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Objective There are many measures of health and/or financial literacy and/or numeracy, which vary widely in terms of length, content, and the extent to which numbers or math operations are involved. Although the literature is large, there is less considers what is known about math prediction and development, perhaps because the bulk of this literature is with adults. This is important because the literature on how math develops, what predicts it, and how to intervene with it, is very large (Cirino, 2022). To the extent that performance and prediction are similar, then information from the developmental literature of mathematics can be brought to bear with regard to health and financial numeracy. Here we assess math cognition variables (arithmetic concepts and number line estimation) alongside working memory, likely the most robust cognitive predictor of math, as well as sociodemographic covariates. We expect all predictors to relate to each type of outcome, though we expect reading to be more related to health and financial numeracy relative to symbolic math. Participants and Methods Participants were 238 young adults, diverse in language and race/ethnicity, enrolled in their first and entry-level college math class at either community college or university; approximately 30% were taking developmental coursework. For this study, participants were given three sets of analogous math problems: (a) pure symbolic; (b) health numeracy context; (c) financial numeracy context. Additional measures were of reading (KTEA-3 Reading Comprehension), math cognition (Arithmetic Concepts and Number Line Estimation), and complex span working memory (Symmetry Span and Reading Span). Correlations assessed relations, and multiple regression assessed prediction. Results All measures involving math correlated, though symbolic math less well than health and financial numeracy with one another. For symbolic math, math cognition and working memory together accounted for R2=56% variance, and all were unique predictors, with arithmetic concepts strongest (ηp2 = .19). For health numeracy, all predictors also accounted for R2=56% variance. Beyond symbolic math, math cognition and working memory were unique predictors (all p < .05); reading comprehension was not. The clearly strongest unique predictor was number line estimation (ηp2 = .06). For financial numeracy, all predictors accounted for R2=61% variance. Beyond symbolic math and reading comprehension, again math cognition and working memory were unique predictors (all p < .05), and again number line estimation was the strongest (ηp2 = .08). Results held with covariate control. Conclusions Math cognition and working memory are known important contributors to math skill. This study shows these to be equally important whether math is in a pure symbolic context, or a health and or financial context. This suggests that the utility of health and financial numeracy measures (and potentially the constructs themselves) needs to consider the underlying concomitants of math skill more generally, particularly as the extent to which numbers and/or specific math operations are used in such measures varies widely. Context is likely important, however, and future work will need to consider practical outcomes (e.g., risky health or financial behaviors and management) across a range of populations.
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Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services
Background: Despite recently expanded access to health insurance, consumers still face barriers to using their coverage to obtain needed health care. Objective: To examine the characteristics of those who delay or avoid health care due to costs. Methods: Participants were recruited via Amazon MTurk and completed a survey assessing demographic characteristics, financial toxicity, health care minimizer-maximizer tendencies, health insurance knowledge, numeracy, delaying/avoiding any care, and delaying/avoiding six common health care services (three preventive and three nonpreventive services). Validated measures were used when available. Delay/avoidance behaviors were categorized into delaying/avoiding any care, preventive care, and nonpreventive care. Logistic regression models examined 1) financial toxicity, 2) minimizer-maximizer tendencies, 3) numeracy, 4) health insurance knowledge, and 5) knowledge of preventive care coverage separately on three forms of delay/avoidance behaviors, controlling for chronic conditions, insurance status, and/or income where appropriate. Results: Of 518 respondents, 470 did not fail attention-check questions and were used in analyses. Forty-five percent of respondents reported delaying/avoiding care due to cost. Multivariable analyses found that financial toxicity was related to delaying/avoiding any care (odds ratio [OR] = 0.884, P < 0.001), preventive care (OR = 0.906, P < 0.001), and nonpreventive care (OR = 0.901, P < 0.001). A tendency to minimize seeking health care (OR = 0.734, P < 0.001) and lower subjective numeracy (OR = 0.794, P = 0.023) were related to delaying/avoiding any care. General health insurance knowledge (OR = 0.989, P = 0.023) and knowledge of preventive care coverage (OR = 0.422, P < 0.001) were related to delaying/avoiding preventive care. Conclusions: Many people delay or avoid health care due to costs, even when insured. Results suggest that there may be different reasons individuals delay or avoid preventive and nonpreventive care. Findings may inform interventions to educate consumers and support discussions about health care costs to facilitate appropriate health care utilization.
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- Award ID(s):
- 2001000
- PAR ID:
- 10277541
- Date Published:
- Journal Name:
- MDM Policy & Practice
- Volume:
- 3
- Issue:
- 1
- ISSN:
- 2381-4683
- Page Range / eLocation ID:
- 238146831876029
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1177/2381468318760298
