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.     

Global employment and decent jobs, 2010–2030: The forces of demography and automation

Globally, an estimated 734 million jobs will be required between 2010 and 2030 to accommodate recent and ongoing demographic shifts, account for plausible changes in labour force participation rates, and achieve target unemployment rates of at or below 4 per cent for adults and at or below 8 per cent for youth. The facts that most new jobs will be required in countries where “decent” jobs are less prevalent and workers in many occupations are increasingly subject to risks of automation further compound the challenge of job creation, which is already quite sizable in historical perspective. Failure to create the jobs that are needed through 2030 would put currently operative social security systems under pressure and undermine efforts to guarantee the national social protection floors enshrined in the Sustainable Development Goals (SDGs).     

Reply to the Commentaries: Of Course,We Do Not Yet Know What it is All About,But Functional Contextualism is a Good Place to Start

In this reply to the commentaries, we note several points of disagreement with Johnson and Greenman on theoretical and empirical grounds. We are particularly surprised by their assumption that attachment has already been established as the key mechanism of change in couple therapy, as our present findings do not support this idea. We also elaborate on Gurman's functional contextualist views and describe why IBCT may be a particularly helpful model for training new couple therapists in a contextualist way.     

Reclaiming ourselves through Testimonio pedagogy: reflections on a curriculum design lab in teacher education

This article details one teacher preparation course centering Latin American Testimonio narratives of struggle/survival amid structural oppression for use in secondary curriculum. As our class of predominantly Latina/o students and two Latina instructors engaged Testimonio pedagogy, we fashioned a hopeful alternative to our own experiences of intergenerational oppression. While research indicates that the experiences and histories of pre-service Teachers of Color lend pedagogical strength and critical consciousness to teacher education, three Latina pre-service students highlight the ways in which Testimonio became more than a pedagogical approach. Testimonio’s collectivity, resistance, hope, and assertions of voice and dignity moved through them not as educators first but as (great-grand)daughters of oppressed though still-resilient People(s). Testimonio emboldened these Latina pre-service educators to recognize and validate their own inherited multiliteracies, (re)claim their connectedness to land, and articulate their visions for more equitable schooling. This work advances research into the essentiality of engaging race and ethnicity in K-12 and teacher education curriculum and pedagogy.     

Using "short" interrupted time-series analysis to measure the impacts of whole-school reforms. With applications to a study of accelerated schools

The present article introduces a new approach for measuring the impacts of whole-school reforms. The approach is based on "short" interrupted time-series analysis, which has been used to evaluate programs in many fields. The approach is used to measure impacts on three facets of student performance: (a) average (mean) test scores, which summarize impacts on total performance; (b) the distribution of scores across specific ranges, which helps to identify where in the distribution of student performance impacts were experienced; and (c) the variation (standard deviation) of scores, which indicates how the disparity in student performance was affected. To help researchers use the approach, the article lays out its conceptual rationale, describes its statistical procedures, explains how to interpret its findings, indicates its strengths and limitations, and illustrates how it was used to evaluate a major whole-school reform--Accelerated Schools.     

Neither Real Americans nor Real Asians? Multigeneration Asian Ethnics Navigating the Terrain of Authenticity

Qualitative Sociology -     

The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples

Emotion‐focused therapy (EFT; Greenberg & Johnson, 1988 Emotionally focused therapy for couples. New York: Guilford Press) is anchored in attachment theory (Johnson, 2003 Attachment processes in couples and families. New York: Guilford) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999, Research and couples therapy: Where do we go from here? American Family Therapy Academy Newsletter). However, there are little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non‐attachment‐focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of integrative behavioral couple therapy and traditional behavioral couple therapy (Christensen et al. Journal of Consulting and Clinical Psychology, 72, 2004, 176) indicate that although there is a trend for early change in attachment‐related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment‐related anxiety through the end of treatment and 2‐year follow‐up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy.     

Indications for the use of low-osmolar contrast agents.

The recent introduction of low-osmolar contrast agents for use in radiology procedures presents a dilemma for health care managers concerned about cost and quality. The new agents are reported to be safer and are better tolerated by patients, but they are very costly. Earlier this year, a survey was sent to hospital-based members of the American College of Physician Executives to determine what policy existed for the use of these agents. As a result of the survey, we have a better picture of the indications for low-osmolar contrast agents being used in clinical practice throughout the United States.