Background: Adequate, quality and affordable housing is the cornerstone to positive community living and health outcomes for people with disabilities (PWD), yet research on this topic is scarce. While housing is an important social determinant of health, a few studies show that individuals with a disability are more likely to be poorly housed. This study contributes to a small body of emerging scholarship on the type of housing and the neighborhoods where people living with a disability reside.

Methods: Applying an intersection lens of disability and race/ethnicity, we analyze data from the 2017 American Housing Survey that uses the six American Community Survey questions to determine disability status. Our analysis breaks down features related to housing inadequacy and quality by different disability types. Multivariate analysis will test the relationships between housing adequacy and disability type, race/ethnicity, as well as their interactions.

Results: Our preliminary descriptive analyses show a higher proportion of housing inadequacy for American households with PWD living in them, as measured by electrical, heating, plumbing, and structural upkeep problems. In addition, PWD households of color report higher rates of moderate to severe housing inadequacy.

Conclusion: Our findings suggest that households with disabled individuals, especially those of color, are more likely to be inadequate and require more upkeep. This study will advance our understanding of the barriers to healthy housing for people with a disability living in the community. These findings will inform housing and social welfare policies in support community of living for people living with disability.

PSH is an effective intervention to improve residential stability and reduce utilization of costlier healthcare services by individuals with disabilities who previously experienced long-term homelessness. However, there has been little focus on their overall health after entering PSH. We surveyed PSH residents in the Chicago metropolitan area. Surveys included questions on socio-demographics, health behaviors, housing characteristics, and housing satisfaction. The primary outcome for this study was HRQL, calculated using the physical (PCS) and mental component summary (MCS) scores from the Short-Form 36. Other variables were selected using the Wilson and Cleary HRQL model. We calculated means, standard deviations, and percentages for all variables of interest. We then conducted bivariate analyses, unadjusted and fully adjusted linear regression models. Our sample included 855 adults currently in PSH. Our sample was predominantly African-American men with an average age of 53 years. Mean scores for PCS and MCS were 39.4 and 46.1, respectively (out of 100). In adjusted analysis, older age and being on disability were associated with worse PCS. Having HIV was associated with better PCS. Being non-Hispanic Black and a high school graduate increased MCS. More depressive symptoms were associated with worse PCS and MCS. Like the general population, improving mental health is associated with increased HRQL in individuals with disabilities who are in PSH. Notably, non-Hispanic Blacks had better mental well-being and those with HIV had better physical well-being. Future research should look at HRQL over time in this population and how PSH may have a differential impact on vulnerable subpopulations.

Experiences of social isolation and loneliness have been compared to smoking in terms of risk to public health. Some groups are at particularly high risk for these feelings, including older adults, people with disabilities, and rural residents. Much research in this area has focused on older adults, but few studies have considered the potentially compounding effects of disability status and rural residency. Using nationwide data of working-age adults with disabilities (n=1,246) collected by the Collaborative on Health Reform and Independent Living (CHRIL), we analyzed how social connectedness and perceived isolation related to health, and whether living arrangement and disability severity affected social connectedness and perceived isolation differently for people living in rural versus urban places. Better health was associated with increased social connectedness and decreased perceived isolation. Disability severity was associated with decreased social connectedness and increased perceived isolation. There was also an interaction between geography and disability severity on social connectedness, where increased number of disability issues was associated with lower ratings of social connectedness for rural residents. People living alone reported more social connectedness and less perceived isolation than those living with others. Tests for interactions suggest the effect of living alone on social connectedness and perceived isolation may be stronger for rural than urban residents. Given our knowledge of the health consequences of social disconnectedness and isolation, these findings underscore the need for future research that addresses these public health risk factors for people with disabilities.

As separate groups, people with disabilities and people who are lesbian/gay/bisexual/transgender/queer (LGBTQ) both experience significant health disparities when compared to the general population. This study sought to understand and quantify these disparities for working age Americans with disabilities who are LGBTQ.

Data from the 2018 National Survey on Health Reform and Disability (NSHRD), a national, internet-based survey of working age adults (18-63) with a wide range of disabilities and/or chronic health conditions, (N=1139; 155 LGBTQ and 984 non-LGBTQ) were used to compare health and access for LGBTQ versus non-LGBTQ respondents. LGBTQ respondents were significantly more likely to report fair to poor overall health, more days of poor physical or mental health, and being unable to participate in usual activities. LGBTQ respondents were also significantly more likely to report difficulty finding health insurance coverage, not getting prescriptions or medical services due to cost, transportation barriers to care, and inability to obtain personal assistance services. Finally, LGBTQ respondents were more than twice as likely to report being refused services by a provider.

Disparities in health and barriers to accessing medical care appear to be additive for people with disabilities who identify as LGBTQ. These disparities are the culmination of more than a century of structural barriers, social stigmas, political forces, and omissions in medical training and medical research. As such, understanding the historical roots of these disparities and documenting their current implications are essential to making meaningful changes that improve access to care and health outcomes for LGBTQ people with disabilities.

Background: Women with physical disabilities make decisions about whether or not to bear children in the context of a larger society that often discourages them from assuming many typical social roles, including the role of mother. This study examined the factors affecting women’s decision-making about bearing children. Methods: Semi-structured interviews were conducted with approximately 40 women whose disabilities began at birth or before puberty and member-checking focus groups were conducted for the purposes of validation. Underlying causes of disability included spinal muscular atrophy, osteogenesis imperfecta, cerebral palsy, spina bifida, spinal cord injury, Larsen syndrome, Ehler-Danlos syndrome, dwarfism and other conditions. Participants were recruited through snowball sampling, community-based organizations, universities and via social media. Results: Women’s experiences with the process of deciding whether or not to have children varied widely. Factors women considered included their own beliefs about their physical ability to have children, information from clinicians, family expectations about their ability to have children or its advisability due to the impact of pregnancy on their health or the impact of their disability on their ability to care for a child. Women with similar clinical profiles frequently made very different decisions about having children based on these and other factors including the extent to which having children was related to their self-concept and their assessment of risk. Conclusions: Improvements can be made in the information and support women receive in the process of deciding whether or not to have children.

A growing body of research indicates that women with physical disabilities (WPD) experience unmet health-related needs and complications of pregnancy uncommon in other women. They report negative attitudes toward pregnancy and childbearing from friends, relatives, strangers, and health care providers (HCPs), and have reported that HCPs lack knowledge about pregnancy and childbearing in WPD. WPD encounter inaccessible health care settings, including hospitals and clinical offices, and lack of adjustable examination tables and scales needed to obtain weights during pregnancy. Many WPD report a need for information about the interaction of their disability and pregnancy. WPD have reported that their need for information is rarely addressed before, during or after pregnancy. No study has addressed the perspectives of WPD and childbirth educators about childbirth education in WPD. A total of 30 participants, 15 WPDs and 15 childbirth educators, were recruited and interviewed by phone about the childbirth education experiences among WPD. Although they had years of experience in providing childbirth education classes, the childbirth educators indicated knowing little about disability and how it relates to WPDs' experiences. They reported receiving no previous education or training in their childbirth education experience to prepare them to address the needs of WPD during pregnancy, including labor and delivery. Although some WPD participants reported attending childbirth education classes, they found little information that pertained to their personal experience and often sought out other WPDs with disabilities similar to their own. Participants in both groups indicated a need to address childbirth experiences in WPD.

Background: Societal views about sexuality and parenting among people with disabilities may limit access to sexual education and the full range of reproductive health services. Thus, women with disabilities may be at increased risk of unintended pregnancies. To date, however, no national population-based studies have examined intendedness of pregnancies among U.S. women with disabilities.

Methods: We conducted cross-sectional analyses of data from the 2011-2013 and 2013-2015 waves of National Survey for Family Growth (NSFG). We calculated the proportion of pregnancies described as unintended among women with disabilities overall, women with each of five types of disabilities, and women with no disabilities. We conducted multivariate logistic regression analyses to examine the relationship of overall disability and each disability type with pregnancy intendedness while controlling for covariates.

Results: A significantly higher proportion of pregnancies occurring in women with disabilities were unintended compared to pregnancies among women without disabilities (52.40% vs. 35.75%, p<0.001). Women with independent living disability had the highest proportion of unintended pregnancies (61.75%). In regression analyses adjusting for covariates, we found significantly higher odds of unintendedness for pregnancies among women with disabilities overall (aOR =1.36, 95% CI=1.11-1.67), hearing disability (aOR=1.62, 95% CI=1.06-2.49), cognitive disability (aOR=1.44, 95% CI=1.12-1.84), and independent living disability (aOR=1.75, 95% CI=1.12-2.73) compared to women without disabilities.

Conclusion: Women with disabilities have higher proportions and odds of unintended pregnancy. Further research is need to understand differences based on type and extent of disability.

background: A paucity of research exists about the role of family caregivers who assist women with intellectual or developmental disabilities (IDD) access sexual and reproductive health care. This exploratory study sought to fill that scholarly void.

methods: An online, cross-sectional survey (N= 134), distributed via social media and disability organizations. The survey included both open- and closed-ended questions. Family caregivers were defined as people who provide care or help in some way a family member with an IDD. Quantitative and qualitative methodologies were used to analyze the data.

results: Family caregivers were primarily parents (89%). Other family caregivers included siblings, grandparents, and cousins. Most participants (97%) reported it was important for women with IDD to receive sexual and reproductive health care. The majority of participants (78%) reported assisting their relative access sexual and reproductive health care, including contraception, Pap smear tests, sexual education, mammograms, sterilization, testing for sexually transmitted infections, and perinatal health care. More than one-third of participants (35%) reported encountering barriers, including lack of knowledge about working with women with IDD by physicians, paucity of providers, family caregivers’ paucity of information, and disability-related considerations.

conclusion: Many family caregivers assist women with IDD access a range of sexual and reproductive health care. Greater attention to improving sexual and reproductive health care for women with IDD is necessary. Further, family caregivers, women with IDD, and health care providers need increased access to information about the sexual and reproductive health of women with IDD.

Background: Mental health is critical to one’s general health and well-being. It is well documented that working-age adults with disabilities in the United States encounter greater disparities in health and socioeconomic status than their counterparts without disabilities. Research also shows that adults with disabilities are more likely to be involved in substance use behavior. These indicate greater needs for mental health services among those with disabilities. However, there is a dearth of literature on disparities in unmet need for mental health care between working-age adults with and without disabilities.

Objective: To examine whether the disparity in unmet need for mental health treatment between working-age adults with and without disabilities exists, after controlling for demographic, health, and financial variables.

Method: This study used a nationally representative sample of community-dwelling adults ages 18-64 from the National Survey on Drug Use and Health for 2015-2017 (n=117,813). This cross-sectional study used sequential logistic regression models to examine the associations of unmet need for mental health treatment with disability status, including demographic, health, and financial variables.

Results: Working-age adults with disabilities had significantly higher odds of unmet need for mental health treatment in the past year compared to their counterparts without disabilities, even after controlling for demographic, health, and financial variables (AOR = 2.79; 95% CI = 2.33, 3.36).

Conclusions: There exists a disparity in unmet need for mental health treatment between working-age adults with and without disabilities. This warrants further research to improve mental health care among the adult population with disabilities.

Background: Although the inverse relationship between income and psychological distress (PD) is well established for the general population, whether a similar pattern exists for people with disabilities is unclear. This study investigates the association between income and PD and tests whether the association differs by disability status and/or number of disabilities.

Methods: Using data from the 2008-2017 National Health Interview Survey (N=127,973), we conducted a series of linear regression models to estimate the association between income and psychological distress, measured by the Kessler 6 Scale (range 0-24). The association was allowed to differ by disability status and number of disabilities. All models controlled for health insurance, employment, education, sex, age, race/ethnicity, and marital status.

Results: Lower income was associated with higher K6 scores for people with and without disabilities. This association was stronger among those with disabilities. For example, compared to those with income at least four times the poverty threshold, poor individuals without a disability scored 0.52 points higher on the K6 Scale. Poor individuals with at least one disability scored 2.71 points higher. The steepness of the income-PD gradient increased as number of disabilities increased.

Conclusions: Results point to a compounded risk of PD among people with disabilities who live in poverty, particularly for those with multiple disabilities. Given that people with disabilities are disproportionately poor, people with disabilities may be particularly vulnerable to PD. Outreach efforts focused on people with disabilities living in poverty may help reduce PD and its associated health risks, including increased mortality.