We examined choice behavior in younger versus older adults using a medical decision-making task similar to Medicare Part D. The study was designed to assess age differences in choice processes in general and specifically designed to examine the effect of choice set size on performance. Data are drawn from a larger study on choice and aging, in which ninety-six younger adults (ages 18–64) and 96 older adults (ages 65–91) selected a prescription drug plan from either 6 or 24 different options. As hypothesized, choice set size was a significant predictor of individuals’ ability to choose the best plan. Participants who were presented with 24 plans were less likely to choose the correct prescription drug plan. Age did not have a negative effect on decision performance; however numeracy and speed of processing significantly affected performance across groups. Older adults were more likely to be characterized as satisficers on a decision personality measure, but this categorization did not predict performance on the choice task.

Earlier frameworks have indicated that older adults tend to experience decline in their deliberative decisional capacity, while their affective abilities tend to remain intact (Peters, Hess, Västfjäll, & Auman, 2007). The present study applied this framework to the study of risky decision-making across the lifespan. Two versions of the Columbia Card Task (CCT) were used to trigger either affective decision-making (i.e., the “warm” CCT) or deliberative decision-making (i.e., the “cold” CCT) in a sample of 158 individuals across the lifespan. Overall there were no age differences in risk seeking. However, there was a significant interaction between age and condition, such that older adults were relatively more risk seeking in the cold condition only. In terms of everyday decision-making, context matters and risk propensity may shift within older adults depending upon the context.

Right-wing ideology and cognitive ability, including objective numeracy, have been found to relate negatively. Although objective and subjective numeracy correlate positively, it is unclear whether subjective numeracy relates to political ideology in the same way. Replicating and extending previous research, across two samples of American adults (ns= 455, 406), those who performed worse on objective numeracy tasks scored higher on right-wing authoritarianism (RWA) and social dominance orientation (SDO), and they self-identified as more conservative on general, social, and economic continua. Controlling for objective numeracy, subjective numeracy related positively to measures of right-wing ideologies. In other words, those who strongly (vs. weakly) endorsed right-wing ideologies believed they are good with numbers yet performed worse on numeracy tasks. We discuss implications for the opposing direction of associations between ideology with objective versus subjective numeracy and similarities with literature on overconfidence.

Genetic screening for BRCA1 and BRCA2 gives women the opportunity for early detection, surveillance, and intervention. One key feature of genetic testing and counseling is the provision of personal lifetime risk. However, little attention has been paid to how women interpret lifetime risk information, despite the fact that they base screening, treatment and family planning decisions on such information. To study this vital issue, we set out to test the ability of women to choose the most appropriate interpretation of National Cancer Institute’s (NCI) message about lifetime risk of developing cancer for a woman with altered BRCA1 and BRCA2 genes. Participants included 277 women who had not undergone genetic testing or had cancer and 207 women who had undergone genetic testing or had cancer. Over 50% of the women who had not undergone genetic testing or had cancer and 40% of those who had undergone genetic testing or had cancer misunderstood NCI’s information. Furthermore, in line with a growing body of research, we found that high numeracy level (objective or subjective) is positively associated with a woman’s ability to correctly interpret NCI’s message.

Genetic testing for breast and ovarian cancer can help target prevention programs, and possibly reduce morbidity and mortality. A positive result of BRCA1/2 is a substantial risk factor for breast and ovarian cancer, and its detection often leads to risk reduction interventions such as increased screening, prophylactic mastectomy and oophorectomy. We examined predictors of the decision to undergo cancer related genetic testing: perceived risk, family risk of breast or ovarian cancer, and numeracy as predictors of the decision to test among women at high risk of breast cancer. Stepwise regression analysis of survey responses from 459 women registered in the Cancer Genetics Network revealed greater likelihood to test for women with more family history, higher perceived risk of mutation, or Ashkenazi descent. Neither subjective nor objective numeracy was associated with the decision to test, although we replicated an earlier finding that subjective numeracy predicted willingness to pay for testing. Findings underscore the need for genetic counselling that disentangles risk perception from objective information to promote better decision-making in the context of genetic testing. Highlighting these factors is crucial for public health campaigns, as well as to clinic-based testing and direct-to-consumer testing.

The Food and Drug Administration (FDA) warned against administering over-the-counter cough and cold medicines to children under 2. This study evaluated whether experienced parents show poorer adherence to the FDA warning, as safe experiences are predicted to reduce the impact of warnings, and how adherence can be improved. Participants included 218 American parents (mean age: 29.98 (SD = 6.16), 82.9% female) with children age ≤ 2 who were aware of the FDA warning. We compared adherence among experienced (N=142; with other children > age 2) and inexperienced parents (N=76; only children ≤2). We also evaluated potential moderating variables (amount of warning-related information received, prevalence of side effects, trust in the FDA, frequency of coughs and colds, trust in drug packaging) and quantified the impact of amount of information. Logistic regression assessed the ability of experience alone, and experience combined with amount of information, to predict adherence. 53.3% of inexperienced but 28.4% of experienced parents were adherent (p = 0.0003). The groups did not differ on potential moderating variables. Adherence was 39.5% among experienced parents receiving “a lot of information”, but 15.4% for those receiving less (p = 0.002); amount of information did not affect adherence in inexperienced parents (p = 0.22) but uniquely predicted adherence compared to a model with experience alone (p = 0.0005). Experienced parents were also less likely to mistrust drug packaging (p = 0.03). Targeting FDA information to experienced parents, particularly via drug packaging, may improve their adherence.

A positive test result for BRCA1/2 gene mutation is a substantial risk factor for breast and ovarian cancer. However, testing is not always covered by insurance, even for high risk women. Variables affecting willingness to pay (WTP) have implications for clinic-based and direct-to-consumer testing. The relative impact of objective and subjective numeracy on WTP, in the context of worry, perceived risk (of having the mutation and developing breast cancer) and family history, was examined in 299 high-risk women, not previously tested for BRCA1/2. Objective and subjective numeracy correlated positively with one another, yet only subjective numeracy correlated (positively) with WTP. This could not be explained by educational level or worry. In line with the numeracy result, other objective factors including family history, age, and Ashkenazi descent were not correlated with WTP. Perceived risk of having a mutation was also correlated with WTP, though perceived risk of developing breast cancer was not, perhaps because it lacks direct connection with testing. Thus, subjective confidence in the ability to interpret test results and perceived risk of a positive test result are more important drivers in paying for BRCA1/2 testing than factors more objective and/or further removed from the testing itself (e.g., perceived risk of developing cancer, family history). Findings underscore the need for genetic counselling that makes probabilistic information accessible and intelligible, so as to build confidence and promote accurate perception of mutation risk and ultimately better decision-making.

Questions about the design of the new US Medicare prescription drug benefit were raised even before its passage, where one of the most heated issues has been the number of plans offered to beneficiaries. Whether beneficiaries believe that there should be extensive or limited choice is still an open question. To study this issue, we analyzed data from the Kaiser Family Foundation/Harvard School of Public Health Survey, which included 718 individuals aged 65 years and above. The survey asked these older adults (i) whether they prefer having dozens of plans or for Medicare to offer a restricted number of plans and (ii) whether they think there are too many, too few or the right amount of plans. Our findings show that the majority of beneficiaries (69%) preferred that Medicare offer a limited number of options while only 29% wanted to see dozens of plans on the market. We also examine the effect of education level, income, political affiliation, race and health status on the desire for more or fewer plans. One surprising finding is that seniors with higher education appear to prefer fewer, not more, plan choices. Overall, our results question the merit of offering so many prescription drugs plan choices to Medicare beneficiaries.