Use of cervical cancer preventive services among US women aged 21-29: an assessment of the 2010 Affordable Care Act rollout through 2018.

PURPOSE: The 2010 Affordable Care Act (ACA) provided millions of people with health insurance coverage and facilitated routine cancer screening by requiring insurers to cover preventive services without cost-sharing. Despite greater access to affordable cancer screening, Pap testing has declined over time. The aim of this study is to assess participation in Pap test and HPV vaccination, and adherence to guidelines as outlined by the American Cancer Society (ACS) from the 2010 ACA provision eliminating cost-sharing for preventive services. METHODS: Using multi-year responses from the Behavioral Risk Factor Surveillance System, we examined the association between the ACA and participation in and adherence to Pap testing and HPV vaccination behaviors as set by the ACS. The sample included women aged 21-29 who completed the survey between 2008 and 2018 (every other year) and who live in 24 US States (N = 37,893). RESULTS: Results showed significant decreases in Pap testing rates but increases in the uptake of the HPV vaccine series for all age groups and across all demographics. Post-ACA year significantly predicted increases in HPV + Pap co-testing participation and adherence. Women with health insurance coverage were more likely to engage in both behaviors. CONCLUSION: Findings raise concerns around declines in the proportion of women receiving and adhering to Pap testing guidelines. A need exists for research to examine the role of increases in HPV vaccination uptake on decreases in Pap testing. Moreover, effective strategies should target increases in cervical cancer screening uptake among women vaccinated against HPV.

On the neural implausibility of the modular mind: Evidence for distributed construction dissolves boundaries between perception, cognition, and emotion.

Firestone & Scholl (F&S) rely on three problematic assumptions about the mind (modularity, reflexiveness, and context-insensitivity) to argue cognition does not fundamentally influence perception. We highlight evidence indicating that perception, cognition, and emotion are constructed through overlapping, distributed brain networks characterized by top-down activity and context-sensitivity. This evidence undermines F&S's ability to generalize from case studies to the nature of perception.

Racial/Ethnic Disparities in Health and Life Insurance Denial Due to Cancer among Cancer Survivors.

This study examined racial/ethnic differences in health/life insurance denial due to cancer among cancer survivors after the passage of the Affordable Care Act (ACA). Behavioral Risk Factor Surveillance System data were obtained from 2012-2020. The dependent variable asked: "Were you ever denied health insurance or life insurance coverage because of your cancer?" Cancer survivors were included if they were diagnosed with cancer after the Affordable Care Act (N = 14,815). Unadjusted and adjusted logistic regressions for age, sex, income, and employment provided odds ratios of insurance denial due to cancer across racial/ethnic groups: Non-Hispanic White, Black, and Other/mixed race; and Hispanic. Statistically significant differences (p < 0.05) were found between those who were denied or not denied insurance across sex, age, race/ethnicity, income, and employment. Adjusted regressions found significantly higher odds ratios of insurance denial for Blacks (OR: 3.00, 95% CI: 1.77, 5.08), Other/mixed race (OR: 2.16, 95% CI: 1.16, 4.02), and Hispanics (OR: 2.13, 95% CI: 1.02, 4.42) compared to Whites. Differences were observed across sex, income, and employment. Cancer survivors report racial/ethnic disparities in health and life insurance denial due to their cancer despite policy changes. This may be harmful for those who are already financially vulnerable due to their cancer diagnosis and exacerbate racial/ethnic cancer disparities.

Angry White Faces: A Contradiction of Racial Stereotypes and Emotion-Resembling Appearance.

Machine learning findings suggest Eurocentric (aka White/European) faces structurally resemble anger more than Afrocentric (aka Black/African) faces (e.g., Albohn, 2020; Zebrowitz et al., 2010); however, Afrocentric faces are typically associated with anger more so than Eurocentric faces (e.g., Hugenberg & Bodenhausen, 2003, 2004). Here, we further examine counter-stereotypic associations between Eurocentric faces and anger, and Afrocentric faces and fear. In Study 1, using a computer vision algorithm, we demonstrate that neutral European American faces structurally resemble anger more and fear less than do African American faces. In Study 2, we then found that anger- and fear-resembling facial appearance influences perceived racial prototypicality in this same counter-stereotypic manner. In Study 3, we likewise found that imagined European American versus African American faces were rated counter-stereotypically (i.e., more like anger than fear) on key emotion-related facial characteristics (i.e., size of eyes, size of mouth, overall angularity of features). Finally in Study 4, we again found counter-stereotypic differences, this time in processing fluency, such that angry Eurocentric versus Afrocentric faces and fearful Afrocentric versus Eurocentric faces were categorized more accurately and quickly. Only in Study 5, using race-ambiguous interior facial cues coupled with Afrocentric versus Eurocentric hairstyles and skin tone, did we find the stereotypical effects commonly reported in the literature. These findings are consistent with the conclusion that the "angry Black" association in face perception is socially constructed in that structural cues considered prototypical of African American appearance conflict with common race-emotion stereotypes.

What Facial Appearance Reveals Over Time: When Perceived Expressions in Neutral Faces Reveal Stable Emotion Dispositions.

It might seem a reasonable assumption that when we are not actively using our faces to express ourselves (i.e., when we display nonexpressive, or neutral faces), those around us will not be able to read our emotions. Herein, using a variety of expression-related ratings, we examined whether age-related changes in the face can accurately reveal one's innermost affective dispositions. In each study, we found that expressive ratings of neutral facial displays predicted self-reported positive/negative dispositional affect, but only for elderly women, and only for positive affect. These findings meaningfully replicate and extend earlier work examining age-related emotion cues in the face of elderly women (Malatesta et al., 1987a). We discuss these findings in light of evidence that women are expected to, and do, smile more than men, and that the quality of their smiles predicts their life satisfaction. Although ratings of old male faces did not significantly predict self-reported affective dispositions, the trend was similar to that found for old female faces. A plausible explanation for this gender difference is that in the process of attenuating emotional expressions over their lifetimes, old men reveal less evidence of their total emotional experiences in their faces than do old women.