Journal of Fluency Disorders 62 (2019) 105725

Contents lists available at ScienceDirect

Journal of Fluency Disorders

journal homepage: www.elsevier.com/locate/jfludis

The influence of workplace discrimination and vigilance on job

T
satisfaction with people who stutter
Laura W. Plexicoa,*, Megan-Brette Hamiltona, Haley Hawkinsb, Stephen Eratha
a
Auburn University, United States
b
University of Alabama, United States

ARTICLE INFO ABSTRACT

Keywords: Purpose The purpose of the present study is to examine the association between workplace
Coping discrimination, vigilance, and job satisfaction in people who stutter and compare this with people
Discrimination who do not stutter. Method Seventy-two people who stutter (PWS) and 92 people who do not
stutter (PWNS) participated in an online survey. Participants completed a survey assessing 6
different areas: (a) background information, (b) job satisfaction, (c) everyday discrimination, and
(d) heightened vigilance. Mediation analyses were conducted to evaluate the relationship be-
tween the independent variables and dependent variable. Results There was a relationship be-
tween being a PWS and job satisfaction, discrimination, and vigilance. PWS were found to ex-
perience higher discrimination as well as be more vigilant. Discrimination and vigilance were
found to mediate the relationship between stuttering and job satisfaction. Conclusion Results of
this study indicate that the participants who stutter differ from PWNS in their job satisfaction,
discrimination, and vigilance. Clinicians can prepare PWS with self-advocacy strategies, legal
knowledge of what their rights are as an employee who identifies as a person who stutters with a
disability, a legal understanding of workplace discrimination, and counseling on the impact of
vigilance on workplace experiences.

1. Introduction

Job satisfaction has been defined as two-fold: a person’s affective response to their work and/or a person’s cognitive response to
their work. A person’s affective response is grounded in their “overall positive emotional appraisal of the job” (Moorman, 1993, p.
761), whereas a person’s cognitive response is based on “logical and rational evaluation of the job conditions” (Moorman, 1993, p.
761). Therefore, job satisfaction plays a vital role in the daily life of an employee.
Discrimination at work is likely to undermine job satisfaction at affective and cognitive levels (cf. Klein & Hood, 2004). People
with disabilities are often the victims of discrimination in the workplace which has been demonstrated to influence job satisfaction
(Di Marco et al., 2016). A person who stutters (PWS) may be perceived by society/employers as a person with a disability and as a
result be a victim of discrimination (Boyle & Blood, 2015; Gerlach, Totty, Subramanian, & Zebrowski, 2018). However, on the other
hand, this same PWS may assume the marginalized social identity of a person who stutters and thus become vigilant against any real
or perceived threats in the workplace (Emerson & Murphy, 2014). It is these two seemingly juxtaposed identities along with their
contextual factors that may impact the job satisfaction of a person who stutters.

⁎
Corresponding author at: Department of Communication Disorders, 1199 Haley Center, Auburn, AL 36849, United States.
E-mail address: lwp0002@auburn.edu (L.W. Plexico).

https://doi.org/10.1016/j.jfludis.2019.105725
Received 17 December 2018; Received in revised form 17 October 2019; Accepted 25 October 2019
Available online 30 October 2019
0094-730X/ © 2019 Elsevier Inc. All rights reserved.
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

1.1. Stuttering as a disability and social identity

The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) provides a fra-
mework for understanding and defining disability. This framework takes into account impairments, activity limitations, and parti-
cipation restrictions that occur when health conditions interact with different contextual factors (World Health Organization, 2001).
Contextual factors address the influence that both environmental and personal factors could have on functioning and disability.
Environmental factors are the external influences such as societal discrimination, while personal factors are the internal influences
such as heightened vigilance on functioning and disability (World Health Organization, 2001; Yaruss & Quesal, 2004). There is now
universal recognition of the important influence of these factors and that these factors could have a positive or negative impact on
overall health. Yet, it remains difficult to come up with a universally “agreed-upon set of personal factors that influence stuttering”
and whether stuttering qualifies as a disability (Yaruss & Quesal, 2004, p. 47).
Stuttering can also be perceived as a social identity. We all have social identities. Our social identities are how we come to define
ourselves in relation to others. It is how we identify as being similar to and a part of a group (i.e., being a PWS) or different from
another group (i.e., PWNS; Brewer, 1991). Social identities are important across different social contexts including the workplace. A
social identity like stuttering can influence personal perceptions as an employee and relationships with co-workers (Bergami &
Bagozzi, 2000). Some identities, like stuttering, are known to be more stigmatizing than others and thus a target for societal ste-
reotyping and discrimination (Boyle & Blood, 2015). Persons who have identities that are associated with a minority group are often
more vigilant and sensitive to indicators of inclusion or whether or not they are respected and accepted by others in the workplace
(Emerson & Murphy, 2014; Steele, Spencer, & Aronson, 2002). Further, minorities are often also concerned with the degree to which
they can be themselves and whether they will have the same opportunities as other employees or experience discrimination (Emerson
& Murphy, 2014).

1.2. Factors that influence discrimination

Discrimination, an outcome that can stem from experiencing stuttering as a disabling condition and/or from societal stereotyping,
is a concern often expressed by many people who stutter and a documented problem for some people who stutter (Boyle & Blood,
2015). At a distal level, societal stereotyping throughout the lifespan is likely to be involved. In regard to societal stereotyping, there
is a wealth of research that demonstrates society’s lack of knowledge, lack of understanding, and negative stigma regarding the
phenomenon of stuttering as well as the negative perceptions society holds concerning people who stutter (Dorsey & Guenther, 2000;
Franck, Jackson, Pimentel, & Greenwood, 2003; Ruscello, Lass, Schmitt, & Pannbacker, 1994).
Secondly, at a more proximal level, educational impairment of those who stutter from early childhood to adulthood could also be
a barrier that contributes to workplace discrimination as well. Ellis and Hartlep (2017) interviewed six adult African American males
who stutter about their educational experiences and found that their stuttering was a large component of their academic performance
and learning experiences. While the males in this study desired positive academic and social experiences in school (e.g., honor
student, class officer), participants reported that their stuttering, calling it a “verbal disability,” in addition to their race, limited such
experiences. Most importantly, they reported that it was teachers’ and peers’ reaction to stuttering that was a major contributor to
their negative feelings and disadvantaged experiences surrounding school. These earlier events continued to influence the partici-
pants’ self-identity and career options in later adulthood. A qualitative study by Daniels, Gabel, and Hughes, (2012)) had similar
findings. The study explored the primary and secondary school experiences of adults who stutter and found that the challenges faced
in their educational environments were both academic (e.g., difficulty reading out loud) and social (e.g., negative self-identity) in
nature. The majority of participants in the study revealed that their past school experiences shaped their experiences for later in life.
For example, many participants reported having a continued fear of speaking and personal identity challenges as adults which
influenced critical decisions in their lives such as job choice.

1.3. Workplace experiences and job satisfaction of PWS

Several studies have identified the disadvantages that people who stutter experience, particularly within employment settings
(Alqhazo, Blomgren, Nelson, & Awwad, 2017; Bricker-Katz, Lincoln, & Cumming, 2013; Craig, Blumgart, & Tran, 2009). In fact, Hurst
and Cooper (1983) found that employers ranked stuttering as the most impairing speech disorder when compared to all other speech
disorders and concluded that stuttering is considered a “vocationally handicapping” problem. Over half of the employers in the study
reported some level of discomfort related to stuttering. Additionally, 85 % of employers agreed that stuttering decreases employ-
ability, 30 % agreed that stuttering would interfere with job performance, 44 % agreed that people who stutter should seek em-
ployment that does not require a lot of speaking, and 40 % agreed that stuttering would interfere with promotion abilities. While this
study shows that discrimination exists from an employer’s perspective, it did not ask about discrimination from the perspective of an
employee. It should be pointed out that the previous study was conducted over thirty years ago. With the more recent implementation
of policies regarding people with disabilities and acknowledgement of the WHO framework, one would hope that more recent studies
would reveal more positive and accurate perceptions of PWS. However, this does not seem to be the case (Hughes, Gabel, & Palasik,
2017; Panico, Daniels, Hughes, Smith, & Zelenak, 2018). Although it is important to understand the perspective of those who
influence and guide the career paths of PWS, the previous studies did not explore the first-person perspective of a person who stutters
and its relationship to overall job satisfaction.
Other studies have evaluated whether or not people who stutter have equal opportunities to pursue different career paths and

2
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

whether they are limited to certain fields. For example, one study asked college students to rank how likely they would be to advise a
person who stutters to do a variety of different jobs. The careers that required increased sociability and communication were not
among highly ranked jobs. Instead, participants rated jobs that require minimum social interaction as better suited for a person who
stutters (Gabel, Blood, Tellis, & Althouse, 2004). This study demonstrates that people think of stuttering as an inhibiting disorder and
exemplifies the phenomenon of role entrapment; students’ responses indicated occupational stereotyping whereby restricting the role
of PWS as inferior or undesirable (cf. Irani, Gabel, Hughes, Swartz, & Palasik, 2009). In a similar study, participants were asked to
rank how likely two different men would be to pursue different careers. The man who stuttered was given advice to seek careers that
did not require much communication in comparison to the man who did not stutter (Logan & O’Connor, 2012). In their survey of
employees as well as employers, Garcia, Laroche, and Barette (2002) found several barriers that might decrease a person who stutter’s
job flexibility as well as their workplace enjoyment. These studies indicate that people who stutter are encouraged to enter or remain
in fields of work that do not require as much communication. There is also a clear difference in the expectations people have for
people who stutter and consequently can result in diminished job flexibility and job satisfaction. Whereas the prior studies have
addressed the perceptions, attitudes, and sometimes actions of those who work with or would potentially work with PWS, they do not
provide evidence of workplace discrimination experienced by PWS and whether it influences overall job satisfaction.
Other studies have evaluated the workplace experiences and more tangible consequences of workplace discrimination. A study by
Blumgart, Tran, and Craig (2010) showed that stuttering in the workplace can cost people economically and inhibit financial gains. In
their study, 37.5 % of participants thought that stuttering kept them from getting a promotion and 7.5 % thought that it was the
reason they had been fired in the past. Similarly, Rice and Kroll (2006) found that 68 % of their sample reported that they felt their
capabilities were being misjudged by supervisors, 28 % felt stuttering interfered with a promotion, and 85 % felt that stuttering was
interfering with their job performance. Garcia et al. (2002) found that barriers associated with stuttering may stop someone from
getting a job thereby prohibiting people who stutter from gaining employment. When completing a survey on workplace barriers,
people who stutter reported 18 more barriers than PWNS. These barriers included having to do tasks like confront others, leave
voicemails, and face time pressure. Similarly, Klein and Hood (2004), reported that stuttering was the source of barriers that kept
people who stutter from doing their job to the best of their ability. Seventy percent of participants believed that stuttering kept them
from being hired or promoted. The previous studies provide a more tangible look at workplace discrimination experiences of PWS,
however none of these studies compare the discrimination experiences of PWS versus PWNS and its relationship to job satisfaction. It
is important to note that there has been evidence that stuttering may not be associated with workplace discrimination. For instance,
McAllister, Collier, and Shepstone (2012) found that stuttering in adolescence did not have a negative impact on education or
employment. However, these findings were determined by data analyzed via a birth cohort study of the National Child Development
Study in Britain and not by self-report.
Gerlach et al. (2018) investigated whether differences exist in labor market outcomes between PWS and PWNS. Their findings
provide evidence for discrimination and that PWS are more disadvantaged than PWNS in the labor market. Specifically, they found
notable gender differences within the stuttering group specifically as it related to observed earning gaps. Males who stutter earn on
average $10,766 less than males who do not stutter and females who stutter earned $18,712 less than females who do not stutter.
Further, males who stutter were less likely to participate in the labor market and females who stutter were more likely to be
underemployed. The earnings gap observed between PWS and PWNS was mostly accounted for by differences in education and
occupation; however, one could hypothesize that discrimination might also be a contributing factor.

1.4. Vigilance as a coping strategy

Discrimination related heightened vigilance is a construct that is generally less well understood and has not been studied sys-
tematically within the context of the experiences of PWS. Stuttering related vigilance would refer to the stresses associated with the
anticipation of discrimination. More specifically, in the minority and stress literature, heightened vigilance is a social construct that is
associated with an anticipation of rejection (Bauerband, Teti, & Velicer, 2019). For that reason, past experiences of stuttering related
stigma and discrimination, which serve as stressors, could result in a negative cognitive appraisal and view that social environments
like the workplace are unpredictable and uncontrollable and that their social identity as PWS is of lesser value than that of PWNS.
Daily mental preparation in anticipation of possible discriminatory acts could predict overall job satisfaction as it can have an
additive effect on overall physical and mental health and weaken well-being across different social contexts like work (Faragher,
Cass, & Cooper, 2005)
As a social construct, vigilance is opposite to attentional avoidance and reflects how one initially orients to threat. Our initial
orientation towards threat is a relatively automatic response that reflects how fast we attend to and detect threat. Heightened
vigilance is associated with a faster response to threat, whereas attentional avoidance is associated with a slower orientation or
response to threat. Discrimination related heightened vigilance serves as a protective coping factor used in anticipation of the threat
of discrimination. The outcome of heightened vigilance is continuous and involves constant monitoring as well as enhanced pro-
cessing and sensitivity to social threat cues or behavior modifications (Hicken, Lee, Ailshire, Burgard, & Williams, 2013). However,
there are differences between anticipating rejection and preparing for rejection across different communication situations. When
evaluating the construct of vigilance, within the context of discrimination, it is important to consider that heightened vigilance can
heighten stress as well as the perception of discrimination that can come as a consequence of being overly sensitive to the behavior of
others (Himmelstein, Young, Sanchez, & Jackson, 2015; Hirsh & Lyons, 2010). Evaluating stuttering related vigilance will provide
additional insight and more information into whether a PWSs overall job satisfaction is related to not only experiences of dis-
crimination but also anticipation of future discrimination.

3
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

1.5. Purpose of the present study

It has been documented that some people who stutter experience stuttering related limitations and discrimination in the work-
place. However, there has been limited research on the job satisfaction of people who stutter and the degree to which overall job
satisfaction can be accounted for by stuttering related discrimination and heightened vigilance. The purpose of this study was to
evaluate whether people who do and do not stutter differ in their overall level of job satisfaction and the degree to which self-reported
everyday discrimination and heightened vigilance in the workplace account for differences observed in overall job satisfaction. The
specific hypotheses for this study were as follows:

1 People who stutter will be less satisfied with their jobs than people who do not stutter.
2 People who stutter will experience more everyday discrimination in the workplace than people who do not stutter and everyday
discrimination will account for lower levels of job satisfaction among people who stutter.
3 People who stutter will be more vigilant than people who do not stutter and vigilance will account for lower levels of job
satisfaction among people who stutter.

2. Method

2.1. Procedure

The following study was reviewed and approved by the Institutional Review Board at Auburn University prior to beginning the
study. To recruit participants the survey was distributed through fliers, email, and social media posts. The National Stuttering
Association also sent a link to an email list in order to reach more people who stutter. Participants consented to the study by
indicating agreement after reading an online information letter upon initiation of the survey. In the introductory statement, it stated
that the survey would be “evaluating workplace discrimination with people who DO and DO NOT stutter” and that participants were
required to be “over the age of 19 and currently active in the workplace.” There was a total of 258 respondents who initiated the
survey; however, only 233 met the initial study eligibility requirements to participate. There were 24 participants who were not
currently active in the workplace and 1 participant who did not meet the age requirement. The data from the remaining 233
respondents was then filtered for survey completion. Sixty-eight participants terminated the survey before they were finished and one
participant did not indicate whether or not they were a PWS, leaving 164 participants to be included in the final analyses in this
paper. Qualtrics, an online survey tool, was used to create and administer the web-based survey. The survey included questions
pertaining to (a) overall job satisfaction (b) everyday discrimination, (c) vigilance and (d) participant demographics. The participants
were also asked questions pertaining to major experiences with discrimination and coping with discrimination that were not included
in the analyses for the current study.

2.1.1. Job satisfaction

In this section, participants were asked a series of questions regarding their level of job satisfaction. The Coker, Osgood, and
Clouse (1995) job satisfaction scale was used. It was derived to evaluate job satisfaction and economic benefits for people with
disabilities. The measure is composed of 17 questions that ask the respondents to indicate their feelings about their job, whether or
not they like their job, and awareness questions. For this study, four “how do you feel” items were used in the analysis. These four
questions asked how they feel about (a) the place they work; (b) amount of money paid; (c) the people they work with; and (d) the
degree to which they feel their job is better than or worse than most. The 4 questions, used in this study, were answered with a Likert
type scale that ranged from 1 = better than most and 3 = worse than most. A lower score on the measure indicates greater job
satisfaction. Chronbah’s alpha for the job satisfaction scale for this study was good (α = 0.77).

2.1.2. Everyday discrimination

This scale included questions regarding everyday situations that a person might feel discriminated in the workplace or com-
munity. This measure was used in a study by Williams, Yu, Jackson, and Anderson (1997) and has been previously validated and
shown to have good internal consistency as well as convergent and divergent validity (Barnes et al., 2004; Clark, Coleman, & Novak,
2004; Kessler, Mickelson, & Williams, 1999; Krieger, Smith, Naishadham, Hartman, & Barbeau, 2005; Taylor, Kamarck, & Shiffman,
2004, 2004).
(). The measure consists of nine questions that cover broad ideas such as being treated with less respect or courtesy, as well as
specifics such as being treated differently in social settings, being called names, and being harassed. The participants rated items on a
6-point scale from almost every day (5) to never (0). For this study a composite was created that excluded a question related to
discrimination at restaurants because such discrimination would not typically occur in the workplace. The composite measure was
scored unidimensionally with higher scores indicating the respondents felt they were discriminated against more in day-to-day
situations. Chronbah’s alpha for the everyday discrimination scale for this study was computed to evaluate overall scale reliability
(α = 0.85).

2.1.3. Heightened vigilance

The vigilance anticipatory coping scale included six questions that evaluated the participants’ attentiveness to situational dis-
crimination. The original measure was created for the Detroit Area Study (Clark, Benkert, & Flack, 2006; Taylor et al., 2004) and has

4
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

Table 1
Basic Demographics.
PWS N (%; SAR) PWNS N (%; SAR)

Sex Male 45 (63.4; 3.7) 31 (34.1; −3.7)

(N = 162)
(NR = 2) Female 26 (36.6; −3.7) 60 (65.9; 3.7)
Age 20s 19 (26.8) 19 (11.6)
(N = 137)
(NR = 27) 30s 16 (22.5) 6 (6.6)
40s 7 (9.9) 18 (19.8)
50s 7 (9.9) 34 (37.4)
60s 7 (9.9) 4 (4.4)

N = Number of participants; SAR = Standardized Adjusted Residuals; % refers to percent of the group sample; NR = No Response.

since then been used in various studies in order to examine the vigilance of health The scale has been shown to have moderate to good
internal consistency (Clark et al., 2006; Himmelstein et al., 2015; LaVeist, Thorpe, Pierre, Mance, & Williams, 2014). The participants
were asked how likely they were to prepare for negative situations throughout their day, prepare in advance for the kind of problems
they are likely to experience, try to prepare for possible insults before leaving home, feel that they always have to be careful about
their appearance to get good service or avoid being harassed, carefully watch what they say and how they say it, and carefully
observe what happens around them. Participants replied to the questions with “very often” (1), to “never” (5). Scores were reversed
for analyses such that higher scores indicate higher vigilance. Chronbach’s alpha was evaluated to assess overall reliability for the
vigiliance scale (α = 0.85).

2.1.4. Participant demographics and background

In order to understand the individuals that we received responses from and also to rule out any cause for differences in job
satisfaction, workplace discrimination and vigilance besides stuttering, we had a demographic and background section. The back-
ground section included a wide variety of questions regarding the participants’ physical appearance, education, beliefs, geographic
location, and career. If the respondent was a person who stutters, the respondent was then queried about treatment history for
stuttering, frequency of treatment, history with support groups, and how they would personally rate stuttering severity. If the
participant did not stutter, the survey was concluded after the initial query about whether or not they considered themselves a person
who stutters question.

2.2. Participants

The sample consisted of 72 people who stutter (PWS; 43.9 %) and 92 people who do not stutter (PWNS; 56.1 %). Table 1 provides
demographic data regarding sex and age. Overall, there were 76 male participants and 86 female participants. A chi-square test of
goodness-of-fit was performed to determine whether the two groups (PWS and PWNS) were equally distributed across the different
sex groups. When a difference in the distribution was observed a contingency table analysis was performed and the standardized
adjusted residuals were examined. Standardized adjusted residuals +/− 2 were taken as evidence that the discrepancy or number of
participants in each group was more or less than would be expected by chance (Agresti & Franklin, 2007; Sharpe, 2015). The two
groups were not equally distributed for sex, χ2 (1, N = 162) = 13.761, p = 0.000. Contingency table analysis of the adjusted
standardized residuals (+/− 2) revealed the PWS group had significantly more males and significantly fewer females than the PWNS
group. The participants provided their age in months. The two groups significantly differed in age (M = 495.75, SD = 161.21); t
(35.00), p = 0.000. The average age in years of the PWS group was 38.16 and 43.72 for the PWNS group. The two groups of
respondents did not differ in distribution with regard to level of education, Fisher’s exact test, p = 0.112 (Table 2).
The two groups were not equally distributed with regard to race χ2 (1, N = 164) = 8.168, p = 0.004; see Table 3). Contingency
table analysis shows that the PWNS had more White respondents and fewer minority respondents than the PWS group. The PWS
group also had more respondents identify as other. There were respondents that represented all eight of the US regions listed

Table 2
Participant Education.
PWS N (%) PWNS N (%)

Education (N = 164) High School 3 (4.2) 6 (6.5)

Some college 8 (11.1) 14 (15.2)
Associate degree 3 (4.2) 10 (10.9)
Bachelor’s degree 26 (36.1) 36 (39.1)
Master’s degree 21 (29.2) 23 (25)
Doctoral degree 8 (11.1) 2 (2.2)
Professional degree 3 (4.2) 1 (1.1)

N = Number of participants; % = Percent of group sample.

5
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

Table 3
Race and Location Demographics.
PWS N (%; SAR) PWNS N (%; SAR)

Race American Indian 0 (0; −0.9) 1 (1.1; 0.9)

(N = 164)
Asian 3 (4.2; 2.0) 0 (0; −2.0)
Black 4 (5.5; 1.7) 1 (1.1; −1.7)
White 56 (77.7; −3.2) 87 (94.6; 3.2)
Biracial 3 (4.2; 0.7) 2 (2.2; −0.7)
Other 6 (8.3; 2.3) 1 (1.1; −2.3)
Hispanic/Latino (N = 162) Yes 6 (8.6; 2.9) 0 (0; −2.9)
(NR = 2) No 64 (91.4; −2.9) 92 (100; 2.9)
Region of US (N = 164) New England 4 (5.6; 1.7) 1 (1.1; −1.7)
Mideast 10 (13.9; 1.6) 6 (6.5; −1.6)
Great Lakes 13 (18.0; 3.5) 2 (2.2; −3.5)
Plains 3 (4.2; 0.7) 2 (2.2; −0.7)
Southeast 19 (26.4; −6.6) 72 (78.2; 6.6)
Southwest 6 (8.3; 0.7) 5 (5.4; −0.7)
Rocky Mountain 2 (2.8; 0.8) 1 (1.1; −0.8)
Far West 5 (6.9; 2.0) 1 (1.1; −2.0)
Other 10 (13.9; 2.9) 2 (2.2; −2.9)

N = Number of participants; SAR = Standardized Adjusted Residuals; % = percent of group sample; NR = No response.

(Table 3). There were twelve respondents reporting that they lived outside the US; however, information on where outside the US was
not obtained. There was diversity with respect to the distribution of the two groups geographic locations, Fisher’s exact test,
p = 0.000. The PWNS group had fewer respondents in the Great Lakes, more respondents in the Southeast, and fewer respondents in
the Far West. The distribution of PWNS outside the US was greater for the PWS group.

2.2.1. History with stuttering

Of all the participants who stutter, 86.1 % (n = 62) reported having some kind of past treatment for stuttering, with the majority
of participants reporting receiving treatment four or more times (n = 25, 40.3 %). The majority (n = 61; 85.9 %) of people who
stutter who responded to the survey reported that they had not participated in an intensive treatment program. Of the participants
who participated in treatment, 73.95 % (n = 45) indicated they experienced relapse following successful treatment. A large pro-
portion of the PWS group (n = 43; 59.7 %) also reported that they were members of the National Stuttering Association. When asked
to rate the severity of stuttering from one to ten, with ten being the most severe, the mean response was a 5.17 (SD 2.37). When
queried about stuttering and the workplace, the majority of respondents indicated that they have openly discussed stuttering with a
supervisor (n = 42; 58.3 %) or coworkers (n = 53; 73.6 %). Half (n = 36; 50 %) of the respondents who stutter also reported that
they avoid speaking situations (e.g., giving presentations, participating in meeting and talking on the phone) at work.

2.2.2. Workforce data

In order to determine the respondents’ place and experience in the workforce, we asked a series of demographic questions about
their career. The two groups of participants were asked to indicate their personal income from the last year (See Table 4 for de-
scriptive statistics). The participants were asked to indicate the industry they were employed with (Table 5). The two groups were
found to differ in their distribution with regard to industry, Fisher’s exact test, p = 0.008. Post hoc comparisons revealed more PWS
in the information industry. When queried about occupation, the two groups were found to differ in their distribution, Fisher’s exact
test, p = 0.02. Contingency table analysis revealed fewer PWS in sales and service positions. The two groups of participants were
found to differ in their distribution with regard to management, χ2 (1, N = 164) = 4.196, p = 0.041, and supervision, χ2 (1,

Table 4
Participant Annual Income in Dollars.
PWS N (%) PWNS N (%)

Income (N = 164) Less than 20,000 14 (19.4) 6 (6.5)

20,000–39,999 11 (15.2) 12 (13.0)
40,000–59,000 11 (15.2) 15 (16.3)
60,000–79,999 15 (20.8) 12 (13.0)
80,000–99,999 3 (4.2) 10 (10.9)
100,000–119,000 7 (9.7) 14 (15.2)
120,000–139,999 3 (4.2) 3 (3.3)
140,000–159,999 1 (1.4) 4 (4.3)
160,000 or more 5 (6.9) 9 (9.8)
Prefer not to say 2 (2.8) 7 (7.6)

N = Number of participants; % refers to percent of the group sample; NR = No Response.

6
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

Table 5
Participant Employment Industry & Occupation.
PWS N (%; SAR) PWNS N (%; SAR)

Emp. Industry Accommodation or food service 3 (4.2; 2.0) 0 (0; −2.0)

(N = 164) Admin., support, waste mgmt., remed. 1 (1.4; −1.4) 5 (5.4; 1.4)
Arts, entertainment, recreation 4 (5.5; 1.1) 2 (2.2; −1.1)
Construction 1 (1.4; −1.4) 5 (5.4; 1.4)
Educational services 19 (26.4; 1.6) 15 (16.3; −1.6)
Finance or insurance 4 (5.5; −1.6) 12 (13.0; 1.6)
Forestry, fishing, hunting, agriculture 0 (0; −0.9) 1 (1.1; 0.9)
Health care or social assistance 11 (15.3; −1.7) 24 (26.1; 1.7)
Information 5 (6.9; 2.6) 0 (0; −2.6)
Management of companies 0 (0; −1.5) 3 (3.3; 1.5)
Manufacturing 0 (0; −0.9) 1 (1.1; 0.9)
Other service (except public admin) 1 (1.4; −0.4) 2 (2.2; 0.4)
Professional scientific or technical 12 (16.7; 0.4) 13 (14.1; −0.4)
Real estate or rental 1 (1.4; −0.4) 2 (2.2; 0.4)
Retail trade 7 (9.7; 1.7) 3 (3.3; −1.7)
Transportation or warehousing 0 (0; −1.3) 2 (2.2; 1.3)
Utilities 2 (2.8; 0.8) 1 (1.1; −0.8)
Wholesale trade 1 (1.4; 0.2) 1 (1.1; −0.2)
Occupation Construction 0 (0; −1.3) 2 (2.2; 1.3)
(N = 164) Government 5 (6.9; −0.04) 8 (8.7; 0.4)
Production, transport. 1 (1.4; 0.2) 1 (1.1; −0.2)
Managmnt., prof. 36 (50.0; 0.7) 41 (44.6; −0.7)
Retired 0 (0; −0.9) 1 (1.1; 0.9)
Sales and office 5 (6.9; −2.8) 21 (22.8; 2.8)
Service 23 (31.9; 2.2) 16 (17.4; −2.2)
Management Yes 18 (25.0; −2.0) 37 (40.2; 2.0)
(N = 164) No 54 (75.0; 2.0) 55 (59.8; −2.0)
Supervisory Yes 21 (29.2; −2.5) 44 (48.4; 2.5)
(N = 164) No 51 (70.8; 2.5) 47 (51.6: −2.5)
(NR = 1)

N = Number of participants; SAR = Standardized Adjusted Residuals; % refers to percent of the group sample; NR = No Response.

N = 163) = 6.171, p = 0.013. Contingency table analysis revealed fewer PWS work in a management position or supervisory po-
sition. When describing level of job difficulty, the two groups were found to differ in their distribution, Fisher’s exact test, p = 0.000.
More PWS reported being in a job that was neither too difficult (SAR = 2.8) nor too easy (SAR = 2.5). The respondents were asked to
rate their job experience as boring, fun or neither. The two groups differed in their distribution, χ2 (1, N = 163) = 6.888, p = 0.032.
More PWS rated their job as boring (SAR = 2.5). The two groups were found to differ in their distribution with regard to whether it
was their choice to take the job in which they were currently employed, Fisher’s exact test, p = 0.045. Fewer PWS indicated that it
was their choice to take they job they were currently employed (SAR = −2.3). The two groups did not differ in their distribution
with regard to type of work performed, χ2 (1, N = 162) = 1.623, p = 0.203, or their beliefs about whether they are being fairly paid,
χ2 (1, N = 163) = 1.792, p = 0.181.

2.3. Analysis

We examined discrimination and vigilance as possible mediators of the association between stuttering and job satisfaction. A
mediating variable carries or accounts for the association between an independent and dependent variable. Discrimination and
vigilance are related variables that were included in separate models to test for corroborating evidence of the hypothesis that
discrimination-related experiences mediate the association between stuttering and lower job satisfaction. Mediation analyses were
conducted with AMOS, which uses full information maximum likelihood estimation to handle missing data. Standardized regression
coefficients are presented in the text below and unstandardized regression coefficients and standard errors are presented in the
figures.

3. Results

To test mediation, we first examined the association between stuttering and job satisfaction. Next, we examined the associations
between stuttering and the hypothesized mediators, discrimination and vigilance, in separate models. Finally, we examined asso-
ciations linking both stuttering and the respective mediator (discrimination or vigilance) with job satisfaction to determine whether
the mediator was associated with job satisfaction and whether the association between stuttering and job satisfaction was diminished
when both stuttering and the mediator were entered in the model simultaneously. We also used a Monte Carlo method to test the
indirect effects from stuttering to job satisfaction through discrimination or vigilance (Selig & Preacher, 2008) Demographic variables

7
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

Table 6
Descriptive Statistics and Correlations among Study Variables.
1 2 3 4 5 6 7 8

1. Age –
2. Sex −.13 –
3. Race −0.03 0.10 –
4. Income 0.49*** −0.14 .05 –
5. Stuttering status −0.20* −0.29*** −0.22** −0.19* –
6. Discrimination −0.28** 0.03 −0.04 −0.25** 0.22** –
7. Vigilance −0.32** −0.01 −0.05 −0.21** 0.27** 0.53*** –
8. Job satisfaction 0.27** 0.08 0.11 0.37*** −0.26** −0.40*** −0.37*** –
Mean – – – 4.19 (2.38) – 2.37 (0.92) 3.19 (0.92) 2.42 (0.51)
(SD)

Note. Sex was coded as 1 = male and 2 = female. Race was coded as 0 = ethnic minority and 1 = white. Stuttering status was coded as 0 = person
who does not stutter and 1 = person who stutters.
*p < 0.05. **p < 0.01. ***p < 0.001.

that were correlated with stuttering and discrimination, vigilance, or job satisfaction (age and income) were covaried in all mediation
and indirect-effect analyses.

3.1. Preliminary analyses

Higher age was correlated with stuttering status (people who stutter were younger), lower discrimination and vigilance, and
higher income and job satisfaction. Higher income was associated with stuttering status (people who stutter reported less income),
lower discrimination and vigilance, and higher job satisfaction. Sex and race/ethnicity were related to stuttering status (more males
and racial/ethnic minorities were represented among people who stutter), but neither sex nor race/ethnicity was related to dis-
crimination, vigilance, or job satisfaction in the current sample; thus, neither sex nor race can account for associations linking
stuttering with discrimination, vigilance, or job satisfaction in the current sample. Stuttering was correlated with higher dis-
crimination and vigilance as well as lower job satisfaction, and higher discrimination and vigilance were correlated with one another
and with lower job satisfaction (See Table 6 for descriptive statistics and correlations).

3.2. Main analyses

3.2.1. Discrimination as a mediator

Controlling for age and income, stuttering was associated with lower job satisfaction, β = −0.18, p < 0.05. Stuttering was also
associated with higher discrimination, β = 0.16, p < 0.05. When both stuttering and discrimination were entered in the model,
discrimination was associated with lower job satisfaction, β = −0.30, p < 0.001, but stuttering was no longer significantly asso-
ciated with job satisfaction, β = −0.14, p = 0.054, indicating that discrimination mediated the association between stuttering and
job satisfaction (see Fig. 1). In addition, the confidence interval of the indirect effect from stuttering to job satisfaction through
discrimination did not include zero, 95 % CI = −0.105, −0.003. Age, income, stuttering, and discrimination explained 26 % of the
variance in job satisfaction.

3.2.2. Vigilance as a mediator

Again, controlling for age and income, stuttering was associated with lower job satisfaction, β = −0.18, p < 0.05. Stuttering was
also associated with higher vigilance, β = .21, p < .01. When both stuttering and vigilance were entered in the model, vigilance was
associated with lower job satisfaction, β = −0.28, p < 0.001, but stuttering was no longer significantly associated with job sa-
tisfaction, β = −0.13, p = 0.080, indicating that vigilance mediated the association between stuttering and job satisfaction (see

Fig. 1. Discrimination mediates the association between stuttering and job satisfaction. Unstandardized regression coefficients (standard errors) are
shown. For the path from stuttering status to job satisfaction, coefficients are shown without discrimination in the model / with discrimination in the
model. The indirect effect from stuttering status to discrimination to job satisfaction is significant (95 % CI = −0.1052, −0.002894). Age and
income were included as covariates. *p < 0.05; **p < 0.01; ***p < 0.001.

8
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

Fig. 2. Vigilance mediates the association between stuttering and job satisfaction. Unstandardized regression coefficients (standard errors) are
shown. For the path from stuttering status to job satisfaction, coefficients are shown without vigilance in the model / with vigilance in the model.
The indirect effect from stuttering status to vigilance to job satisfaction is significant (95 % CI = −0.1173, −0.01278). Age and income were
included as covariates. *p < 0.05; **p < 0.01; ***p < 0.001.

Fig. 2). In addition, the confidence interval of the indirect effect from stuttering to job satisfaction through vigilance did not include
zero, 95 % CI = −0.117, −0.013. Age, income, stuttering, and vigilance explained 24 % of the variance in job satisfaction.

4. Discussion/Clinical implications

The WHO’s ICF provides us with a framework for understanding stuttering as a disability and deriving policy for such. While
specific legislation and policies have been put in place internationally to protect the rights of people who stutter, positive outcomes of
such implementation in environments such as employment have yet to be determined. Previous studies have highlighted the attitudes
and perceptions towards people who stutter (Dorsey & Guenther, 2000; Franck et al., 2003; Lass et al., 1992) including employers
(Garcia et al., 2002; Hurst & Cooper, 1983) and career counselors (Walker, Mayo, & Louis, 2016). The findings of these studies
demonstrated that many individuals have a negative perception of the abilities that PWS have in arenas such as workplace en-
vironment. This study was designed to examine self-reported discrimination in people who stutter, with a particular focus on un-
derstanding any differences between PWS and PWNS in the areas of job satisfaction and whether everyday discrimination and
vigilance account for any observed associations between stuttering and lower job satisfaction.
In the present study, PWS reported more discrimination and vigilance as well as lower job satisfaction, compared to PWNS.
Furthermore, discrimination and vigilance mediated, or accounted for, the association between stuttering and lower job satisfaction.
Results are consistent with previous studies regarding workplace discrimination of PWS (Blumgart et al., 2010; Garcia et al., 2002;
Gerlach et al., 2018; Klein & Hood, 2004; Rice & Kroll, 2006). The results suggest that PWS do encounter some displays of dis-
crimination, such as those suggested by Garcia et al. (2002), with regard to employment and experiences after having obtained a job.
The participants in Blumgart et al. (2010) study reported being denied promotions at work and being unfairly fired as a result of them
being PWS. While this study did not analyze specific circumstances, the results of being discriminated against are consistent. Because
the association between stuttering and lower job satisfaction was mediated by discrimination experiences, our findings indicate that
stuttering may not be driving the group’s overall work experience and job satisfaction. It is likely that PWS can find increased
enjoyment or job satisfaction in the workplace. The key to a PWS finding job satisfaction then may be to thwart the discrimination
they are receiving, and not necessarily an increased need for accommodations or treatment for their stuttering.
Results from this study add to the literature in regard to whether vigilance can account for job satisfaction. PWS were found to be
more vigilant in the workplace than PWNS. Vigilance being associated with being a PWSs suggests that PWS may cope differently
with than PWNS in the workplace. These actions and behaviors align with the underlying feelings that some PWS report such as
negative self-identity (Daniels et al., 2012). Understanding the actions and behaviors that PWS do in response to workplace dis-
crimination is a critical component to 1) mitigating the anxiety and negative self-identity that is often associated with discrimination
and/or stuttering itself and 2) addressing the vigilant behavior in therapy. This sentiment more than likely is an extension of the
feelings and experiences that occurred in their childhood education as suggested by Daniels et al. (2012) and the societal stigma that
exists in regard to the phenomenon of stuttering and to PWS. Whereas vigilance can be thought of as a protective factor used to
anticipate a threat of some type, for the population of PWS, this heightened vigilance may be indicative of the role that societal
stereotyping and discrimination is playing in the workplace. And further, indicating that there is a heightened awareness of their
circumstance as a PWS in the workplace. To be consistently and continuously monitoring whether or not a threat exists, and
moreover, how to attend to that threat, can exacerbate any already present feelings of discomfort. Therefore, it is important to
determine whether the planning and preparation being performed by PWS is productive or counterproductive to their ability to get
hired, their job performance, and/or their job satisfaction; results of the present study suggest that the vigilance of PWS diminishes
their job satisfaction.

4.1. How professionals can work to increase job satisfaction

Dangermond (2015) reports that in the United States over 90 % of jobs require some degree of verbal communication. Further,
verbal communication has been rated by employers as the most important skill for candidates seeking employment (National
Association of Colleges & Employers, 2016 as cited in Gerlach et al., 2018). Prior studies have shown that requirements for verbal
communication in the workplace, like leaving voicemails and speaking to individuals face-to-face are barriers for PWS (Garcia et al.,
2002).

9
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

Professionals can assist PWS prior to applying for a job by working through communication related fears and heightened vigilance
that they may encounter as a result of a certain job and experiences. The view that stuttering can be identified as a disability and that
PWS may consider stuttering an accepted or embraced part of their identity should be taken into account when counseling on job
preparation or how to manage workplace experiences. Counseling people who stutter and having a working relationship with the
client has been found to be an important factor when working with a person who stutters (Plexico, Manning, & DiLollo, 2010).
Professionals can also prepare PWS with self-advocacy strategies, legal knowledge of what their rights are as an employee who
identifies as a person with a communication disability, and legal understanding of workplace discrimination. Self-advocacy strategies
would address ways that a PWS can self-disclose to their employers that they are a PWS which could potentially reduce the feelings of
threat that can create heightened vigilance. By taking this critical step in self-disclosing, it may allow space for an open discussion
about topics that an employer may feel uncomfortable addressing themselves for fear of offending or possibly making unethical or
illegal remarks. Furthermore, self-disclosure may also help prevent employers from unintentionally behaving in a way that would be
perceived as discriminatory or stigmatizing. Implementing self-advocacy strategies in the workplace may also allow for the PWS to
request accommodations that they feel may assist in performing their job more effectively. These accommodations may take the form
of job restructuring (i.e., reallocating functions of a job, such as speaking on the phone) or allowing flexible leave or schedules to
accommodate stuttering related treatment. However, these accommodations should be initiated by the PWSs and not unilaterally
decided by employers. Additional recommendations to assist PWS with employment opportunities have been provided by the
National Stuttering Association (NSA). These recommendations include conducting mock interviews, providing one-on-one con-
sultations with the Employment Advocacy Committee, and viewing a webinar series that addresses participation in meetings, phone
calls, and presentations (National Stuttering Association, 2018).
Internationally, some countries have provisions to legally protect the rights of individuals with disabilities from unfair treatment
and discrimination, whereas other countries lack or have gaps in their legislation. Several countries have signed the UN Convention on
the Rights of Persons with Disabilities (CRPD) adopted by the United Nations in 2006 and ratified in 2009. These countries have pledged
a commitment to the rights of persons with disabilities; however, the national laws and commitments vary across partner countries.
Of the countries that signed the CRPD, significantly fewer countries have signed the Optional Protocol to the CRPD that allows for
complaints to be filed when rights are violated. These countries continue to have gaps with regard to policy or legal legislation to
prevent discrimination.
Other countries have more specific legislation and policy in place to protect the rights of persons with disabilities. For example,
North America passed the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), Australia has the Disability Discrimination
Act of 1992, the United Kingdom (with the exception of Northern Ireland) has the Equality Act of 2010, there is the New Zealand
Human Rights Act (1993) and Bill of Rights Act (1990), and Japan has the Fundamental Law for Disabled Persons enacted in 1993 and
revised in 2004. The legislation and laws that have been passed by these countries define disability, describe the rights of persons
with disabilities, promote equal opportunity, and indicate that it is illegal to discriminate against individuals with disabilities across
many domains of living (e.g., education, employment, public accommodations, recreation, institutionalization, and health). We
continue to need to have this discussion about the rights of PWS because the courts have a complicated history with regard to the
degree to which they interpret stuttering as a disability. Regardless, PWS need to be aware of their rights and what can be done when
they feel they are being discriminated against in the workplace.

4.2. Career counselor, recruiter, and employer education

While it is important for professionals to assist PWS with job preparation and workplace employment expectations, it is equally
important to educate those who have the power and are in the position to direct a PWS’ career trajectory. This includes career
counselors, who advise PWS on career choices; recruiters, who have the power and ability to identify and hire PWS; and employers,
who will inevitably manage and supervise PWS. While some general awareness exists of stuttering, professionals and PWS have a
responsibility to disseminate accurate information about stuttering and to lobby for equal opportunities in the workplace. As an
example, Britain has developed an Employers Stammering Network (ESN) that promotes equal opportunity in the workforce for
people who stutter (Gerlach et al., 2018). Using this organization as a model may help other countries to educate employers more
about stuttering in addition to providing employers with support and recommendations on how to recruit and assist PWS in their
companies (Gerlach et al., 2018). Additionally, in the United States, the National Stuttering Organization has implemented a cam-
paign called “We Stutter @ Work.” Through a series of programs, this campaign seeks to improve workplace outcomes for PWS by
eliminating the stigma surrounded by stuttering (National Stuttering Associaton, 2019). While it is important to educate employers
on the nature of stuttering, it is also critical to educate them on effective listener strategies (e.g., acknowledgement of the speaker as a
PWS, not finishing a PWS sentences, monitor verbal and nonverbal language for indicators of impatience or discomfort) that align
with the preferences of the stuttering community (Lee & Manning, 2010).

5. Limitations and future research

One of the main limitations of this study includes challenges associated with recruitment. The study has a relatively small sample
size and only recruited people who were currently working, therefore limiting the scope of responses to those presently active in the
workforce. Investigation of persons who were not currently working may have achieved different results or more diverse responses
due to reasons such as retirement, being laid off, or being fired. In addition, advertising for a study about stuttering and dis-
crimination may have disproportionately attracted PWS who have experienced elevated discrimination or primed PWS to report more

10
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

discrimination, thus potentially inflating the association between stuttering and discrimination in the present study. As a result of
these issues, the sample may not be entirely representative of the experiences of the general population of PWS. The limited diversity
of the sample (e.g., ethnicity, sexual orientation) also prevented a stronger examination of how stuttering may intersect with other
identities as related to discrimination, vigilance, and job satisfaction.
Other limitations include the cross-sectional research design and the pooling of male and female participants’ responses. Although
the present study did not aim to examine gender effects, the pooling of both male and female responses may be masking gender
effects. Gender differences in the workplace are readily observed in areas of salary and treatment, therefore an understanding of how
gender differences are manifested in workplace discrimination of PWS would be a significant contribution to the current corpus of
research. In addition to gender, we tested for numerous demographic differences between PWS and PWNS. Given the number of
analyses conducted, there is a risk of false positives so these results should be interpreted with caution. We controlled for income (and
age) due to the correlations linking income with stuttering status, discrimination, vigilance, and job satisfaction. Controlling for
income rules out the possibility that income explains the associations among the main constructs of interest, strengthening the
evidence that stuttering and discrimination contribute to lower job satisfaction. However, controlling for income is a conservative
statistical approach that potentially dampens the true effect of stuttering on job satisfaction via discrimination because lower income
is one means through which discrimination may occur among people who stutter.
Building upon the results of this study, future research can evaluate the directionality of discrimination and vigilance on job
satisfaction. While we have suggested that discrimination and vigilance mediate associations between stuttering and job satisfaction,
the cross-sectional and non-experimental design of the study precludes any conclusions about directionality or causality. It is possible
that lower job satisfaction leads to increased discrimination or vigilance or that no causal association exists. Further research can
examine how PWS can develop this skill of vigilance to benefit oneself in the workplace versus implementing this skill and having it
cause problems in the workplace/negatively affect their environment and performance. It is also important to note that the measures
of discrimination and vigilance in the present study did not refer to stuttering-related or workplace discrimination or vigilance
specifically. Future studies can examine whether PWS are experiencing workplace discrimination related to stuttering and what
influence is such discrimination having on job satisfaction. Finally, by interviewing PWS, professionals can gain a better under-
standing of what discrimination in the workplace actually “looks” like and what strategies are already being used by PWS themselves
in order to be successful in various work settings.

Financial disclosure

None.

References

Agresti, A., & Franklin, C. A. (2007). Statistics: The art and science of learning from data. New Jersey: Pearson Prentice Hall.
Alqhazo, M., Blomgren, M., Nelson, R., & Awwad, M. A. (2017). Discrimination and internalized feelings experienced by people who stutter in Jordan. International
Journal of Speech-language Pathology, 19(5), 519–528.
Americans with Disabilities Act Amendments Act of 2008. Pub. L. No. 110-325, 122 Stat. 3553 (2008).
Barnes, L. L., De Leon, C. F. M., Wilson, R. S., Bienias, J. L., Bennett, D. A., & Evans, D. A. (2004). Racial differences in perceived discrimination in a community
population of older blacks and whites. Journal of Aging and Health, 16(3), 315–337.
Bauerband, L. A., Teti, M., & Velicer, W. F. (2019). Measuring minority stress: Invariance of a discrimination and vigilance scale across transgender and cisgender
LGBQ individuals. Psychology and Sexuality, 10(1), 17–30.
Bergami, M., & Bagozzi, R. P. (2000). Self-categorization, affective commitment and group self-esteem as distinct aspects of social identity in the organization. The
British Journal of Social Psychology, 39(4), 555–577.
Blumgart, E., Tran, Y., & Craig, A. (2010). An investigation into the personal financial costs associated with stuttering. Journal of Fluency Disorders, 35, 203–215.
Boyle, M., & Blood, G. W. (2015). Stigma and stuttering: Conceptualizations, applications, and coping. Stuttering meets stereotype, stigma, and discrimination: An overview of
attitude research. West Virginia University Press43–70.
Brewer, M. B. (1991). The social self: On being the same and different at the same time. Personality & Social Psychology Bulletin, 17(5), 475–482.
Bricker-Katz, G., Lincoln, M., & Cumming, S. (2013). Stuttering and work life: An interpretative phenomenological analysis. Journal of Fluency Disorders, 38(4),
342–355.
Clark, R., Benkert, R. A., & Flack, J. M. (2006). Large arterial elasticity varies as a function of gender and racism-related vigilance in black youth. Journal of Adolescent
Health, 39(4), 562–569.
Clark, R., Coleman, A. P., & Novak, J. D. J. D. (2004). Brief Report: Initial psychometric properties of the everyday discrimination scale in black adolescents. Journal of
Adolescence, 27(3), 363–368.
Coker, C. C., Osgood, K., & Clouse, K. R. (1995). A comparison of job satisfaction and economic benefits of four different employment models for persons with
disabilitiesMenomonie, WI: University of Wisconsin-Stout, Rehabilitation Research and Training Center on Improving Community Based Rehabilitation Programs
(Report No. 54751-0798) (ERIC Document Reproduction Service No. ED3460825).
Craig, A., Blumgart, E., & Tran, Y. (2009). The impact of stuttering on the quality of life in adults who stutter. Journal of Fluency Disorders, 34(2), 61–71.
Dangermond, N. (2015). The occupational requirements survey: Estimates from preproduction testing. Monthly Lab. Rev. 138, 1.
Daniels, D. E., Gabel, R. M., & Hughes, S. (2012). Recounting the K-12 school experiences of adults who stutter: A qualitative analysis. Journal of Fluency Disorders,
37(2), 71–82.
Di Marco, D., López-Cabrera, R., Arenas, A., Giorgi, G., Arcangeli, G., & Mucci, N. (2016). Approaching the discriminatory work environment as stressor: The
protective role of job satisfaction on health. Frontiers in Psychology, 7, 1313.
Dorsey, M., & Guenther, R. K. (2000). Attitudes of professors and students toward college students who stutter. Journal of Fluency Disorders, 25(1), 77–83.
Ellis, A. L., & Hartlep, N. D. (2017). Struggling in silence: A qualitative study of six african american male stutterers in educational settings. The Journal of Educational
Foundations, 30(1–4), 33–62.
Emerson, K. T., & Murphy, M. C. (2014). Identity threat at work: How social identity threat and situational cues contribute to racial and ethnic disparities in the
workplace. Cultural Diversity & Ethnic Minority Psychology, 20(4), 508.
Faragher, E. B., Cass, M., & Cooper, C. L. (2005). The relationship between job satisfaction and health: A meta-analysis. Occupational and Environmental Medicine, 62(2),
105–112.

11
L.W. Plexico, et al. Journal of Fluency Disorders 62 (2019) 105725

Franck, A. L., Jackson, R. A., Pimentel, J. T., & Greenwood, G. S. (2003). School-age children’s perceptions of a person who stutters. Journal of Fluency Disorders, 28(1),
1–15.
Gabel, R. M., Blood, G. W., Tellis, G. M., & Althouse, M. T. (2004). Measuring role entrapment of people who stutter. Journal of Fluency Disorders, 29(1), 27–49.
Garcia, L. J., Laroche, C., & Barette, J. (2002). Work integration issues go beyond the nature of the communication disorder. Journal of Fluency Disorders, 35, 187–211.
Gerlach, H., Totty, E., Subramanian, A., & Zebrowski, P. (2018). Stuttering and labor market outcomes in the united states. Journal of Speech Language and Hearing
Research, 61(7), 1649–1663.
Hicken, M. T., Lee, H., Ailshire, J., Burgard, S. A., & Williams, D. R. (2013). “Every shut eye, ain’t sleep”: The role of racism-related vigilance in racial/ethnic disparities
in sleep difficulty. Race and Social Problems, 5(2), 100–112.
Himmelstein, M. S., Young, D. M., Sanchez, D. T., & Jackson, J. S. (2015). Vigilance in the discrimination-stress model for Black Americans. Psychology & Health, 30(3),
253–267.
Hirsh, E., & Lyons, C. J. (2010). Perceiving discrimination on the job: Legal consciousness, workplace context, and the construction of race discrimination. Law &
Society Review, 44(2), 269–298.
Hughes, C. D., Gabel, R. M., & Palasik, S. T. (2017). Examining the relationship between perceptions of a known person who stutters and attitudes toward stuttering.
Canadian Journal of Speech-Language Pathology & Audiology, 41(3).
Hurst, M. A., & Cooper, E. B. (1983). Vocational rehabilitation counselors’ attitudes towards stuttering. Journal of Fluency Disorders, 8, 13–27.
Irani, F., Gabel, R., Hughes, S., Swartz, E. R., & Palasik, S. T. (2009). Role entrapment of people who stutter reported by K-12 teachers. Contemporary Issues in
Communication Science and Disorders : CICSD, 36, 45–54.
Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.
Journal of Health and Social Behavior, 40(3), 208–230.
Klein, J. K., & Hood, S. B. (2004). The impact of stuttering on employment opportunities and job performance. Journal of Fluency Disorders, 29, 255–273.
Krieger, N., Smith, K., Naishadham, D., Hartman, C., & Barbeau, E. M. (2005). Experiences of discrimination: Validity and reliability of a self-report measure for
population health research on racism and health. Social Science & Medicine, 61(7), 1576–1596.
Lass, N. J., Ruscello, D. M., Schmitt, J. F., Pannbacker, M. D., Orlando, M. B., Dean, K. A., ... Bradshaw, K. H. (1992). Teachers’ perceptions of stutterers. Language,
Speech, and Hearing Services in Schools, 23(1), 78–81.
LaVeist, T. A., Thorpe, R. J., Pierre, G., Mance, G. A., & Williams, D. R. (2014). The relationships among vigilant coping style, race, and depression. The Journal of Social
Issues, 70(2), 241–255.
Lee, K., & Manning, W. H. (2010). Listener responses according to stuttering self-acknowledgment and modification. Journal of Fluency Disorders, 35(2), 110–122.
Logan, K. J., & O’Connor, E. M. (2012). Factors affecting occupational advice for speakers who do and do not stutter. Journal of Fluency Disorders, 37(1), 25–41.
McAllister, J., Collier, J., & Shepstone, L. (2012). The impact of adolescent stuttering on educational and employment outcomes: Evidence from a birth cohort study.
Journal of Fluency Disorders, 37(2), 106–121.
Moorman, R. H. (1993). The influence of cognitive and affective based job satisfaction measures on the relationship between satisfaction and organizational citizenship
behavior. Human Relations, 46(6), 759–776.
National Association of Colleges and Employers (2016). Job outlook survey. Retrieved fromhttp://www.naccweb.org/surveys/job-outlook.aspx.
National Stuttering Associaton (2019). We stutter @ work. Retrieved fromhttps://westutter.org/careersuccess/.
National Stuttering Association (2018). Stuttering in the workplace. Retrieved fromhttps://westutter.org/who-we-help/job-seekers/.
Panico, J., Daniels, D. E., Hughes, S., Smith, R. E., & Zelenak, J. (2018). Comparing perceptions of student teachers and regular education teachers toward students
who stutter: A mixed-method approach. Speech Language and Hearing, 21(4), 245–255.
Plexico, L. W., Manning, W. H., & DiLollo, A. (2010). Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering. Journal of
Fluency Disorders, 35(4), 333–354.
Ruscello, D. M., Lass, N. J., Schmitt, J. F., & Pannbacker, M. D. (1994). Special educators’ perceptions of stutterers. Journal of Fluency Disorders, 19(2), 125–132.
Rice, M., & Kroll, R. (2006). The impact of stuttering at work: Challenges and discrimination. International Stuttering Awareness Day Online Conference 2006.
Selig, J. P., & Preacher, K. J. (2019). Monte Carlo method for assessing mediation An interactive tool for creating confidence intervals for indirect effects. [Computer software].
Available from http://quantpsy.org/.
Sharpe, D. (2015). Your chi-square test is statistically significant: Now what? Practical Assessment, Research & Evaluation, 20.
Steele, C. M., Spencer, S. J., & Aronson, J. (2002). Contending with group image: The psychology of stereotype and social identity threat. Advances in experimental social
psychology, Volume 34, Academic Press379–440.
Taylor, T. R., Kamarck, T. W., & Shiffman, S. (2004). Validation of the Detroit Area Study Discrimination Scale in a community sample of older African American
adults: The Pittsburgh healthy heart project. International Journal of Behavioral Medicine, 11(2), 88–94.
Walker, R., Mayo, R., & Louis, K. O. (2016). Attitudes of college career counselors towards stuttering and people who stutter. Perspectives of the ASHA Special Interest
Groups, 1(4), 44.
World Health Organization (2001). International classification of functioning, disability, and health. Geneva: World Health Organization.
Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination.
Journal of Health Psychology, 2(3), 335–351.
Yaruss, J. S., & Quesal, R. W. (2004). Stuttering and the international classification of functioning, disability, and health (ICF): An update. Journal of Communication
Disorders, 37(1), 35–52.

Laura Plexico, Ph.D., CCC-SLP is a Professor in the Communication Disorders Department at Auburn University. She teaches courses in fluency disorders and speech
science. Her research concentrates on psychosocial aspects of stuttering, communicative interaction, and the processes of personal change.

Haley Hawkins, B.S., is a graduate student in the Department of Communication Disorders at The University of Alabama. She is currently a graduate teaching
assistant for anatomy and physiology and speech science courses. Her research interests include the psychological and social impacts of stuttering.

Megan-Brette Hamilton, Ph.D., CCC-SLP is an Assistant Professor in the Communication Disorders Department at Auburn University. She teaches courses on child
and adolescent language disorders and clinical problem solving for school-age populations. Her research focuses on the classroom experiences (e.g., literacy, student-
teacher interactions) of speakers of nonmainstream dialects of English, with a particular focus on African American English-speaking children. Dr. Hamilton’s work
also explores the cultural-linguistic competence of professionals working with culturally-linguistically diverse populations.

12