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Students with disabilities with unmet health care needs are vulnerable to adverse educational outcomes, including exclusionary discipline. We examined the association between schools' spatial proximity to health care providers and their use of suspension to discipline students with disabilities. The study sample included the 398 public secondary schools in the Boston Metropolitan Statistical Area. We merged census-tract and school-level data from several sources, including the American Community Survey, the Health Resources and Services Administration, the Massachusetts Department of Public Health, and the U.S. Department of Education. Zero-inflated beta regression models were used to examine the association between schools' locations in medically underserved areas (MUAs) and the out-of-school suspension rates of students qualifying for special education services in the 2013–14 school year. Nested models and mediation analysis were used to parse the effects of medical underservice and neighborhood poverty on suspension rates. The suspension rate of students with disabilities was about 5 percentage points higher in schools located in medically underserved areas compared to schools that are not in MUAs, controlling for school- and neighborhood-level characteristics (z = 1.97, p <.05). Medical underservice significantly mediated the effect of neighborhood poverty on suspensions of students with disabilities (indirect effect, p <.05), accounting for 44% of the total effect of poverty. The findings indicate that schools with limited geographic access to health care services may more likely to use suspension as a tool to manage the behavior of students with disabilities. • The spatial distribution of health resources is unequal in the Boston area. • Local health contexts impact schools' inclusion of students with disabilities. • Schools in medically underserved areas suspend more students with disabilities. • Local health contexts impact suspension rates above and beyond neighborhood poverty. [ABSTRACT FROM AUTHOR]

There is increasing interest in the role of contextual factors in promoting well-being among parents of children with developmental disabilities. This study aimed to examine whether social network types moderate the impacts of having a child with a developmental disability on parents' health. Using cross-sectional data from the Midlife in the United States survey (MIDUS 2 and Refresher cohorts), we analyzed a sample of 363 parents of children with developmental disabilities and 4,919 parents of children without developmental disabilities. K-means cluster analysis was implemented to identify a social network typology. Modified Poisson and negative binomial regression models estimated the effect of having a child with a developmental disability and the typology on parents' physical health (self-rated health, number of chronic conditions) and mental health (self-rated mental health, major depression). The cluster analysis revealed two social network types. Parents of children with developmental disabilities were more likely to have "restricted/unsupported" networks, whereas parents in the comparison group were more likely to have "diverse/supported" networks. Social support was more important for differentiating the network types of parents of children with developmental disabilities, while social integration was more salient for the comparison group. Parents of children with developmental disabilities fared worse on all outcomes relative to parents of children without disabilities. However, the typology had a compensatory psychological effect; the diverse/supported network type conferred greater mental health benefits to parents of children with developmental disabilities than to those in the comparison group. The diverse/supported network type was also associated with better physical health, but the associations did not differ between the two parent groups. The results of this study emphasize the importance of social determinants of well-being for those with exceptional parenting responsibilities. Strengthening social networks may have a particularly positive impact on such parents' mental health. • Parents in midlife can be classified into two social network types. • Social support is paramount for parents of children with developmental disabilities. • Social integration matters more for other parents. • Diverse and supported network type is beneficial for parents' health. • Network type buffers the effects of having a child with developmental disabilities. [ABSTRACT FROM AUTHOR]

Developmental disabilities (DD) research has depended on volunteer and clinical samples, with limited racial/ethnic diversity. This study focused on improving diversity and retention in DD research. The sample included 225 parents with a child with DD and 4,002 parents without children with DD from diverse racial/ethnic groups, drawn from Midlife in the United States, a national longitudinal study. Unexpectedly, parents of children with DD from diverse racial/ethnic groups were more likely to participate longitudinally than other groups. Relative participant payment was a factor that enhanced their likelihood of retention. This research illustrates how large national studies can be leveraged to increase representativeness and ongoing participation of diverse racial/ethnic groups, especially in combination with other factors, such as parenting a child with DD., (©AAIDD.)

Background: Little is known about the factors that contribute to racial/ethnic disparities among children with special health care needs (CSHCN)., Objective: To quantify the contributions of determinants of racial/ethnic disparities in health and health care among CSHCN in Boston, Massachusetts., Methods: A sample of 326 Black, Latino, and white CSHCN was drawn from the Boston Survey of Children's Health, a city-wide representative sample of children. The study implemented Oaxaca-Blinder-style decomposition techniques to examine the relative contributions of health resources and child-, family-, and neighborhood-level factors to disparities in four outcomes: health status, barriers to medical care, oral health status, and utilization of preventive dental care., Results: White CSHCN had a greater likelihood of having very good/excellent health and oral health and were less likely to experience barriers to care than Black CSHCN. Compositional differences on predictors explained 63%, 98%, and 80% of these gradients, respectively. Group variation in household income, family structure, neighborhood support, and exposure to adverse childhood experiences accounted for significant portions of the Black-white gaps in health and access. White CSHCN were also more likely to have very good/excellent health and oral health compared to Latino CSHCN. Differences on predictors accounted for about 86% and 80% of these gaps, respectively. Household income, adverse childhood experiences, and household language emerged as significant determinants of Latino-white disparities., Conclusions: Racial/ethnic health disparities among CSHCN are explained by relatively few determinants. Several of the contributing factors that emerged from the analysis and could be targeted by public health and policy interventions., Competing Interests: Conflicts of interest The authors report no conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The objective of this study was to examine the physical and mental health impact of violence against youth with and without disabilities. We analyzed data from the National Crime Victimization Survey (2008-2016), a nationally representative survey on crime in the United States. Respondents included 729 adolescents (12-17 years) and 953 young adults (18-24 years) who experienced violence in the previous 6 months. Disability status was determined using a six-item screener. Outcome measures included several physical and mental health symptoms experienced for at least one month following violence. Data were analyzed using multivariable logistic, Poisson, and negative binomial regression models. The results indicated that, for at least one month following a violent incident, adolescents and young adults with disabilities were more likely to experience headaches, sleep difficulty, changes in eating or drinking habits, fatigue, muscle pain, and severe distress compared to peers without disabilities. Young adults with disabilities were also more likely to experience stomach problems, depression, and anxiety. Adolescents and young adults with disabilities experienced a greater number of concurrent physical and mental health symptoms compared to peers without disabilities. The results suggest that the health effects of violence are worse for youth with disabilities compared to their nondisabled peers. These findings emphasize the importance of screening young people with disabilities for violence exposure and ensuring that trauma and health services are universally accessible.

Objective: Research on hospitalizations related to self-injurious behavior and ideation among adults with autism spectrum disorder (ASD) is limited. This study compared admissions, average length of stay, and costs of resources to deliver care for such hospitalizations between adults with and without ASD., Methods: The 2014 Healthcare Cost and Utilization Project National Inpatient Sample was used to compare 5,341 discharge records for adults with ASD and 16,023 records for adults without ASD, matched on age and gender in a 1:3 ratio. Hierarchical logistic and linear regressions accounted for clustering by hospital. Covariates included gender, race-ethnicity, age, region, comorbidities, number of procedures, and insurance., Results: Among hospitalized adults, those with ASD were twice as likely as those without ASD to have a hospitalization related to self-injurious behavior and ideation. Among hospital stays for self-injurious behavior and ideation, adults with ASD had average lengths of stay that were 2.14 days longer (95% confidence interval [CI]=1.20-3.08) compared with adults without ASD. Among adults with a hospitalization related to self-injurious behavior and ideation, unadjusted average costs for those with ASD were 36.8% higher than for adults without ASD. After the analysis accounted for covariates and length of stay, adults with ASD still had 7.48% (95% CI=1.05%-14.32%) higher costs., Conclusions: Adults with ASD were twice as likely as adults without ASD to have a hospitalization related to self-injurious behavior and ideation. Among adults with such a hospitalization, those with ASD had longer stays and, even after the analysis accounted for length of stay, higher costs.