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.     

Demand for gambling: development and assessment of a gambling purchase task

Self-report purchase tasks are a novel approach examining the reinforcing value of addictive behaviour relative to increasing monetary costs required to access the addictive behaviour (i.e. demand). These measures reveal a positive relationship between the indices of demand and addiction problem severity and can elucidate factors associated with motivation for substance use. Gambling is an addictive behaviour that has not been examined using this paradigm. This study seeks to adapt and examine the purchase task for gambling behaviour. A gambling purchase task was devised that asked individuals how often per month they would gamble at various cover charges. Participants were 73 adults from the community with either gambling disorder (n = 28) or alcohol use disorder (n = 24) or were a healthy control (n = 21). Both the alcohol and gambling purchase tasks were administered. Results demonstrate discriminant validity of the gambling purchase task, as individuals with gambling disorder have significantly greater demand for accessing gambling than other groups. The alcohol purchase task also evidenced discriminant validity in that individuals with alcohol use disorder have significantly greater demand for alcohol than other groups. These findings support the use of the gambling purchase task to assess the demand for gambling.     

Forecasting intraday time series with multiple seasonal cycles using parsimonious seasonal exponential smoothing

This paper concerns the forecasting of seasonal intraday time series that exhibit repeating intraweek and intraday cycles. A recently proposed exponential smoothing method involves smoothing a different intraday cycle for each distinct type of day of the week. Similar days are allocated identical intraday cycles. A limitation is that the method allows only whole days to be treated as identical. We introduce a new exponential smoothing formulation that allows parts of different days of the week to be treated as identical. The result is a method that involves the smoothing and initialisation of fewer terms. We evaluate forecasting up to a day ahead using two empirical studies. For electricity load data, the new method compares well with a range of alternatives. The second study involves a series of arrivals at a call centre that is open for a shorter duration at the weekends than on weekdays. Among the variety of methods considered, the new method is the only one that can model in a satisfactory way in this situation, where the number of periods on each day of the week is not the same.     

‘There is always this feeling of otherness’: exploring the lived experiences of visually impaired immigrant women in Canada

This paper explores the experiences of immigrant women with visual impairment in the Greater Toronto and Hamilton Area (GTHA) of Canada. Conceptually, the paper draws from feminist disability theory and critical scholarship on blindness to consider the discursive and material processes shaping women’s experiences across different socio-cultural contexts. Empirically, the paper draws from in-depth interviews with seven women. The analysis is organized around three themes. The first explores women’s understandings of visual impairment. The second examines the ways in which women’s experiences of visual impairment are shaped by meanings and attitudes that circulate within their cultural communities, and the extent to which immigration might challenge or reinforce these meanings. The third examines the shifting barriers and opportunities women face with respect to social and economic participation. We close by identifying the conceptual implications of our research.     

Differential customer racial attitudes toward scandal and patriotism: The Mitchell Report,the Olympics,race, and baseball memorabilia

This paper investigates differential customer racial reaction to negative and positive publicity related to professional athletes. In terms of negative publicity, it analyzes the effect of mention in the Mitchell Report on the price of baseball cards. In regards to positive publicity, it considers the impact of having been identified as a member of the United States Olympic or national team. After controlling for player productivity with performance statistics, the effects of being mentioned in the Mitchell Report are isolated within regression analysis to draw conclusions concerning customer racial attitudes toward the steroids scandal. Similar analysis is conducted to see the impact of being seen as a baseball representative of the United States. Regression results are consistent with the conclusion that negative publicity devalues the cards of nonWhite players but not of White players. Positive publicity, however, increases the value of a player's card regardless of ethnicity.     

For compassion or money? The factors influencing the funding of micro loans

Aided by the Internet, microfinance institutions have found new ways to expand the reach of financing entrepreneurial projects on a small scale. Using a unique data set of individual loans posted to Kiva.org, we explore the determinants of lenders’ nonprofit lending choices in the growing microfinance industry. We find that lenders make choices in purposive ways even in the absence of market interest rates, especially with respect to the demographic characteristics of borrowers and the uses of proposed funds. Hence, the results provide valuable new information about consumer choice in charitable giving and investment.     

Using In Vitro High‐Throughput Screening Data for Predicting Benzo[k]Fluoranthene Human Health Hazards

Today there are more than 80,000 chemicals in commerce and the environment. The potential human health risks are unknown for the vast majority of these chemicals as they lack human health risk assessments, toxicity reference values, and risk screening values. We aim to use computational toxicology and quantitative high‐throughput screening (qHTS) technologies to fill these data gaps, and begin to prioritize these chemicals for additional assessment. In this pilot, we demonstrate how we were able to identify that benzo[k]fluoranthene may induce DNA damage and steatosis using qHTS data and two separate adverse outcome pathways (AOPs). We also demonstrate how bootstrap natural spline‐based meta‐regression can be used to integrate data across multiple assay replicates to generate a concentration–response curve. We used this analysis to calculate an in vitro point of departure of 0.751 μM and risk‐specific in vitro concentrations of 0.29 μM and 0.28 μM for 1:1,000 and 1:10,000 risk, respectively, for DNA damage. Based on the available evidence, and considering that only a single HSD17B4 assay is available, we have low overall confidence in the steatosis hazard identification. This case study suggests that coupling qHTS assays with AOPs and ontologies will facilitate hazard identification. Combining this with quantitative evidence integration methods, such as bootstrap meta‐regression, may allow risk assessors to identify points of departure and risk‐specific internal/in vitro concentrations. These results are sufficient to prioritize the chemicals; however, in the longer term we will need to estimate external doses for risk screening purposes, such as through margin of exposure methods.     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.