1. Employment after Spinal Cord Injury: Analysis of 1,391 cases James S. Krause, Ph.D. Lynne E. Broderick, M.P.H. Shepherd Center, Atlanta, GA

2. Funding Source This research was supported by a Model Spinal Cord Injury Systems grant from the National Institute for Disability and Rehabilitation Research (NIDRR) of the Office of Special Education and Rehabilitation Services (OSERS) #H133N00023

3. Background Spinal cord injury (SCI) is significant barrier to return to employment 29% individuals with SCI employed, compared to 74% general population Several injury and biographic characteristics associated with employment status oChronologic age and age at injury onset oEducation level oRace/ethnicity oGender

4. Purpose The purpose of this study was to investigate the relationships of multiple biographic, injury related, education, personality and locus of control variables with post-injury employment outcomes. Special Emphasis: The role of years of education in mediating the relationships between race- ethnicity and injury related factors with employment outcomes.

5. Hypotheses 1.Level of education is a mediating factor for the relationship of race/ethnicity with employment status 2.Three aspects of locus of control are associated with differential employment outcomes 3.Personality is associated with differential employment outcomes

6. Method - Participants Identified from patient files of Southeastern United States rehabilitation hospital Inclusion Criteria oTraumatic SCI oAt least 18 years of age oInjured for at least one year

7. Method - Instruments Three primary questions regarding employment oPost-injury status (Ever work since injury?) oCurrent status (Working? Not working?) oTotal number years worked post-injury Biographic information oRace/ethnicity oGender oInjury factors (type, severity, circumstances of onset) oEducation Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) Multidimensional Health Locus of Control Scale (MHLC)

8. Results - Descriptive N=1,391 74% male 75% Caucasian, 22% African-American Average age 41.6 years Average of 9.7 years since SCI onset 55% of participants had cervical injuries

9. Results – Employment At time of study o27% participants were employed o44% had worked at some time since SCI onset oAverage 5.7 years employed since SCI onset

10. Results –Factors Associated with Current Employment Status Gender oNot significant Race oCaucasian participants were more likely to be employed than Minority participants Age oParticipants who were younger were more likely to be employed Time since injury oParticipants more than 5 years post injury were more likely to be employed

11. Results –Factors Associated with Current Employment Status (cont’d) Education oParticipants with more than 12 years of education more likely to be employed Injury Severity oParticipants with less severe injuries more likely to be employed

12. Percent Currently Employed by Racial- Ethnic Background and Education Caucasian Minority

13. Percent Employed Since Injury by Racial– Ethnic Background and Education Caucasian Minority

14. Results – Locus of Control Locus of Control (MHLC) Higher employment rates oHigher Internality scores olower Chance oLower Powerful Others scores

15. Results – Personality Three of five scales related to a greater probability of being currently employed oLower scores on Neuroticism-Anxiety oLower Aggression-Hostility oHigher scores on Activity scale

16. Results – Logistic Regression Significantly associated with current employment status oCaucasian Male (OR 2.25) oAge at onset Under 18 at injury (OR 7.95) oYears post injury 21-25 Years (OR 4.15) oInjury severity ASIA D (OR 5.62) oYears of education 16+ years of education (OR 22.24) oPowerful Others (LOC) (OR.97) oActivity (Personality) (OR 1.03)

17. Implications Increasing education of individuals with minority backgrounds to level of 4-year degree could diminish differences in employment outcomes Personality and Locus of Control oPersonality – being energetic, having positive affect, lack of resentment and hostility lead to employability oLocus of Control – feeling uninfluenced by chance and Powerful Others will lead to employability

18. Limitations All data were self-report Data on employment outcomes were limited oNo distinction was made on number of hours working per week No data were collected on financial disincentives or barriers to employment

19. Future Research Need to oLook at detailed global employment outcomes after SCI oGain a greater understanding of factors that underlie differences in outcomes between groups More research is needed on how aging impacts employability and how this may be overcome