The Future of Financing for Long-Term Care: The Own Your Future Campaign

The purpose of this study was to examine the outreach effort and impact of a joint federal-state campaign, Own Your Future, promoting awareness and planning for long-term care (LTC) in the state of Washington. The study applied survey methodology to evaluate the extent of campaign dissemination, evidence of its impact on LTC planning behaviors, and barriers to purchasing private LTC insurance. A total of 3,198 survey responses from a randomly selected community sample and a Washington State employee sample (ages 51 to 71) were analyzed. Results indicated that the impact of the campaign was limited, both with respect to awareness of the campaign itself and to initiation of LTC planning behaviors. Quantitative data revealed a high prevalence of health-related problems (e.g., obesity, diabetes), inadequate knowledge of basic LTC-related information (e.g., cost, payers), and negative attitudes toward purchasing LTC insurance among respondents. Qualitative analyses suggested that respondents perceived significant problems related to affordability and accountability within the current LTC insurance industry. These possible barriers to the purchase of LTC insurance suggest targets to be addressed by policy makers seeking to find ways to offset the public costs of LTC.     

Motivators for Seeking Gambling-Related Treatment Among Ontario Problem Gamblers

A random digit dialing telephone survey was used to interview 8,467 adults in Ontario, Canada. The NODS-CLiP was used to identify a representative sample of 730 gamblers (54.3% male, mean age 45.3 years) with possible past year gambling problems in order to explore factors that might affect disordered gamblers’ motivators for seeking gambling-related help. A final sample of 526 gamblers provided useable data on possible reasons for and barriers to seeking help, awareness of services, self-perception of gambling problems and experience with help-seeking. Financial and relationship issues were the most frequently volunteered motivators. However, over two-thirds of the respondents could not think of a reason for seeking help. Gamblers who had self-admitted or more severe problems, who knew how to get help, who were employed and had more education, and who identified possible barriers to seeking help were more likely to suggest motivators, especially financial ones. More research is recommended on gamblers’ trajectory towards recognition of a gambling problem, the process of overcoming specific barriers to treatment, and the role of social advantage (e.g., education and employment), in order to devise educational campaigns that will encourage earlier help-seeking among disordered gamblers.     

Response Effects in the Electronic Survey

This report examines the electronic survey as a research tool.In an electronic survey, respondents use a text processing programto self-administer a computer-based questionnaire. As more peoplehave access to computers, electronic surveys may become widespread.The electronic survey can reduce processing costs because itautomates the transformation of raw data into computer-readableform. It can combine advantages of interviews (e.g., prompts,complex branching) with those of paper mail surveys (e.g., standardization,anonymity). An important issue is how the electronic surveyaffects the responses of people who use it. We conducted anexperimental sample survey on health attitudes, behaviors, andpersonal traits using two forms of administration: electronicand paper mail. Closed-end responses in the electronic surveywere less socially desirable and tended to be more extreme thanwere responses in the paper survey. Open-ended responses thatcould be edited by respondents were relatively long and disclosing.These findings are consistent with other research on computer-mediatedcommunication, raising general issues about using computersto collect self-report data.     

Evaluating the effectiveness of the first breast cancer awareness campaign in the United Arab Emirates: Lessons learned and next steps

Following an innovative breast cancer awareness campaign in the United Arab Emirates, a dual language survey of 500 women and in-depth interviews were conducted. The study found television advertising to be the most optimal awareness communication method, particularly among Emirati and other Arab women respondents. The research also found strong support for a year-long awareness campaign.     

Voluntary long-term care insurance: best practices for increasing employee participation

This is the second of two Issue Briefs (April and May 2000) on long-term care (LTC) insurance. The previous Issue Brief addressed the problem of increasing sponsorship, while this report addresses the issue of increasing employee participation. Participation rates in group LTC insurance plans tend to be low. A potential watershed event for the development of the employment-based group LTC market is the proposed LTC program for federal employees and retirees (a program that would have to be enacted by Congress). The perception of a successful offering to federal employees could provide an enormous boost to the group LTC insurance market. Employee communication and education are seen as critical to the success of LTC enrollments. The importance of support shown by an employer for a new LTC plan offering cannot be overstated. Unlike 401(k) plan participation trends, LTC participation rates are highest among large companies. Insurers tend to view the 40-60 age range as the primary target for group LTC insurance, and employee salary as the best predictor of LTC insurance enrollment. Higher educational levels also are associated with higher levels of LTC participation. Perceived need for LTC insurance is perhaps the biggest barrier to the purchase of LTC insurance by employees due to competing financial priorities and the fact that LTC issues are generally off the "radar screens" of younger employees. Plans with skilled nursing home and home care benefits experience higher participation rates than plans lacking these benefits. The availability of lower-cost and long duration benefit options can be an important factor in determining participation. Most sponsors have chosen to offer noncontributory (i.e., fully employee-paid) LTC plans. Employer reluctance to make contributions may be caused by HIPAA's prohibition on the inclusion of LTC insurance in cafeteria plans. One of the major advantages of group LTC plans is the availability of guaranteed issue (i.e., issuing coverage without requiring evidence of insurability) for employees, which is not available in the individual LTC market. It is easy for enrollment to be derailed by the presence of any of a number of harmful conditions, such as employer-sponsors who distance themselves from the offer, ineffective communications, or difficult enrollment processes. Achieving consistently strong levels of participation in LTC plans will require employer-sponsors and their insurance carriers to form strong partnerships, with worker participation as their primary stated goal.     

Employer-sponsored long-term care insurance: best practices for increasing sponsorship

Behind the enthusiasm of policymakers for long-term care (LTC) insurance is the belief that increased ownership of private LTC insurance will reduce the government's future liability for financing the nation's LTC needs, currently projected by the Congressional Budget Office to increase by 2.6 percent annually between 2000 and 2040. Some observers say that sustained economic growth could keep these increased expenditures at the same share of total GDP; others argue that current federal expenditure trends will become unsustainable without large tax increases. The potential of the employer-sponsored group LTC market to stave off a national LTC financing crisis has recently started to receive popular notice in the news media. However, for the potential of the group LTC market to be realized, there must be widespread employer sponsorship of group LTC plans and significant participation levels among eligible employees in these plans. The present analysis of industry data estimates the LTC plan sponsorship rate for all U.S. employers with 10 or more employees at 0.2 percent. The sponsorship rate among large employers is significantly higher (8.7 percent). The greatest growth opportunities are projected to lie in the smaller employer market, because it is enormous and virtually untapped. Nonsponsors cite a variety of barriers to employer sponsorship of LTC plans. For many nonsponsors, the most important obstacles are the intrinsic characteristics of their work forces: employees are too young, transient, part-time, and/or low-income to be suitable for LTC insurance. For many others, lack of awareness and low priority are the primary obstacles. Because group LTC insurance has been widely available for only 10 years, many benefits managers view it as "too new and untested." Prior to the passage of the Health Insurance Portability and Accountability Act (HIPAA), in August 1996, the tax treatment of long-term care insurance premiums was unclear because Congress had not addressed the issue and the Internal Revenue Service had not issued clear guidance. In essence, HIPAA served to clarify the tax status of LTC insurance and establish product criteria for tax qualification. The interventions contained in HIPAA appear to have been insufficient to stimulate coverage growth rates that will meaningfully reduced the future burden on government financing of LTC. Although employment-based LTC insurance appears to be the best mechanism for mass expansion of coverage at affordable rates, the data suggest that employer sponsorship of LTC plans is relatively rare, especially among smaller employers, and that sponsorship rates may not dramatically increase without significant investments in employer education and new incentives.     

Couples Managing the Risk of Financing Long-Term Care

This study examined the complexity of financial long-term care (LTC) decision outcomes among married couples. Supporting the theory of planned behavior, couples reported a range of consensus patterns with their financial LTC intentions and behaviors. Five newly articulated typologies of couples emerged from consensus patterns revealing that couples reported a range of financial LTC intentions and behaviors. More couples reported consensus with their financial LTC behaviors compared to intentions; financial LTC decision outcomes reflected a dynamic and on-going process; and couples were not always in agreement on their financial LTC decision outcomes. Findings reinforce the importance of family practitioners going beyond working with individuals to understanding couple-level planning for financing LTC.     

Feedback from participants and leaders in an intervention program: the 1997-1998 opening doors process evaluation

Parents, students, and program leaders involved in an in-school drug prevention program called Opening Doors were assessed for their perceptions of the efficacy of the program. In general, the feedback indicated a very high program satisfaction level from respondents with parents indicating the highest level satisfaction (92%). Areas for improvement ranged from: parent attendance, invitation process, increased support from schools, and increasing awareness of scheduling and time involvement by leaders and school administration based on program leader feedback as well as invitation process and program duration from the parents (e.g., 37% thought the program was too short). Student satisfaction may be predicted from the perceived impact of the program on significant relationships (e.g., with peers and family) as well as affective reactions to the program (e.g., enjoyment of the program). Finally, a school-level analysis indicated that the application of the Opening Doors Program in different schools was provided uniformly.     

Employees as information influencers of organization’s CSR practices: The impacts of employee words on public perceptions of CSR

This study investigates the impact of employees’ words about their organization’s corporate social responsibility (CSR) activities on external publics’ attitudes and behaviors toward the organization. Specifically, it examines how the valence (positive vs. negative) of employees’ words regarding a CSR campaign interacts with the type of channel (face-to-face vs. social media) of employees’ communication behaviors, and how these factors affect external publics’ perceived authenticity of the organization’s CSR, corporate attitudes, and purchasing intentions, respectively. An online experiment among 221 general consumers in the United States was conducted. The results demonstrated that negative messages regarding CSR distributed by employees in face-to-face communication decreased publics’ favorable attitudes and behavioral intentions to a greater extent than that distributed via social media (i.e., Facebook). However, the effect of communication channel became insignificant when positive messages regarding CSR were shared by employees. The results further showed that perceived authenticity mediated the effects of channel and message valence on publics’ attitudes and behavioral intentions. Theoretical and practical implications for CSR practices and employee communication are discussed.     

An Exploratory Investigation of Heterosexual Licensed Domestic Partners

In‐depth telephone interviews were conducted in four cities in an exploratory study of 23 licensed cohabitors to determine why they have chosen to legitimize their intimate unions through domestic partnership ordinances, rather than through legal marriage. The cohabitors in this sample are pursuing these licensed partnerships to obtain an economic benefit (e.g., health insurance coverage for a partner); as a substitute for legal remarriage; to legitimize their unions in a way other than through legal marriage; or as an ideological alternative to legal marriage. Regardless of motivations to pursue domestic partnership certificates, these respondents are divided over whether they should have the same rights and responsibilities as the married.     

Perception of Substance Use Problems in Asian American Communities by Chinese,Indian, and Vietnamese American Youth

SUMMARY

The study was a cross-sectional survey using a convenience sample of 87 Asian American youth respondents to examine their perceptions of substance use problems in the Asian American community. The authors examined respondents' perceptions of the severity of substance use problems in the Asian American community, perceived characteristics of persons with problems of substance use, perceived etiology of substance use problems, beliefs about treatment, perceived help-seeking preferences and helpful services. The youth demonstrated an increased awareness of the severity of substance use problems in the community, although such awareness was more prominent for drinking problems than drug use problems. Respondents showed a positive attitude toward treatment, although such an attitudinal change was not yet accompanied by a change in their behavioral preferences. Findings suggested a tendency for Asian American youth respondents to utilize personal resources rather than professional help or formal treatment programs in response to substance use problems. In addition, respondents shared similar “myths” of Asian problem drinkers and drug users. Implications for developing culturally relevant interventions for prevention and treatment as well as future research are discussed.     

Perception and determination of child maltreatment: Exploratory comparisons across three countries

Objective

Little is known about perception and determination of child maltreatment across countries. Although differences in perception and determination of maltreatment across regions of a single country are well documented, comparative knowledge across countries remains sparse. This internet survey examined perception of abusive behaviors and factors considered important in determining maltreatment in three countries (i.e., the United States, Ghana, and Nigeria).

Method

Forty-five abusive behaviors comprising physical, sexual, and emotional abuse, child neglect, and child labor, as well as 13 factors considered important in determining maltreatment, were examined among a convenience sample of 327 respondents in the United States, Ghana, and Nigeria. Respondents were recruited within and outside universities in the three countries and links to the survey were sent to respondents who are nonstudents.

Results

With all the countries combined, consensus was high for 15 of the 45 abusive behaviors, although levels of consensus and perceptions varied by country and race. Consensus was high for all of the abusive behaviors among respondents in the United States, 36 of the abusive behaviors among respondents in Ghana, and none of the abusive behaviors among respondents in Nigeria. Respondents who are White/Caucasian were significantly more likely to perceive 5 of the behaviors as abuse than respondents who are Black/non-Caucasian. Similarly, factors considered important in determining maltreatment differed by country and race. Respondents in the United States and Ghana were more likely to consider 9 of the 13 factors important in determining maltreatment compared to respondents in Nigeria. Also, Caucasians/Whites were more likely to consider 6 of the 13 factors important in determining maltreatment compared to Blacks/non-Caucasians.

Conclusion

Despite racial and regional differences, there are indications that cross-cultural consensus on perception and determination of abusive behaviors is possible. Understanding differences in socio-cultural experiences may help bridge the current gaps in cross-cultural consensus on perception and determination of abusive behaviors.     

The Impact of American Media Exposure and Self-Esteem on Chinese Urban Adolescent Purchasing Involvement

This study based on a sample of 429 Beijing high school students shows that Chinese urban adolescents’ purchasing involvement can be predicted by the adolescents’ self-esteem. Individuals’ self-evaluation motivates them to get involved in family purchasing activities. This study suggests that Chinese consumer involvement is potentially shaped by both cognitive factors (e.g., self-esteem) and social factors (e.g., media use). However, the study indicates that exposure to American mass media does not have significant impact on adolescents’ family purchasing involvement. This finding raises possibilities for further investigation in the area. Limitations and suggestions for future studies are provided.

Motivators and Barriers to Participation of Ethnic Minority Families in a Family-Based HIV Prevention Program

Summary

Involving low-income, ethnic minority families in lengthy HIV prevention programs can be challenging. Understanding the motivators and barriers to involvement may help researchers and practitioners design programs that can be used by populations most at risk for HIV exposure. The present study discusses motivators and barriers to involvement in the Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP), using data from a sample of 118 families that participated at varying levels in the twelve sessions of the program. Most participants chose motivators that reflect their perceptions of individual and/or family needs (“CHAMP might help me, mine, and other families”), and of characteristics of the program, such as CHAMP staff were friendly, CHAMP was fun. Among barriers to involvement, respondents expressed concerns about confidentiality, and about being judged by program staff. Respondents also reported experiencing many stressful events in their families (e.g., death and violence in the family) that may have been barriers to their involvement. Knowing these motivators and barriers, researchers and practitioners can enhance involvement in HIV prevention programs.     

Factor Analysis of Barriers to Treatment for Problem Gambling

Attitudes toward problem gambling treatment were investigated in a telephone survey of 1,203 persons in Central Queensland Australia (598 women and 605 men, mean age = 45.8 years). Survey items were compiled from existing substance abuse questionnaires (Center on Alcoholism, Substance Abuse and Addictions, 1995; Sobell et al., 1991). An exploratory factor analysis identified five potential barriers to treatment, including: availability, stigma, cost, uncertainty, and avoidance. Relative to those with few problems, respondents who had numerous gambling problems were more concerned about treatment costs, and the availability and effectiveness of treatment. In addition to the above concerns, older persons more often negatively judged the treatment seeker. In contrast, educated respondents had generally more positive attitudes towards problem gamblers and treatment seeking.     

What's (Not) Wrong With Low‐Income Marriages

In the United States, low marriage rates and high divorce rates among the poor have led policymakers to target this group for skills‐ and values‐based interventions. The current research evaluated the assumptions underlying these interventions; specifically, the authors examined whether low‐income respondents held less traditional values toward marriage, had unrealistic standards for marriage, and had more problems managing relational problems than higher income respondents. They assessed these issues in a stratified random sample that oversampled low‐income and non‐White populations (N = 6,012). The results demonstrated that, relative to higher income respondents, low‐income respondents held more traditional values toward marriage, had similar romantic standards for marriage, and experienced similar skills‐based relationship problems. Low‐income groups had higher economic standards for marriage and experienced more problems related to economic and social issues (e.g., money, drinking/drug use) than did higher income respondents. Thus, efforts to save low‐income marriages should directly confront the economic and social realities these couples face.     

Family use of community services in economically stressed rural counties

This study focuses on stresses, coping strategies, and satisfactions of respondents in eight economically distressed rural counties in the state of Washington. An adult sample is divided into two groups: those who indicate specific economic problems and/or are unemployed (n=236) and those who are still employed and do not report specific economic stresses (n=190). Although those with specific economic problems show higher levels of perceived stress and financial dissatisfaction, there are no differences reported in over-all family satisfaction. Results point to the importance of providing specific employment-related community services to family members in these types of communities.Dorothy Z. Price, Ph.D. is a Professor in the Department of Child and Family Studies, Washington State University, Pullman WA 99164-2010. Her research interests include decision making and consumer behavior. She received her Ph.D. from Michigan State University.Lonnie J. Dunlap, M.A., is a Graduate Research Assistant in the Interdisciplinary Ph.D. Program, Washington State University, Pullman, WA 99164-2010. Her research interests include work and family interactions and career development.