characterize the sample in terms of presence of functional limitations. The sample consisted of people with a wide variety of functional limitations. The findings are presented in the form of three themes constructed from the transcripts: Other people's difficulties in understanding, Strategies to cope with the limitation, and Uncertainty of evacuation. The findings highlight that older people may perceive a lack of reliance on the physical environment and other people's support in evacuation situations. Instead, they considered relying primarily on their own ability to mitigate issues caused by functional limitations. The findings may be used to inform future in depth-studies aimed at achieving an equal evacuation safety for all.
... Experiencing discrimination has significant emotional and psychological effects, which have been compared to the effects of traumatic stress (Polanco-Roman, Danies, & Anglin, 2016). Health researchers have increasingly incorporated experiences of discrimination into health outcome analyses to examine complex and multifaceted intersections between discrimination and health, including health behaviours, navigation of the health care system, maintenance of physical and mental health and well-being, and discrimination on the basis of health and disability (Krieger, 2012;Namkung & Carr, 2019). To evaluate the prevalence and effect of discrimination on health, multiple instrumentsall of which are self-report questionnaireshave been developed to measure discrimination. ...
The Everyday Discrimination Scale (EDS) is one of the most widely used measures of discrimination in health research, and has been useful for capturing the impact of discrimination on health. However, psychometric analysis of this measure has been predominantly among Black Americans, with limited examination of its effectiveness in capturing discrimination against other social groups. This paper explores the theoretical and historical foundations of the EDS, and draws on the analytic framework of Messick’s theory of unified validity to examine the effectiveness of the EDS in capturing diverse experiences of discrimination. Encompassing both social consequences and value implications, Messick’s unified validity contends that psychometric evaluation alone is insufficient to justify instrument use or ensure social resonance of findings. We argue that despite the robust psychometric properties and utility in addressing anti-Black race-related discrimination, the theoretical foundations and research use of the EDS have yet to respond to current discrimination theory, particularly intersectionality. This paper concludes with guidance for researchers in using the EDS in health research across diverse populations, including in data collection, analysis, and presentation of findings.
... AYA survivors may be limited in employment options to those with adequate health insurance to cover care of both cancer and late and long-term effects (19). Moreover, employment discrimination on the basis of disability is well documented (20), and although employers are required by law to provide reasonable accommodations for disabilities (21), requests are not always fulfilled. AYAs might be discriminated against in hiring, retention, or promotion due to their cancer or the effects on their work and educational history even though they can perform the job requirements. ...
... Second, reports of birth intention may also be subject to fathers' perception and emotional status, which may render one particularly sensitive to perceiving certain life events. 40 The third limitation is the lack of information about the mothers of the children, especially their disability status and pregnancy intendedness, which might be a confounder of some of the observed relationships. Fourth, some fathers with severe disabilities may be precluded from survey participation due to their functional barriers and the lack of accommodations, and if so, our results may underestimate the differences by disability status. ...
Background
Men’s birth intention is an indicator of their sexual health and plays an important role for their child’s health and development; however, birth intendedness in fathers with disabilities has been unknown.
Objective
This study examines disparities in birth intendedness among fathers with and without disabilities and explores whether the differences vary by marital status or race/ethnicity.
Methods
Data from the 2011-2017 National Survey of Family Growth (NSFG) were used to examine pregnancy intendedness for fathers with and without disabilities (n = 2,324) about their last birth in the five years preceding the interview. Multinomial regression models estimated the odds ratios of fathers’ disability status on birth intention controlling for covariates. Interaction effects of disability status by marital status or race/ethnicity were also tested.
Results
Fathers with disabilities were 1.89 (95% CI = 1.21, 2.95) times as likely to report their last birth as unwanted versus intended compared to those without disabilities after adjusting for covariates. Although married fathers without disabilities were less likely to report unintended birth than their unmarried counterparts, the protective effect of marriage was not evident among fathers with disabilities.
Conclusions
Disabled fathers are at a higher risk of unintended birth compared to nondisabled fathers. These findings highlight the need to increase access to family planning services for disabled men. Further research is needed to better understand the risk factors that contribute to disabled fathers’ unintended birth and how these are linked to their child and family well-being.
... Previous studies conducted in Norway, Canada, the United States and the United Kingdom suggest that persons with disabilities are subject to labour market discrimination. Statistical analyses document disabilityrelated gaps in employment and wages that are unexplained by other observable factors relevant to employment (Baldwin and Johnson, 2006), while persons with disabilities themselves report subjective experiences with discrimination in surveys and qualitative interviews (Lindsay, 2011;Vedeler, 2014;Namkung and Carr, 2019). Results from qualitative and survey-based research on employers are mixed and show that employers express reluctance towards hiring persons with disabilities, yet also report positive attitudes towards workers with disabilities (Lengnick-Hall, Gaunt and Kulkarni, 2008;Ju, Roberts and Zhang, 2013). ...
Disability is associated with persistent labour market disadvantages. What is not clear is the extent to which these disadvantages result from employers’ discriminatory hiring decisions. Although observational research and laboratory experiments provide indicative evidence of its existence, few studies have used randomized field experiments such as correspondence studies to investigate the occurrence of disability discrimination. This article extends current knowledge by presenting the results of a correspondence study used to measure discrimination against wheelchair users in a new context: the Norwegian labour market. In the experiment, 1,200 fictitious applications with randomly assigned information about the applicants’ disability status were sent in pairs to 600 private sector employers with job openings. The experiment documents negative effects of disability on callbacks from employers across various occupations. The findings suggest that discrimination in hiring processes is a mechanism through which disability-related inequality in employment outcomes is perpetuated.
... This difference between the two instruments may have important implications for the composition of the identified group with disabilities. For example, recent studies have shown that the discrimination and stigma faced by persons with disabilities in general is much more prevalent among younger persons with disabilities in particular, as it "violates cultural norms and expectations regarding able-bodied working-age adults" (Namkung and Carr, 2019). Similarly, respondents' understanding of what "activities people usually do" may vary with socio-demographic characteristics such as gender, age, ethnicity, and educational attainment. ...
Rationale
Different measures for quantifying the percentage of people with a disability in surveys result in diverging estimates of prevalence and disability-related inequalities. Thus understanding the implications of using different disability measures is of vital policy importance. This study is the first to investigate the within-survey variation in disability prevalence based on two internationally recognized measures: the Washington Group Short Set (WGSS) and the Global Activity Limitation Indicator (GALI). It is also the first to examine the disability-related inequality in voter turnout, based on official validated voter records.
Methods
We use data on 11,308 25-54-year-old respondents from the 2016 wave of the Survey of Health, Impairment and Living Conditions in Denmark (SHILD) to estimate the disability prevalence based on the WGSS and the GALI. Moreover, we investigate health characteristics of individuals with a disability according to the two measures and inequalities in two central social policy success parameters: voter turnout and employment.
Results
The WGSS estimates higher disability prevalence (10.6%) than the GALI (5.5%). Only 2.5% of the sample are in both groups, implying that largely, different individuals are defined as having a disability depending on which measure is used. The health profiles of the two groups also differ, as people with a GALI-defined disability are significantly more likely to report a severe mental illness or a major physical health problem. The GALI estimates indicate larger inequalities between people with and without a disability than the WGSS for the probability of being employed, whereas there are no significant differences for voter turnout.
Conclusion
The choice of disability measure strongly influences within-survey estimates of disability prevalence, the health profile of the defined groups, and inequalities in outcomes. The WGSS underrepresents the number of people suffering from severe mental illness. Estimated inequalities in employment are larger for the GALI than for the WGSS.
Background and Objectives
Recent studies suggest a growing trend in marijuana use, compared to a stable prevalence of marijuana use disorder among US adults over the first 15 years of the 21st century. This study investigated the recent patterns of marijuana use disorder among people with disabilities (PWD).
Methods
We extracted a nationally representative sample ( N = 209,058) from the 2015–2019 National Survey on Drug Use and Health data set and examined associations by functional disability status (any disability, disability by type, and number of disabling limitations) with marijuana use disorder using a series of independent multivariable logistic regression models. We also performed trend analyses during the study period.
Results
The prevalence of marijuana use disorder (from 1.7% to 2.3%) increased significantly among PWD between 2015 and 2019 ( p ‐trend < .001). PWD were significantly more likely to report marijuana use disorder (odds ratio [OR], 1.37, 95% confidence interval [CI], 1.24–1.52) than people without disability (PWoD). Those with cognitive limitation only (OR, 1.78, 95% CI, 1.53–2.06) and ≥2 limitations (OR, 1.29, 95% CI, 1.10–1.51) were more likely to report marijuana use disorder than PWoD.
Discussion and Conclusions
PWD had a consistently higher prevalence of marijuana use disorder than PWoD. Additionally, the level of risk for marijuana use disorder varied by disability type and number of disabling limitations.
Scientific Significance
Our study provided new nuance on disparities in marijuana use disorder between PWD and PWoD and further revealed the varied risks for marijuana use disorder across different disability statuses.
هدفت الدراسة الحاليَّة إلى الكشف عن تأثر إنجاب الأطفال ذوي الإعاقة في حدوث )وقوع( الطاق بن الزوجن، بالكشف عن
المشكلات النفسية والاجتماعية الناتجة عن إنجاب طفل من ذوي الإعاقة في مدينة حائل، من وجهة نظر أمهات الأطفال ذوي الإعاقة.
كما هدفت الدراسة إلى وضع مقرح يسهم في الحد من وقوع الطاق تأثرًا بالمشكلات النفسية والاجتماعية الناتجة عن إنجاب طفل
من ذوي الإعاقة. واستخدمت الدراسة الحالية المنهج النوعي، ووظفت المقابلة شبه المنظمة أداةً لجمع البيانات. وتألَّفت عينة الدراسة
من ) 5( من الأمهات المطلقات اللواتي لديهن طفل من ذوي الإعاقة. وقد توصلت الدراسة إلى أن أبرز المشكلات النفسية الناتجة
عن إنجاب طفل ذي إعاقة، الي كان لها أثرها في وقوع الطاق، من وجهة نظر أمهات الأطفال ذوي الإعاقة؛ كانا الخوف والصدمة،
وأن أبرز المشكلات الاجتماعية الي أسهمت في وقوع الطاق بعد إنجاب أطفال من ذوي الإعاقة، هي سلبية المجتمع المحيط بالأسرة،
وانخفاض مستوى وعيه، وامتناع الأمهات المطلقات عن الزواج مرة أخرى بعد إنجاب طفل ذي إعاقة. وقدَّمت الدراسة مقترحًا للحدِّ
من وقوع الطاق، تمثَّل في توعية الأسرة والمجتمع، لحماية حقوق الأسرة واستقرار الحياة الزوجية بعد إنجاب طفل من ذوي الإعاقة.
Narratives rooted in ableism portray disabled children as burdens on their families. Prior research highlights health disparities between mothers of disabled children and mothers of nondisabled children, but little is known about how socio-structural contexts shape these inequities. Using longitudinal data from the Future of Families and Child Wellbeing Study (n = 2,338), this study assesses whether the relationship between early childhood disability and maternal health varies by household socioeconomic status (SES). Findings reveal that, on average, mothers of children disabled by age five report worse health than mothers of nondisabled children; however, this pattern is only evident among lower SES mothers and disappears for higher SES mothers. Contextualizing the findings within the systemic ableism literature highlights how-instead of portraying disabled children as burdens on their families-scholars and policymakers should focus on how ableism and poverty burden disabled people and their families in ways that pattern health risks.
Race and gender differences in the quality of one’s health care encounters are widely documented, but few studies explore the multiplicative impacts of race and gender. Drawing on intersectionality frameworks, we contrast white, Black, Hispanic, Asian, and Native American men’s and women’s perceptions of disrespectful treatment from health care providers and staff (e.g., receptionists, clerks) in low-income health settings. Data are from the 2014 Health Center Patient Survey (N=5,385), a nationally representative survey of community-dwelling patients receiving care at health centers funded through Section 330 of the Public Health Service Act. Our results show race and sex differences in the study outcomes, yet weaker support for intersectional effects. Asian men and women report significantly more disrespectful treatment from providers and staff, relative to other ethnic groups. Across race and ethnic groups, women are more likely than men to report disrespectful treatment from staff. Health care providers and staff may require training focused on the distinctive needs of Asian patients, for whom “saving face” is a salient goal. Structural changes to reduce wait times and employ medical interpreters, and staff training focused on verbal and nonverbal communication may mitigate against actions perceived as disrespectful in low-income health settings.
There is a paucity of robust nationally representative data from low- and middle-income countries (LMICs) on the prevalence and risk factors associated with exposure of women with/without disability to either discrimination or violence. We undertook secondary analysis of data collected in Round 6 of UNICEF’s Multiple Indicator Cluster Surveys (MICS) involving nationally representative data from 29 countries with a total sample size of 320,426 women aged 18 to 49 years. We estimated: (1) prevalence rates for exposure to discrimination and violence among women with/without disabilities in the previous year in a range of LMICs; (2) the relative risk of exposure when adjusted for demographic and contextual characteristics; (3) the relative risk of exposure associated with specific functional difficulties associated with disabilities; and (4) the association between country-level estimates and national wealth and human development potential. Our results indicated that women with disabilities were approximately twice as likely as women without disabilities to be exposed to violence and discrimination in the past year, and approximately one-third more likely to feel unsafe in either their home or local neighbourhood and to be at greater risk of domestic violence. Risk of exposure was associated with national characteristics (national wealth, human development potential) and within country factors, especially relative household wealth and level of education. These results must be of concern on two counts. First, they attest to the ongoing violation of the human rights of women with disabilities. Second, they point to increased exposure among women with disabilities to several well-documented social determinants of poorer health.
Background
Reducing the rate and impact of problematic smartphone use (PSU) among deaf and hard-of-hearing (DHH) students has become a social issue. Research has suggested that perceived discrimination is associated with PSU, although the underlying mechanism of this association for DHH students is not clear.
Aims
This study explored the mediating roles of sense of security and social avoidance in the association between perceived discrimination and PSU among Chinese DHH students.
Method
Five hundred and seventy DHH students, selected through simple random sampling, participated in an online survey, which included measurements of perceived discrimination, sense of security, social avoidance, and PSU. The results were analyzed with SPSS 25.0 and Mplus 7.0.
Results
(1) Perceived discrimination, sense of security, and social avoidance were significantly associated with PSU among DHH students; (2) sense of security and social avoidance played mediating roles separately in the association between perceived discrimination and PSU; (3) sense of security and social avoidance played serial mediating roles in the relationship between perceived discrimination and PSU.
Conclusions
The findings suggest that discriminatory experiences of DHH students are related to a relatively low sense of security and high social avoidance, which may lead to PSU. The results have important implications for the prevention of and intervention for PSU among DHH students.
Longevity entails a higher prevalence of chronic impairments that often come with aging, such as age-related vision loss (ARLV). Dependence and increasing vulnerabilities contrast sharply with contemporary reductionist models of positive aging, and gradually worsening eyesight exposes older adults with ARLV to situations where idealized models of late life do not fit them. In analyzing semi-structured interviews conducted in Denmark with 40 older adults, aged 55–70 years, with vision loss, this study examines how people in late midlife and early late life negotiate their vulnerability, dependence, and need for help across different contexts. The findings illustrate how these lived experiences situate people with ARVL outside the idealized late life and how they negotiate their need for help in both their work life and private life. The findings also show how people with age-related vision loss perform a balancing act between the lived vulnerability and the prescribed role of vulnerability arising from social discourses. Some contexts allow people with ARVL to negotiate and re-negotiate their vulnerability, while others, such as work-life contexts, often offer less room for negotiating vulnerability and need for help. The study makes it clear that, given the cultural emphasis on extended work lives, the ways in which work cultures can adapt to age diversity and age-related disabilities must receive more attention.
Students with learning disabilities (LDs) experience heightened levels of social isolation, but researchers have not fully explored its various dimensions at school or determined which aspects contribute to educational gaps associated with LDs. Using the National Longitudinal Study of Adolescent to Adult Health, we find that middle and high school students with LDs are more likely to experience most types of isolation. Student with LDs have fewer friends, their friends are less educationally ambitious, they feel more detached and disliked at school, and they are more likely to avoid friendships, though surprisingly not more likely to be actively rejected. Mediation analyses indicate that the aspect of social isolation that contributes most to the LD-gap in high school graduation is one's number of school friends and their educational expectations. Perceptions of social isolation are also consequential, and together these account for nearly one-quarter of the LD-gap in high school graduation, net of past grades.
Adults with disability have significantly lower rates of labor force participation relative to persons without disability, although it is unclear whether this disparity extends to subjective workplace experiences. Using data from the 2004 to 2006 wave of the National Survey of Midlife Development in the United States (n =2,030), we evaluate: (1) whether U.S. workers with physical disability report higher levels of perceived job discrimination and unequal workplace opportunities and lower levels of supervisor and coworker support and (2) whether these patterns differ by sex, age, and occupation group. We find that workers with physical disability fare significantly worse on all four outcomes net of covariates. Disability takes a particularly large toll on men's perceived workplace opportunities and white-collar employees' relationships with coworkers. Young adult workers (ages 30-39) with disability report significantly more support from their supervisor relative to their counterparts without disability. We discuss implications for research and policy.
Background:
In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity.
Discussion:
In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients.
Conclusion:
Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.
Objective:
Foundational theoretical perspectives suggest that socioeconomic disadvantage (SED) increases an individual's risk of being exposed to unfair treatment or discrimination. However, little empirical attention has been given to the role of perceived discrimination in the SED-health gradient. Addressing this knowledge gap, the current study examined the mediating role of discrimination in the longitudinal association between SED and self-rated health.
Method:
Participants in the Midlife in the United States (MIDUS) study were followed over 3 waves covering a 17- to 19-year period (N = 6,286; 53% female; 91% White; mean age at baseline = 47 years, SD = 13). SED was assessed from education, occupational prestige, income, and assets; self-rated health was measured at baseline and follow-up assessments. Two measures of discrimination-perceived inequality in work and everyday discrimination-were considered as mediators.
Results:
Both measures of discrimination emerged as important explanatory variables in the link between SED and health. SED at the baseline assessment was associated with changes in self-rated health over the 17- to 19-year period (B = -.15, p < .001). Measures of discrimination partially mediated this longitudinal association, explaining 22% of the total effect. Exposure to discrimination and its health consequences were also more pronounced at younger ages.
Conclusion:
Additional research is needed to replicate the findings of this study using objective health measures and to examine possible interventions. Challenging the ideologies and practices that underlie social class-related discrimination, or mitigating its harmful consequences, will both be important approaches to consider. (PsycINFO Database Record
IntroductionThe systematic deprivation of equal access to valued opportunities has greatly harmed the disadvantaged. Discrimination, whether it is based on gender, race, sexual orientation, or physical health exacts a high toll. This is especially true with respect to the role of race and equality in the USA today. This paper attempts to evaluate the significance of perceived discrimination among a multiethnic sample of physically disabled and non-disabled study participants. Methods
We employ survey data from a community-based multiethnic sample of study participants to assess whether physical disability increases perceptions of discrimination across racial/ethnic groups. Additionally, we assess whether physical disability impacts the relationship between discrimination and depressive symptoms and whether this relationship is consistent across race/ethnicity. ResultsDescriptive and multivariate analyses indicate that disabled whites and Hispanics report higher levels of discrimination than their non-disabled counterparts. However, this pattern was not observed among black respondents who report high levels of discrimination regardless of their disability status. OLS models indicate that among Hispanics, physical disability moderates the relationship between discrimination and depressive symptoms. Among black and white study participants, physical disability does not moderate this relationship. Conclusion
Taken together, the results demonstrate the continuing significance of race as a source of discrimination and a health risk.
By modifying the work environments, work routines, and work tasks of employees with health restrictions, organizations can effectively help them continue to perform their jobs successfully. As such, job accommodations are an effective tool to secure the continued employment of aging workers who develop disabilities across their life span. However, while accommodations tackle health-related performance problems, they might create new challenges on the part of the affected employee. Building on the organizational change and accommodations literatures, we propose a theoretical framework of negative experiences during accommodation processes and apply it to qualitative data from group interviews with 73 manufacturing workers at a German industrial company who were part of the company's job accommodation program. Although problems associated with health-related impairments were mostly solved by accommodation, affected employees with disabilities reported about interpersonal problems and conflicts similar to those that typically occur during organizational change. Lack of social support as well as poor communication and information were raised as criticisms. Furthermore, our findings indicate that discrimination, bullying, and maltreatment appear to be common during accommodation processes. To make accommodation processes more successful, we derive recommendations from the organizational change literature and apply it to the accommodation context. We also emphasize unique characteristics of the accommodation setting and translate these into practical implications.
This contribution reviews the state of the art of research on the effects of prejudice on its targets. We structure this review around ongoing debates and core questions that have been guiding this field of research and how these are addressed by recent evidence. We address five central themes that have characterized research on the way prejudice emerges in modern societies, and the impact this has on its targets. First, we examine whether members of devalued groups tend to over- or under-estimate the extent to which they are targeted by discrimination. Second, we assess the self-protective and harmful effects of perceived discrimination on well-being. Third, we consider whether concealable stigmas are less problematic than visible stigmas. Fourth, we examine whether individual success is helpful or harmful for the disadvantaged group. Finally, as a fifth theme, we review evidence of the social costs of confronting prejudice and highlight the more neglected social benefits of confrontation. The research evidence we present in this way aims to resolve a number of common misunderstandings regarding the presence and implications of prejudice in modern societies.
As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.
We aimed to examine the relationship between healthcare discrimination and new or worsened disability.
This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.
Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study.
Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.
In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16-2.27).
One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.
Disability is an emerging field within public health; people with significant disabilities account for more than 12% of the US population. Disparity status for this group would allow federal and state governments to actively work to reduce inequities. We summarize the evidence and recommend that observed differences are sufficient to meet the criteria for health disparities: population-level differences in health outcomes that are related to a history of wide-ranging disadvantages, which are avoidable and not primarily caused by the underlying disability. We recommend future research and policy directions to address health inequities for individuals with disabilities; these include improved access to health care and human services, increased data to support decision-making, strengthened health and human services workforce capacity, explicit inclusion of disability in public health programs, and increased emergency preparedness. (Am J Public Health. Published online ahead of print February 17, 2015: e1-e9. doi:10.2105/AJPH.2014.302182).
Objectives: This study addresses whether age, functional limitation and other stressor exposure, and psychosocial coping resources influence variation in perceived stigma and the form this influence takes (i.e., independent and/or interdependent).
Methods: Using data from two waves of a large community study of adults (age 20–93) with chronic health conditions (n = 417), a residual change regression analysis considers direct and moderating factors influencing perceived stigma over a 3-year period.
Results: Age, functional limitation, the experience of discrimination, and self-esteem independently account for variation in perceived stigma. Moderation tests reveal that age is associated with a greater increase in stigma in the context of greater functional limitation and increases in limitation. Functional limitation and stressor exposure are also associated with declines in stigma in the context of greater mastery and self-esteem.
Discussion: Multiple processes bear on perceived stigma among people with chronic health conditions. Implications for stigma and stress research are discussed.
There are few quantitative studies that show the workplace is experienced in a different way by employees with disabilities. This article fills this gap using data from the British Workplace Behaviour Survey, which found that employees with disabilities and long-term illnesses were more likely to suffer ill-treatment in the workplace and experienced a broader range of ill-treatment. Different types of disability were associated with different types of ill-treatment. The survey also showed who employees with disabilities blamed for their ill-treatment and why they believed the ill-treatment had occurred. Drawing on the existing literature, four possible explanations for ill-treatment are considered: negative affect raises perceptions of ill-treatment; ill-treatment leads to health effects; ill-treatment results from stigma or discrimination; ill-treatment is a consequence of workplace social relations. Although some of these explanations are stronger than others, the discussion shows that more research is required in order to decide between them.
Negative interpretations are a central component of cognitive models of depression. Previous research on interpretation biases in depression has relied on self-report measures. Self-report measures have limited validity because they may measure a response bias rather than a cognitive bias. To overcome this limitation, recent investigations have used response latencies as a measure of interpretation bias with mixed results. We examined interpretation bias using a modified word sentence association paradigm (Beard and Amir in Cogn Therapy Res 33:406–415, 2009). In comparison with individuals without dysphoria, dysphoric individuals were significantly faster to endorse the association between negative words and ambiguous sentences. These results suggest that negative interpretations are primed in depression, suggesting that training towards benign interpretations may have therapeutic value.
People with invisible impairments have choices as whether or not to reveal or conceal their impairments in social interaction. They may pass for “normal” if they silence impairment and disability experiences. Social conventions support silence. Disclosing impairments may occur in many circumstances, for many reasons and may have many ramifications. People with invisible impairments and the dilemmas they face have received little attention in disability research. This article discusses concealment and disclosure of invisible impairments as ongoing processes with an emphasis on performance, motivation and context.
Previous research on the education-to-employment transition for students with disabilities has suggested that participation in school-to-work programs is positively associated with post-high school success. This article utilizes data from the National Longitudinal Survey of Youth 1997 (NLSY97) to extend these findings in several ways. First, we assess the efficacy of specific types of school-based and work-based initiatives, including job shadowing, mentoring, cooperative education, school-sponsored enterprise, technical preparation, internships, and career major. Next, we extend the usual focus on the employment outcomes of work status and financial compensation to consider job-specific information on the receipt of fringe benefits. Overall, results from longitudinal multivariate analyses suggest that transition initiatives are effective in facilitating vocational success for this population; however, different aspects of school-to-work programs are beneficial for different aspects of employment. School-based programs are positively associated with stable employment and full-time work while work-based programs most consistently increase the likelihood that youth with disabilities will be employed in jobs that provide fringe benefits. Analyses also indicate that – once individuals with disabilities are stably employed – they can be employed in "good" jobs that provide employee benefits.
Despite persistently low employment rates among working-age adults with disabilities, prior research on employer practices and attitudes toward workers with disabilities paints a generally rosy picture of successfully accommodated workers in a welcoming environment. Findings from previous studies might have been biased because of either employer self-selection or social desirability, yielding non-representative or artificially positive conclusions.
In this study, a novel approach was used to survey human resource professionals and supervisors working for employers known or reputed to be resistant to complying with the ADA's employment provisions. Attendees of employer-requested ADA training sessions were asked to assess various possible reasons that employers in general might not hire, retain, or accommodate workers with disabilities and to rate strategies and policy changes that might make it more likely for employers to do so.
As cited by respondents, the principal barriers to employing workers with disabilities are lack of awareness of disability and accommodation issues, concern over costs, and fear of legal liability. With regard to strategies employers might use to increase hiring and retention, respondents identified increased training and centralized disability and accommodation expertise and mechanisms. Public policy approaches preferred by respondents include no-cost external problem-solving, subsidized accommodations, tax breaks, and mediation in lieu of formal complaints or lawsuits.
Findings suggest straightforward approaches that employers might use to facilitate hiring and retention of workers with disabilities, as well as new public programs or policy changes that could increase labor force participation among working-age adults who have disabilities.
Objectives: This article uses data from MIDUS (Midlife in the United States), a national study of Americans (N = 7,108), to investigate factors that predict longitudinal retention. With its extensive age range (25-75 at Time 1) and long-term design (9- to 10-year survey interval), MIDUS is useful for investigating common sociodemographic and health predictors of continuing participation. Method: The authors conducted logistic regression analyses of baseline sociodemographic and health variables predicting retention. Select interaction terms examined the interplay between targeted variables. Results: Consistent with prior research, higher retention rates were found among Whites, females, and married individuals as well as those with better health and more education. Interaction analyses further clarified that (a) health status better predicted retention among older compared to younger respondents and among women compared to men, (b) marital status better predicted retention among Whites compared to non-Whites and among women compared to men, and (c) economic status better predicted retention among those with poorer functional health status. Discussion: The authors’ analyses clarify that longitudinal retention varied depending on respondents’ sociodemographic characteristics and their health status. The unique contribution of this article is that factors predicting nonparticipation can be offset by, or compensated for, other factors.
Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes.
Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour; this can lead to impoverishment, social marginalisation, and low quality of life. We aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia.
We did a cross-sectional survey in 27 countries, in centres affiliated to the INDIGO Research Network, by use of face-to-face interviews with 732 participants with schizophrenia. Discrimination was measured with the newly validated discrimination and stigma scale (DISC), which produces three subscores: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination.
Negative discrimination was experienced by 344 (47%) of 729 participants in making or keeping friends, by 315 (43%) of 728 from family members, by 209 (29%) of 724 in finding a job, 215 (29%) of 730 in keeping a job, and by 196 (27%) of 724 in intimate or sexual relationships. Positive experienced discrimination was rare. Anticipated discrimination affected 469 (64%) in applying for work, training, or education and 402 (55%) looking for a close relationship; 526 (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced.
Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
This study explored open-ended responses regarding attributions underlying health appraisals made by older adults, resulting in five categories (physical health, attitudinal/behavioral, externally focused, health transcendence, nonreflective). The older the respondents, the less likely they were to focus on physical aspects of their health. Health optimists were the most likely to make attitudinal/behavioral or health transcendent attributions, while poor-health realists were most likely to mention physical health aspects and least likely to make attitudinal or behavioral attributions. While poor-health realists were at the highest risk of dying within a three-year period, health optimists were significantly less likely to die than poor-health realists, in spite of sharing similar health status. Respondents who were unable to identify underlying attributions were significantly more likely to die than were those identifying any other attribution. In conclusion, health attributions provide unique insight into the complex relationship between older adults' health appraisals, health status, and mortality.
This research was aimed at identifying critical steps in the decline in physical function that often parallels aging. Six basic and nine instrumental activities of daily living (ADLs) were classified into four domains of disability characterized by specific underlying physical impairment. The hierarchical order of this classification was verified in two random samples representative of the older home-dwelling population. The concordance level of disability and results of performance-based measures of physical function were also tested. Finally, the cross-cultural reliability of the model was verified in seven population-based samples of older persons living in five European countries. In older persons the disabling process follows a general pattern of progression based on a typical sequence of impairments.
Reactions toward older adults have been widely researched, but the question of whether such reactions are due to age per se or due to the presence of other stigmas (e.g., physical disabilities) has received little attention. This study was designed to investigate emotional reactions and willingness to help older versus younger adults who exhibited a wide range of stigmas, including AIDS, leg amputation, depression, and so on. Guided by attribution theory, the cause of the stigmas was further ascribed to either uncontrollable or controllable factors. Older adults evoked less anger than younger individuals, particularly in the case of blindness, depression, leg amputation, lung cancer, and unemployment. Subjects were also more willing to help an older than a younger amputee. Moreover, stigmas ascribed to uncontrollable factors generally produced less anger, more pity, and greater willingness to help than stigmas described as due to controllable causes. These results provide little support for the notion of ageism, at least within an age range of up to 65 years, but suggest that responses to older adults with stigmas may be subject to positive stereotyping.
Background and objectives:
Guided by cumulative inequality theory, this study poses two main questions: (a) Does women's poor health compromise household financial assets? (b) If yes, is wealth sensitive to the timing of women's health limitations? In addressing these questions, we consider the effect of health limitations on wealth at older ages, as well as examine how health limitations influence wealth over particular segments of the life course, giving attention to both the onset and duration of health limitations.
Research design and methods:
Using 36 years of data from the National Longitudinal Survey of Mature Women, piecewise growth curve and linear regression models were used to estimate the effects of life course timing and duration of health limitations on household wealth.
Results:
The findings reveal that women who experienced health limitations accumulated substantially less wealth over time, especially if the health limitations were manifest during childhood or early adulthood.
Discussion and implications:
This study identifies how early-life health problems lead to less wealth in later life.
We examine the hypothesis that psychological distress due to perceived discrimination can result in chronic pain, where perceived discrimination is based on age, gender, race, ethnicity, disability, sexual orientation, height/weight, religion, and other characteristics. Using a sample of 1908 individuals from the two most recent waves (2004-2006 and 2013-2014) of panel data from the National Survey of Midlife Development in the United States, we apply instrumental variables regression where measures of daily and lifetime perceived discrimination are instruments whose effects on chronic pain are mediated by psychological distress. We find statistically significant dose-response relationships between daily perceived discrimination and psychological distress, between lifetime perceived discrimination and psychological distress, and between psychological distress and chronic pain. Based on our instrumental variables regression model, we estimate that 4.1 million people in the US in 2016, aged 40 and older, experience chronic pain that is caused by increased psychological distress, where psychological stress has increased due to perceived discrimination.
Background:
Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.
Objective:
To determine the epidemiology and clinical course of functional impairment and decline in middle age.
Design:
Cohort study.
Setting:
The Health and Retirement Study.
Participants:
6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.
Measurements:
Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes.
Results:
Impairment in ADLs developed in 22% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3% to 5%) of participants had died, 9% (CI, 8% to 11%) had further ADL decline, 50% (CI, 48% to 52%) had persistent impairment, and 37% (CI, 35% to 39%) had recovered independence. In the 10 years after the initial impairment, 16% (CI, 14% to 18%) had 1 or more episodes of functional decline and 28% (CI, 26% to 30%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs.
Limitation:
Functional status was self-reported.
Conclusion:
Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age.
Primary funding source:
National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.
The authors investigate potential discrimination against people with disabilities through a field experiment that sent job applications to 6,016 accounting positions for which the applicants’ disabilities are unlikely to affect productivity. One-third of the cover letters disclosed that the applicant had a spinal cord injury, one-third disclosed the presence of Asperger’s syndrome, and one-third did not mention disability. The disability applications received 26% fewer expressions of employer interest. This gap was concentrated among experienced applicants and small private companies that are not covered by the Americans with Disabilities Act (ADA). Tests suggest possible positive effects of the ADA, but not of state laws, in reducing the disability gap. Results indicate there may be substantial room for employer and policy initiatives to improve employment opportunities for people with disabilities.
The Americans with Disabilities Act prohibits discrimination on the basis of disability and requires schools to provide reasonable accommodations for persons with disabilities. The profession of nursing is striving for diversity and inclusion, but barriers still exist to realizing accommodations for people with disabilities. Promoting disclosure, a supportive and enabling environment, resilience, and realistic expectations are important considerations if we are to include among our ranks health professionals who can understand, based on similar life experiences of disability, a fuller range of perspectives of the patients we care for.
Consistent with the weathering hypothesis, many studies have captured racial/ethnic disparities in average functional health trajectories. The same mechanisms of social inequality that contribute to worse average health among minority adults may also contribute to greater fluctuations in their physical function at upper ages. Using panel data from the Health and Retirement Study, we examine patterns of intraindividual variability over time in trajectories of functional limitations for White, Black, and Hispanic older adults. Intraindividual variability increases with age for both Whites and Blacks and such increase is greater for Blacks. Hispanics have the greatest intraindividual variability but there is no age-based pattern. Socioeconomic status and comorbidity are associated with intraindividual variability for all race/ethnicity yet do not explain the age-based increase in intraindividual variability for Whites or Blacks. The findings suggest further nuances to the weathering hypothesis—social disadvantage can generate instability in physical function as minority adults age.
Objectives
In the United States, the average age of people living with early-acquired physical disabilities is increasing. This cohort is said to be aging with disability and represents a unique population among older adults. Given recent policy efforts designed to merge aging and disability services, it is critical that models of “successful aging” include and are relevant to this population. However, many current definitions of successful aging emphasize avoidance of disability and high levels of physical function as necessary to well-being.
Method
In 9 focus groups, we examined perspectives of “successful aging” in 49 middle-aged and older individuals living with spinal cord injury, multiple sclerosis, muscular dystrophy, or postpolio syndrome. Transcripts were analyzed using a structured qualitative coding approach and Dedoose indexing software.
Results
Participants ranged in age from 45 to 80 years (M = 62) and had lived with their disability diagnosis for an average of 21 years. Analysis revealed 4 primary themes of successful aging: resilience/adaptation, autonomy, social connectedness, and physical health (including access to general and specialty healthcare).
Discussion
Results highlight the need for a nuanced application of the “successful aging” paradigm in this population.
Purpose:
To identify and synthesize research evidence on workplace accommodations used by employers to recruit, hire, retain, and promote persons with physical disabilities.
Method:
A structured search of six electronic journal databases was undertaken to identify peer-reviewed literature on the topic published from January 1990 to March 2016. Articles describing or evaluating workplace disability accommodation policies and practices were given a full-text review. Topic experts were contacted to identify additional studies.
Results:
Details on specific accommodations described in 117 articles were synthesized and organized into three groups comprised of a total of 12 categories. The majority of studies did not rigorously evaluate effectiveness or cost-effectiveness of the accommodations under study.
Conclusions:
This evidence synthesis provides an overview of the peer-reviewed literature of value to occupational rehabilitation professionals and employers seeking guidance on workplace accommodation policies and practices for persons with physical disabilities. A wide range of accommodation options is available for addressing physical, social, and attitudinal barriers to successful employment. Besides physical/technological modifications, accommodations to enhance workplace flexibility and worker autonomy and strategies to promote workplace inclusion and integration are important. More comprehensive reporting and evaluations of the effectiveness of accommodations in research literature are needed to develop best practices for accommodating persons with disabilities. Implications for rehabilitation There is a substantial peer-reviewed literature that provides insights into the barriers for persons with physical disabilities and the workplace accommodation practices to address them, though rigorous evaluations of effectiveness and cost-effectiveness are uncommon. Attitudinal and social barriers stemming from stereotypes, ignorance and lack of knowledge are as important as physical barriers to employment for persons with physical disabilities. In addition to physical/technological modifications, accommodations to enhance workplace flexibility and autonomy of a worker, as well as strategies to promote workplace inclusion and integration may facilitate successful employment of persons with physical disabilities.
Objectives:
To determine whether subjective poor sleep prospectively increases functional limitations and incident disability in a national sample of adults living in the United States.
Design:
Prospective cohort.
Setting:
Longitudinal Survey of Midlife Development in the United States (MIDUS).
Participants:
Young, middle-aged, and older men and women (aged 24-75) surveyed in 1995/96 (MIDUS 1) and followed up in 2004-06 (MIDUS 2). Complete data were available for 3,620 respondents.
Measurements:
Data were from telephone interviews and self-administered questionnaires. Participant reported chronic sleep problems within the prior month; functional limitations were assessed using the Functional Status Questionnaire. Demographic (age, sex, race), socioeconomic (educational attainment), health (chronic conditions, depression), and health behavior (obesity, smoking) covariates were assessed to reduce potential confounding.
Results:
Approximately 11% of the sample reported chronic sleep problems at both MIDUS waves. Average number of activity of daily living (ADL) and instrumental activity of daily living (IADL) limitations increased significantly between MIDUS 1 (ADL limitations: 0.06; IADL limitations: 0.95) and MIDUS 2 (ADL limitations: 0.15; IADL limitations: 1.6; P < .001). Adjusted regression models estimating change in ADL scores showed that chronic sleep problems at MIDUS 1 predicted significantly greater increases in ADL (incident rate ratio (IRR) = 1.55, P < .001) and IADL (IRR = 1.28, P < .001) limitations. In those with no functional limitations at baseline, logistic regression models showed that chronic sleep problems significantly increased the odds of incident ADL (odds ratio (OR) = 2.33, 95% confidence interval (CI) = 1.68-3.24, P < .001) and IADL (OR = 1.70, 95% CI = 1.21-2.42, P = .002) disability.
Conclusion:
Reports of chronic sleep problems predicted greater risk of onset of and increases in functional limitations 9 to 10 years later. Poor sleep may be a robust and independent risk factor for disability in adults of all ages.
With the aging of the population, an increasing sex ratio of women to men, the potential for increased disability-free life expectancy, and increasing health-care costs, health promotion and physical activity personnel engaged in research, policy, or practice need a full understanding of the physical, cultural, and social context in which consecutive age cohorts move through life. This paper integrates research information from health promotion, the physical activity sciences, social gerontology, and demography; it is divided into six sections focusing on demographic and cultural diversity, the cultural meaning of physical activity, active lifestyles, catalysts and barriers to the emergence of an active older population, and promoting lifelong active living. Employing a macro (societal) rather than a micro (individual) level of analysis, the paper emphasizes that aging is a lifelong social process leading to diverse lifestyles in middle and later adulthood, that there is considerable heterogeneity in physical and social experiences and capacities within and between age cohorts, and that aging is a women’s issue, particularly with respect to health and activity promotion.
Prejudice and discrimination represent a major barrier to the recovery and community integration of individuals with serious mental illnesses. Yet, little is known about the diverse ways prejudicial practices are enacted at the workplace beyond blatant discrimination. This paper presents findings about the manifestations of prejudice and discrimination at the workplace. Data were gathered from a national sample of individuals with serious mental illnesses who reported perceiving negative attitudes at work as part of their participation in a larger study on sustained employment (n = 234) and from a subsequent study on workplace psychiatric prejudice and discrimination (n = 202). Qualitative analyses of data collected through two different surveys informed the development of a comprehensive taxonomy that identified a range of prejudicial and discriminatory practices that fell within two contextual domains: work performance and collegial interactions. The specific categories within each of these domains represented a continuum of more subtle to more blatant expressions of psychiatric prejudice and discrimination that influenced workers with mental illnesses through different impact pathways. Study findings informed the development of a broader conceptual framework for understanding and combating psychiatric prejudice and discrimination in employment settings and improving the workplace inclusion and employment outcomes of individuals with serious mental illnesses.
In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: (a) briefly reviews definitions of discrimination, illustrated with examples from the United States; (b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; (c) concisely summarizes extant evidence--both robust and inconsistent--linking discrimination and health; and (d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.
Background:
We aimed to investigate the relationship between potentially modifiable risk factors in middle age and disability after 13 years using the Framingham Offspring Study (FOS). We further aimed to develop a disability risk algorithm to estimate the risk of future disability for those aged 45-65 years.
Methods:
FOS is a longitudinal study. We used examination 5 (1991-1995; 'baseline') and examination 8 (2005-2008; 'follow-up'). We included participants aged between 45-65 years at 'baseline' with complete predictor and outcome measures (n=2031; mean age 53.9 years). Predictors considered were body mass index, smoking, hypertension, diabetes and dyslipidaemia. We used multinomial logistic regression to identify predictors of disability or death.We assessed external validity using Australian data.
Results:
By examination 8, 156 participants had disability and 198 had died. Disability was associated with smoking (OR (95% CI) 1.81 (1.18 to 2.78)); obesity (2.95 (1.83 to 4.77)); diabetes 1.96 (1.11 to 3.45) and being female (OR 1.67 (1.13 to 2.45). The model performed moderately well in predicting disability and death in an Australian population. Based on our algorithm, a 45-year-old man/woman with the combined risk factors of obesity, diabetes and smoking has similar likelihood of surviving free of disability to a 65-year-old man/woman without any of the same risk factors.
Conclusions and relevance:
The derived risk algorithm allows, for the first time, quantification of the substantial combined impact on future disability of key modifiable risk factors in mid-life. Here we demonstrated the combined impact of obesity, diabetes and smoking to be similar to 20 years of aging.
Disabled people want to have the same opportunities and experiences as everyone else, yet owing to a number of barriers they are often excluded from meaningful employment. There are few statistics available in the UK to provide an accurate understanding of the number of disabled people within construction, and there remains a lack of research on employment, disability and construction. The perceptions of, and barriers faced by, young disabled people in considering potential employment in the construction industry were investigated. A participatory research approach was adopted which places disabled people at the heart of the research process. A mix of interviews and mini focus groups was undertaken with a total of 49 participants drawn from the North West of England. The need for inclusive approaches within the construction industry came across strongly, with participants preferring to be treated equally rather than being treated favourably. Disabled young people are unlikely to consider employment within construction without better awareness raising by industry–both employers and professional institutions–of the range and scope of opportunities available, and a dispelling of the myths that construction is for able-bodied, fit, men.
Similarities and differences were examined in the out‐of‐school recreation and leisure activity participation of 422 children with physical disabilities and 354 children without disabilities. The roles of age (six to eight years, nine to 11 years, and 12–14 years), gender, and disability status were examined with respect to the diversity, intensity, location, companionship, and enjoyment of participation in five types of activities, controlling for family income. The findings indicate that dimensions and types of activity participation are differentially influenced by age, gender, and disability. Age cohort comparisons indicated that children without disabilities experienced a widening social world characterised by more intense social participation, greater participation with non‐family members, and stable levels of enjoyment across the age groups. In contrast, children with disabilities in the various age groups were similar in their intensity of social participation and the nature of their companionship, with 12–14 year olds reporting less enjoyment of social activities than those aged six to eight years or nine to 11 years. The findings support the utility of a developmental and contextual perspective in understanding children’s patterns of participation. The information can be used by service providers and managers interested in creating centre‐based or community‐based recreational opportunities, and in providing information to parents about how to encourage children’s recreation and leisure participation.
Although perceived discrimination (especially due to race-ethnicity) decreases mental health, the influence ofperceived discrimination
due to other reasons on mental health needs to be explored. This study examines the relationship between perceived age discrimination
and mental health and determines whether psychosocial resources explain or buffer (i.e., reduce the strength of) this relationship.
Using a nationally-representative sample of persons aged 25–74 from the Midlife Development in the United States survey, this
study finds that perceived age discrimination is associated with higher psychological distress and lower positive well-being.
Perceived age discrimination is more negatively associated with women's mental health than men's. Although sense of control
buffers the relationship between perceived age discrimination and psychological distress, perceived age discrimination decreases
sense of control and social support.
Social science research on stigma has grown dramatically over the past two decades, particularly in social psychology, where researchers have elucidated the ways in which people construct cognitive categories and link those categories to stereotyped beliefs. In the midst of this growth, the stigma concept has been criticized as being too vaguely defined and individually focused. In response to these criticisms, we define stigma as the co-occurrence of its components–labeling, stereotyping, separation, status loss, and discrimination–and further indicate that for stigmatization to occur, power must be exercised. The stigma concept we construct has implications for understanding several core issues in stigma research, ranging from the definition of the concept to the reasons stigma sometimes represents a very persistent predicament in the lives of persons affected by it. Finally, because there are so many stigmatized circumstances and because stigmatizing processes can affect multiple domains of people's li...
The prevalence of perceived discrimination among people reporting an emotional, psychological, or psychiatric condition in a population of people with a disability has not been studied. Our study evaluated a model that integrated having an emotional, psychological, or psychiatric condition while accounting for age, sex, education, employment, marital status, immigration status, and type of community to estimate the prevalence of perceived discrimination in the population of people with a disability. We hypothesized that higher levels of perceived discrimination would occur in people reporting an emotional, psychological, or psychiatric condition.
The Participation and Activity Limitation Survey (PALS) by Statistics Canada is a postcensual survey of community residents reporting health-related impairments. PALS was used to evaluate the interaction between self-reported emotional, psychological, or psychiatric conditions and demographic variables and the odds of experiencing discrimination.
In the overall sample, 14.5% perceived discrimination and 18.2% reported having an emotional, psychological, or psychiatric condition. Thirty-five per cent of people with such conditions perceived discrimination. When adjusting for covariates, people reporting an emotional, psychological, or psychiatric condition were 3 times more likely to perceive having been discriminated against than people without such conditions. Across medical conditions, perceived discrimination was higher in people who also reported an emotional, psychological, or psychiatric condition.
The results demonstrate that perceived discrimination and the presence of an emotional, psychological, or psychiatric condition frequently co-occur in people with a disability and therefore programs aimed at reducing the discrimination of emotional, psychological, or psychiatric conditions should take this into account.
Using nearly 30,000 employee surveys from fourteen companies, we find disability is linked to lower average pay, job security, training, and participation in decisions, and to more negative attitudes toward the job and company. Disability gaps in attitudes vary substantially, however, across companies and worksites, with no attitude gaps in worksites rated highly by all employees for fairness and responsiveness. The results indicate that corporate cultures that are responsive to the needs of all employees are especially beneficial for employees with disabilities. [ABSTRACT FROM AUTHOR] Copyright of Industrial Relations is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
This article examines the extent to which racial differences in socio-economic status (SES), social class and acute and chronic indicators of perceived discrimination, as well as general measures of stress can account for black-white differences in self-reported measures of physical and mental health. The observed racial differences in health were markedly reduced when adjusted for education and especially income. However, both perceived discrimination and more traditional measures of stress are related to health and play an incremental role in accounting for differences between the races in health status. These findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health.
We examine the extent to which body weight affects three types of perceived interpersonal mistreatment, and evaluate whether these patterns vary by race, social class, and gender in a large sample of American men and women.
We use data from the first wave (1995) of the Midlife Development in the United States (N = 3,511), a survey of persons aged 25-74, to contrast underweight, normal weight, overweight, obese I, and obese II/III persons' reports of three types of perceived interpersonal mistreatment: disrespectful treatment; harassment/teasing; and being treated as if one has a character flaw. We assess whether these relationships are contingent upon one's gender, race, and occupational status. We control for possible confounding influences, including physical and mental health.
In the total sample, obese I and obese II/III persons report significantly higher levels of all three types of perceived mistreatment (compared to normal weight persons), even when demographic, socioeconomic status, and health characteristics are controlled. Among black men, however, obese II/III persons report significantly lower levels of all three types of perceived mistreatment, compared to their normal weight peers. Among both men and women, obese professional workers report significantly more perceived interpersonal mistreatment, compared to obese persons of lower socioeconomic status.
These findings reveal the ways that intersecting social identities may shape obese Americans' perceptions of stigmatizing interpersonal encounters.
The concepts of felt and enacted stigma (Scambler and Hopkins, 1986(1)) are well established in epilepsy research. However, more recent research tends to focus on either those doing the stigmatising or utilises quantitative methodologies, exploring daily occurrences of stigma for those with epilepsy. The current study aims to explore the concept of felt stigma in today's society, arguing that a return to a phenomenological approach would allow people with epilepsy to discuss issues of importance to them, seeing them as the experts on this concept (Byrne, 2001(17)).
Fifty-two people with epilepsy were recruited via an advertisement on the Epilepsy Action website, thirty of whom took part in a follow-up interview. The interviews were analysed following Lemon and Taylor's (1997)(22) phenomenological approach.
Three themes emerged, surrounding issues of embarrassment of having the condition, non-disclosure of the diagnosis and misconceptions of the condition. These findings support previous research which argues that people with epilepsy perceive a stigma due to feeling different from the rest of society, meaning that they conceal their condition as a way of managing such stigma and thus need to renegotiate their social identity. Additionally, the moderating role of education in increasing knowledge of epilepsy, with a view to reducing felt stigma, was evident.
The findings indicated a need to promote epilepsy awareness programmes as a means of increasing public knowledge of epilepsy, with the aim of reducing felt stigma.
This article describes a substantial update to mvis, which brings it more closely in line with the feature set of S. van Buuren and C. G. M. Oudshoorn’s implementation of the MICE system in R and S-PLUS (for details, see http://www.multiple-imputation.com). To make a clear distinction from mvis,the principal program of the new Stata release is called ice. I will give details of how to use the new features and a practical illustrative example using real data. All the facilities of mvis are retained by ice. Some improvements to micombine for computing estimates from multiply imputed datasets are also described. Copyright 2005 by StataCorp LP.
This investigation explored 2 hypotheses derived from socioemotional selectivity theory: (a) Selective reductions in social interaction begin in early adulthood and (b) emotional closeness to significant others increases rather than decreases in adulthood even when rate reductions occur. Transcribed interviews with 28 women and 22 men from the Child Guidance Study, conducted over 34 years, were reviewed and rated for frequency of interaction, satisfaction with the relationship, and degree of emotional closeness in 6 types of relationships. Interaction frequency with acquaintances and close friends declined from early adulthood on. Interaction frequency with spouses and siblings increased across the same time period and emotional closeness increased throughout adulthood in relationships with relatives and close friends. Findings suggest that individuals begin narrowing their range of social partners long before old age.
Epilepsy is, in the majority of cases, a short-lived and self-limiting clinical condition. However, individuals labelled as epileptic frequently continue to feel stigmatised, even after their seizures remit. This paper describes the nature and extent of stigma in a group of individuals with epilepsy in remission. The distinction between 'felt' and 'enacted' stigma is examined, and found to be supported by the data.
Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicians tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.