A mounting body of health care research reports that American retirees are likely to face large and increasing expenditures for out-of-pocket health care costs and that they often struggle to finance these expenditures.  It is, however, unclear whether the general population understands what their likely out-of-pocket health care expenditures might be in retirement.  It is even less clear whether the population appreciates how much these costs can vary from person to person and over time.  It is critically important to know whether Americans understand these costs and to what degree misunderstanding might hamper their financial planning  for retirement, especially in light of recent discussion of Medicare reform that could affect these costs.

This article explores this previously unexamined question of how much Americans expect to pay for their out-of-pocket health care spending in etirement.  To answer this question,we surveyed 2000 near retirees and retirees to gauge their expectations with regard to their own likely expenditures.  We then compared their responses to experts’ estimates. Our findings suggest that, surprisingly, many respondents have a reasonable sense of the magnitude of likely out-of-pocket expenditures, at least for the median, or typical, retiree.  However, we also found people struggle to understand potential variability in expenditures that might cause them to spend more than the typical retiree.  In particular, they underestimate how much personal health experience can affect individual spending.These results suggest that misperception of typical spending may not be a primary factor in retirees’ inability to finance out-of-pocket health care costs, but that misperception of the risk of spending above the median is likely an important factor.  We discuss educational,regulatory, and health policy implications of our findings.

Nicotine dependence (ND) is a key construct that organizes physiological and behavioral symptoms associated with persistent nicotine intake. Measurement of ND has focused primarily on cigarette smokers. Thus, validation of brief instruments that apply to a broad spectrum of tobacco product users is needed.

We examined multiple domains of ND in a longitudinal national study of the United States population, the United States National Epidemiological Survey of Alcohol and Related Conditions (NESARC). We used methods based in item response theory to identify and validate increasingly brief measures of ND that included symptoms to assess ND similarly among cigarette, cigar, smokeless, and poly tobacco users.

Confirmatory factor analytic models supported a single, primary dimension underlying symptoms of ND across tobacco use groups. Differential Item Functioning (DIF) analysis generated little support for systematic differences in response to symptoms of ND across tobacco use groups. We established significant concurrent and predictive validity of brief 3- and 5- symptom indices for measuring ND.

Measuring ND across tobacco use groups with a common set of symptoms facilitates evaluation of tobacco use in an evolving marketplace of tobacco and nicotine products.