Tobacco use and health insurance literacy among vulnerable populations: implications for health reform

Abstract 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 < 0.05) after adjustment. Participants who were less educated, African American, and less numerate reported more difficulty understanding health insurance (p < 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

Единое образовательное пространство в рамках государств содружества

Prostate cancer is the most commonly diagnosed cancer in men. Evidence suggests that smokers may be at increased risk of prostate cancer compared to non-smokers. In the present study we ask whether adult men who smoke are also less likely to undergo screening for prostate cancer. Adult men aged 46 and above completed a single questionnaire including demographic items and items concerning their smoking status and previous testing for prostate cancer. The questionnaire also included an 11 item numeracy scale. Compared to smokers, non-smokers and ex-smokers were around two times more likely to have undergone screening for prostate cancer, and had been tested more frequently. Smokers are not only more likely to develop prostate cancer, they are, paradoxically, less likely to undergo screening for prostate cancer. Health care professionals need to be cognizant of individual differences in screening behavior and that smokers have a reduced likelihood of choosing to screen. © 2012 Elsevier Ltd

Cognitive ability and authoritarianism: Understanding support for Trump and Clinton

publisher: Elsevier articletitle: Cognitive ability and authoritarianism: Understanding support for Trump and Clinton journaltitle: Personality and Individual Differences articlelink: http://dx.doi.org/10.1016/j.paid.2016.10.054 content_type: article copyright: © 2016 Elsevier Ltd. All rights reserved

Call to claim your prize: Perceived benefits and risk drive intention to comply in a mass marketing scam.

Mass marketing scams extract an enormous toll, yet the literature on scams is just emerging. In Experiment 1, 211 adults reviewed a solicitation and rated their intention of contacting an "activation number" for a prize. Scarcity and authority were manipulated. Many (48.82%) indicated some willingness to contact to "activate" the winnings. Intention of responding was inversely related to the perception of risk (b = -.441, p < .001) and positively associated with perception of benefits (b = .554, p < .001), but not with the experimental condition. In Experiment 2, 291 adults were randomly assigned to one of the three conditions (low, medium, or high activation fee), and were asked to report willingness to contact. Activation fees decreased intent to contact, but percentages remained high (25.70%), with higher perception of risk reducing contact rates (b = -.581, p < .001), and benefit perception increasing intent to contact (b = .381, p < .001). Our studies indicate that consumers are responding to perceived risks and benefits in their decision-making, regardless of persuasion elements used by scammers. In summary, our studies find that consumers with lower levels of education and high perception of benefits are at increased risk for mass marketing scams. (PsycINFO Database Recor

Physician trainees' decision making and information processing: choice size and Medicare Part D.

Many patients expect their doctor to help them choose a Medicare prescription drug plan. Whether the size of the choice set affects clinicians' decision processes and strategy selection, and the quality of their choice, as it does their older patients, is an important question with serious financial consequences. Seventy medical students and internal medicine residents completed a within-subject design using Mouselab, a computer program that allows the information-acquisition process to be examined. We examined highly numerate physician trainees' decision processes, strategy, and their ability to pick the cheapest drug plan-as price was deemed the most important factor in Medicare beneficiaries' plan choice-from either 3 or 9 drug plans. Before adjustment, participants were significantly more likely to identify the lowest cost plan when facing three versus nine choices (67.3% vs. 32.8%, p<0.01) and paid significantly less in excess premiums ($60.00 vs.$128.51, p<0.01). Compared to the three-plan condition, in the nine-plan condition participants spent significantly less time acquiring information on each attribute (p<0.05) and were more likely to employ decision strategies focusing on comparing alternate plans across a single attribute (search pattern, p<0.05). After adjusting for decision process and strategy, numeracy, and amount of medical training, the odds were 10.75 times higher that trainees would choose the lowest cost Medicare Part D drug plan when facing 3 versus 9 drug plans (p<0.05). Although employing more efficient search strategies in the complex choice environment, physician trainees experienced similar difficulty in choosing the lowest cost prescription drug plans as older patients do. Our results add further evidence that simplifications to the Medicare Part D decision environment are needed and suggest physicians' role in their patients' Part D choices may be most productive when assisting seniors with forecasting their expected medication needs and then referring them to the Medicare website or helpline

Supplemental Material for 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 present study used a mixed-methods approach to investigate how understanding of risks and benefits alongside psychosocial variables affected the Facebook sharenting behavior 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 harboring 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 behavior

Ultrasound-guided Transvaginal Aspiration in the Management of Actinomyces Pelvic Abscess

Background: Increasing reports of intrauterine device (IUD)-related abdominopelvic actinomycosis have been described recently. Surgical therapy has been the usual treatment when tubo-ovarian abscess is identified

Correction: Prospective mental imagery as its link with anxiety and depression in prisoners

[This corrects the article DOI: 10.1371/journal.pone.0191551.]