Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

What to Do at Low Doses: A Bounding Approach for Economic Analysis

To quantify the health benefits of environmental policies, economists generally require estimates of the reduced probability of illness or death. For policies that reduce exposure to carcinogenic substances, these estimates traditionally have been obtained through the linear extrapolation of experimental dose-response data to low-exposure scenarios as described in the U.S. Environmental Protection Agency's Guidelines for Carcinogen Risk Assessment (1986). In response to evolving scientific knowledge, EPA proposed revisions to the guidelines in 1996. Under the proposed revisions, dose-response relationships would not be estimated for carcinogens thought to exhibit nonlinear modes of action. Such a change in cancer-risk assessment methods and outputs will likely have serious consequences for how benefit-cost analyses of policies aimed at reducing cancer risks are conducted. Any tendency for reduced quantification of effects in environmental risk assessments, such as those contemplated in the revisions to EPA's cancer-risk assessment guidelines, impedes the ability of economic analysts to respond to increasing calls for benefit-cost analysis. This article examines the implications for benefit-cost analysis of carcinogenic exposures of the proposed changes to the 1986 Guidelines and proposes an approach for bounding dose-response relationships when no biologically based models are available. In spite of the more limited quantitative information provided in a carcinogen risk assessment under the proposed revisions to the guidelines, we argue that reasonable bounds on dose-response relationships can be estimated for low-level exposures to nonlinear carcinogens. This approach yields estimates of reduced illness for use in a benefit-cost analysis while incorporating evidence of nonlinearities in the dose-response relationship. As an illustration, the bounding approach is applied to the case of chloroform exposure.     

Valuation of childhood risk reduction: the importance of age, risk preferences, and perspective.

This article explores two problems analysts face in determining how to estimate values for children's health and safety risk reductions. The first addresses the question: Do willingness‐to‐pay estimates for health risk changes differ across children and adults and, if so, how? To answer this question, the article first examines the potential effects of age and risk preferences on willingness to pay. A summary of the literature reporting empirical evidence of differences between willingness to pay for adult health and safety risk reductions and willingness to pay for health and safety risk reductions in children is also provided. The second dimension of the problem is a more fundamental issue: Whose perspective is relevant when valuing children's health effects—society's, children's, adults‐as‐children, or parents'? Each perspective is considered, followed ultimately by the conclusion that adopting a parental perspective through an intrahousehold allocation model seems closest to meeting the needs of the estimation problem at hand. A policy example in which the choice of perspective affects the outcome of a regulatory benefit‐cost analysis rounds out the article and emphasizes the importance of perspective.     

English Language Proficiency of Immigrants and Refugees in the Twin Cities Metropolitan Area

Studies of the determinants of English language ability have generally focused on the largest immigrant groups in the United States. Much less is known about smaller, but significant regional concentrations of immigrants and refugees. This article presents data on four very distinct and understudied groups: Russians, Somalis, Hmong, and Mexicans in the Midwest. We found large differences in English language proficiency across the different national origin groups, even after controlling for background variables. These differences were not attributable to refugee status or to linguistic distance from English. Being Somali, migrating to the United States at a young age and having a college diploma were the best predictors of both spoken and written proficiency. The returns to higher education were particularly noteworthy — respondents with college diplomas were more than 29 times more likely than non‐high school graduates to speak English well, and more than 20 times as likely to read well. Women appear to have benefited more than men from completing college in terms of spoken English proficiency since the male‐female gap narrows among the highly educated. Length of time in the United States was a good predictor of whether an individual speaks English at home, regardless of age of entry to the country.     

The Development of Affect Specificity in Infants' Use of Emotion Cues

This study examined the emergence of affect specificity in infancy. In this study, infants received verbal and facial signals of 2 different, negatively valenced emotions (fear and sadness) as well as neutral affect via a television monitor to determine if they could make qualitative distinctions among emotions of the same valence. Twenty 12‐ to 14‐month‐olds and 20 16‐ to 18‐month‐olds were examined. Results suggested that younger infants showed no evidence of referential specificity, as they responded similarly to both the target and distracter toys, and showed no evidence of affect specificity, showing no difference in play between affect conditions. Older infants, in contrast, showed evidence both of referential and affect specificity. With respect to affect specificity, 16‐ to 18‐month‐olds touched the target toy less in the fear condition than in the sad condition and showed a larger proportion of negative facial expressions in the sad condition versus the fear condition. These findings suggest a developmental emergence after 15 months of age for affect specificity in relating emotional messages to objects.     

FAMILY THERAPISTS' RESPONSE TO AIDS: AN EXAMINATION OF ATTITUDES,KNOWLEDGE, AND CONTACT*

As the number of individuals and families impacted by AIDS continue to multiply, family therapists will increasingly be asked to become engaged in the challenge of caring for those affected. To date, little has been written in family therpy journals regarding the response of family therapists to this crisis. This paper represents an initial attempt to examine the atitudes of clinical members of the American Association for Marriage and Family Therapy toward AIDS and persons with AIDS. Included in the study are data regarding the therapists' contact with persons with AIDS, gays, and lesbians, and the impact of such contact on attitudes. Implications for future research, training, and treatment of those affected by AIDS are also provided.