We conducted a survey experiment where we provided a randomly assigned group of United States citizens information about the efficiency of their school district while the control group did not receive such information. We then asked both groups questions about their perception of school district efficiency, their trust in the school district to do what is right, whether they would support taxes to increase school spending, and their desired level of school spending. We find that residents in the most efficient districts who are provided efficiency information are more likely to perceive their district as efficient and have higher levels of trust. On the other hand, we find that providing efficiency information causes residents in the least efficient school districts to favor lower levels of school spending. We also find evidence of a discontinuity at the efficiency/inefficiency margin suggesting that some citizens may employ a heuristic based on whether their district is above or below state averages.

Medical care received at end-of-life is often not aligned with individuals' values and care preferences. Much can get in the way of an individual communicating and documenting their preferences to care providers and close others, even if it is a goal to do so. The objective of this work was to develop a measure of Advance Care Planning Self-Efficacy (ACP SE) focused on three important behaviors: completing a living will, documenting a healthcare agent, and discussing quality versus quantity of life issues. Measure development was framed by the Transtheoretical Model (TTM) of behavior change. Following the completion of focus groups and formative qualitative work, an independent sample (N = 310, adults aged 50+) was randomly split into two halves for exploratory and confirmatory factor analyses (EFA/CFA). Multivariate analyses examined relationships between ACP SE and other TTM constructs. Results of the CFA demonstrated excellent internal consistency (α = .95) and good model fit (CFI = .89, RMSEA = .13). Self-efficacy was framed by the TTM as situation-specific confidence. Through the measure development process, it was found that confidence to do ACP was impacted by various situational and attitudinal variables. ACP Self-Efficacy was found to differ significantly by Stage of Change. This study produced a reliable and valid measure of situation-specific confidence for ACP grounded within the TTM that could enhance future interventions aimed at increasing participation in ACP.

Introduction: Vaping is common among young adults in the United States. The Transtheoretical Model (TTM) has demonstrated success in smoking cessation efforts; however, it has not been comprehensively applied to vaping cessation, and core TTM vaping measures have not been developed. Method: A cross-sectional survey including measures of stage of change (SOC), temptation to vape, and decisional balance (DCBL) was disseminated (n = 459). Items were adapted from TTM smoking scales. The sample was split for exploratory and confirmatory factor analyses (EFA/CFA). Analyses of variance assessed relationships between constructs and SOC. Results: EFA/CFA resulted in one Temptation scale (CFI = .95; α = .87) and two DCBL scales (CFI = .91; Pros α = .72; Cons α = .72). Temptation to vape and Pros of vaping decreased significantly across SOC, while Cons increased significantly. Conclusions: TTM vaping measures for two key TTM constructs were developed utilizing a college sample. Results suggest that the developed measures map well onto the TTM framework.

Researchers have examined civic engagement as a health promotion tool among older adults and adolescents, yet less is known about its mental health implications for young adults. This systematic review identified 53 articles on civic engagement and well-being in young adults. Five key themes emerged: (1) varying associations between type of civic engagement and well-being, (2) duration and frequency of civic behaviors, (3) directionality in the civic-to-well-being pathway, (4) mediation and moderation factors affecting the civic-to-well-being pathway, and (5) civic engagement as a tool for coping with adversity or systemic oppression. Civic engagement demonstrates a heterogeneous relationship to well-being; future research should focus on the explanatory pathways for positive, negative, and null correlations particularly among historically marginalized young adults.

PURPOSE:To redevelop and improve Transtheoretical Model (TTM) exercise measures for Black and Hispanic/Latinx adults. The redeveloped scales will address barriers to exercise potentially relevant to populations of color in the United States (US). DESIGN:Cross-sectional, split-half measure development. SETTING:Online survey in the US. SUBJECTS:450 Black and/or Hispanic/Latinx adults. MEASURES:Demographics, exercise engagement (IPAQ-SF), stage of change (SOC), decisional balance (DCBL), self-efficacy (SE), and barriers to exercise. ANALYSIS:Split-half exploratory (EFA) and confirmatory factor analyses (CFA) were executed to establish measurement structure and fit, followed by multivariate analyses to assess constructs by SOC. RESULTS:EFA/CFA for DCBL revealed three factors (α = .85, .70, .75) which represented Pros of exercise, Cons of exercise related to time and safety, and Cons of exercise related to physical or emotional discomfort. Model fit was adequate (CFI = .89). For SE, two factors (α = .85, .77) resulted with good model fit (CFI = .91). These factors reflected self-efficacy to exercise when confronted with generally challenging situations, and self-efficacy to exercise when specifically experiencing affective difficulties, such as depression or anxiety. Lastly, a novel Barriers measure resulted in three factors (α = .82, .77, .76), representing barriers encountered due to family responsibilities, work obligations, and health challenges, with good model fit (CFI = .95). Shifts in the core TTM constructs by SOC largely mapped onto the theoretical trends expected under the TTM. CONCLUSION:This study produced systematically developed TTM exercise measures for Black and Hispanic/Latinx adults in the US that address and incorporate important barriers to exercise. This research represents an important step forward in broadening the inclusion of diverse populations to TTM measure development processes and may lead to a better understanding of relevant factors impeding exercise engagement in the US.

We report the results of a random assignment experiment that examines the effect of revealing actual school district performance on three important outcomes: perceptions of efficiency, trust in government, and support for higher taxes for increased school spending. We randomly assign survey respondents to a control group or experimental condition that includes information about how their school district's test scores compare to their state average. Our study includes 2604 observations from an on-line panel fielded in the United States from October through December, 2022 which allows us to precisely estimate the effect of performance information on outcomes. We find that providing high-performance information has significant and substantial effects that improve efficiency perceptions, trust in the school district, and support for taxes. When residents living in school districts with the highest levels of performance are informed about their school district's relative performance, they are more likely to believe their community gets its money's worth for the local taxes they pay for K12 public education, trust their school district to do what is right, and support a tax increase for additional school spending. Providing information on relative school performance to residents living in school districts with the lowest levels of performance does not have a significant effect on their perceptions. High-performing school districts would benefit from touting their school performance while low-performing school districts should consider providing context when revealing performance information.

Researchers have found that elderly white voters are less supportive of school spending if they reside in a community with a high concentration of non-white school children, a finding typically attributed to growing intergenerational and ethnic conflict between older and younger generations. We test whether white voters living in high minority areas are more likely to perceive their schools as being inefficient and find evidence of such racial mismatch consistent with the literature. One explanation is that white voters in high minority areas may believe schools are inefficient because of the correlation between minority concentration and poverty, given that it is more expensive to educate children in poverty. A second possibility is that white voters in high minority areas believe schools are inefficient because of bias, whether conscious or unconscious. We find convincing evidence of this second explanation that bias produces the racial mismatch effect for older white individuals.

Improving efficiency is the basis for important public school reforms. While there has been substantial scholarship examining the relationship between actual and perceived performance, there has been very little research examining this relationship for efficiency. We use a large and representative sample of U.S. residents and data on student achievement and public school spending to examine the relationship between actual and perceived efficiency. We find a strong positive relationship between actual efficiency and our measure of perceived efficiency. Our research supports the normative tendency of public managers towards increased transparency and suggests that citizens will respond appropriately to information.

BACKGROUND:Cytomegalovirus (CMV) mismatched, donor IgG-positive/recipient IgG-negative, solid organ transplant recipients (SOTRs) are at high risk of CMV invasive disease. Post-prophylaxis disease is an issue in this population. Some programs employ surveillance after prophylaxis (SAP) to limit the incidence of post-prophylaxis disease. METHODS:This was a single-center retrospective cohort study that included all CMV mismatched SOTRs from 2003 to 2017. Patients underwent SAP with weekly CMV plasma viral load for 12 weeks. The subjects were classified into three post-prophylaxis DNAemia patterns: no DNAemia, one episode of DNAemia, and multiple episodes of DNAemia. We calculated the cumulative incidence of each DNAemia pattern. We also determined 5-year mortality based on DNAemia pattern stratified by organ transplant type. RESULTS:Post-prophylaxis recurrent DNAemia occurred in 63% of lung recipients and 32% of non-lung recipients (p =  .003). Tissue invasive CMV disease was diagnosed in 3% of the population and CMV syndrome was diagnosed in 33%. Recurrent DNAemia was not associated with 5-year mortality. CONCLUSION:In this cohort, undergoing SAP tissue invasive disease was uncommon and CMV DNAemia recurrence did not have an impact on long-term mortality.

In this paper, we seek to improve models of support for taxes, spending and borrowing beyond income, ideology and party identification. We discuss how trust in government and willingness to pay taxes have been measured in research around the globe. We present the notion of attachment as how citizens characterize the quality of their relationship to government. We test our measure of attachment, using well-understood analogies, with a sample of adult residents in the United States. The choice of analogy is a strong predictor of voter support for borrowing. These effects are separate from, and in addition to, commonly employed determinants (income, education, ideology, and party identification) and allow for stronger anti-government sentiments to be captured.

Young adults may benefit from civic engagement as a health promotion tool, as civic engagement is generally associated with positive well-being. However, more information is needed to examine civic engagement among lesser-educated young adults who are least likely to civically engage, and more likely to demonstrate mental health needs. We surveyed noncollege young adults (N = 621) to measure their civic engagement, meaning, civic efficacy, well-being, and sociodemographic factors. Using an a priori model, direct, indirect, and full effects path analyses were conducted across men and women, and then the entire sample. The full effects model best fit the data with mediation by civic efficacy and meaning (chi(2)(2) = 0.59, p = 0.74; comparative fit index = 1.0; root mean square error of approximation = 0.00, 90% confidence interval [0.00-0.06]; R-2 = 0.42). Types of engagement (civic, electoral, activism, and online) demonstrated differing relationships with well-being. Stakeholders should resource young adults with civic skills and coping strategies to address the many challenges that civic experiences often elicit.

US local governments often seek voter approval through bond referenda prior to borrowing. Passing bond referenda increases borrowing authority and potential debt levels, which can influence government credit risk. Focusing on Texas local governments, we estimate the causal effects of bond authorization on credit risk with a regression discontinuity design. Credit risk is measured by the average bond yields of existing debt. For school districts, one standard deviation increase in authorized debt per capita causes bond yields to increase by approximately 9.9–22.5 basis points in the subsequent 12 months. We find no effects for cities and counties.

Abstract Background Cytomegalovirus (CMV) seronegative solid organ transplant (SOT) recipients who receive grafts from seropositive donors are at high risk of CMV disease. Antiviral prophylaxis in usually given to this group of patients to prevent illness. Patients are still at risk of CMV after completion of prophylaxis. Surveillance after prophylaxis is used in some centres to prevent late CMV disease, but there is scant information of its efficacy. Finally, little is known on CMV kinetics post-prophylaxis in high-risk patients. Methods This was a retrospective cohort study including adult CMV mismatch (D+/R-) SOT recipients between 2003-2017 at a multiorgan transplant center in Canada. Post-prophylaxis CMV kinetics were classified into 3 patterns of DNAemia: no DNAemia, single episode of DNAemia and recurrent episodes of DNAemia. We calculated the cumulative incidence of each DNAemia pattern. We also compared 5-year mortality according to CMV DNAemia pattern by Cox-regression analysis. Patients were monitored weekly with CMV viral load for 12 weeks after completion of prophylaxis. Results Two-hundred and forty-five transplant patients were included (Table 1). Median follow up time was 9.2 years (7-12.7). Death occurred in 32 patients during the study period, the median time to death was 7.3 years (4.9-10). Pattern 1 (no CMV DNAemia) occurred in 38%, 27% had a single episode (pattern 2) of CMV DNAemia and 35% had recurrent (pattern 3) CMV DNAemia. Median time to DNAemia was 186 days. The first episode occurred at a significantly shorter interval in liver recipients when compared to non-liver recipients, 158 days (134-217) vs. 208 days (149-315), p=0.0164. Recurrent CMV DNAemia (pattern 3) was significantly more common in lung transplant recipients compared to non-lung transplant recipients. (63% vs. 32% p=0.003). Mortality at 5 years was statistically not different between CMV patterns, adjusted by organ transplanted and age (Pattern 1 reference; pattern 2 HR 1.484 [0.24-9. Table 1.Population characteristics.* Includes 16 simultaneous kidney-pancreas, pancreas after kidney or pancreas alone, 1 combined liver-kidney, 1 multivisceral. ATG: Anti-thymocyte globulin. Conclusion A surveillanceafter prophylaxis strategy allowed us to characterize the CMV kinetics post-prophylaxis, with 35% of CMV mismatch patients having recurrent CMV episodes. CMV kinetic pattern was not associated with 5 years mortality in CMV high-risk patients. Disclosures Carlos Cervera, Associate Professor, Astra-Zeneca: Advisor/Consultant|AVIR Pharma: Grant/Research Support|AVIR Pharma: Honoraria|Lilly: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Sunovion: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Honoraria|VerityPharma: Advisor/Consultant.

A small but growing literature suggests that simply using the word “tax” can create a visceral negative reaction among citizens. We tested tax word aversion using a representative sample of US residents who are randomly placed into experimental conditions and asked parallel questions about their support for services (approval of a tax increase or a revenue increase). The only difference between the two questions is the word “tax.” We find that the use of the word “tax” lowers support by about six and eight percentage points for fire and school services, respectively. This direct test of tax word aversion is based on a strong experimental design and a sufficient number of observations (over 4000) that allow for precise impact estimates.

Background:Immune-based therapies are standard-of-care treatment for coronavirus disease 2019 (COVID-19) patients requiring hospitalization. However, safety concerns related to the potential risk of secondary infections may limit their use. Methods:We searched OVID Medline, Ovid EMBASE, SCOPUS, Cochrane Library, clinicaltrials.gov, and PROSPERO in October 2020 and updated the search in November 2021. We included randomized controlled trials (RCTs). Pairs of reviewers screened abstracts and full studies and extracted data in an independent manner. We used RevMan to conduct a meta-analysis using random-effects models to calculate the pooled risk ratio (RR) and 95% CI for the incidence of infection. Statistical heterogeneity was determined using the I 2 statistic. We assessed risk of bias for all studies and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation methodology. We conducted a meta-regression using the R package to meta-explore whether age, sex, and invasive mechanical ventilation modified risk of infection with immune-based therapies. The protocol is registered with PROSPERO (CRD42021229406). Results:This was a meta-analysis of 37 RCTs including 32 621 participants (mean age, 60 years; 64% male). The use of immune-based therapy for COVID-19 conferred mild protection for the occurrence of secondary infections (711/15 721, 4.5%, vs 616/16 900, 3.6%; RR, 0.82; 95% CI, 0.71-0.95; P = .008; I 2 = 28%). A subgroup analysis did not identify any subgroup effect by type of immune-based therapies (P = .85). A meta-regression revealed no impact of age, sex, or mechanical ventilation on the effect of immune-based therapies on risk of infection. Conclusions:We identified moderate-certainty evidence that the use of immune-based therapies in COVID-19 requiring hospitalization does not increase the risk of secondary infections.

Background . Stress levels among Americans are considerable. This research examined Transtheoretical Model of Behavior Change (TTM) constructs for stress management in groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. Methods . Secondary data analysis of a computer-tailored intervention group examined construct use over time across the three groups. Adults (n=427) meeting criteria for not engaging in stress management behaviors at baseline comprised the analytic sample. Participants received three TTM-tailored feedback interventions to help facilitate change at baseline, 3 and 6 months. Demographics, Stage of Change, 10 Processes of Change, Decisional Balance (Pros and Cons), and Self-Efficacy were assessed at baseline, 6, 12, and 18 months. Repeated measures MANOVA followed by ANOVAs, with Tukey follow-up tests assessed differences in use of TTM constructs longitudinally across dynatype groups. Results . Ten of the 13 TTM constructs differentiated between Successful Changers and Stable Non-Changers at baseline and over time. Relapsers were more similar to Successful Changers than to Stable Non-Changers in their use of all constructs, except Self-Efficacy. Conclusion . Findings suggest that baseline cognitive and behavioral constructs can improve prediction of different intervention outcomes 18 months later.

This article reports on an experiment testing whether additional information influences support for bond referenda. Respondents were randomly assigned to treatment conditions that varied the way the potential implications of property tax increases were presented to voters. The results show a persistent negative effect of tax information on the probability of support for school bond referenda across all treatments. Specifically, the results show that the probability of voting yes decreased by 6 to 9 percentage points, depending on the treatment. This result persists across multiple specifications and robustness tests. The effects are consistent across populations, with only those with high levels of education showing no statistically significant effect of the treatment on their support for school referenda. Evidence for Practice Some states require bond referenda to include statements that seek to make plain the connection between ballot passage and property taxes, while others do not. We find a persistent negative effect of property tax information on the probability of support for school bond referenda of 6 to 9 percentage points, depending on the wording. This line of research has become increasingly important to public policy making given that about half the states, including the largest state, California, have some type of property tax wording requirements for referenda. We argue that providing wording connecting property taxes to bond referenda passage is consistent with transparency efforts governments have pursued for decades. However, such wording might not improve the accuracy of information for citizens since, ultimately, the ensuing property tax levy depends on myriad factors, only one of which is debt service on bonds.

Middle class is a social construct and a moniker so central to the identity politics of the United States that it has become a persistent part of the rhetoric of both major political parties. This article seeks to understand how the way in which people categorize themselves in social class matches the observable characteristics that might be used to objectively classify them into such groups. This article examines survey data from a national poll and finds that a majority of the respondents consider themselves members of the middle class. While those in the lowest and highest income categories are less likely to categorize themselves as middle class (controlling for other factors), many in these groups also consider themselves middle class.