THE AFFORDABLE CARE ACT AND COLLEGE ENROLLMENT DECISIONS

We investigate the effect of the expansion of the federal dependent coverage mandate for young adults under the Affordable Care Act (ACA) on college enrollment decisions of young Americans. The expansion removes the requirement that young individuals need to be enrolled as full‐time students in order to remain on their parents' health insurance past the age of 18 and expands the coverage mandate to age 26 irrespective of student status. This changes the incentives for the full‐time college enrollment decisions of young individuals. We use panel data from the Survey of Income and Program Participation (SIPP) for the years 2003–2013 and estimate that the dependent coverage expansion under the ACA decreases the probability to enroll as full‐time student by 3 percentage points using a difference‐in‐differences framework. Furthermore, we find that part‐time college enrollment is unaffected by the new policy. The results are robust to changes in the model specification and become stronger when we increase the sample overlap between treatment and control groups using trimming based on propensity scores. (JEL C35, I23, I10, I18)     

Sleep and Its Association With Socioeconomic Status,Health, and Risky Behaviors Among Ghanaian School Children

Socioeconomic differences in sleep and how sleep relates to health and risky behaviors among 12‐ to 18‐year‐old Ghanaians (N = 1,195) were investigated. Overall, 49.2% of boys and 60.8% of girls had inadequate sleep. Girls (OR = 1.6, 95% CI = 1.3–2.0) and older (16‐ to 18‐year‐olds) adolescents (OR = 1.6, 95% CI = 1.3–2.1) had higher probability of inadequate sleep than boys and younger (12‐ to 15‐year‐old) adolescents, respectively. High material affluence, low parental education, low parental occupational grade, drunkenness, marijuana use, drug use, and not having plans to continue schooling after graduation decreased the chances of inadequate sleep, while low school performance, low fruit and vegetable intake, and tiredness during daytime increased the probability of inadequate sleep. Promotion of adequate sleep and gender equality should be taken into consideration in adolescent health promotion programs.     

Trends in Cohabitation Outcomes: Compositional Changes and Engagement Among Never‐Married Young Adults

Cohabitation is now the modal first union for young adults, and most marriages are preceded by cohabitation even as fewer cohabitations transition to marriage. These contrasting trends may be due to compositional shifts among cohabiting unions, which are increasingly heterogeneous in terms of cohabitation order, engagement, and the presence of children, as well as across socioeconomic and demographic characteristics. The author constructs 5‐year cohabitation cohorts for 18‐ to 34‐year‐olds from the 2002 and 2006–2010 cycles of the National Survey of Family Growth (n = 17,890 premarital cohabitations) to examine the outcomes of cohabitations over time. Compared to earlier cohabitations, those formed after 1995 were more likely to dissolve, and those formed after 2000 were less likely to transition to marriage even after accounting for the compositional shifts among individuals in cohabiting unions. Higher instability and decreased chances of marriage occurred among both engaged and non‐engaged individuals, suggesting society‐wide changes in cohabitation over time.     

Coverage Bias in Traditional Telephone Surveys of Low-Income and Young Adults

The proportion of adults with only wireless telephones is growingrapidly. Using 2006 data from the National Center for HealthStatistics’ National Health Interview Survey, this articleis among the first to reveal that noncoverage of this populationcan result in nonnegligible bias for traditional random-digit-diallandline telephone surveys that do not call wireless telephonenumbers. In 2006 in the United States, 17 percent of low-incomeadults with household income below 200 percent of the federalpoverty thresholds, 25 percent of young adults aged 18–29years, and 32 percent of low-income young adults lived in householdswith only wireless telephones. Within each of these three subgroups,we compared wireless-only adults and adults with landline telephoneson demographic characteristics and 13 key indicators of healthstatus, health behaviors, health care service use, and healthcare access. Even after statistical adjustments that accountfor demographic differences between adults living in householdswith and without landlines, telephone surveys of landlines willunderestimate the prevalence of health behaviors, such as bingedrinking, smoking, and HIV testing. Obesity may be overestimatedand physical activity may be underestimated for low-income youngadults. No significant bias is predicted for other measuresof health status and health insurance coverage. Sample weightingprocedures that incorporate adjustments for multiple demographiccharacteristics are necessary to help attenuate coverage biasin traditional telephone surveys, but may not be sufficientfor behavioral risk factor surveys of low-income and young adults.     

Small employers and health benefits: findings from the 2000 Small Employer Health Benefits Survey

Many small employers (between two and 50 workers) are making decisions about whether to offer health benefits to their workers without being fully aware of the tax advantages that can make this benefit more affordable. Fifty-seven percent of small employers did not know that they can deduct 100 percent of their health insurance premiums. Nearly one-half of small employers are not aware that workers who purchase health insurance on their own generally cannot deduct 100 percent of their health insurance premiums. Small employers are largely unaware of the laws that have been enacted by nearly all states and the federal government with the intent of making health insurance more accessible and more affordable for many small employers. More than 60 percent did not know that insurers may not deny health insurance coverage to small employers even when the health status of their workers is poor. Most employers offer sound business reasons for offering health benefits to workers. Many have found that it helps with employee recruitment and retention, increases productivity, and reduces absenteeism. Nearly 50 percent of the employers offering dependent (family) coverage report that the workers do not take coverage for their dependents because the dependents have coverage from somewhere else. Twenty-seven percent report their employees decline dependent coverage because they cannot afford the premiums. Many small employers that do not offer health benefits are potential purchasers. Twelve percent are either extremely or very likely to start offering health benefits in the next two years, and 17 percent are somewhat likely to start offering health benefits. A number of factors would increase the likelihood that a small business would seriously consider offering a health benefits plan. Two-thirds of small-business owners said they would seriously consider offering health benefits if the government provided assistance with premiums. Almost one-half would consider doing so if insurance costs fell 10 percent. In addition, one-half would be more likely to seriously consider offering a health benefits plan if employees demand it. Many small employers with health benefits have recently switched health plans, and 34 percent report that they did so within the past year. Affordability for the employer and the worker is clearly a critical factor affecting the likelihood of switching health plans. Nearly all employers who have switched health plans within the past five years cite cost as the main reason. One-third of companies offering health benefits think they will change coverage, and 5 percent think they would drop coverage if the cost of health insurance were to increase by 5 percent.     

Factors Influencing Uptake and Use of a New Health Information App for Young People

Abstract

When young people need health information they are increasingly likely to use online sources and health apps (applications). Yet, these are not necessarily well-designed, reliable or appropriate, and research has primarily focused on adult use. Our study is the first to use qualitative mixed methods (focus groups and interviews) to apply the Technology Acceptance Model (TAM) to understand 26 young people’s uptake and use of a new, clinically-approved health app (application) for 16–25?year olds. We found that perceived usefulness, perceived ease-of-use, social influences and trust, all differently impacted children and young people health-app acceptance and effectiveness. Implications for future research and young-person health-app development are discussed.     

Emotional Health and Well‐being in Schools: Involving Young People

Prevalence studies of emotional health and well‐being (EHWB) of young people indicate that that there is cause for concern. Very few studies have examined EHWB from the perspective of young people. This study examined the views of young people about their EHWB in the context of secondary education in the UK. Eight focus groups were conducted in five secondary schools with pupils in year 10 (aged 13–14). The findings suggested that whilst pupils thought some aspects of EHWB are well provided for in the school curriculum, there were problems with coherence of EHWB policy. Mental health topics were thought to be neglected in the EHWB curriculum especially in relation to self‐harm. Three problems regarding talking about EHWB were identified. Firstly, the quality of EHWB lessons depended on the enthusiasm and creativity of the teacher taking the lesson. Secondly, pupils were concerned about confidentiality. Thirdly, many pupils preferred to talk to friends about EHWB issues. The findings of the study suggest a need for greater involvement of young people in the planning, implementation and evaluation of the EHWB curriculum.     

The Perspectives of Young Men and Their Teenage Partners on Maternity and Health Services During Pregnancy and Early Parenthood

This study discusses young couples’ interactions with maternity and health services paying particular attention to men’s perspectives. Findings are based on research conducted in Scotland with men (aged 16–25) and their teenage partners (aged 16–19). Most young men were very involved in their child’s life and provided support and care to their partner during pregnancy and in early parenthood. Men often felt excluded or judged when accessing services, although positive experiences were reported too. The study discusses ways in which maternity and health services can be better attuned to meet the needs of young couples and be inclusive of men.     

Emergence of a consonant bias during the first year of life: New evidence from own‐name recognition

Recent evidence suggests that during the first year of life, a preference for consonant information during lexical processing (consonant bias) emerges, at least for some languages like French. Our study investigated the factors involved in this emergence as well as the developmental consequences for variation in consonant bias emergence. In a series of experiments, we measured 5‐, 8‐, and 11‐month‐old French‐learning infants orientation times to a consonant or vowel mispronunciation of their own name, which is one of the few word forms familiar to infants at this young age. Both 5‐ and 8‐month‐olds oriented longer to vowel mispronunciations, but 11‐month‐olds showed a different pattern, initially orienting longer to consonant mispronunciations. We interpret these results as further evidence of an initial vowel bias, with consonant bias emergence by 11 months. Neither acoustic‐phonetic nor lexical factors predicted preferences in 8‐ and 11‐month‐olds. Finally, counter to our predictions, a vowel bias at the time of test for 11‐month‐olds was related to later productive vocabulary outcomes.     

Health Insurance and Risk of Divorce: Does Having Your Own Insurance Matter?

Most American adults under 65 obtain health insurance through their employers or their spouses' employers. The absence of a universal health care system in the United States puts Americans at considerable risk for losing their coverage when transitioning out of jobs or marriages. Scholars have found evidence of reduced job mobility among individuals who are dependent on their employers for health care coverage. In this study, the author found similar relationships between insurance and divorce. She applied the hazard model to married individuals in the longitudinal Survey of Income Program Participation (N = 17,388) and found lower divorce rates among people who were insured through their partners' plans without alternative sources of their own. Furthermore, she found gender differences in the relationship between health care coverage and divorce rates: Insurance‐dependent women had lower rates of divorce than men in similar situations. These findings draw attention to the importance of considering family processes when debating and evaluating health policies.     

Characteristics of the nonelderly with selected sources of health insurance and lengths of uninsured spells

This Issue Brief examines the characteristics of individuals with selected sources of coverage and combinations of sources of coverage over a 12-month period. In addition, it examines the characteristics of individuals who experience spells without health insurance and the lengths of these spells. It uses the most recent 12-month period from the Survey of Income and Program Participation and builds on previous research on the lengths of spells with and without health insurance. Analysis of individuals' health insurance coverage from October 1994 to September 1995 showed that approximately 77.6 percent of the nonelderly had health insurance coverage during this entire period. In addition, 22.4 percent of the nonelderly were uninsured for at least one month during this period, and 7.4 percent of the nonelderly were uninsured for the entire period. Of those with health insurance coverage for the entire year, approximately 83 percent were covered by private health insurance, with at least 81 percent of this group receiving the coverage from employment-based sources. Eighty-five percent of the spells without health insurance with an observed beginning and end lasted for 4 months or less, and 99 percent lasted for 8 months or less. When examining the spells with either an observed beginning or end, 55 percent of these spells were found to last for 4 months or less, and 87 percent were found to last for 8 months or less. However, investigation of all spells without health insurance showed that approximately one-half of all spells without health insurance coverage lasted for 8 months or longer. This report found that two-thirds of spells without health insurance last for less than one year, confirming previous research that a majority of these spells are for less than a year. However, this report also confirms the existence of a significant number--approximately one-third of all individuals with a spell of noncoverage--of chronically uninsured individuals. These individuals are the most likely to delay seeking treatment for illnesses and to use the emergency room as their only site of care. Because they are in poverty or near poverty, much of this care is uncompensated. Thus, to the extent that providers can shift these costs onto other payers, all individuals and employers share in these costs through higher health insurance premiums or higher taxes to finance public hospitals and public insurance programs. Recent major health insurance legislation has addressed access to health insurance, and in many cases focused solely on continued access to employment-based coverage, but has done very little to address the affordability of coverage. However, as this report demonstrates, many individuals experiencing spells without health insurance have low incomes. Thus, to obtain coverage, individuals need not only increased access to health insurance but also the ability to afford this health insurance.     

Toddlers’ Responses to Infants’ Negative Emotions

Early developments in toddlers’ responses to adults’ distress have been extensively examined, but less work has been directed to young children's responses to other children in distress. In the current study, we examined 12‐, 18‐, and 24‐month‐old children's (N = 71) behavioral and affective responses to a crying infant (doll) present in the room with the child. A comparison condition included a contented, neutral infant to contrast with the crying infant so as to disambiguate social interest from distress‐specific responding. Results showed that 12‐month‐olds were neither particularly interested in nor concerned about the infant, although they did discriminate between conditions. In contrast, 18‐ and 24‐month‐olds were socially interested and attentive to the infant, but 24‐month‐olds exhibited greater affective concern to the crying infant than did 18‐month‐olds. Children at all three ages were also mildly distressed themselves by the infant's crying, and this did not decline over the second year. Both girls and children without siblings were more interested in the infant; no effects were found for gender, daycare experience, or siblings on affective concern.     

The New Destination Disadvantage: Disparities in Hispanic Health Insurance Coverage Rates in Metropolitan and Nonmetropolitan New and Established Destinations

Hispanics have the lowest health insurance rates of any racial or ethnic group, but rates vary significantly across the United States. The unprecedented growth of the Hispanic population since 1990 in rural areas with previously small or nonexistent Hispanic populations raises questions about disparities in access to health insurance coverage. Identifying spatial disparities in Hispanic health insurance rates can illuminate the specific contexts within which Hispanics are least likely to have health care access and inform policy approaches for increasing coverage in different spatial contexts. Using county‐level data from the 2009–13 American Community Survey, I find that early new destinations (i.e., those that experienced rapid Hispanic population growth during the 1990s) have the lowest Hispanic adult health insurance coverage rates, with little variation by metropolitan status. Conversely, among the most recent new destinations that experienced significant Hispanic population growth during the first decade of the 2000s, metropolitan counties have Hispanic health insurance rates that are similar to established destinations, but rural counties have Hispanic health insurance rates that are significantly lower than those in established destinations. Findings demonstrate that the new destination disadvantage is driven entirely by higher concentrations of immigrant noncitizen Hispanics in these counties, but labor market conditions were salient drivers of the spatially uneven distribution of foreign‐born noncitizen Hispanics to new destinations, particularly in rural areas.     

NIDA: Daily marijuana use at 13% in noncollege young adults

The latest Monitoring the Future (MTF) survey results on teens transitioning to adulthood shows that more than 13 percent who are not in college are using marijuana on a daily basis. Conducted for the National Institute on Drug Abuse (NIDA), MTF is a national survey released in December every year, with a specialized focus on 19‐ to 22‐year‐olds released in the following September.     

Trends in Employee Wage and Health Insurance Compensation for Employer-Sponsored Health Insurance (ESI) Coverage

Health insurance coverage continues to be an important benefit of employment and employer-sponsored insurance is the most prominent form of health coverage in the US. We examine trends in both employer and employee contributions to the costs of health insurance premium between 2002 and 2005 and assess these contributions relative to changes in worker wages. We do this for the US overall and for the 50 states plus the District of Columbia. We found a significant increase of 15.5% in the share of total compensation going toward health benefits (from 12.3–14.2%) for workers with individual coverage and an increase of 13.5% (from 20.6–23.4%) for workers with family coverage. Wages over this time period decreased 3.0% for workers with individual coverage and increased 0.8% for workers with family coverage.     

Building Health Insurance Literacy: Evidence from the Smart Choice Health Insurance™ Program

With the passage of the Patient Protection and Affordable Care Act (ACA) of 2010, the health insurance literacy of Americans became a critical issue. In response, a consumer education program was created and tested by university researchers and educators associated with Cooperative Extension. This article draws extensively on the emerging literature on health insurance literacy and on data from participants in the Smart Choice Health Insurance? program. The intent of the study was to understand socio-demographic and environmental variables that predict initial health insurance literacy and gains in health insurance literacy. A standardized instrument measuring health insurance literacy was used to collect the data. Multivariate analysis showed higher income consumers demonstrated greater initial health insurance literacy scores compared to middle income consumers, whereas younger, male and lower educated consumers reported lower initial health insurance literacy. After participating in the Smart Choice Health Insurance? program, consumers who made greater gains in their health insurance literacy tended to be female, higher income, and consumers residing in states that showed supportiveness of the ACA. The findings highlight the importance of considering sociodemographic characteristics in program design and delivery, as well as how contextual issues, such as the political environment, might impact the delivery of educational efforts. Findings from the analyses help inform ways to adapt and tailor educational opportunities that focus on health insurance literacy for a range of consumers.     

Young Infants Match Facial and Vocal Emotional Expressions of Other Infants

Research has demonstrated that infants recognize emotional expressions of adults in the first half year of life. We extended this research to a new domain, infant perception of the expressions of other infants. In an intermodal matching procedure, 3.5‐ and 5‐month‐old infants heard a series of infant vocal expressions (positive and negative affect) along with side‐by‐side dynamic videos in which one infant conveyed positive facial affect and another infant conveyed negative facial affect. Results demonstrated that 5‐month‐olds matched the vocal expressions with the affectively congruent facial expressions, whereas 3.5‐month‐olds showed no evidence of matching. These findings indicate that by 5 months of age, infants detect, discriminate, and match the facial and vocal affective displays of other infants. Further, because the facial and vocal expressions were portrayed by different infants and shared no face–voice synchrony, temporal, or intensity patterning, matching was likely based on detection of a more general affective valence common to the face and voice.     

Americans’ Approval of the 2010 Affordable Care Act: Self‐interest and Symbolic Politics*

Public opinion data show substantial variation in attitudes toward the Affordable Care Act (ACA). Utilizing a 2013 Gallup survey of U.S. adults, we examine the effects of self‐interest and symbolic politics measures on several dimensions of ACA approval. Supporting symbolic politics, we find liberal political ideology, democratic party affiliation, and positive evaluations of President Obama are consistently associated with greater approval of the ACA generally, as well as the belief that the ACA will improve the healthcare situation of the United States and one's family specifically. In contrast, self‐interest variables produce less consistent results. Self‐reported familiarity with the law and being uninsured due to one's employer not offering health insurance are associated with greater belief the ACA will improve the healthcare situation of one's family specifically, but not the U.S. healthcare situation generally. Together these findings suggest that political values and symbols—in particular perceptions of President Obama—may be more important in shaping attitudes toward the ACA than self‐interest variables, especially in contexts assessing more generalized support for the legislation.     

Adolescents’ Narratives of Schadenfreude

This study explored the experiential determinants of schadenfreude, how schadenfreude changes as a function of relationship, and how recollections of schadenfreude may vary by age. Using a narrative approach, 12‐ and 15‐year‐olds (N = 60) described times they felt schadenfreude toward various peers and adults. We coded their responses to extract information regarding preceding misfortunes and underlying reasons for schadenfreude. We found that adolescents' schadenfreude often involved another’s physical harm and failure, and was rooted in reasons of deservingness and personal gain. There were unique trends in the types of misfortunes and reasons mentioned toward each target of interest. Finally, deservingness reasoning was prominent within 15‐year‐olds’ schadenfreude experiences. The findings are discussed in relation to adolescents’ emotional experiences in conflict situations.