National Opinion Research Center

The responsiveness of government policies to citizens' preferences is a central concern of various normative and empirical theories of democracy. Examining public opinion and policy data for the United States from 1935 to 1979, we find considerable congruence between changes in preferences and in policies, especially for large, stable opinion changes on salient issues. We present evidence that pubic opinion is often a proximate cause of policy, affecting policy more than policy influences opinion. One should be cautious, however, about concluding that democratic responsiveness pervades American politics.

This study compared three methods of collecting survey data about sexual behaviors and other sensitive topics: computer-assisted personal interviewing (CAPI), computer-assisted self-administered interviewing (CASI), and audio computer-assisted self-administered interviewing (ACASI). Interviews were conducted with an area probability sample of more than 300 adults in Cook County, Illinois. The experiment also compared open and closed questions about the number of sex partners and varied the context in which the sex partner items were embedded. The three mode groups did not differ in response rates, but the mode of data collection did affect the level of reporting of sensitive behaviors: both forms of self-administration tended to reduce the disparity between men and women in the number of sex partners reported. Self-admimstration, especially via ACASI, also increased the proportion of respondents admitting that they had used illicit drugs. In addition, when the closed answer options emphasized the low end of the distribution, fewer sex partners were reported than when the options emphasized the high end of the distribution; responses to the open-ended versions of the sex partner items generally fell between responses to the two closed versions.

We begin this article with the assumption that attitudes are best understood as structures in long-term memory, and we look at the implications of this view for the response process in attitude surveys. More specifically, we assert that an answer to an attitude question is the product of a four-stage process. Respondents first interpret the attitude question, determining what attitude the ques-tion is about. They then retrieve relevant beliefs and feelings. Next, they apply these beliefs and feelings in rendering the appropriate judgment. Finally, they use this judgment to select a response. All four of the component processes can be affected by prior items. The prior items can provide a framework for interpreting later questions and can also make some responses appear to be redundant with earlier answers. The prior items can prime some beliefs, making them more accessible to the retrieval process. The prior items can suggest a norm or standard of comparison for making the judgment. Finally, the prior items can create consistency pressures or pressures to appear moderate. Because of the multiple processes involved, context effects are difficult to predict and sometimes difficult to replicate. We attempt to sort out when context is likely to affect later responses and include a list of the variables that affect the size and direction of the effects of context. Within social psychology, there is an emerging consensus that attitudes are best understood as structures that reside in long-term memory (Fazio, Sanbonmatsu, Powell, & Kardes, 1986;

Contrary to common stereotypes, loneliness is not restricted to old age but can occur at any life stage. In this study, we used data from a large, nationally representative German study (N = 16,132) to describe and explain age differences in loneliness from late adolescence to oldest old age. The age distribution of loneliness followed a complex nonlinear trajectory, with elevated loneliness levels among young adults and among the oldest old. The late-life increase in loneliness could be explained by lower income levels, higher prevalence of functional limitations, and higher proportion of singles in this age group. Consistent with an age-normative perspective, the association of income, relationship status, household size, and work status with loneliness differed between different age groups. In contrast, indicators of the quantity of social relationships (social engagement, number of friends, contact frequency) were universally associated with loneliness regardless of age. Overall, these findings show that sources of loneliness in older adults are well understood. Future research should focus on understanding the specific sources of loneliness in middle-aged adults. (PsycINFO Database Record

UNLABELLED: We estimated the global burden of hepatitis E virus (HEV) genotypes 1 and 2 in 2005. HEV is an emergent waterborne infection that causes source-originated epidemics of acute disease with a case fatality rate thought to vary by age and pregnancy status. To create our estimates, we modeled the annual disease burden of HEV genotypes 1 and 2 for 9 of 21 regions defined for the Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2010 Study), which represent 71% of the world's population. We estimated the seroprevalence of anti-HEV antibody and annual incidence of infection for each region using data from 37 published national studies and the DISMOD 3, a generic disease model designed for the GBD Study. We converted incident infections into three mutually exclusive results of infection: (1) asymptomatic episodes, (2) symptomatic disease, and (3) death from HEV. We also estimated incremental cases of stillbirths among infected pregnant women. For 2005, we estimated 20.1 (95% credible interval [Cr.I.]: 2.8-37.0) million incident HEV infections across the nine GBD Regions, resulting in 3.4 (95% Cr.I.: 0.5-6.5) million symptomatic cases, 70,000 (95% Cr.I.: 12,400-132,732) deaths, and 3,000 (95% Cr.I.: 1,892-4,424) stillbirths. We estimated a probability of symptomatic illness given infection of 0.198 (95% Cr.I.: 0.167-0.229) and a probability of death given symptomatic illness of 0.019 (95% Cr.I.: 0.017-0.021) for nonpregnant cases and 0.198 (95% Cr.I.: 0.169-0.227) for pregnant cases. CONCLUSION: The model was most sensitive to estimates of age-specific incidence of HEV disease.

This paper presents the first systematic attempt by economists to analyze the determinants of individuals' participation in religious activities. A multiperiod utility-maximizing model of household behavior is developed which includes among its implications the shape of a household's life-cycle religious-participation profile and the division of religious participation between husband and wife. The theory is empirically tested using statewide church-membership data and survey data on individuals' frequency of church attendance. The paper concludes by discussing several extensions of the model which lead to additional potentially testable hypotheses.

Democratic theory must pay attention to what influences public opinion. In this study the content of network television news is shown to account for a high proportion of aggregate changes (from one survey to another) in U.S. citizens' policy preferences. Different news sources have different effects. News commentators (perhaps reflecting elite or national consensus or media biases) have a very strong positive impact, as do experts. Popular presidents tend to have positive effects, while unpopular presidents do not. In contrast, special interest groups tend to have a negative impact.

OBJECTIVES: To examine the relationships between socioeconomic status (SES) and health across the life course and their variations by gender and race/ethnicity. METHODS: The sample included 19,949 respondents aged 50 or over from the 1998 Health and Retirement Study. RESULTS: Lower childhood SES was associated with worse health outcomes in later life. Part of the effect of childhood SES on adult health occurred through childhood health. The impact of childhood SES on education and income in adulthood explained an even larger share of this effect. We also found a stronger effect of adult SES for those with lower childhood SES than for those with more advantaged childhoods. Moreover, childhood SES had a similar impact on health in later life for women and men and for Whites and non-Whites. However, college education seemed more important for women's later health, whereas income seemed more important for men's health. Education appeared to have a weaker effect on adult health for Blacks and Hispanics than for Whites. DISCUSSION: Both childhood and adult SES are important for health. The negative impact of low childhood SES can be partially ameliorated if people from a low SES position during childhood mobilize to higher status in adulthood.

Estimates of the upper limits to human longevity have important policy implications that directly affect forecasts of life expectancy, active life expectancy, population aging, and social and medical programs tied to the size and health status of the elderly population. In the past, investigators have based speculations about the upper limits of human longevity on observations of past trends in mortality. Here the estimate of the upper bound is based on hypothesized reductions in current mortality rates necessary to achieve a life expectancy at birth from 80 to 120 years and an expectation of life at age 50 from 30 to 70 years. With the use of conditional probabilities of death from complete life tables for the United States, reductions in mortality required to achieve extreme longevity (that is, 80 to 120 years) were compared with those resulting from hypothetical cures for all cardiovascular diseases, ischemic heart disease, diabetes, and cancer. Results indicate that in order for life expectancy at birth to increase from present levels to what has been referred to as the average biological limit to life (age 85), mortality rates from all causes of death would need to decline at all ages by 55%, and at ages 50 and over by 60%. Given that hypothetical cures for major degenerative diseases would reduce overall mortality by 75%, it seems highly unlikely that life expectancy at birth will exceed the age of 85.

Expected a posteriori (EAP) estimation of ability, based on numerical evaluation of the mean and variance of the posterior distribution, is shown to have unusually good properties for computerized adaptive testing. The calculations are not complex, precede noniteratively by simple summation of log likelihoods as items are added, and require only values of the response function obtainable from precalculated tables at a limited number of quadrature points. Simulation studies are reported showing the near equivalence of the posterior standard deviation and the standard error of measurement. When the adaptive testings terminate at a fixed posterior standard deviation criterion of .90 or better, the regression of the EAP estimator on true ability is virtually linear with slope equal to the reliability, and the measurement error homogeneous, in the range ± 2.5 standard deviations.

Past studies have offered diverse estimates of the role of policy preferences, party loyalties, candidate personalities and other factors in voting decisions. Most have postulated recursive (that is, one-way) causal relationships among the central variables. This study specifies a non-recursive simultaneous equation model and estimates its parameters for the 1972 and 1976 elections using CPS data. The estimates differ markedly from those of simple recursive models. Policy preferences appear to have much more influence on voting decisions, and party attachments much less, than was previously thought. Candidate evaluations strongly affect voters' perceptions of closeness to candidates on policy issues. Party identification may be influenced by short-term factors. Differences between 1972 and 1976 reflect the issue-oriented McGovern candidacy. Simultaneous equation models offer no cure-all; in the absence of accepted theory many specifications are open to controversy. But future research must take account of reciprocal causal paths.

A method of item factor analysis based on Thur stone's multiple-factor model and implemented by marginal maximum likelihood estimation and the EM algorithm is described. Statistical significance of suc cessive factors added to the model is tested by the likelihood ratio criterion. Provisions for effects of guessing on multiple-choice items, and for omitted and not-reached items, are included. Bayes constraints on the factor loadings are found to be necessary to suppress Heywood cases. Numerous applications to simulated and real data are presented to substantiate the accuracy and practical utility of the method. Index terms: Armed Services Vocational Aptitude Bat tery, Beta prior, EM algorithm, Item factor analysis, TESTFACT, Tetrachoric correlation.

BACKGROUND AND METHODS: In order to elucidate the medical care of patients with human immunodeficiency virus (HIV) infection in the United States, we randomly sampled HIV-infected adults receiving medical care in the contiguous United States at a facility other than military, prison, or emergency department facility during the first two months of 1996. We interviewed 76 percent of 4042 patients selected from among the patients receiving care from 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas. RESULTS: During the first two months of 1996, an estimated 231,400 HIV-infected adults (95 percent confidence interval, 162,800 to 300,000) received care. Fifty-nine percent had the acquired immunodeficiency syndrome according to the case definition of the Centers for Disease Control and Prevention, and 91 percent had CD4+ cell counts of less than 500 per cubic millimeter. Eleven percent were 50 years of age or older, 23 percent were women, 33 percent were black, and 49 percent were men who had had sex with men. Forty-six percent had incomes of less than $10,000 per year, 68 percent had public health insurance or no insurance, and 30 percent received care at teaching institutions. The estimated annual direct expenditures for the care of the patients seen during the first two months of 1996 were $5.1 billion; the expenditures for the estimated 335,000 HIV-infected adults seen at least as often as every six months were $6.7 billion, which is about $20,000 per patient per year. CONCLUSIONS: In this national survey we found that most HIV-infected adults who were receiving medical care had advanced disease. The patient population was disproportionately male, black, and poor. Many Americans with diagnosed or undiagnosed HIV infection are not receiving medical care at least as often as every six months. The total cost of medical care for HIV-infected Americans accounts for less than 1 percent of all direct personal health expenditures in the United States.

This paper uses a permanent income model as a laboratory to study how consumption /savings profiles and security market prices are altered when consumers are `robust decision makers'. Robust decision makers use the same probabilistic specification of the income and endowment shocks as would expected utility maximizers. But they regard this specification as a reference point about which they suspect small specification errors. They want decisions to be insensitive to these errors. This leads them to focus on consequences of their decisions under `worst cases'. We show that such a preference for robustness lies concealed within the quantity implications of the permanent income model, and how its presence can be coaxed out of market-based measures of `risk-aversion'. Indeed, we show that large market-based measures of risk aversion can emerge from a concern about making small specification errors. The first part of this paper reinterprets the decision rules for saving and consumption from a rational expectations version of Hall's (1978) permanent income model. We verify identical behavior by someone who does not know enough about the probability laws for income and preference shocks to have rational expectations, and who manages his ignorance about them in a sophisticated and cautious way.

BACKGROUND: Although there have been many studies of physician-assisted suicide and euthanasia in the United States, national data are lacking. METHODS: In 1996, we mailed questionnaires to a stratified probability sample of 3102 physicians in the 10 specialties in which doctors are most likely to receive requests from patients for assistance with suicide or euthanasia. We weighted the results to obtain nationally representative data. RESULTS: We received 1902 completed questionnaires (response rate, 61 percent). Eleven percent of the physicians said that under current legal constraints, there were circumstances in which they would be willing to hasten a patient's death by prescribing medication, and 7 percent said that they would provide a lethal injection; 36 percent and 24 percent, respectively, said that they would do so if it were legal. Since entering practice, 18.3 percent of the physicians (unweighted number, 320) reported having received a request from a patient for assistance with suicide and 11.1 percent (unweighted number, 196) had received a request for a lethal injection. Sixteen percent of the physicians receiving such requests (unweighted number, 42), or 3.3 percent of the entire sample, reported that they had written at least one prescription to be used to hasten death, and 4.7 percent (unweighted number, 59), said that they had administered at least one lethal injection. CONCLUSIONS: A substantial proportion of physicians in the United States report that they receive requests for physician-assisted suicide and euthanasia, and about 7 percent of those who responded to our survey have complied with such requests at least once.

Sociality permeates each of the fundamental motives of human existence and plays a critical role in evolutionary fitness across the lifespan. Evidence for this thesis draws from research linking deficits in social relationship--as indexed by perceived social isolation (i.e. loneliness)--with adverse health and fitness consequences at each developmental stage of life. Outcomes include depression, poor sleep quality, impaired executive function, accelerated cognitive decline, unfavourable cardiovascular function, impaired immunity, altered hypothalamic pituitary-adrenocortical activity, a pro-inflammatory gene expression profile and earlier mortality. Gaps in this research are summarized with suggestions for future research. In addition, we argue that a better understanding of naturally occurring variation in loneliness, and its physiological and psychological underpinnings, in non-human species may be a valuable direction to better understand the persistence of a 'lonely' phenotype in social species, and its consequences for health and fitness.

OBJECTIVE: We evaluated the association between parents' beliefs about vaccines, their decision to delay or refuse vaccines for their children, and vaccination coverage of children at aged 24 months. METHODS: We used data from 11,206 parents of children aged 24-35 months at the time of the 2009 National Immunization Survey interview and determined their vaccination status at aged 24 months. Data included parents' reports of delay and/or refusal of vaccine doses, psychosocial factors suggested by the Health Belief Model, and provider-reported up-to-date vaccination status. RESULTS: In 2009, approximately 60.2% of parents with children aged 24-35 months neither delayed nor refused vaccines, 25.8% only delayed, 8.2% only refused, and 5.8% both delayed and refused vaccines. Compared with parents who neither delayed nor refused vaccines, parents who delayed and refused vaccines were significantly less likely to believe that vaccines are necessary to protect the health of children (70.1% vs. 96.2%), that their child might get a disease if they aren't vaccinated (71.0% vs. 90.0%), and that vaccines are safe (50.4% vs. 84.9%). Children of parents who delayed and refused also had significantly lower vaccination coverage for nine of the 10 recommended childhood vaccines including diphtheria-tetanus-acellular pertussis (65.3% vs. 85.2%), polio (76.9% vs. 93.8%), and measles-mumps-rubella (68.4% vs. 92.5%). After adjusting for sociodemographic differences, we found that parents who were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe had significantly lower coverage for all 10 childhood vaccines. CONCLUSIONS: Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines.

OBJECTIVES: The National Social Life, Health and Aging Project is the first population-based, nationally representative study to ask older adults about their recent experience of mistreatment. This article provides estimates of mistreatment by family members and examines the association of mistreatment with demographic and health characteristics. METHODS: We selected community-residing participants aged 57 to 85 using a multistage area probability design. Of those eligible, 3,005 participated in the study, for a weighted response rate of 75.5%. We asked respondents if in the past year they had experienced mistreatment in the following domains: verbal, financial, and physical. We asked those who reported mistreatment about their relationship to the person responsible. RESULTS: In all, 9% of older adults reported verbal mistreatment, 3.5% financial mistreatment, and 0.2% physical mistreatment by a family member. Odds of verbal mistreatment were higher for women and those with physical vulnerabilities and were lower for Latinos than for Whites. Odds of financial mistreatment were higher for African Americans and lower for Latinos than for Whites and were lower for those with a spouse or romantic partner than for those without partners. DISCUSSION: Few older adults report mistreatment by family members, with older adults quite insulated from physical mistreatment.

Abstract This article describes a simple model of the effects of time on memory. The model combines the effects of forgetting and telescoping where the event is remembered as occurring more recently than it did. The model is tested on behavior data for which validation information are available. The use of records and of aided recall are shown to have opposite effects on memory errors. Records reduce telescoping effects, but not errors of omission. Aided recall reduces omissions, but does not reduce and may even increase telescoping. The article also includes a discussion of other characteristics of the interview and the respondent that affect memory.

OBJECTIVE: We developed a novel population-level model for projecting future direct spending on diabetes. The model can be used in the federal budget process to estimate the cost implications of alternative policies. RESEARCH DESIGN AND METHODS: We constructed a Markov model simulating individuals' movement across different BMI categories, the incidence of diabetes and screening, and the natural history of diabetes and its complications over the next 25 years. Prevalence and incidence of obesity and diabetes and the direct spending on diabetes care and complications are projected. The study population is 24- to 85-year-old patients characterized by the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and National Health Interview Survey. RESULTS: Between 2009 and 2034, the number of people with diagnosed and undiagnosed diabetes will increase from 23.7 million to 44.1 million. The obesity distribution in the population without diabetes will remain stable over time with approximately 65% of individuals of the population being overweight or obese. During the same period, annual diabetes-related spending is expected to increase from $113 billion to $336 billion (2007 dollars). For the Medicare-eligible population, the diabetes population is expected to rise from 8.2 million in 2009 to 14.6 million in 2034; associated spending is estimated to rise from $45 billion to $171 billion. CONCLUSIONS: The diabetes population and the related costs are expected to at least double in the next 25 years. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system.