Tobacco Use and Health Insurance Literacy Among Vulnerable Populations: Implications for Health Reform

Background: Under the Affordable Care Act (ACA), millions of Americans have been enrolling in the health insurance marketplaces. Nearly 20% of them are tobacco users. As part of the ACA, tobacco users may face up to 50% higher premiums that are not eligible for tax credits. Tobacco users, along with the uninsured and racial/ethnic minorities targeted by ACA coverage expansions, are among those most likely to suffer from low health literacy – a key ingredient in the ability to understand, compare, choose, and use coverage, referred to as health insurance literacy. Whether tobacco users choose enough coverage in the marketplaces given their expected health care needs and are able to access health care services effectively is fundamentally related to understanding health insurance. However, no studies to date have examined this important relationship.Methods: Data were collected from 631 lower-income, minority, rural residents of Virginia. Health insurance literacy was assessed by asking four factual questions about the coverage options presented to them. Adjusted associations between tobacco use and health insurance literacy were tested using multivariate linear regression, controlling for numeracy, risk-taking, discount rates, health status, experiences with the health care system, and demographics.Results: Nearly one third (31%) of participants were current tobacco users, 80% were African American and 27% were uninsured. Average health insurance literacy across all participants was 2.0 (SD 1.1) out of a total possible score of 4. Current tobacco users had significantly lower HIL compared to non-users (−0.22, p \u3c 0.05) after adjustment. Participants who were less educated, African American, and less numerate reported more difficulty understanding health insurance (p \u3c 0.05 each.)Conclusions: Tobacco users face higher premiums for health coverage than non-users in the individual insurance marketplace. Our results suggest they may be less equipped to shop for plans that provide them with adequate out-of-pocket risk protection, thus placing greater financial burdens on them and potentially limiting access to tobacco cessation and treatment programs and other needed health services

Adult age differences in risk perception and risk taking

Research on self-reported risk perception and risk taking suggests age-related decrements in risk preference, with older adults less likely to engage in general and domain-specific risk taking (i.e., in financial, health-related, ethical, career, and leisure contexts). Data relating to social risks, however, are inconsistent. With respect to behavioral risk-taking tasks, age-related differences vary depending on task characteristics and older adults' cognitive capacities. Specifically, older adults are less good at learning to take advantageous risks and take fewer risks when faced with gains, especially financial and mortality-based ones. We contextualize these trends by referencing relevant theoretical frameworks (see Frey et al., 2021) and by drawing on the COVID-19 pandemic to illustrate recent examples of age-related differences in real-life risk responses.</p

Adolescents’ and young adults’ online risk taking : the role of gist and verbatim representations

Young people are exposed to and engage in online risky activities, such as disclosing personal information and making unknown friends online. Little research has examined the psychological mechanisms underlying young people’s online risk taking. Drawing on Fuzzy Trace Theory, we examined developmental differences in adolescents’ and young adults’ online risk taking and assessed whether differential reliance on gist representations (based on vague, intuitive knowledge) or verbatim representations (based on specific, factual knowledge) could explain online risk taking. One hundred and twenty two adolescents (ages 13-17) and 172 young adults (ages 18-24) were asked about their past online risk taking behaviour, intentions to engage in future risky online behaviour, and gist and verbatim representations. Adolescents had significantly higher intentions to take online risks than young adults. Past risky online behaviours were positively associated with future intentions to take online risks for adolescents and negatively for young adults. Gist representations about risk negatively correlated with intentions to take risks online in both age groups, while verbatim representations positively correlated with online risk intentions, particularly among adolescents. Our results provide novel insights about the underlying mechanisms involved in adolescent and young adults’ online risk taking, suggesting the need to tailor the representation of online risk information to different age groups

Facebook sharenting in mothers of young children: the risks are worth it but only for some

Sharenting, or sharing information of children by parents on social media sites, has received much media attention. While offering many benefits, it may also contain risks. The current study used a mixed methods approach to investigate how understanding of risks and benefits alongside psychosocial variables affected the Facebook sharenting behaviour of 190 mothers with young children. Findings reveal that awareness of risks was associated with a decrease in posting frequency, although most still chose to share sensitive information such as pictures and activity information. Furthermore, mothers chose to focus on unlikely safeguarding concerns rather than long-term repercussions such as identity fraud or right to digital privacy. Negative experiences on social media were not associated with reduced posting. This result is particularly important given that perception of most risks outweighed the benefits. Psychosocial factors such as social anxiety may help explain why despite harbouring important privacy concerns parents continue to share sensitive information. Future research should focus on highlighting long-term repercussions in this parent population and theoretical work could benefit from incorporating an understanding of how psychological factors motivate and impact this behaviour

One Fish, Two Fish, Red Fish, Blue Fish: Effects of Price Frames, Brand Names, and Choice Set Size in Medicare Part D Insurance Plan Decisions

Because many seniors choose Medicare Part D plans offering poorer coverage at greater cost, the authors examined the effect of price frames, brand names, and choice set size on participants\u27 ability to choose the lowest cost plan. A 2×2×2 within-subjects design was used with 126 participants aged 18 to 91 years old. Mouselab, a web-based program, allowed participants to choose drug plans across eight trials that varied using numeric or symbolic prices, real or fictitious drug plan names, and three or nine drug plan options. Results from the multilevel models suggest numeric versus symbolic prices decreased the likelihood of choosing the lowest cost plan (-8.0 percentage points, 95% confidence interval=-14.7 to -0.9). The likelihood of choosing the lowest cost plan decreased as the amount of information increased suggesting that decision cues operated independently and collectively when selecting a drug plan. Redesigning the current Medicare Part D plan decision environment could improve seniors\u27 drug plan choices

Perception of Risk for Older Adults: Differences in Evaluations for Self versus Others and across Risk Domains

Background and Objectives: Proxy decision-making may be flawed by inaccurate perceptions of risk. This may be particularly true when older adults are the targets of the decisions, given the pervasive negative stereotypes about older adults. Methods: In study 1, individuals aged 18- to 87 years (as target persons) as well as one of their close social partners (as informants) reported on the risks they perceived for the target person in various life domains. Study 2 additionally explored potential differences in how people make risky decisions on behalf of younger and older adult targets. Younger (age 18–35 years) and older (age 60–81 years) adults (as target persons of the risk evaluations) as well as informants reported on risk perceptions and the likelihood of risk-taking for health, financial, and social scenarios concerning the target persons. Congruence between self-rated and informant-rated risk perceptions and risk-taking were computed on a dyadic as well as a group level. Results: Informants’ risk perceptions were positively associated with the risks their partners perceived for themselves. Informants and their partners agreed that social risks vary little across adulthood, but they disagreed in terms of recreational, financial, and health risks, and in terms of the decisions they would make. Conclusion: Family members, partners, and close friends are sensitive to vulnerabilities of their social partners, but in some domains and according to their partners’ age they perceive a greater (or smaller) risk than their partners perceive for themselves. In situations requiring surrogate decision-making, people may decide differently from how their social partners would decide for themselves

Risky choice in younger versus older adults: Affective context matters

Earlier frameworks have indicated that older adults tend to experience decline in their deliberative decisional capacity, while their affective abilities tend to remain intact (Peters, Hess, Västfjäll, & Auman, 2007). The present study applied this framework to the study of risky decision-making across the lifespan. Two versions of the Columbia Card Task (CCT) were used to trigger either affective decision-making (i.e., the “warm” CCT) or deliberative decision-making (i.e., the “cold” CCT) in a sample of 158 individuals across the lifespan. Overall there were no age differences in risk seeking. However, there was a significant interaction between age and condition, such that older adults were relatively more risk seeking in the cold condition only. In terms of everyday decision-making, context matters and risk propensity may shift within older adults depending upon the context

Does Medical Risk Perception and Risk Taking Change with Age?

Across adulthood, people face increasingly more risky medical problems and decisions. However, little is known about changes in medical risk taking across adulthood. Therefore, the current cross‐sectional study investigated age‐related differences in medical risk taking with N = 317 adults aged 20–77 years using newly developed scenarios to assess medical risk taking, and additional measures designed to evaluate risk‐taking behavior in the medical domain. Greater expected benefits on the Domain‐Specific Risk‐Taking Scale—Medical (DOSPERT‐M) predicted more active risk taking, whereas higher perceived risk predicted less active risk taking. Next, we examined differences in active and passive risk taking, where passive risk taking refers to risk taking that is associated with inaction. Age was associated with less passive risk taking, but not with active risk taking, risk perception, or expected benefits on the DOSPERT‐M. Participants were overall more likely to opt for taking medical action than not, even more so for a scenario about a vaccine for a deadly flu than for a scenario about a chemotherapy treatment for cancer. Overall, participants were more likely to accept medication (vaccine or chemotherapy) for their child than for themselves. Increasing age was associated with a lower likelihood of accepting the treatment or vaccine for oneself. Taken together, our study provides important insights about changes in medical risk taking across adulthood when people face an increasing number of complex and risky medical decisions

Willingness to test for BRCA1/2 in High Risk Women: Influenced by Risk Perception and Family Experience, rather than by Objective or Subjective Numeracy?

Genetic testing for breast and ovarian cancer can help target prevention programs, and possibly reduce morbidity and mortality. A positive result of BRCA1/2 is a substantial risk factor for breast and ovarian cancer, and its detection often leads to risk reduction interventions such as increased screening, prophylactic mastectomy and oophorectomy. We examined predictors of the decision to undergo cancer related genetic testing: perceived risk, family risk of breast or ovarian cancer, and numeracy as predictors of the decision to test among women at high risk of breast cancer. Stepwise regression analysis of survey responses from 459 women registered in the Cancer Genetics Network revealed greater likelihood to test for women with more family history, higher perceived risk of mutation, or Ashkenazi descent. Neither subjective nor objective numeracy was associated with the decision to test, although we replicated an earlier finding that subjective numeracy predicted willingness to pay for testing. Findings underscore the need for genetic counselling that disentangles risk perception from objective information to promote better decision-making in the context of genetic testing. Highlighting these factors is crucial for public health campaigns, as well as to clinic-based testing and direct-to-consumer testing. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Emotion Goals: What do Sexual Offenders Want to Feel?

Sexual offenders typically experience more negative emotions and greater difficulties in regulating emotions than non-offenders. However, limited data exist on what sexual offenders want to feel (i.e., their emotion goals). Notably, emotion goals play a key role in emotion regulation and contribute to emotional experience. The present study tested whether sexual offenders (N = 31) reported higher scores for negative emotion goals and lower scores for positive emotion goals, compared with general offenders (N = 26) and non-offenders (N = 26). In addition, we tested whether sexual offenders differed from the other two groups in their perceived pleasantness and perceived utility of emotions. Sexual offenders reported greater scores for the emotion goal of sadness, and lower scores for the emotion goal of excitement, compared with both general offenders and non-offenders. State and trait levels of these emotions could not fully account for these differences. Furthermore, sexual offenders reported lower perceived pleasantness for sadness than general offenders and lower perceived pleasantness for excitement compared with both other groups. Finally, sexual offenders reported greater perceived utility of sadness than non-offenders. These novel findings and their implications for research and interventions are discussed in the context of sexual offenders' emotional dysfunction