CHAPTER 26 - Euro-stresses and Strains

The financial impact and consequences of cancer on the lives of survivors remain poorly understood. This is especially true for colorectal cancer. We investigated objective cancer-related financial stress, subjective cancer-related financial strain, and their association with health-related quality of life in colorectal cancer survivors. This was a cross-sectional postal survey. The study was conducted in Ireland, which has a mixed public-private healthcare system. Colorectal cancer survivors, diagnosed 6 to 37 months prior, were identified from the population-based National Cancer Registry. Cancer-related financial stress was assessed as impact of cancer on household ability to make ends meet and cancer-related financial strain by feelings about household financial situation since cancer diagnosis. Health-related quality of life was based on European Organisation for Research and Treatment of Cancer QLQ-C30 global health status. Logistic regression was used to identify associations between financial stress and strain and low health-related quality of life (lowest quartile, score ≤50). A total of 493 survivors participated. Overall, 41% reported cancer-related financial stress and 39% cancer-related financial strain; 32% reported both financial stress and financial strain. After adjustment for sociodemographic and clinical variables, the odds of low health-related quality of life were significantly higher in those who reported cancer-related financial stress postdiagnosis compared with those who reported no change in financial stress postcancer (OR = 2.54 (95% CI, 1.62-3.99)). The odds of low health-related quality of life were also significantly higher in those with worse financial strain postdiagnosis (OR =1.73 (95% CI, 1.09-2.72)). The OR for those with both cancer-related financial stress and financial strain was 2.59 (95% CI, 1.59-4.22). Survey responders were younger, on average, than nonresponders. Responders and nonresponders may have differed in cancer-related financial stress and strain or health-related quality of life. Four in 10 colorectal cancer survivors reported an adverse financial impact of cancer. Cancer-related financial stress and strain were significantly associated with low health-related quality of life. To inform support strategies, additional research is needed to better understand how both objective and subjective financial distress influence survivors' health-related quality of life. See Video Abstract http://links.lww.com/DCR/A447.

Cancer places a financial and economic burden on individuals, but relatively little is known about the consequences. We investigated associations between cancer-related financial stress and strain and psychological well-being. Individuals >6 months post-diagnosis with breast, prostate and lung cancer, identified from the National Cancer Registry Ireland, completed a postal questionnaire. Financial stress was assessed by the impact of the cancer diagnosis on household ability to make ends meet, financial strain by feelings about household financial situation since the cancer diagnosis and psychological well-being (depression, anxiety and distress) by the Depression Anxiety Stress Scales-21. Logistic regression was used to identify associations between financial stress and strain and depression, anxiety and distress of (a) any severity and (b) severe or worse. The response rate was 54%. Of 654 respondents, 49% reported increased financial stress and 32% increased financial strain due to cancer. Depression, anxiety and distress were present in: 36%, 29% and 29%, respectively (any severity); and 14%, 13% and 13%, respectively (severe or worse). In adjusted analyses, depression risk was raised threefold in those reporting increased cancer-related financial stress (odds ratio (OR) = 2.79, 95%CI 1.87-4.17) and increased cancer-related financial strain (OR = 3.56, 95%CI 2.23-5.67). For severe or worse depression, the risk estimates were more pronounced (increased stress: OR = 4.36, 95%CI 2.35-8.10; increased strain: OR = 8.21, 95%CI 3.79-17.77). Similar associations were found for anxiety and distress. Cancer-related financial stress and strain were consistently associated with increased risk of adverse psychological outcomes. If confirmed, these findings provide further rationale for initiatives to alleviate the financial burden of cancer.

Muslim young adults’ financial strain and financial stress during the COVID-19 pandemic: The moderating role of religiosity

This paper focuses on the process of exchange rate management during the two European Monetary System(EMS) crises, in 1981–83 and 1992–93, and examines the factors which led the French governments to adhere to the EMS. France's strong franc (franc fort) policy is a useful test case for maintaining national commitment to European monetary integration. The origin of the franc fort policy can be traced back to the exchange rate crisis of 1981–83. By actively supporting European institutions and emphasizing the emergence of a strong and united European common currency, France discovered the way to bolster confidence in her economic policy. Beyond this focal point, political justification and economic rationality became mutually reinforcing, configuring French national preference in European monetary integration. The response of the French government to the EMS crisis of 1992–93 was more consistent compared to the response to the 1981–83 crisis, and reflected the accumulation of loyalty to European monetary integration. This loyalty, however, was made neither from purely economic calculation nor out of normative commitment French European monetary policy reflected the interaction between domestic politics and European monetary integration. The French commitment to the franc fort also was based on domestic political bases such as the existence of a core policy group, a centralized policy‐making structure, and an issue linkage between the franc fort and European integration.

Objective financial stress, which incorporates all medical and non-medical financial stressors by households, shapes patients’ subjective perceptions of financial strain. This study addresses whether patient age and disability days reveal patients to have different perceptions of financial strain even when their households incur the same level of financial stress. Among patients with the same level of household financial stress, older patients perceived less financial strain from difficulty paying bills than younger patients. However, among patients reporting above-average disability days, older patients also perceived more financial strain than younger patients about the adequacy of their health insurance and finances in the future. Thus, financial strain measures that focus on projected health needs should supplement those that describe current household circumstances to improve screenings of older patients who are under-prescribed, or unable to adhere to, a regimen for all necessary health care.

Economic burden on families coping with end-stage cancer remains poorly understood. Advanced malignancy threatens financial stability of families, and interventions are needed to buffer them from impoverishment. This study examined the relationship between subjective and objective assessments of financial burden on families (financial strain and stress, respectively) and identified potentially modifiable factors to inform intervention efforts. Using national survey data, we analyzed responses from households that had recently experienced a cancer death; 176 of households provided information on financial strain, and 158 provided data on financial stress. In addition to self-reported appraisals of financial burden, measures assessed elements of the cancer care experience, treatment, symptom burden, work impact, insurance coverage, and demographics. Despite being well insured, approximately a quarter of respondents reported that the cost of care was a major financial burden, and a third used all or most of their savings. Financial strain and stress were moderately positively correlated (r = 0.46, p < 0.01). Higher financial stress scores were negatively correlated with decedent's age at death (r = -0.34, p < 0.01), and minority respondents ('other' race) reported much higher financial stress (M = 4.7; SD = 3.2) than White (M = 0.8; SD = 1.4) or Black (M = 1.6; SD = 2.2) respondents (p < 0.001). Financial burden was also associated with no or limited insurance coverage, changes in employment, severe pain and nausea, and provider interactions during the cancer care experience (e.g., whether the MD paid attention to non-medical factors or having unanswered questions about medications) (p < 0.05 for all). The cancer care experience, symptoms, and work impact were associated with financial burden and have important implications for research and practice. Copyright © 2015 John Wiley & Sons, Ltd.

Cancer may have a significant financial impact on patients, but the characteristics that predispose patients to cancer-related financial hardship are poorly understood. We investigated factors associated with cancer-related financial stress and strain in breast and prostate cancer survivors in Ireland, which has a complex mixed public-private healthcare system. Postal questionnaires were distributed to 1373 people diagnosed with cancer 3-24 months previously identified from the National Cancer Registry Ireland. Outcomes were cancer-related financial stress (impact of cancer diagnosis on household ability to make ends meet) and financial strain (concerns about household financial situation since cancer diagnosis). Modified Poisson regression was used to estimate relative risks (RR) for factors associated with cancer-related financial stress and strain. Seven hundred forty survivors participated (response rate = 54 %). Of the respondents, 48 % reported cancer-related financial stress and 32 % cancer-related financial strain. Compared to those employed at diagnosis, risk of cancer-related financial stress was significantly lower in those not working (RR = 0.71, 95 % CI 0.58-0.86) or retired (RR = 0.48, 95 % CI 0.34-0.68). It was significantly higher in those who had dependents; experienced financial stress pre-diagnosis; had a mortgage/personal loans; had higher direct medical out-of-pocket costs; and had increased household bills post-diagnosis. For cancer-related financial strain, significant associations were found with dependents, pre-diagnosis employment status and pre-diagnosis financial stress; risk was lower in those with higher direct medical out-of-pocket costs. Cancer-related financial stress and strain are common. Pre-diagnosis employment status and financial circumstances are important predictors of post-diagnosis financial wellbeing. These findings could inform development of tools to identify patients/survivors most in need of financial advice and support.

With the onset of globalization, the economic contexts and working conditions within many countries are changing, presenting new challenges' for governments, organizations, and workers. Amid these challenges, concerns about personal finances are prevalent among employees and detrimental to workers' health, well-being, and families. Research on how this financial stress affects employees at work is lacking. In this thesis, I propose an appraisal-based model of financial stress whereby actual income and expenses are related to perceptions of income adequacy to afford wants and needs. These adequacy perceptions are, in turn, related to financial strain, representing a heightened negative affective state regarding one's financial situation. I hypothesize that, through a drain in emotional resources, financial strain will negatively predict life satisfaction by potentially inhibiting participation in healthy, enjoyable behaviors. I argue that this drain in emotional resources will also inhibit successful task performance and restrict participation in discretionary citizenship behaviors. Data from two working samples provide support for the hypothesized financial stress model and establish preliminary evidence of construct validity for new financial stress scales. In a prospective investigation, financial strain fully mediated the effects of income adequacy on subsequent life satisfaction, but was not related to job performance. Instead, perceived income adequacy to afford wants had a direct negative relationship with both task performance and citizenship behaviors at work, while income adequacy to afford needs had a positive direct effect on organizational citizenship behaviors. This work resolves many conceptual inconsistencies about financial stress in the literature, and contributes to the understanding of how income perceptions and financial stress might influence psychological resources and work motivation. This work has important implications for how organizations manage employees who may be experiencing low income adequacy and high financial strain. Finally, there are several meaningful opportunities for future research that would substantially build upon existing theory and evidence in this new area of financial stress and work.

Tobacco use and perceived financial strain among junior enlisted in the U.S. Military in 2002

General introduction.- General introduction.- One: Currency Competition.- I. The theory of currency competition.- 1. The future unit of value.- 2. Currency competition: A sceptical view.- 3. Monetary integration and monetary stability: The economic criteria of the monetary constitution.- II. The history of currency competition.- 1. Private competitive note issue in monetary history.- 2. The Scottish banking system in the eighteenth and nineteenth century.- 3. The need for a lender of last resort.- 4. Further remarks on past experiences.- 5. The British monetary experience, 1797-1821.- III. The history of monetary thought on currency competition.- 1. Central bank monopoly in the history of economic thought: A century of myopia in England.- 2. Past justifications for public intervention.- Appendix to Chapter III. Free banking and currency competition: A bibliographical note.- IV. The current debate: The return to gold and the liberalization of banking.- 1. Backgrounder on the gold standard.- 2. Going for solid gold.- Appendix. Senate of the United States - Bill S.1704: To provide for the minting of U.S. gold coins.- Two: Monetary Union.- to Part Two. Which monetary integration?.- V. The European Monetary System.- 1. From the myth of the 'snake' to the myth of the 'E.C.U.'.- 2. Monetary Europe today: A cartel of central banks.- VI. Is the adjustable peg a viable option?.- 1. The adjustable peg: A viable option for the E.M.S.?.- 2. Monetary target or exchange-rate target?.- 3. The adjustable peg: An illusory compromise.- VII. Freely flexible exchange rates or a common currency?.- 1. Freely flexible exchange rates or a common currency? A new look at the issue.- 2. Political union and monetary union.- VIII. Exchange controls for ever?.- 1. Exchange controls for ever? The experience of the United Kingdom.- 2. Why do exchange controls exist?.- 3. A case for temporary exchange controls?.- IX. Towards a better European Monetary System.- Appendix to Bibliographical Note (Lawrence H. White).- The authors.- Index of names.

ABSTRACTThe article examines first the European Monetary System (EMS) experience and whether it can be applied to the International Monetary System (IMS). The EMS has particular features: it is not simply a regional Bretton Woods, and it also has a dimension going beyond the monetary field.Countries participating in the EMS exchange rate mechanism (ERM) have achieved a substantial reduction in exchange rate variability and a high degree of convergence toward cost and price stability. On a worldwide scale, things would be different: general political events have great influence on exchange rates, and large capital shifts are more likely. Whether the same degree of convergence of monetary policies can be achieved worldwide is doubtful. In the absence of a common political interest in integration, short‐term and domestic policy considerations will probably dominate policy decisions.In the second section the article addresses the relationship between the ERM currencies and the US dollar. There have been suggestions for a ‘common dollar policy’. However, advance agreement on a common policy is difficult to imagine, in view of the differing interests of individual ERM countries, as well as the United States. The main problem for the relationship between ERM currencies, the dollar, the yen, and pound sterling lies in the need for more convergence of developments and compatibility of policies.The achievements of the EMS do not lead to the conclusion that a system of stabilized exchange rates would work satisfactorily on a worldwide scale. A high degree of policy co‐ordination, not only of monetary policy, but also of other economic policies, would be needed.

Is the european monetary System (EMS) a useful approach to the problems it is meant to solve and to the pursuit of the objectives that its promoters have set for themselves? A review by the authors of a number of economic motives which underly the creation of the EMS leads them to conclude that the various economic problems which the european readily blame on floating exchange rates find in fact their origins in the economic policies pursued by the national governments. Moreover, the authors consider that the defense of parities in the EMS, either through intervention in the exchange markets or by other means, can involve high economic costs and that in the longer run market forces always triumph when parities no longer reflect the fundamental positions of the respective economies. Among the other factors which limit the usefulness of the EMS the authors identify the continuing lack of macro-economic policy coordination by participating countries, its regional character, the underestimation of the importance of the american dollar in the international monetary system and the impact of its fluctuations on european currencies and the tendency of the EMS to harmonize inflation rates at a higher level than should be aimed for. The authors therefore conclude that it is doubtful that the EMS constitutes a useful instrument of economic policy and that efforts towards european monetary union based on such a system of parities can be successful under present circumstances.

Financial Stress and Economic Policy Uncertainty: Impulse Response Functions and Causality

This article uses a structural vector autoregression approach to analyse the impact of financial stress on the economy and the relationship between monetary policy and financial stress in the ASEAN-5 economies (Indonesia, Malaysia, Philippines, Singapore and Thailand). We find that an increase in financial stress leads to tighter credit conditions and lower economic activity in all five countries. The estimated impact on the real economy displays an initial rapid decline followed by a gradual dissipation. In Malaysia, the Philippines and Thailand, the central banks tend to reduce policy interest rates (IRs) when financial stress increases, although there is substantial cross-country variation in the magnitude and time dynamics. The lower policy IRs are found to have little significant effects in lowering financial stress, but are still effective in stimulating economic activity through other channels. These findings imply that easing monetary policy is likely necessary but insufficient to address growth slowdowns associated with financial stress. Monetary easing should instead be complemented with other policy measures which are targeted at restoring financial stress to normal levels.

IntroductionDespite successful public health campaigns, tobacco use persists as a major cause of preventable illness and death. While tobacco taxation is recognized as an effective control strategy, concerns remain about potential financial strain on lower socioeconomic groups. This study investigates the relationship between household tobacco expenditure and financial stress in Australia, a country with high tobacco taxes and declining smoking rates.MethodsHousehold data from the 2015-16 Australian Household Expenditure Survey were analyzed (N = 10 036). Financial stress was measured using a scale based on nine self-reported indicators. Respondents were asked to report if their household had experienced any of these difficulties, for example, inability to pay utility bills or going without meals. Negative binomial regression models assessed the association between tobacco expenditure share and financial stress, adjusting for sociodemographic factors, household wealth, and other expenditures.ResultsFinancial stress was more prevalent among households that did (45.0%; (95% CI = 42.5 to 47.5)) versus did not (25.4%) purchase tobacco. All levels of tobacco expenditure were significantly associated with higher financial stress bivariably, after controlling for covariates. For instance, households in the second-lowest tobacco expenditure share quintile had a higher mean financial stress score than non-purchasing households (RR = 1.59, CI = 1.36 to 1.85, p < .001).DiscussionIn Australia, financial stress is prevalent among tobacco-purchasing households, and household tobacco expenditure is significantly associated with increased financial stress even at modest levels of spending, that is, the lower quintiles of tobacco expenditure. These findings underscore the need for targeted policies to mitigate financial strain and support smoking cessation among vulnerable populations.