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Strategy for improving health care for uninsured, low-income, and minorities in the US

A new set of strategies released today by the Commonwealth Fund Commission on a High Performance Health System could dramatically improve how the U.S. health care system serves vulnerable populations – those in the U.S. who are uninsured, low-income, or members of racial and ethnic minority groups.

According to the new report, Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations, closing the health care divide will require a three-pronged policy framework that ensures adequate access to health care and financial protection, strengthens the health care system’s ability to serve vulnerable populations, and supports coordination between the traditional health care system and the resources outside of the health care system that vulnerable groups rely upon.

The report highlights the significant divide between vulnerable populations and their more secure counterparts in rates of receiving recommended screening and preventive care, control of chronic diseases, and hospital admissions for conditions that may be preventable with good primary care and community health outreach. For example:

• Just four of 10 low-income adults receive all recommended screening and preventive care, compared with six of 10 higher-income adults.
• Nearly three of 10 (29%) uninsured adults diagnosed with diabetes do not have it well controlled, twice the rate of the insured (15%).
• Black adults are hospitalized for heart failure at rates (959 per 100,000) more than twice the rate for Hispanic adults (466 per 100,000), and nearly three times the rate for white adults (349 per 100,000).

“Our current economic situation has increased the number and proportion of people who are vulnerable, leaving even more families at risk of suffering from our health care system’s inequities,” said Commission Chair David Blumenthal, M.D., Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School. “The recommendations in this report can encourage policymakers to focus on the unique issues facing these populations, and work toward creating a high performance health system for all.”

The authors note that Affordable Care Act provisions targeted at vulnerable populations will go a long way toward improving health care for these groups, primarily through expanded health insurance, increased financial support for community health centers, and reforms that should improve health care quality and allow for people in vulnerable groups to receive better coordinated health care. However, vulnerable groups will remain at risk for poor health outcomes unless crucial issues beyond health insurance coverage like access to health care, affordability, care coordination, and the financial stability of safety-net hospitals are addressed.

A Policy Framework for Vulnerable Populations

In the report, the 17-member Commission lays out a policy framework that builds on Affordable Care Act reforms to create a more equitable health care system. The Commission comprises experts and leaders representing every sector of health care, as well as the state and federal policy arena, the business sector, professional societies, and academia.

The framework’s overarching strategies revolve around ensuring adequate access and financial protection, strengthening the care delivery systems serving vulnerable populations, and coordinating the traditional health care system with outside resources also affecting vulnerable groups. Highlights of the framework include:

• Create enough willing providers for Medicaid beneficiaries. To alleviate the shortage of providers, and particularly specialty care providers, willing to serve Medicaid patients, the Commission recommends considering payment reforms to reward high-quality networks of providers for providing optimal care for Medicaid beneficiaries, more equitable Medicaid payment rates, and developing the workforce needed to care for vulnerable populations.
• Stabilize health insurance coverage. The report recommends limiting gaps and disruptions in health insurance that come from job or income changes by actions such as guaranteeing year-long coverage periods, providing access to the same insurance plans in exchanges and in Medicaid, merging small-group and individual health insurance exchanges, coordinating eligibility and enrollment for all forms of subsidized insurance through the exchanges, and ensuring that adequate numbers of essential community providers are included in both Medicaid and the subsidized plans.
• Limit out-of-pocket health care costs. The Commission recommends protecting consumers – particularly low-income families who may struggle with out-of-pocket costs despite affordable premiums – from excessive out-of-pocket health care costs through insurance benefit designs with incentives to use effective care and reasonable income-related limits on overall out-of-pocket spending.
• Ensure the financial stability of the safety net while stimulating higher performance. Ensure adequate funding for the safety-net system to continue to provide services to vulnerable populations, and use those financial resources to stimulate and reward higher performance.
• Promote greater clinical integration in safety-net care systems. Payment reform and regulatory changes that explicitly encourage collaboration and affiliation should be used to encourage providers to work together across health care settings and assure coordinated care for patients. In addition, safety-net providers should be encouraged to participate in accountable care systems that serve vulnerable groups.
• Focus on comprehensive, coordinated, team-based primary care for all providers serving vulnerable populations. The report cites evidence that much of the disparity in care experienced by vulnerable populations can be eliminated if they receive patient- and family-centered primary care that emphasizes team-based care, care coordination, care management, and preventive care. In addition, coordination with mental health and substance abuse services are particularly important for vulnerable patients. Government and private payers could promote team-based care for vulnerable groups by giving incentives for providers and patients and offering technical assistance and supports.
• Foster an infrastructure of community-based support services. All providers serving vulnerable populations should be able to link their practices with community-based services like transportation, translation, or nutritional support, which they may need to fully access and benefit from the health care system to help meet their patients’ needs.
• Align efforts between the health care delivery system and public health services. Providers serving vulnerable populations, as well as state and federal government agencies, should promote coordination of efforts between the health care delivery system and local public health resources and programs to develop effective approaches to addressing medical issues that affect vulnerable groups like obesity, diabetes, and asthma.

“This policy framework builds on the great strides we expect to be made for vulnerable populations once the Affordable Care Act takes full effect in 2014,” said Commonwealth Fund Executive Vice President for Programs Anthony Shih, M.D. “By addressing crucial issues like access to care, affordability, quality improvement, and better coordinated care, these recommendations seek to assure that the uninsured, those with low incomes, and racial and ethnic minorities see the full promise of health reform and experience a truly equitable health care system.”

“The Affordable Care Act is a big step forward in terms of addressing the significant needs of vulnerable groups and the health care providers who serve them,” said Commonwealth Fund President Karen Davis. “However, the inequity in our health care system is significant and – as laid out in the Commission’s new report – more work must be done in order to close that gap and assure that we have a health care system that provides all of us with access to high quality health care.”

The Commission report, Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations, by Commonwealth Fund researchers Edward L. Schor, M.D., Julia Berenson, Anthony Shih, M.D., Sara R. Collins, Cathy Schoen, Pamela Riley, M.D., and Cara Dermody, will be available at http://www.commonwealthfund.org/Publications/Fund-Report/2011/Oct/Ensuring-Equity.aspx on Friday, October 7th, 2011.

The Commonwealth Fund Commission on a High Performance Health System, formed in April 2005, seeks opportunities to change the delivery and financing of health care to improve system performance and to identify public and private policies and practices that would lead to those improvements. It also explores mechanisms for financing improved health insurance coverage and investment in the nation’s capacity for quality improvement.

The Commission’s members are:

• David Blumenthal, M.D., M.P.P. (Chair), Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School
• Maureen Bisognano, M.Sc., Institute for Healthcare Improvement
• Sandra Bruce, M.S., Resurrection Health Care
• Christine K. Cassel, M.D., American Board of Internal Medicine and ABIM Foundation
• Michael Chernew, Ph.D., Department of Health Care Policy Harvard Medical School
• John M. Colmers, M.P.H., Health Care Transformation and Strategic Planning Johns Hopkins Medicine
• Patricia Gabow, M.D. Denver Health
• Glenn M. Hackbarth, J.D.Consultant
• George C. Halvorson Kaiser Foundation Health Plan Inc.
• Jon M. Kingsdale, Ph.D., Consultant
• Gregory P. Poulsen, M.B.A., Intermountain Health Care
• Neil R. Powe, M.D., M.P.H., M.B.A., San Francisco General Hospital
• Louise Y. Probst, R.N., M.B.A., St. Louis Area Business Health Coalition
• Martín J. Sepúlveda, M.D., FACP, IBM Corporation
• David A. Share, M.D., M.P.H., Blue Cross Blue Shield of Michigan
• Glenn D. Steele, Jr., M.D., Ph.D., Geisinger Health System
• Alan R. Weil, J.D., M.P.P., National Academy for State Health Policy

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.

Contact: Mary Mahon
mm@cmwf.org
212-606-3853
Commonwealth Fund

Report reveals economic, social costs of hunger in America

The Great Recession and the currently tepid economic recovery swelled the ranks of American households confronting hunger and food insecurity by 30 percent. In 2010 48.8 million Americans lived in food insecure households, meaning they were hungry or faced food insecurity at some point during the year. That’s 12 million more people than faced hunger in 2007, before the recession, and represents 16.1 percent of the U.S. population.

Yet hunger is not readily seen in America. We see neither newscasts showing small American children with distended bellies nor legions of thin, frail people lined up at soup kitchens. That’s primarily because the expansion of the critical federal nutrition assistance program, the Supplemental Nutrition Assistance Program, helped many families meet some of their household food needs.

But in spite of the increase in Supplemental Nutrition Assistance Program funding, many families still have to make tough choices between a meal and paying for other basic necessities. In 2010 nearly half of the households seeking emergency food assistance reported having to choose between paying for utilities or heating fuel and food. Nearly 40 percent said they had to choose between paying for rent or a mortgage and food. More than a third reported having to choose between their medical bills and food.

What’s more, the research in this paper shows that hunger costs our nation at least $167.5 billion due to the combination of lost economic productivity per year, more expensive public education because of the rising costs of poor education outcomes, avoidable health care costs, and the cost of charity to keep families fed. This $167.5 billion does not include the cost of the Supplemental Nutrition Assistance Program and the other key federal nutrition programs, which run at about $94 billion a year.

We call this $167.5 billion America’s hunger bill. In 2010 it cost every citizen $542 due to the far-reaching consequences of hunger in our nation. At the household level the hunger bill came to at least $1,410 in 2010. And because our $167.5 billion estimate is based on a cautious methodology, the actual cost of hunger and food insecurity to our nation is probably higher.

This report also estimates the state-by-state impact of the rising hunger bill from 2007 through 2010. Fifteen states experienced a nearly 40 percent increase in their hunger bill compared to the national increase of 33.4 percent. The sharpest increases in the cost of hunger are estimated to have occurred in Florida (61.9 percent), California (47.2 percent), and Maryland (44.2 percent).

Our research in this report builds upon and updates a 2007 report principally sponsored by the Sodexo Foundation and written by Brandeis University Professor Donald Shepard, the principal author of this report; Larry Brown, who was then on the faculty at of the Harvard School of Public Health; and Timothy Martin and John Orwat from Brandeis University. That initial report, “The Economic Costs of Domestic Hunger,” was the first to calculate the direct and indirect cost of adverse health, education, and economic productivity outcomes associated with hunger. This study extends the 2007 study, examining the recession’s impact on hunger and the societal costs to our nation and to each of the 50 states in 2007 and 2010. It also provides the first estimate of how much hunger contributes to the cost of special education, which we found to be at least $6.4 billion in 2010.

The 2007 report estimated America’s hunger bill to be $90 billion in 2005, sharply lower than the $167.5 billion bill in 2010. In the pages that follow, we will describe how we calculated our nation’s annual hunger bill. We then argue that any policy solutions to address the consequences of hunger in America should consider these economic calculations. The reason: We believe our procedures for expressing the consequences of this social problem in economic terms help policymakers gauge the magnitude of the problem and the economic benefits of potential solutions.

In this paper we do not make specific policy proposals beyond adopting our methodology for calculating hunger in America, but we do point out that expanding the Supplemental Nutrition Assistance Program to all food insecure households could cost about $83 billion a year. While we do not recommend this approach, we note that nonetheless it would cost the nation much less than the most recent hunger bill in 2010 of $167.5 billion.

There are other policy approaches that also could achieve sustained reduction in hunger and food insecurity – approaches that rely on a mix of federal policies to boost the wages of the lowest-wage earners, increase access to full-time employment, and modestly expand federal nutrition programs. These policies are consistent with the variables used to allocate federal nutrition funding to states under The Emergency Food Assistance Program. In using the state’s poverty and unemployment rates, this program recognizes that improved economic conditions reduce hunger and the need for emergency support.

Donald S. Shepard is a professor at the Heller School, Brandeis University, in Waltham, Massachusetts. Elizabeth Setren is an assistant economist at the Federal Reserve Bank of New York. Donna Cooper is a Senior Fellow with the Center for American Progress.

Contact: Susan Chaityn Lebovits
lebovits@brandeis.edu
718-736-4027
Brandeis University

Certain biofuel mandates unlikely to be met by 2022; unless new technologies, policies developed

It is unlikely the United States will meet some specific biofuel mandates under the current Renewable Fuel Standard by 2022 unless innovative technologies are developed or policies change, says a new congressionally requested report from the National Research Council, which adds that the standard may be an ineffective policy for reducing global greenhouse gas emissions. Achieving this standard would likely increase federal budget outlays as well as have mixed economic and environmental effects.

In 2005, Congress enacted the Renewable Fuel Standard as part of the Energy Policy Act and amended it in the 2007 Energy Independence and Security Act. The amended standard mandated that by 2022 the consumption volume of the renewable fuels should consist of:

• 15 billion gallons of conventional biofuels, mainly corn-grain ethanol;
• 1 billion gallons of biomass-based diesel fuel;
• 4 billion gallons of advanced renewable biofuels, other than ethanol derived from cornstarch, that achieve a life-cycle greenhouse gas threshold of at least 50 percent; and
• 16 billion gallons of cellulosic biofuels produced from wood, grasses, or non-edible plant parts — such as from corn stalks and wheat straw. Except for biodiesel, these volumes are measured in ethanol units.

The committee that wrote the report said that production of adequate volumes of biofuels are expected to meet consumption mandates for conventional biofuels and biomass-based diesel fuel. However, whether and how the mandate for cellulosic biofuels will be met is uncertain. Currently, no commercially viable biorefineries exist for converting cellulosic biomass to fuel. The capacity to meet the renewable fuel mandate for cellulosic biofuels will not be available unless the production process is unexpectedly improved and technologies are scaled up and undergo several commercial-scale demonstrations in the next few years. Additionally, policy uncertainties and high costs of production may deter investors from aggressive deployment, even though the government guarantees a market for cellulosic biofuels up to the level of the consumption mandate, regardless of price.

Greenhouse Gas Emissions

The extent to which using biofuels rather than petroleum will reduce greenhouse gas emissions is uncertain, the report says. How biofuels are produced and the changes in land use or land cover that occur in the process affect biofuels’ impact on such emissions. Dedicated energy crops will have to be grown to meet the mandate, which will probably require conversion of uncultivated land or the displacement of commodity crops and pastures. If the expanded production involves removing perennial vegetation on a piece of land and replacing it with an annual commodity crop, then the land-use change would incur a one-time greenhouse gas emission from biomass and soil that could be large enough to offset benefits gained by displacing petroleum-based fuels with biofuels over subsequent years. Such land conversion may disrupt any future potential for storing carbon in biomass and soil. In addition, the renewable fuel standard can neither prevent market-mediated effects nor control land-use or land-cover changes in other countries.

Economic Effects

Only in an economic environment characterized by high oil prices, technological breakthroughs, and a high implicit or actual carbon price would biofuels be cost-competitive with petroleum-based fuels, the committee concluded. The best cost estimates of cellulosic biofuel are not economical compared with fossil fuels when crude oil’s price is $111 per barrel. Furthermore, absent major increases in agricultural yields and improved efficiency in converting biomass to fuels, additional cropland will be required for growing cellulosic feedstock. This could create competition among different land uses and, in turn, raise cropland prices.

In addition, achieving the renewable fuel standard would increase the federal budget outlays, mostly as a result of increased spending on grants, loans, loan guarantees, and other payments to support the development of cellulosic biofuels and foregone revenue as a result of biofuel tax credits. Moreover, nutritional and other income assistance programs are often adjusted for changes in the general price level. If food retail prices go up, expenses could increase for the Supplemental Nutrition Assistance Program and Special Supplemental Assistance Program for Women, Infants, and Children, as well as for much larger income assistance programs, such as Social Security, military and civilian retirement programs, and Supplemental Security Income Program. Nevertheless, given that biofuels are only one of many factors affecting food retail prices, it will be hard to attribute any future increases in program costs to the standard alone.

Environmental Effects

Although biofuels hold potential for providing net environmental benefits compared with using petroleum-based fuels, specific environmental outcomes from increasing biofuels production to meet the renewable fuel consumption mandate cannot be guaranteed. The type of feedstocks produced, management practices used, land-use changes that feedstock production might incur, and such site-specific details as prior land use and regional water availability will determine the mandate’s environmental effects, the report says. Biofuels production has been shown to have both positive and negative effects on water quality, soil, and biodiversity. However, air-quality modeling suggests that production and use of ethanol to displace gasoline is likely to increase air pollutants such as particulate matter, ozone, and sulfur oxides. In addition, published estimates of water use over the life cycle of corn-grain ethanol are higher than petroleum-based fuels.

Barriers and Opportunities

Key barriers to achieving the renewable fuel mandate are the high cost of producing cellulosic biofuels compared with petroleum-based fuels and uncertainties in future biofuel markets, the report finds. Biofuel production is contingent on subsidies, the nature of the mandate, and similar policies. Although the mandate guarantees a market for the cellulosic biofuels produced, even at costs considerably higher than fossil fuels, uncertainties in enforcement and implementation of the mandated levels affect investors’ confidence and discourage investment. To reduce costs of biofuels, the committee suggested carrying out research and development to improve feedstock yield and increasing the conversion yield from biomass to fuels.

The study was sponsored by the U.S. Department of Agriculture, U.S. Department of Energy, and U.S. Environmental Protection Agency. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are independent, nonprofit institutions that provide science, technology, and health policy advice under an 1863 congressional charter. Panel members, who serve pro bono as volunteers, are chosen by the Academies for each study based on their expertise and experience and must satisfy the Academies’ conflict-of-interest standards. The resulting consensus reports undergo external peer review before completion. For more information, visit http://national-academies.org/studycommitteprocess.pdf. A panel roster follows.

Contacts:
Jennifer Walsh, Media Relations Officer
Shaquanna Shields, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu

Pre-publication copies of Renewable Fuel Standard: Potential Economic and Environmental Effects of U.S. Biofuel Policy are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

NATIONAL RESEARCH COUNCIL
Division on Earth and Life Studies
Board on Agriculture and Natural Resources
Board on Energy and Environmental Systems

Committee on Economic and Environmental Impacts of Increasing Biofuels Production

Lester B. Lave1 (chair, deceased)
Professor and Director
Tepper School of Business
Carnegie Mellon University
Pittsburgh

Ingrid C. Burke (co-chair)
Director
Haub School and Ruckelshaus Institute of
Environment and Natural Resources, and
Professor
Department of Botany
University of Wyoming
Laramie

Wallace E. Tyner (co-chair)
James and Lois Ackerman Professor of Agricultural Economics, and
Co-director
Center for Research on Energy Systems and Policy
Purdue University
West Lafayette, Ind.

Virginia H. Dale
Director
Center for Bioenergy Sustainability, and
Corporate Fellow
Environmental Sciences Division
Oak Ridge National Laboratory
Oak Ridge, Tenn.

Kathleen E. Halvorsen
Associate Professor of Natural Resource Policy
Michigan Technological University
Houghton

Jason D. Hill
Assistant Professor
Department of Bioproducts and Biosystems Engineering
University of Minnesota
St. Paul

Stephen R. Kaffka
Director
California Biomass Collaborative, and
Extension Specialist
Department of Plant Sciences
University of California
Davis

Kirk C. Klasing
Professor of Animal Nutrition
Department of Animal Science
University of California
Davis

Stephen J. McGovern
Consultant
PetroTech Consultants
Mantua, N.J.

John A. Miranowski
Professor of Economics
Iowa State University
Ames

Aristides A.N. Patrinos
President
Synthetic Genomics Inc.
La Jolla, Calif.

Jerald L. Schnoor 2
Allen S. Henry Chair in Engineering and Co-director
Department of Civil and Environmental Engineering
University of Iowa
Iowa City

David Schweikhardt
Professor
Department of Agricultural, Food, and Resource Economics
Michigan State University
East Lansing

Theresa L. Selfa
Assistant Professor
Department of Environmental Studies
State University of New York College of Environmental Science and Forestry
Syracuse

Brent L. Sohngen
Professor
Department of Agricultural, Environmental, and Development Economics
Ohio State University
Columbus

J. Andres Soria
Assistant Professor of Wood Chemistry
School of Natural Resources and Agricultural Science
University of Alaska
Palmer

RESEARCH COUNCIL STAFF

Kara Laney
Study Co-director

Evonne Tang
Study Co-director

1 Member, Institute of Medicine

2 Member, National Academy of Engineering

Contact: Jennifer Walsh
news@nas.edu
202-334-2138
National Academy of Sciences

Growing up in bad neighborhoods has a ‘devastating’ impact

Growing up in a poor neighborhood significantly reduces the chances that a child will graduate from high school, according to a study published in the current (October) issue of the American Sociological Review. And the longer a child lives in that kind of neighborhood, the more harmful the impact.

The study by sociologists Geoffrey Wodtke and David Harding of the University of Michigan and Felix Elwert of the University of Wisconsin is the first to capture the cumulative impact of growing up in America’s most disadvantaged neighborhoods on a key educational outcome: high school graduation.

“Compared to growing up in affluent neighborhoods, growing up in neighborhoods with high levels of poverty and unemployment reduces the chances of high school graduation from 96 percent to 76 percent for black children,” said Wodtke, a doctoral student who works with Harding at the U-M Institute for Social Research (ISR). “The impact on white children is also harmful, but not as large, reducing their chances of graduating from 95 percent to 87 percent.”

In contrast to earlier research that examined neighborhood effects on children at a single point in time, the new study uses data from the ISR Panel Study of Income Dynamics to follow 2,093 children from age 1 through age 17, assessing the neighborhoods in which they lived every year.

“We found that black and white children had starkly different patterns of exposure to bad neighborhoods over the long term,” Wodtke said. “Black children were about seven times more likely than white children to experience long-term residence in the most disadvantaged 20 percent of neighborhoods.”

For the study, the researchers defined disadvantaged neighborhoods as those characterized by high poverty, unemployment and welfare receipt, many female-headed households, and few well-educated adults.

“Our results indicate that sustained exposure to disadvantaged neighborhoods has a much greater negative impact on the chances a child will graduate from high school than earlier research has suggested,” Wodtke said.

“The current findings demonstrate the importance of neighborhoods throughout childhood, and resonate with evidence from several other studies suggesting that residence in disadvantaged neighborhoods may have a negative effect on the cognitive development of children many years or even generations later,” Harding said.

“And while our study does not speak to the efficacy of specific policy interventions needed to improve communities that have suffered decades of structural neglect, it seems likely that a lasting commitment to neighborhood improvement and income desegregation would be necessary to resolve the problems identified in our study.”

Harding and Wodtke are also affiliated with the U-M Department of Sociology, part of the College of Literature, Science, and the Arts.

ISR Panel Study of Income Dynamics: http://psidonline.isr.umich.edu

David Harding: www.psc.isr.umich.edu/people/profile/688

Felix Elwert: www.ssc.wisc.edu/soc/faculty/show-person.php?person_id=388

Established in 1949, the University of Michigan Institute for Social Research is the world’s largest academic social science survey and research organization, and a world leader in developing and applying social science methodology, and in educating researchers and students from around the world. ISR conducts some of the most widely cited studies in the nation, including the Thomson Reuters/University of Michigan Surveys of Consumers, the American National Election Studies, the Monitoring the Future Study, the Panel Study of Income Dynamics, the Health and Retirement Study, the Columbia County Longitudinal Study and the National Survey of Black Americans. ISR researchers also collaborate with social scientists in more than 60 nations on the World Values Surveys and other projects, and the institute has established formal ties with universities in Poland, China and South Africa. ISR is also home to the Inter-University Consortium for Political and Social Research, the world’s largest digital social science data archive. For more information, visit the ISR website at www.isr.umich.edu.

Contact: Diane Swanbrow
swanbrow@umich.edu
734-647-9069
University of Michigan

‘Finding yourself’ on Facebook

American teenagers are spending an ever-increasing amount of time online, much to the chagrin of parents who can’t seem to tear their children away from Twitter, YouTube, and Facebook. But despite the dangers that lurk on the web, the time that teens spend on the Internet can actually be beneficial to their healthy development, says a Tel Aviv University researcher.

Prof. Moshe Israelashvili of TAU’s Jaime and Joan Constantiner School of Education, with his M.A. student Taejin Kim and colleague Dr. Gabriel Bukobza, studied 278 teens, male and female, from schools throughout Israel. They found that many teens were using the Internet as a tool for exploring questions of personal identity, successfully building their own future lives using what they discover on the Web.

Prof. Israelashvili’s research, which was published in the Journal of Adolescence, encourages parents and educators to look at engagement with the online world as beneficial for teens. Social networking, he says, is a positive example of Internet use: “Facebook use is not in the same category as gambling or gaming.” As a result, Prof. Israelashvili says, researchers should redefine the characteristics of the disorder called “Internet addiction” in adolescents.

Redefining internet addiction

The TAU researchers asked the teens to rate themselves in terms of Internet use, ego clarification, and self-understanding, and how well they related to their peer group. The researchers discovered that there was a negative correlation between Internet overuse and the teens’ levels of ego development and clarity of self-perception. Prof. Israelashvili refers to it as an indication that some Internet use is destructive and isolating while some is informative and serves a socializing function.

These results show that the current understanding of adolescent Internet addiction demands redefinition. Psychiatrists now classify an “Internet addict” as a person who spends more than 38 hours on the Internet every week. But it’s the quality, not the quantity that matters, argues Prof. Israelashvili. The researchers determined that many teens who participated in the study met the psychiatric standard of “Internet addiction,” but were actually using the Internet as a tool to aid in their journey of self-discovery.

Prof. Israelashvili says that there are two different kinds of teenage “Internet addicts.” The first group is composed of adolescents who really are addicted, misusing the Internet with things like online gaming and gambling or pornographic websites, isolating themselves from the world around them. The other group of teens can be defined as “self clarification seekers,” whose use of the Internet helps them to comprehensively define their own identities and place in the world. These teens tend to use the Internet for social networking and information gathering, such as on news sites or Twitter.

Adding in family time

Parents and educators should change the conversations they have with teens about Internet use, the researchers urge. The Internet is a big part of our modern lifestyle, and both adults and children are spending more time there. As a result, what is important is how that time is used. Students must learn to use the Internet in a healthy way – as a source of knowledge about themselves in relation to their peers around the world, recommends Prof. Israelashvili.

If parents still don’t like the amount of time their teens are spending in front of the computer, they should consider becoming an information resource for their adolescent children, encouraging a healthy flow of conversation in the household itself. “Too many parents are too preoccupied,” says Prof. Israelashvili. “They demand high academic achievements, and place less importance on teaching their children how to face the world.” Teens won’t give up the Internet, but they may spend less time online if family interactions meet some of the same needs.

By the time teens reach the age of 18 or 19, they enter a new phase of life called “emerging adulthood,” in which they take the lessons of their adolescence and implement them to build a more independent life. If they have spent their teenage years worrying only about their academic performance or gaming, they won’t be able to manage well during their emerging adulthood and might have difficulties in making personal decisions and relate well to the world around them, Prof. Israelashvili concludes.

American Friends of Tel Aviv University (www.aftau.org) supports Israel’s leading, most comprehensive and most sought-after center of higher learning. Independently ranked 94th among the world’s top universities for the impact of its research, TAU’s innovations and discoveries are cited more often by the global scientific community than all but 10 other universities.

Internationally recognized for the scope and groundbreaking nature of its research and scholarship, Tel Aviv University consistently produces work with profound implications for the future.

Contact: George Hunka
ghunka@aftau.org
212-742-9070
American Friends of Tel Aviv University

Study ‘changes our understanding’ of youth voting behavior

Low-income youth are more apt to vote if they are engaged in political activism and influenced by friends and family, according to a study by Michigan State University education scholars that sheds new light on voting behavior.

Previous research held that poor youth tend to either vote or get involved in political activism such as peaceful protests, but not generally both. The new study, however, found a connection between political activism and the ballot box.

“This study changes our understanding of youths’ political behavior,” said Matthew Diemer, associate professor of education and lead researcher on the project.

The study is scheduled to run in the November/December print edition of the research journal Child Development.

It’s well known that young people from poor and working-class families tend to vote less often than affluent youth. Diemer and doctoral student Cheng-Hsien Li, both from MSU’s College of Education, set out to explore the factors involved in getting low-income youth engaged in politics.

They analyzed a sample from the national Civic and Political Health Survey, which gauges young people’s attitudes about government and sociopolitical issues. Their sample included 665 surveys from low-income participants under age 25.

Diemer said he controlled for civic and political knowledge, as young people who know more about these issues tend to be more engaged.

The researchers found that it was largely discussions with peers and parents – and not the influence of teachers – that fueled political engagement among low-income youth.

In some cases, Diemer said, individual schools or school districts may choose to steer clear of emphasizing issues such as social justice and racism in civics class. In other cases, civics teachers may not feel comfortable discussing potentially controversial issues with their students.

If civics teachers had more autonomy and freedom to engage students in discussions about politics and social-justice issues, Diemer said it would likely affect their participation in politics.

“The traditional civics class focuses on things like knowing the three branches of government. That’s still important, obviously, but I think it’s also important for students to understand what motivates people to participate in political and social issues and to have lasting commitments,” Diemer said.

“If we can have teachers spend time on this new type of civics,” he added, “then maybe we can get a generation of younger people who are more engaged politically.”

Contact: Matthew Diemer
diemerm@msu.edu
517-355-6684
Michigan State University

New analysis suggests Civil War took bigger toll than previously estimated

The Civil War – already considered the deadliest conflict in American history – in fact took a toll far more severe than previously estimated. That’s what a new analysis of census data by Binghamton University historian J. David Hacker reveals.

Hacker says the war’s dead numbered about 750,000, an estimate that’s 20 percent higher than the commonly cited figure of 620,000. His findings will be published in December in the journal Civil War History.

“The traditional estimate has become iconic,” Hacker says. “It’s been quoted for the last hundred years or more. If you go with that total for a minute – 620,000 – the number of men dying in the Civil War is more than in all other American wars from the American Revolution through the Korean War combined. And consider that the American population in 1860 was about 31 million people, about one-tenth the size it is today. If the war were fought today, the number of deaths would total 6.2 million.”

The 620,000 estimate, though widely cited, is also widely understood to be flawed. Neither the Union nor the Confederacy kept standardized personnel records. And the traditional estimate of Confederate war dead – 258,000 – was based on incomplete battle reports and a crude guess of deaths from disease and other non-combat causes. Although it is impossible to catalogue the fate of each of the 3 million or more men who fought in the war from 1861-65, some researchers have tried to re-count deaths in selected companies, regiments and areas. But Hacker says these attempts at a direct count will always miss people and therefore always underestimate deaths.

“There are also huge problems estimating mortality with census data,” Hacker explains. “You can track the number of people of certain ages from one census to the next, and you can see how many are missing. But the potential problem with that is that each census undercounted people by some unknown amount, and an unknown number of people moved in and out of the country between censuses.”

However, new data sets produced in the last 10 years or so, instead of giving the aggregate number of people in certain age groups, identify each person and his or her age, race and birthplace. Hacker realized that civilian deaths were so low relative to soldiers’ deaths that he could compare the number of native-born men missing in the 1870 Census relative to the number of native-born women missing and produce an estimate from that.

Hacker looked at the ratio of male survival relative to female survival for each age group. He established a “normal” pattern in survival rates for men and women by looking at the numbers for 1850-1860 and 1870-1880. Then he compared the war decade, 1860-1870, relative to the pattern.

His new estimate of Civil War deaths contains a wide margin: 650,000 to 850,000, with 750,000 as the central figure.

Pulitzer Prize-winner James McPherson, the preeminent living historian of the war, says he finds Hacker’s estimate plausible.

“Even if it might not be quite as high as 750,000, I have always been convinced that the consensus figure of 620,000 is too low, and especially that the figure of 260,000 Confederate dead is definitely too low,” McPherson says. “My guess is that most of the difference between the estimate of 620,000 and Hacker’s higher figure is the result of underreported Confederate deaths.”

Like earlier estimates, Hacker’s includes men who died in battle as well as soldiers who died as a result of poor conditions in military camps.

“Roughly two out of three men who died in the war died from disease,” Hacker says. “The war took men from all over the country and brought them all together into camps that became very filthy very quickly.” Deaths resulted from diarrhea, dysentery, measles, typhoid and malaria, among other illnesses.

McPherson says the new figure should gain acceptance among historians of the era.

“An accurate tally – or at least a reasonable estimate – is important in order to gauge the huge impact of the war on American society,” he says. “Even if the number of war dead was ‘only’ 620,000, that still created a huge impact, especially in the South, and a figure of 750,000 makes that impact – and the demographic shadow it threw on the next two generations of Americans – just that much greater.”

Contact: Gail Glover
gglover@binghamton.edu
607-777-2174
Binghamton University

Power corrupts, especially when it lacks status

Ever wonder why that government clerk was so rude and condescending? Or why the mid-level manager at your company always doles out the most demeaning tasks? Or, on a more profound level, why the guards at Abu Ghraib tortured and humiliated their prisoners?

In a new study, researchers at USC, Stanford and the Kellogg School of Management have found that individuals in roles that possess power but lack status have a tendency to engage in activities that demean others. According to the study, “The Destructive Nature of Power without Status,” the combination of some authority and little perceived status can be a toxic combination.

The research, forthcoming in the Journal of Experimental Social Psychology, is “based on the notions that a) low-status is threatening and aversive and b) power frees people to act on their internal states and feelings.” The study was conducted by Nathanael Fast, assistant professor of management and organization at the USC Marshall School of Business; Nir Halevy, acting assistant professor of organizational behavior at the Stanford Graduate School of Business; and Adam Galinsky, professor of management and organizations at the Kellogg School of Management at Northwestern University.

To test their theses, the authors conducted an experiment with students who were told they would be interacting with a fellow student in a business exercise and were randomly assigned to either a high-status “Idea Producer” role or low-status “Worker” role. Then these individuals were asked to select activities from a list of 10 for the others to perform; some of the tasks were more demeaning than others.

The experiment demonstrated that “individuals in high-power/low-status roles chose more demeaning activities for their partners (e.g., bark like a dog three times) than did those in any other combination of power and status roles.”

According to the study, possessing power in the absence of status may have contributed to the acts committed by U.S. soldiers in the Abu Ghraib prison in Iraq in 2004. That incident was reminiscent of behaviors exhibited during the famous Stanford Prison Experiment with undergraduate students that went awry in the early 1970s. In both cases the guards had power, but they lacked respect and admiration in the eyes of others and in both cases prisoners were treated in extremely demeaning ways.

Fast said that he and his colleagues focused on the relationship between power and status because “although a lot of work has looked at these two aspects of hierarchy, it has typically looked at the isolated effects of either power or status, not both. We wanted to understand how those two aspects of hierarchy interact. We predicted that when people have a role that gives them power but lacks status – and the respect that comes with that status – then it can lead to demeaning behaviors. Put simply, it feels bad to be in a low status position and the power that goes with that role gives them a way to take action on those negative feelings.”

Social hierarchy, the study says, does not on its own generate demeaning tendencies. In other words, the idea that power always corrupts may not be entirely true. Just because someone has power or, alternatively, is in a “low status” role does not mean they will mistreat others. Rather, “power and status interact to produce effects that cannot be fully explained by studying only one or the other basis of hierarchy.”

One way to overcome this dynamic, according to the authors, is to find ways for all individuals, regardless of the status of their roles, to feel respected and valued. The authors write: “…respect assuages negative feelings about their low-status roles and leads them to treat others positively.”

Opportunities for advancement may also help. “If an individual knows he or she may gain a higher status role in the future, or earn a bonus for treating others well, that may help ameliorate their negative feelings and behavior,” Fast said.

The researchers conclude, however, that, “Our findings indicate that the experience of having power without status, whether as a member of the military or a college student participating in an experiment, may be a catalyst for producing demeaning behaviors that can destroy relationships and impede goodwill.”

Contact: Amy Blumenthal
amyblume@marshall.usc.edu
213-740-5552
University of Southern California

Intuitive thinking may influence belief in God

Intuition may lead people toward a belief in the divine and help explain why some people have more faith in God than others, according to research published by the American Psychological Association.

In a series of studies, researchers at Harvard University found that people with a more intuitive thinking style tend to have stronger beliefs in God than those with a more reflective style. Intuitive thinking means going with one’s first instinct and reaching decisions quickly based on automatic cognitive processes. Reflective thinking involves the questioning of first instinct and consideration of other possibilities, thus allowing for counterintuitive decisions.

“We wanted to explain variations in belief in God in terms of more basic cognitive processes,” researcher Amitai Shenhav said. “Some say we believe in God because our intuitions about how and why things happen lead us to see a divine purpose behind ordinary events that don’t have obvious human causes. This led us to ask whether the strength of an individual’s beliefs is influenced by how much they trust their natural intuitions versus stopping to reflect on those first instincts.”

The research was published online in the Journal of Experimental Psychology: General. The study from the Harvard University Psychology Department was conducted by Shenhav, a doctoral student; post-doctoral fellow David Rand, PhD; and associate professor Joshua Greene, PhD.

In the first part of the study, 882 U.S. adults, with a mean age of 33 and consisting of 64 percent women, completed online surveys about their belief in God before taking a cognitive reflection test. The test had three math problems with incorrect answers that seemed intuitive. For example, one question stated: “A bat and a ball cost $1.10 in total. The bat costs $1 more than the ball. How much does the ball cost?” The automatic or intuitive answer is 10 cents, but the correct answer is 5 cents. Participants who had more incorrect answers showed a greater reliance on intuition than reflection in their thinking style.

Participants who gave intuitive answers to all three problems were 1 ½ times as likely to report they were convinced of God’s existence as those who answered all of the questions correctly. That pattern was found regardless of other demographic factors, such as the participants’ political beliefs, education or income. “How people think — or fail to think — about the prices of bats and balls is reflected in their thinking, and ultimately their convictions, about the metaphysical order of the universe,” the journal article stated.

Participants with an intuitive thinking style also were more likely to have become more confident believers in God over their lifetimes, regardless of whether they had a religious upbringing. Individuals with a reflective style tended to become less confident in their belief in God. The study also found that this pronounced link between differing thinking styles and levels of faith could not be explained by differences in the participants’ thinking ability or IQ. “Basic ways of thinking about problem solving in your everyday life are predictive of how much you believe in God,” Rand said. “It’s not that one way is better than the other. Intuitions are important and reflection is important, and you want some balance of the two. Where you are on that spectrum affects how you come out in terms of belief in God.”

In another study, with 373 participants, the researchers found they could temporarily influence levels of faith by instructing participants to write a paragraph describing a personal experience where either intuitive or reflective thinking led to a good result. One group was told to describe a time in their lives when intuition or first instinct led to a good outcome, while a second group was instructed to write about an experience where a good outcome resulted from reflecting and carefully reasoning through a problem. When they were surveyed about their beliefs after the writing exercise, participants who wrote about a successful intuitive experience were more likely to report they were convinced of God’s existence than those who wrote about a successful reflective experience.

These studies suggest a causal link between intuitive thinking and a belief in God, but the researchers acknowledged the opposite may also be true, that a belief in God may lead to intuitive thinking. Future research will help explore how cognitive styles are influenced by genes and environmental factors, such as upbringing and education, Rand said.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 154,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

Article: “Divine Intuition: Cognitive Style Influences Belief in God,” Amitai Shenhav; David G. Rand, PhD; and Joshua D. Greene, PhD; Harvard University; Journal of Experimental Psychology: General; online.

Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/pubs/journals/releases/xge-ofp-shenhav.pdf Amitai Shenhav can be contacted at ashenhav@wjh.harvard.edu or (510) 388-0469.

Contact: APA Public Affairs
public.affairs@apa.org
202-336-5700
American Psychological Association

Black white marriages increased rapidly since 1980s, study finds

A new study of interracial marriages in the United States since the 1980s suggests that the racial boundary between blacks and whites continues to break down, but is not yet close to disappearing. The study, published in the Journal of Marriage and Family, reveals that marriages between black and white populations have continued to increase while Latin and Hispanic Americans have turned to marrying their racial compatriots from newly arrived immigrant populations.

Marriages between African Americans and whites increased rapidly between 1980 and 2008, outpacing the rate of unions between whites and other ethnic and racial groups, including Latinos, Asian Americans and American Indians. However, the total number of marriages between blacks and whites continues to be much smaller than those between whites and other racial and ethnic groups.

“The number of marriages between whites and African Americans is undeniably increasing rapidly, but it is still a small number,” said Zhenchao Qian, lead author of the study and professor of sociology at Ohio State University. “Our results point to better race relations in 2008 than 1980, but we still have a way to go. The racial boundary is blurred, but it is still there.”

In 1980, only 5 percent of black men married a white woman, but that increased to 14 percent in 2008. Still, by comparison, 38 percent of Asian American men and Hispanic men married a white woman in 2008.

The study uses data from the 2008 American Community Survey, an ongoing survey of American households conducted by the U.S. Census bureau. The survey includes about 3 million people a year. The researchers also use data from the 1980 U.S. census.

“Understanding changes in interracial marriages is complex because it involves two different factors,” said Qian, “the marriage market of who is available to marry and also individuals’ choices about who they would be willing to marry.”

Overall, while marriages between blacks and whites showed large increases between 1980 and 2008, there was only a slight increase in marriages between whites and Hispanics while the results showed that marriages between U.S. born and foreign born Asians and Hispanics increased rapidly between 2000 and 2008.

This is due to the increase in immigration of Hispanics and Asians into the United States resulting in a larger pool of potential marriage partners from their own racial and ethnic groups.

“With the enormous growth of the immigrant population, Asians and Hispanics now have more opportunities than ever to find a marital partner who shares the same cultural background. Such marriages reinforce their cultural identity,” said co-author Dr Daniel Lichter from Cornell University.

“It used to be that race trumped everything, including education, when it came to marriage between blacks and whites; that is changing,” concluded Qian “For the first time, we found that highly educated blacks and whites were more likely to intermarry. That is very significant and is another sign that racial boundaries are blurring.”

Contact: Ben Norman
Scholarlynews@wiley.com
44-012-437-70375
Wiley-Blackwell

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