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

Associations of occupational attributes and excessive drinking

Numerous work-related drinking mechanisms have been posited and, oftentimes, examined in isolation. We combined data from over 100 occupational attributes into several factors and tested the association of these factors with measures of alcohol use. We used the NLSY79 2006 wave, a U.S. representative sample of 6,426 workers ages 41 to 49 and the 2006 Occupational Information Network database (O*NET), a nationally representative sample of nearly 1,000 occupations. We conducted exploratory factor analysis on 119 occupational attributes and found three independent workplace characteristics – physical demands, job autonomy, and social engagement - explained the majority of the variation. We then tested the association of these composite attributes with three drinking measures, before and after adjusting for gender, race/ethnicity, and a measure of human capital using count data models. We then stratified by gender and repeated our analyses. Men working in occupations with a one standard deviation higher level of physical demand (e.g. construction) reported a higher number of heavy drinking occasions (+20%,

Does Exposure and Receptivity to E-cigarette Advertisements Relate to E-cigarette and Conventional Cigarette Use Behaviors among Youth? Results from Wave 1 of the Population Assessment of Tobacco and Health Study

Background: E-cigarettes (EC) are the most commonly used tobacco product among youth. Additionally, youth EC users are progressing to smoking conventional cigarettes (CC). Although known to target youth, there are no current restrictions in the US on EC marketing, including advertising. The purpose of this study is to evaluate the relationship between EC advertisements and youth EC and CC use behaviors. Methods: This study analyzed data from youth (12-17 years) aware of EC in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) study (n=12,199). Weighted logistic regression models assessed whether exposure and receptivity to any of five randomized EC ads (two TV and three print) were associated with the outcomes of EC and CC behaviors of ever use, current (past 30 day) use, and susceptibility to future use. Additional analyses determined whether EC advertising exposure and EC and CC behaviors associations were moderated by EC advertising receptivity. All models were adjusted for sociodemographics, other combustible tobacco product use, and parent smoking. Results: EC advertisement exposure was significantly associated to ever and current EC use as well as susceptibility to EC and CC (p Conclusion: These findings demonstrate exposure to EC advertisements are particularly associated with EC use behaviors, but could play a role in future CC use as well. Youth who are receptive to EC advertisements appear particularly vulnerable. Further studies should focus on the role of receptivity to EC advertisements among youth in order to support regulatory policy targeting EC advertising

Differences in treatment for substance use disorders by insurance status: Self-help only versus outpatient medical treatment

Background: The role of insurance on substance use disorders (SUD) treatment utilization generally is poorly understood and still less is known on how insurance status relates to the use of evidence-based treatment (i.e., medicalization approach) compared to other treatments, like single self-help groups, where the research on effectiveness is less supportive. This study examines associations between health insurance and any SUD treatment utilization as well as use of single self- help versus medicalization approach. Methods: A cross-sectional study design was used. Data were from the 2015-2017, public use National Surveys on Drug Use and Health (NSDUH). Adjusted logistic regressions were used to examine the associations controlling for socio-demographics, recent major depressive episode, and survey year. All analyses used survey weights to be representative of the US population and account for the NSDUH’s complex survey design. Results: After adjustment for covariates, those with publicly insured remained more likely to use any SUD treatment in the past year (odd ratio [OR] 1.82; 95% CI: 1.36-2.43), compared to those without insurance. Further, compared with uninsured, those with public insurance reported lower odds of using only self-help treatment (OR 0.42; 95% CI: 0.23-0.74) versus medicalization approach utilization. Conclusions: Publicly insured persons with SUD are more likely to use SUD treatment in the past year than the uninsured. Uninsured people with SUD are more likely to use single self-help as a substitute for medicalization approach.https://scholarscompass.vcu.edu/gradposters/1098/thumbnail.jp

Job attributes, job satisfaction and the return to health after breast cancer diagnosis and treatment

Background: As detection and treatment of cancer has advanced, the number of working age women with breast cancer has increased. This study provides new information on the intersection of breast cancer treatment and job tasks and how, together, they impact employed and newly diagnosed women. Methods: The sample comprised 493 employed women within two months of initiating treatment. Job satisfaction and demands were assessed by pre-diagnosis recall along with measures of mental and physical health and assessed again nine months after initiating treatment. Using seemingly unrelated regression, we tested the effect of job tasks and satisfaction on mental and physical health nine months post-treatment initiation, controlling for pre-diagnosis health status, patient characteristics, and job tasks. Results: Physical job demands prior to diagnosis were not significantly associated with mental or physical health nine months after treatment initiation. Employment in cognitively demanding and less satisfying jobs was associated with decreases in mental health and increases in problems with work or daily activities nine months post-treatment initiation (p\u3c0.05). Women who received five or more cycles of chemotherapy reported lower vitality, social functioning, and worse measures of physical health compared to those who did not receive chemotherapy (p\u3c0.05). Conclusions: Employment in cognitively demanding and unsatisfying jobs may impede mental health recovery, particularly in patients who receive longer chemotherapy regimens. Such information may be used by patients and clinicians in deciding when to undergo chemotherapy and whether job tasks can be restructured to hasten recovery

Marginal abatement cost curves for UK agriculture, forestry, land-use and land-use change sector out to 2022

Greenhouse gas emissions from agriculture, land use, land use change and forestry (ALULUCF) are a significant percentage of UK industrial emissions. The UK Government is committed to ambitious targets for reducing emissions and all significant industrial sources are coming under increasing scrutiny. The task of allocating shares of future reductions falls to the newly appointed Committee on Climate Change (CCC), which needs to consider efficient mitigation potential across a range of sectors. Marginal abatement cost curves are derived for a range of mitigation measures in the agriculture and forestry sectors over a range of adoption scenarios and for the years 2012, 2017 and 2022. The results indicate that in 2022 around 6.36 MtCO2e could be abated at negative or zero cost. Further, in same year over 17% of agricultural GHG emissions (7.85MtCO2e) could be abated at a cost of less than the 2022 Shadow Price of Carbon (£34tCO2e).Environmental Economics and Policy,

MARGINAL ABATEMENT COST CURVES FOR UK AGRICULTURAL GREENHOUSE GAS EMISSIONS

This paper addresses the challenge of developing a ‘bottom-up’ marginal abatement cost curve (MACC) for greenhouse gas emissions from UK agriculture. A MACC illustrates the costs of specific crop, soil, and livestock abatement measures against a ‘‘business as usual’’ scenario. The results indicate that in 2022 under a specific policy scenario, around 5.38 MtCO2 equivalent (e) could be abated at negative or zero cost. A further 17% of agricultural GHG emissions (7.85 MtCO2e) could be abated at a lower unit cost than the UK Government’s 2022 shadow price of carbon (£34 (tCO2e)-1). The paper discusses a range of methodological hurdles that complicate cost-effectiveness appraisal of abatement in agriculture relative to other sectors.Climate change, Marginal abatement costs, Agriculture, Environmental Economics and Policy, Resource /Energy Economics and Policy, Q52, Q 54, Q58,

A synchrotron study of Ba5Ta2Cl2O9

The structure of pentabarium ditantalum dichloride nonaoxide, Ba5Ta2Cl2O9, is isotypic with Ba5Ru1.6W0.4Cl2O9 and with one polymorph of Ba5Ru2Cl2O9. It is related to the perovskite structure and shows a ten-layer stacking of BaO3 and BaCl blocks along the c axis. The Ta cations occupy octahedral interstices, forming Ta2O9 dimers of distorted face-shared TaO6 octahedra. Except for one O atom, all atoms are situated on special positions: Ba1 (Wyckoff position (6) over bar m2), Ba2 and Ba3 (3m.), Ta (3m.), Cl (3m.) and O1 (mm2)