BACKGROUND: Many studies have examined barriers to health care utilization, with the majority conducted in the context of specific populations and diseases. Less research has focused on why people avoid seeking medical care, even when they suspect they should go. OBJECTIVE: The purpose of the study was to present a comprehensive description and conceptual categorization of reasons people avoid medical care. DESIGN: Data were collected as part of the 2008 Health Information National Trends Survey, a cross-sectional national survey. PARTICIPANTS: Participant-generated reasons for avoiding medical care were provided by 1,369 participants (40% male; M age =48.9; 75.1% non-Hispanic white, 7.4% non-Hispanic black, 8.5% Hispanic or Latino/ a). MAIN MEASURES: Participants first indicated their level of agreement with three specific reasons for avoiding medical care; these data are reported elsewhere. We report responses to a follow-up question in which participants identified other reasons they avoid seeking medical care. Reasons were coded using a general inductive approach. KEY RESULTS: Three main categories of reasons for avoiding medical care were identified. First, over one-third of participants (33.3% of 1,369) reported unfavorable evaluations of seeking medical care, such as factors related to physicians, health care organizations, and affective concerns. Second, a subset of participants reported low perceived need to seek medical care (12.2%), often because they expected their illness or symptoms to improve over time (4.0%). Third, many participants reported traditional barriers to medical care (58.4%), such as high cost (24.1%), no health insurance (8.3%), and time constraints (15.6%). We developed a conceptual model of medical care avoidance based on these results. CONCLUSIONS: Reasons for avoiding medical care were nuanced and highly varied. Understanding why people do not make it through the clinic door is critical to extending the reach and effectiveness of patient care, and these data point to new directions for research and strategies to reduce avoidance.

People's attitudes toward mathematics are multifaceted. Across four studies, we found that children and adults have different attitudes about mathematics when asked specifically about whole numbers, as opposed to fractions. The vast majority of children and adults reported negative attitudes toward fractions despite having positive attitudes toward whole numbers. Across both children and adults, the difference in fraction and whole-number attitudes was present across levels of math achievement, indicating that it was not just participants who were worse at math whose attitudes differed by number type. These findings may have important implications for how children and adults engage with numerical information when presented as fractions. KEYWORDSAttitudes; fractions; individual differences; integrated theory of whole number and fractions development; mathematics attitudes; mathematics education; whole number bias PEOPLE ENCOUNTER FRACTIONS in many everyday contexts. Reasoning with fractions and other ratios underlies common tasks including measuring and scaling (e.g., when calculating a discount, measuring a length, or following a recipe) and is often necessary for complex decision making (e.g., evaluating health-risk information at the doctor's office or comparing interest rates at the bank). Furthermore, fractions are an essential facet of the development of mathematical skills. Fraction proficiency uniquely predicts concurrent academic achievement in the sixth and eighth grades (Torbeyns, Schneider, Xin, & Siegler, 2015), students' readiness to learn Algebra I (the "gatekeeper" to higher mathematics; Booth & Newton, 2012), and high school mathematics achievement (over and above early whole number skills and general cognitive ability, Siegler et al., 2012). Despite their importance, fractions are difficult for children to master (e.g., Siegler,

Palliative care aims to improve quality of life for people with serious illness and their families. One potential barrier to palliative care uptake is inaccurate knowledge and/or negative beliefs among the general population, which may inhibit early interest in, communication about, and integration of palliative care following subsequent illness diagnosis. We explored knowledge and beliefs about palliative care among the general public using nationally-representative data collected in 2018 as part of the cross-sectional Health Information National Trends Survey. Only individuals who had heard of palliative care ( n = 1,162, M age = 51.8, 64% female) were queried on knowledge and beliefs. We examined whether self-assessed level of awareness of palliative care (i.e., knowing a little vs. enough to explain it) was associated with the relative likelihood of having accurate/positive beliefs, inaccurate/negative beliefs, or responding “don’t know” to questions about palliative care. Respondents who indicated knowing a lot about palliative care had more accurate versus inaccurate knowledge than those who knew a little on only two of six items and more positive attitudes on only one of three items. In particular, respondents with greater awareness were equally likely to report that palliative care is the same as hospice and requires stopping other treatments, and equally likely to believe that palliative care means giving up and to associate palliative care with death. Those with higher awareness were less likely than those with lower awareness to respond “don’t know,” but greater awareness was not necessarily associated with having accurate or positive beliefs about palliative care as opposed to inaccurate or negative beliefs. Thus, even members of the general public who perceived themselves to know a lot about palliative care were often no less likely to report inaccurate knowledge or negative beliefs (versus accurate and positive, respectively). Findings suggest a need to improve awareness and attitudes about palliative care.

Background Information avoidance is a defensive strategy that undermines receipt of potentially beneficial but threatening health information and may especially occur when threat management resources are unavailable. Purpose We examined whether individual differences in information avoidance predicted intentions to receive genetic sequencing results for preventable and unpreventable (i.e., more threatening) disease and, secondarily, whether threat management resources of self-affirmation or optimism mitigated any effects. Methods Participants (N=493) in an NIH study (ClinSeq®) piloting the use of genome sequencing reported intentions to receive (optional) sequencing results and completed individual difference measures of information avoidance, self-affirmation, and optimism. Results Information avoidance tendencies corresponded with lower intentions to learn results, particularly for unpreventable diseases. The association was weaker among individuals higher in self-affirmation or optimism, but only for results regarding preventable diseases. Conclusions Information avoidance tendencies may influence decisions to receive threatening health information; threat management resources hold promise for mitigating this association.