February 2000

Grant Results

SUMMARY

From 1993 to 1998, researchers at Harvard University School of Public Health designed and fielded original public opinion surveys on health issues and reviewed and synthesized existing surveys conducted by other organizations.

The purpose of the surveys was to provide ongoing public opinion information that could inform RWJF's grantmaking process. Also, the surveys were designed to further inform the public and decision-makers about trends in public opinion on topics related to RWJF's goals.

The surveys covered the topics of health care reform, gun control, children's health policy, drug policy and tobacco regulations.

Key Findings

  • A March 1993 survey found Americans ambivalent about what they wanted health care reform to accomplish.
  • Analysis of 44 surveys found that support for President Clinton's health care plan had declined over time and that public opinion on key health issues remained sharply divided.
  • A review of historical data on gun control found that both gun owners and non-owners supported specific control policies but opposed measures that might lead to taking away all guns.
  • In a 1997 survey on children's health issues, respondents identified drug abuse and crime as more serious issues than poverty and access to care, which many experts ranked as more important.
  • An analysis of data from 100 national opinion surveys found more support for severe punishment for using illegal drugs than for treatment as a policy response.
  • Another analysis found support for strict tobacco reform tempered by general concerns over high taxation and government overregulation.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through four grants totaling $767,377.

 See Grant Detail & Contact Information
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THE PROBLEM

In January 1993 Board of Trustees of RWJF approved in principle a general campaign to educate the public about the problems of the health care system and about potential solutions. To develop the campaign, a thorough understanding of the public's knowledge, attitudes, and values regarding the health care system was considered essential. Also, RWJF wanted a baseline against which the campaign's impact could be gauged.

For reasons unrelated to the survey, the public education campaign was not implemented, but health care reform reached the top of the public's agenda and remained an important area of interest for RWJF. In addition, RWJF's strategic plan identified other areas in which public perceptions were important.

The staff believed an ongoing public opinion research project would complement and improve RWJF-supported survey efforts, and would provide useful information to inform both public policy debates and RWJF's future grantmaking.

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THE PROJECT

These four grants provided funds to design original public opinion surveys and also to review and synthesize existing surveys conducted by other organizations. The surveys covered the topics of health care reform, gun control, children's health policy, drug policy, and tobacco regulation.

The first grant (ID# 021324) supported a telephone survey to determine public knowledge of, and attitudes toward, the health care system. Two thousand Americans were surveyed nationwide in March 1993 on more than 200 questions. Because the intention was largely to help design a public education campaign, the survey included examples of positive and negative arguments about health care reform to determine which messages moved the public. The data were collected under subcontract by the survey research firm of Marttila & Kiley, Inc. Two focus groups planned as part of the project were not conducted because of time pressures associated with health care reform initiatives.

The second grant (ID# 022192) supported the synthesis of existing survey data and the design of new in-depth surveys dealing with subjects selected annually by the grantee in consultation with Foundation staff. These subjects were expected to include such key program areas as health care reform, illegal drugs, tobacco and alcohol abuse, access to care, and chronic care. In addition to helping Foundation staff understand public attitudes, the results of the work were intended to guide the media toward areas of Foundation interest and to inform congressional and other opinion leaders about the public's view of these subjects.

At the end of the first year the project was revised to focus primarily on health care reform. The grant supported three new surveys on that topic:

  1. A January 1994 survey on health reform options, particularly the issue of employer mandates versus individual mandates and other Republican alternatives.
  2. A June 1994 survey to evaluate the effect on viewers of a RWJF-funded two-hour "NBC News" special on health care reform ("To Your Health") (grant ID# PC401).
  3. An oversampling of Americans in a three-nation survey of public attitudes toward health care systems to assess how Americans experienced managed care, compared to fee-for-service health plans.

The three-nation survey, which compared public attitudes in the United States, Canada, and Germany, was conducted by the Harvard School of Public Health in 1994 under grant ID# 021474. In addition, the grantee reviewed existing polling data on public attitudes toward national health care reform, and analyzed the frequency and content of media coverage of health care reform. This grant also supported a review of all available polling data since 1935 on Americans' attitudes toward and experience with gun ownership and gun control.

The third grant (ID# 028733) was a renewal of the second and provided support for: (1) syntheses of existing polls and related media coverage, and (2) planning and analysis of new public opinion polls. The principal investigator and the Foundation agreed to focus on three subjects: children's health policy, illegal drugs, and tobacco regulation.

To assist the Foundation in developing options for improving children's health care and to explore alternatives for expanding children's health insurance coverage, the grantee designed and supervised a telephone survey of attitudes toward children's health issues.

The fourth grant (ID# 030714) permitted a subcontractor, the University of Maryland Survey Research Center, to conduct a survey of 1,501 adults from August to November 1997 on children's health care. In addition, the primary research team reviewed the results of 70 previous surveys relevant to children's health insurance.

To study Americans' attitudes toward illicit drugs, the research team reviewed more than 100 national opinion surveys. The study of attitudes toward tobacco issues, undertaken in response to the US Senate's decision to end consideration of comprehensive tobacco control legislation, involved a review of more than 100 surveys dating back to 1957. The focus was on the implications of current public attitudes for the future of legislative initiatives.

Some of the work was also supported by the Henry J. Kaiser Family Foundation, the Nathan Cummings Foundation, the National Press Foundation, The Commonwealth Fund, and the Minnesota Star Tribune.

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FINDINGS

  • Americans surveyed in March 1993 were ambivalent about what they wanted health care reform to accomplish, lacked detailed knowledge of the issues, and came to the debate with a set of conflicting core values. Among the latter, for example, Americans showed "moral concern" for the uninsured but did not blame themselves for the problems of the health care system and were willing to make only limited personal sacrifices for the sake of reform. The findings were summarized in a report to the Foundation, A Survey of American Attitudes Toward Health Care Reform, and in Health Affairs (Spring I, 1994). In Health Affairs, the grantee wrote that the public "will be receptive to clearly-stated messages," giving an advantage in the debate to interest groups with large advertising budgets and to major political figures with free access to the media. The article concluded that "the critical battleground for proponents and opponents of health reform will be determined by the public's answer to one simple question: Will my family be better or worse off because of health care reform?"
  • Public support for President Clinton's health care plan declined over time, and Americans remained sharply divided over the key questions of how to expand coverage and control health care costs. Results of a review of 44 surveys dealing with health care reform, including the grantee's January 1994 survey, were reported in The Journal of the American Medical Association (JAMA) (May 18, 1994). "Unless Americans are willing to strike a balance among the competing options for reform and show some willingness to pay more to achieve universal coverage, the current health care debate could result in gridlock, as similar debates have in the past," the article said. In Health Affairs (Summer, 1995), the grantee attributed the decline in public support for the Clinton Administration reform plan to a number of strategic and substantive decisions, including the decision to guarantee coverage to everyone at the same time. "The president's choice of an 'everyone together' strategy led to a lack of clarity in the public's mind about exactly what the plan would do for working people," the article reported.
  • While viewers of the NBC special "To Your Health" believed it increased their knowledge of health care reform, the program did not have a measurable impact on their understanding of the issues. The 351 adults who watched the program did no better on a 20-question "quiz" than did 237 adults who were surveyed before the program aired.
  • Non-elderly sick Americans in managed care plans reported more difficulty getting services and treatment than their counterparts in fee-for-service plans, and were more likely to be unhappy with their care. The results were reported in Health Affairs (Summer 1996), based on the sampling of Americans in the grantee's three-nation survey of public attitudes toward health care systems.
  • Both gun owners and non-owners supported specific gun-control policies, but most Americans also believe that stricter laws may lead to taking all guns away, which the vast majority opposes. "Given these conflicting viewpoints, the political process is likely to move slowly and incrementally on this issue," predicted the investigators in JAMA (June 12, 1996), based on their historical review of polling data on gun issues.
  • The American public most frequently named drug abuse, crime, and the breakdown of home life as the most serious problems facing young people. The 1997 survey on children's health policy also found that childhood poverty and problems in accessing health care, which many experts consider to be among the most important, drew only limited concern. "Often the public is unaware of which problems actually affect the most children or affect them most severely," the grantee reported in JAMA (December 23/20, 1998).
  • Although most Americans do not see the illegal drug problem lessening after years of increased spending, they nevertheless support allocating greater resources in generally the same direction. The study of previous surveys on drug abuse also found that more severe punishment for the possession and sale of drugs drew support from the largest number of people, while increased funding for drug treatment did not rank high as a priority. The study was reported in JAMA (March 18, 1998).
  • From 1985 to 1997, the share of Americans supporting stronger government action to reduce smoking rose from 42 percent to 55 percent. However, the review of surveys on smoking found that general concerns about high taxation and the level of government regulation tempered public support for higher cigarette taxes and stricter regulation of the tobacco industry. "Health professionals need to do a better job educating the public about which policies will reduce teenage smoking significantly, in particular, the deterrent effect of increased cigarette taxes," the investigators reported in JAMA (October 14, 1998).

Communications

The results of the surveys and survey reviews performed by the grantee were widely disseminated through journal articles, reports, meetings, and the news media. (See the Bibliography.) During the 1993–94 health care reform debate, the grantee also prepared six reports for the Health Subcommittee of the House Ways and Means Committee on key trends in public opinion on the issue. Computer-readable data from the original surveys and supporting documentation were deposited at the Roper Center for Public Opinion Research at the University of Connecticut (Storrs).

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AFTER THE GRANT

The grantee is continuing to perform survey work for the Foundation under a three-year renewal grant effective September 1, 1998 (ID# 030110).

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GRANT DETAILS & CONTACT INFORMATION

Project

Public Opinion Research on Children's Health Care and Insurance, Drug and Tobacco Policy, and Other Health Issues

Grantee

Harvard University School of Public Health (Boston,  MA)

  • Baseline Poll for the RWJF Public Education Campaign on Health Care
    Amount: $ 163,837
    Dates: March 1993 to July 1993
    ID#:  021324

  • Synthesis of Public Opinion Research in Areas of Foundation Interest: Phase I
    Amount: $ 295,842
    Dates: August 1993 to July 1996
    ID#:  022192

  • Synthesis of Public Opinion Research in Areas of Foundation Interest: Phase II
    Amount: $ 233,248
    Dates: August 1996 to July 1998
    ID#:  028733

  • Study of the Public's Beliefs, Values, Attitudes, and Policy Preferences Regarding Children's Health Care and Insurance
    Amount: $ 74,450
    Dates: June 1997 to May 1998
    ID#:  030714

Contact

Robert J. Blendon, Sc.D.
(617) 432-4502

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books and Reports

Blendon RJ and Benson JM. Public Opinion Update on Health Care Reform #1–6. Boston: Harvard School of Public Health, 1993–94.

Blendon RJ, Benson JM, Marttila J, Kiley T, Shelter M, Connolly FJ and Gergen D. A Survey of American Attitudes Toward Health Care Reform. Boston: Harvard School of Public Health, 1993.

Book Chapters

Blendon RJ, Brodie M, Benson J, Altman D and James M. "Public Knowledge on Health Care Reform: Lessons Learned for Future Debates." The Future of American Health Care. Volume IV. Transforming the System: Building a New Structure for a New Century. Edited by Robert J. Blendon and Mollyann Brodie. New York: Faulkner & Gray, 1994.

Articles

Blendon RJ, Benson J, Brodie M and Hugick L. "Channel Surfing Through Health Reform." Journal of American Health Care, 4(5): 41–46, 1994.

Blendon RJ, Benson J, Donelan K, Leitman R, Taylor H, Koeck C and Gitterman D. "Who Has the Best Health Care System? A Second Look." Health Affairs, 14(4): 220–230, 1995. Abstract available online.

Blendon RJ, Brodie M and Benson J. "What Happened to Americans' Support for the Clinton Health Plan?" Health Affairs, 14(2): 7–23, 1995. Abstract available online.

Blendon RJ, Brodie M, Hyams TS and Benson JM. "The American Public and the Critical Choices for Health System Reform." Journal of the American Medical Association, 271(19): 1539–1544, 1994.

Blendon RJ, Hyams TS and Benson J. "Health Care and the 1996 Election." Inquiry, 33(1): 10–14, 1996.

Blendon RJ, Marttila J, Benson JM, Shelter MC, Connolly FJ and Kiley T. "The Beliefs and Values Shaping Today's Health Reform Debate." Health Affairs, 13(1): 274–284, 1994. Abstract available online.

Blendon RJ and Young JT. "The Public and the Comprehensive Tobacco Bill." Journal of the American Medical Association, 280(14): 1279–1284, 1998.

Blendon RJ and Young JT. "The Public and the War on Illicit Drugs." Journal of the American Medical Association, 279(11): 827–832, 1998. Abstract available online.

Blendon RJ, Young JT and Hemenway D. "The American Public and the Gun Control Debate." Journal of the American Medical Association, 275(22): 1719–1722, 1996.

Blendon RJ, Young JT, McCormick MC, Kropf M and Blair J. "Americans' Views on Children's Health." Journal of the American Medical Association, 280(24): 2122–2127, 1998.

Donelan K, Blendon RJ, Benson J, Leitman R and Taylor H. "All Payer, Single Payer, Managed Care, No Payer: Patients' Perspectives in Three Nations." Health Affairs, 15(2): 254–265, 1996. Abstract available online.

Young JT, Hemenway D, Blendon RJ and Benson JM. "The Polls-Trends: Guns." Public Opinion Quarterly, 60(4): 634–649, 1996.

Survey Instruments

"Attitudes Toward Children's Health Care Issues Survey." University of Maryland Survey Research Center, fielded August — November 1997.

"Harvard School of Public Health/NBC-TV Health Care Special Evaluation." Princeton Survey Research Associates, fielded June 1994.

"Oversample" (of Americans to a three-nation survey of public attitudes toward health care systems). Louis Harris and Associates Inc., fielded February — April 1995.

"Survey of American Attitudes Toward Health Care Reform." Marttila & Kiley Inc., fielded March 1993.

"The Chafee Bill Study." Princeton Survey Research Associates, fielded January 1994.

"The Tobacco Bill Study." Chilton Research Services, fielded June 1998.

Presentations and Testimony

Robert J. Blendon, results of "Attitudes Toward Children's Health Care Issues Survey," at a meeting on children's health care, the Robert Wood Johnson Foundation, Washington, December 8, 1997.

Robert J. Blendon, results of "Attitudes Toward Children's Health Care Issues Survey," at a meeting on concerns for children, Task Force for Child Survival and Development and the Robert Wood Johnson Foundation, Atlanta, February 12–13, 1998.

John T. Young, results of "Attitudes Toward Children's Health Care Issues Survey," at the annual meeting of the American Association for Public Opinion Research, St. Louis, May 14–17, 1998.

Audio-Visuals and Computer Software

"Attitudes Toward Children's Health Care Issues Survey," University of Maryland Survey Research Center, August—November 1997. Sent to the Roper Center for Public Opinion Research, University of Connecticut (Storrs, CT).

"Harvard School of Public Health/NBC-TV Health Care Special Evaluation," Princeton Survey Research Associates, June 1994. Sent to the Roper Center for Public Opinion Research, University of Connecticut (Storrs, CT).

"Oversample" (of Americans to a three-nation survey of public attitudes toward health care systems), Louis Harris and Associates Inc., February—April, 1995. Sent to the Roper Center for Public Opinion Research, University of Connecticut (Storrs, CT).

"Survey of American Attitudes Toward Health Care Reform," Marttila & Kiley Inc., March, 1993. Sent to the Roper Center for Public Opinion Research, University of Connecticut (Storrs, CT).

"The Chafee Bill Study," Princeton Survey Research Associates, January 1994. Sent to the Roper Center for Public Opinion Research, University of Connecticut (Storrs, CT).

News Conferences

News Conference: The Journal of the American Medical Association article "The Public and the War on Illicit Drugs," Washington, March 17, 1998.

Print Coverage

"The Gridlock Is Us," The New York Times, May 22, 1994.

"Drug abuse biggest problem facing kids, poll finds," Reuters, December 8, 1997.

"Drugs top adult fears for kids' well-being," USA Today, December 9, 1997.

"Poll shows drugs top worry facing children," Plain Dealer (Cleveland), December 9, 1997.

"Survey: U.S. kids face tough obstacles," Boston Herald, December 9, 1997.

"What Worries Americans Most About Their Children," The Washington Post, December 16, 1997.

"Kids' Health Care Fares Poorly in Poll," Los Angeles Times, February 2, 1998.

"Doctors push care, not prison, for drug addicts," USA Today, March 18, 1998.

"A Public Paradox on the Drug War," The Washington Post, March 23, 1998.

"Kids Today," Clinton (IL) Daily Journal, June 22, 1998.

Mass Media

"Fox 43 News at Ten," results of survey of Americans' attitudes toward children's health care, WPMT-TV, York, PA, December 8, 1997.

"The Phil Valentine Show," drug abuse, WWDB 96.5 FM, Philadelphia, December 9, 1997.

"Nightline," drug addiction, ABC Television, March 18, 1998.

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Report prepared by: Michael H. Brown
Reviewed by: Karyn L. Feiden
Reviewed by: Robert Narus
Program Officer: Joel Cantor
Program Officer: James Knickman

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