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.     

Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.     

Caregiver Emotional Expressiveness,Child Emotion Regulation,and Child Behavior Problems among Head Start Families

The present study examined the relationships between caregivers' self‐reported positive and negative emotional expressiveness, observer assessments of children's emotion regulation, and teachers' reports of children's internalizing and externalizing behaviors in a sample of 97 primarily African American and Hispanic Head Start families. Results indicated that higher caregiver negativity and lower child emotion regulation independently predicted more internalizing behavior problems in children. Additionally, children's externalizing behavior problems were negatively predicted by caregivers' self‐reports of positive emotional expressiveness. Importantly, results also suggested that caregivers' emotional expressiveness and children's behavioral problems may be non‐linearly related, and that child gender may play an important moderating role. These results emphasize the importance of family emotional climate and child emotion regulation in the behavioral development of preschool‐age children, and highlight the need for improved theoretical and practical understanding of socioemotional development in diverse populations.     

Factors impacting the assessment of maternal culpability in cases of alleged fetal abuse

These studies explored attitudes toward maternal culpability in cases of alleged fetal abuse. In experiment one, general culpability for the use of various substances during pregnancy was assessed as well as the impact of other potentially relevant factors. One hundred and twenty students completed the survey. Participants overwhelmingly supported treating drug use by pregnant women as a criminal offense. With regard to the assessment of more specific questions, the lack of consensus regarding what factors effect culpability is striking. Experiment two examined the possible impact of the mothers' race (White or Black) and social class (Poor or Middle class) on the assessment of culpability. One hundred and sixty-four community members responded to a survey sent to randomly selected persons in upstate South Carolina. The results indicate that at least in response to a brief, written, case scenario, neither race nor social class make a large impact on participants' sanction recommendations.     

Linking Financial Strain to Marital Instability: Examining the Roles of Emotional Distress and Marital Interaction

Using a sample consisting of 4,997 married couples from the National Survey of Families and Households, individual emotional distress, the occurrence of couple disagreements, couple fighting, and couple quality time together mediated the relationship between financial strain and personal assessments of marital instability. The overall results suggest that financial strain influences both positive and negative forms of couple interaction which are stronger mediators than personal emotional distress of the relationship between financial strain and marital instability. The results further suggest that there were no gender differences among these linkages.     

Consequences and Costs of Closing a Publicly Funded Methadone Maintenance Clinic

Objective. We examine volunteering to support the relief effort after the bombing of the Murrah Federal Building. We address two issues: (1) how widespread was volunteering and what forms did it take, and (2) does Wilson and Musick’s (1997a) “integrated theory of volunteer work” help to explain variation in volunteering in this disaster situation? Methods. We use data from the 1996 Oklahoma City Survey (OKC Survey). The 1996 OKC Survey is based on a random sample of the adult population of Oklahoma City and was administered 10 months after the bombing. Results. Nearly 75 percent of the sample respondents volunteered to support the relief effort in at least one way; giving money and donating nonprofessional goods or services were the two most prevalent volunteer activities. Socioeconomic status, knowing someone killed or injured in the bombing, belonging to voluntary organizations before the bombing, and being affiliated with a religious denomination were predictors of volunteering, depending on the type of volunteer activity considered. Conclusions. The magnitude of volunteering after the Murrah Building bombing was in line with volunteer efforts after other disasters. The integrated theory of volunteer work is a useful framework for studying volunteering after disasters.     

Development Guidelines from a Study of Suicide Prevention Mobile Applications (Apps)

Every day, Americans are inundated with advertisements and appeals to purchase the latest mobile technology in the form of smart phones, tablets, and their accompanying applications (apps). Human service organizations (HSOs) across the United States have begun to recognize that apps can provide a valuable resource for individuals and communities by addressing social issues. Additionally, forward-thinking HSOs are aware that apps are a fresh and important way of reaching a rapidly changing, tech-savvy population. But just like the marketplace at large yields a variety of apps that range from useful and engaging to poorly contrived and ineffective, HSOs' foray into app development has achieved mixed results. This report analyzes existing mobile applications available for one specific field of HSO service delivery—suicide prevention—in order to describe what is currently available and to generate beginning guidelines for the development, implementation, and evaluation of new suicide prevention apps for underserved populations. Twenty-seven apps were analyzed and recommendations for HSOs and future research are presented.     

Male Juveniles with Sexual Behavior Problems: Are There Differences Among Racial Groups?

This study used archival data on a sample of 186,492 referrals from a southwestern state Juvenile Probation Commission to compare the characteristics of 5,439 male Black, Hispanic, and White juveniles with sexual behavior problems on the five most common sexual offenses in the data set. The characteristics of 181,053 juveniles of the three races without sexual behavior problems were also compared on the basis of the seven most common nonsexual offenses. The bases of comparison were the seven variables: reported incidence of sexual offenses, the primary caregivers or living arrangements, age, suspected sexual abuse, suspected emotional abuse, suspected physical abuse, and special education status, on which racial differences were found. Prevention and treatment implications of findings are discussed.     

Preparing Social Workers to Identify and Integrate Culturally Affirming Bibliotherapy into Treatment

Despite gains in redefining America as a ‘salad bowl’ versus a ‘melting pot’, stereotypes about racial and ethnic minorities, including African Americans, remain embedded in the fabric of the United States. By acknowledging the significance of stereotypes, race, and culture on the lives of clients, culturally affirming bibliotherapy is a tool that can empower them, validate their experiences, and promote the development of a positive self‐identity or self‐concept. This paper focuses on its use with African American youth, however, because, race impacts all individuals of African descent, this tool can and should be incorporated into their treatment as well when deemed appropriate.     

Using Fairness Models to Improve Equity in Health Delivery Fleet Management

Inefficiency and inequity are two challenges that plague humanitarian operations and health delivery in resource‐limited regions. Increasing capacity in humanitarian and health delivery supply chains is one option that has the potential to improve equity while maintaining efficiency. For example, the nonprofit organization Riders for Health has worked to increase capacity by providing reliable transportation to health workers in rural parts of sub‐Saharan Africa; with more motorcycle hours at their disposal, health workers can perform more outreach to outlying communities. We develop a model using a family of fairness function to quantify the efficiency and equity of health delivery as capacity is increased via development programs. We present optimal resource allocations under utilitarian, proportionally fair, and egalitarian objectives and extend the model to include dual modes of transport and diminishing returns of subsequent outreach visits. Finally, we demonstrate how to apply our model at a regional level to provide support for humanitarian decision makers such as Riders for Health. We use data from the baseline phase of our evaluation trial of Riders for Health in Zambia to quantify efficiency and equity for one real‐world scenario.