Winning isn't everything: Guilt proneness and competitive vs. non-competitive motivation

OBJECTIVE

Guilt proneness is associated with both high motivation to succeed and enhanced concern for others. However, in competition, achieving success requires harming others' interests, which demotivates guilt-prone individuals. Given the prevalence of competition in social and professional life, we examine the relation between guilt proneness, general motivation, and competitive motivation.

METHOD

Two experiments and two laboratory studies (N = 1735) measured guilt proneness, general motivation, and competitive motivation, and their effects on competitive preferences and choices. Study settings included students' choice of playing a game individually vs. competitively (Study 1), physicians' likelihood to seek residency in medical fields characterized by high competitiveness (Study 2), amateur athletes' preferences between inclusive and win-oriented team strategies (Study 3), and online workers' evaluations of a hypothetical scenario (Study 4).

RESULTS

Guilt proneness was related positively to general motivation, but negatively to competitive motivation. Guilt proneness, indirectly through lower competitive motivation, predicted a lower likelihood of pursuing competitive paths and preference for non-competitive strategies. Emphasizing prosocial aspects of competitiveness attenuated these effects.

CONCLUSIONS

Guilt proneness is related to high general motivation but to a lower desire to win. Guilt-prone individuals strive for excellence, but through non-competitive paths, whereas people with lower guilt proneness prefer competing.

An Economic Model of Gambling Behaviour: A Two-Stage Approach

Gambling can cause significant harms and these can result in a net negative utility from participation, although lower levels of participation have potential benefits and can yield positive net utility. It is therefore important to understand and distinguish between these two stages of gambling behaviour. Currently, economic models have had limited focus on explaining why someone would gamble despite it yielding a negative utility. Here, we present a two-stage model, motivated by empirical literature and intuitive assumptions, that improves on existing economic models by distinguishing between the likelihood of gambling participation and of gambling that yields a negative utility. The model's predictions are empirically testable, consistent with existing literature, and add new insights. The model's ability to distinguish between the two stages helps to inform interventions that aim to reduce the prevalence of gambling-related harm while avoiding the need for restrictive approaches that aim to eliminate gambling altogether.

The (temporary) Covid-19 baby bust in Mexico

In this paper, we investigate whether fertility and newborn health changed during the Covid-19 pandemic in Mexico. We use national administrative data and an event-study design to examine the impact of the Covid-19 pandemic on fertility and newborn health characteristics. Our findings suggest that Mexico's fertility declined temporarily as measured by conceptions that likely occurred during the stay-at-home order. Initially, the general fertility rate fell by 11-12 per cent but quickly rebounded and returned close to its original levels by the end of 2021. Newborn health also deteriorated during the pandemic. Instances of low birthweight and prematurity substantially increased, with both remaining elevated over the entire pandemic period.

Childhood behavioral problems are associated with the intergenerational transmission of low education: a 16-year population-based study

The intergenerational transmission of low educational attainment is well-documented, but little is known about how behavioral problems in childhood explain this association. Drawing upon a population-based cohort study (n = 3020) linked to administrative records, we investigated the extent to which inattentive, internalizing, externalizing, and prosocial behaviors at child ages 6-8 years accounted for associations between parental education and child's risk of failing to graduate from high school. We adjusted for economic, demographic, cognitive, and perinatal factors, as well as parental mental health. Using logistic regressions and the Karlson-Holm-Breen decomposition method, we found that childhood behaviors together explained 19.5% of the association between mother's education and child's high school graduation status at age 22/23, and 13.7% of the association between father's education and this same outcome. Inattentive behaviors were most strongly associated with failure to graduate from high school, while the role of other behaviors was modest or negligible. Inattentive behaviors may represent a mediational pathway between parental education and child education. Early interventions targeting inattentive behaviors could potentially enhance the prospects of intergenerational educational mobility.

Vocational Outcomes in ASD: An Examination of Work Readiness Skills as well as Barriers and Facilitators to Employment Identified by Autistic Adults

Little is known about work readiness skills among autistic adults. This study sought to address this by examining work readiness skills and their relation to vocational outcomes among 281 autistic young adults. It also examined perceived barriers and facilitators to employment as articulated by a subset of autistic adults. Results revealed a variegated work readiness profile. Stronger work readiness skills (particularly work style/adaptability) were associated with more favorable vocational outcomes. Autistic participants articulated both barriers and facilitators to employment related to the autism phenotype, job search/work readiness, and workplace education. These findings indicate the need for research on phenotype-driven vocational rehabilitation strategies as well as workplace psychoeducation/accommodations to support vocational outcomes for autistic adults.

The psychological imprint of inequality: Economic inequality shapes achievement and power values in human life

OBJECTIVE

This research investigates how economic inequality shapes basic human values across three cross-national, cross-regional, and longitudinal studies (Ntotal  = 219,697).

METHODS

Study 1 examined the relationship between objective economic inequality and values across 77 societies from all five continents (n = 170,525). Study 2 examined the relationship between objective economic inequality and values across 51 regions in the United States (n = 48,559). Study 3 used a two-year longitudinal design to examine the relationship between perceived economic inequality and values (n = 613).

RESULTS

Results from multilevel modeling and longitudinal analysis suggested that people who lived in areas with higher economic inequality and who perceived higher economic inequality were more likely to endorse achievement and power values. Moreover, people who perceived higher economic inequality were less likely to endorse benevolence values. These effects were robust in within-country tests (Studies 2 and 3) but not in the cross-country tests (Study 1) when accounting for sociodemographic characteristics.

CONCLUSIONS

Our findings suggest that economic inequality may act as an antecedent of self-enhancement values, particularly within countries. In a world of rising economic inequality, this may over time lead to an overemphasis on achievement and power which have been shown to erode social cohesion.

Racial/Ethnic Differences in Association Between Medicaid Expansion and Causes and Costs of Readmission After Acute Ischemic Stroke

OBJECTIVE

The purpose of this study was to examine whether the relative frequency of leading causes and total associated costs of readmission after acute ischemic stroke changed with Medicaid expansion, and how these changes differed by racial/ethnic group.

METHODS

We used a difference-in-differences approach to compare changes in the relative frequency of leading causes of unplanned 30-day readmission and to examine changes in the costs associated with unplanned readmission between expansion states (AR, MD, NM, and WA) and non-expansion states (FL and GA). To estimate the differential effect of Medicaid expansion by race/ethnicity on the causes and cost of readmission, we added a time*treatment*race interaction. Multinomial logistic regression was performed to analyze the changes in readmission cause. Gamma log-link modeling was used to study changes in readmission costs for expansion compared to non-expansion states.

RESULTS

The final multinomial model showed an association between expanded Medicaid and the relative frequency of sepsis readmission for White patients. According to predictive margins, White patients in expansion states had an estimated increase of 3.3 percentage points in the share of readmissions for sepsis but not for White patients in non-expansion states. In contrast, non-White patients in expansion states had a decrease of 1.8 percentage points in the share of readmissions for sepsis. Overall, Medicaid expansion was associated with a net increase of 6.7 percentage points in the share of readmissions for sepsis among non-Hispanic Whites relative to all other groups. In the final gamma model, Medicaid expansion was associated with a decrease in readmission costs overall. According to predictive margins, the net cost reduction in expansion versus non-expansion states was an average of $2509.

CONCLUSIONS

Medicaid expansion is associated with an overall decrease in unplanned readmission costs and an increase among readmitted White patients in the likelihood of readmission for sepsis.

How Does Enlistment Motivation Shape Organizational Commitment? The Role of Career Identity and Organizational Support

This study, based on the integrative model of commitment and motivation and organizational support theory, examined the mechanism of intrinsic and extrinsic enlistment motivation on three facets of organizational commitment. A three-wave field questionnaire survey was conducted among 1606 Reserve Officers' Training Corps cadets from Chinese universities. The results showed that both intrinsic and extrinsic motivation positively predicted affective commitment, normative commitment, and continuous commitment. The positive effect of intrinsic motivation was stronger than extrinsic motivation. However, the interactive effect of intrinsic and extrinsic motivation negatively predicted the three aspects of organizational commitment. Career identity mediated all the direct effects above. Moreover, organizational support moderated the effects of intrinsic and extrinsic motivation on career identity. When organizational support was low, the positive effect of intrinsic motivation on career identity was stronger; whereas, when organizational support was high, the positive effect of extrinsic motivation on career identity was stronger. Furthermore, extrinsic motivation and organizational support jointly moderated the effect of intrinsic motivation on career identity and the mediating effects between intrinsic motivation and the three facets of organizational commitment. Specifically, when extrinsic motivation and organizational support were low, the direct and mediating effects above were stronger.

Using Prevention Research to Reduce Racial Disparities in Health Through Innovative Funding Strategies: The Case of Doula Care

Racial disparities in maternal birth outcomes are substantial even when comparing women with similar levels of education. While racial differences in maternal death at birth or shortly afterward have attracted significant attention from researchers, non-fatal but potentially life-threatening pregnancy complications are 30-40 times more common than maternal deaths. Black women have the worst maternal health outcomes. Only recently have health researchers started to view structural racism rather than race as the critical factor underlying these persistent inequities. We discuss the economic framework that prevention scientists can use to convince policymakers to make sustainable investments in maternal health by expanding funding for doula care. While a few states allow Medicaid to fund doula services, most women at risk of poor maternal health outcomes arising from structural racism lack access to culturally sensitive caregivers during the pre-and post-partum periods as well as during birth. We provide a guide to how research in health services can be more readily translated to policy recommendations by describing two innovative ways that cost-benefit analysis can help direct private and public funding to support doula care for Black women and others at risk of poor birth outcomes.

Compartir por altruismo o equidad: Prosocialidad según el nivel socioeconómico

La paradoja “Tener menos dar más” consiste en la generosidad de personas con bajos recursos económicos. Sin embargo, sólo se había explorado con estudiantes de clase media alta y con juegos del dictador con puntos. En este estudio realizamos el juego del dictador con dinero con 24 personas, de ocupaciones diversas y de niveles socioeconómicos (NSE) altos y bajos, con el objetivo de observar si la paradoja se mantenía y conocer los motivos que los participantes daban a su conducta. Los resultados muestran que las personas de NSE alto dieron significativamente más en promedio (M = 18.2, DE = 4.06); sin embargo, las personas de NSE bajo en general tendieron a dar la mitad de su dinero (M = 10, DE = 4.08) apelando a razones de equidad. Si bien la paradoja “Tener menos dar más” no se observó, se discuten los procesos que llevan a las personas de diferentes recursos económicos a compartir.

Publishing in potentially predatory journals: Do universities adopt university leaders' dishonest behavior?

With the development of science digitalization, it became possible to detect dishonest behavior. The increasing magnitude of predatory publishing has boosted scientific research on the topic. While studies on university leaders' impact concentrate mainly on its positive effects on organizational performance, to date, little is known about whether academic leaders can negatively influence the organizations they lead depending on their engagement in academic misconduct. Using a sample of Russian universities and their leaders from 2010-2020, I ask whether universities tend to adopt leaders' dishonest behavior. Specifically, I analyzed whether universities increase publications in potentially predatory journals after a leader with such a record enters the office. Relying on a culture theory of academic misconduct, I discuss the role-related factors that contribute to a leader's influence over employees. I focus on whether the leader's influence relates to external incentives for universities to publish more, the leader's career development type, or the leader's and university's research area. The findings demonstrate that the share of publications in potentially predatory journals tends to increase if a leader with such publications assumes office, especially if the university is research-oriented. The results suggest that academic reputation of a leader matters to the university's consequent misconduct.

Mechanisms of impulsive choice: Experiments to explore and models to map the empirical terrain

Impulsive choice is preference for a smaller-sooner (SS) outcome over a larger-later (LL) outcome when LL choices result in greater reinforcement maximization. Delay discounting is a model of impulsive choice that describes the decaying value of a reinforcer over time, with impulsive choice evident when the empirical choice-delay function is steep. Steep discounting is correlated with multiple diseases and disorders. Thus, understanding the processes underlying impulsive choice is a popular topic for investigation. Experimental research has explored the conditions that moderate impulsive choice, and quantitative models of impulsive choice have been developed that elegantly represent the underlying processes. This review spotlights experimental research in impulsive choice covering human and nonhuman animals across the domains of learning, motivation, and cognition. Contemporary models of delay discounting designed to explain the underlying mechanisms of impulsive choice are discussed. These models focus on potential candidate mechanisms, which include perception, delay and/or reinforcer sensitivity, reinforcement maximization, motivation, and cognitive systems. Although the models collectively explain multiple mechanistic phenomena, there are several cognitive processes, such as attention and working memory, that are overlooked. Future research and model development should focus on bridging the gap between quantitative models and empirical phenomena.

Sick, Hungry, and Vulnerable: Federal Stimulus and Food Security on Marginalized Populations During the COVID-19 Pandemic

In addition to the threat of serious illness, COVID-19 and subsequent restrictions had devastating economic consequences for many US citizens. This study examines the evolution of food security over the first months of the COVID-19 pandemic testing whether the initial economic stimulus payment improved the nutritional well-being of vulnerable populations. We use data from phase 1 of the Census Bureau's Household Pulse Survey among a nationally representative sample of adults and the 2017-2018 Current Population Survey Food Security Supplement. Using an ordered logistic regression, we assess differences in the incidence and severity of food security across demographic, income, geographic, and employment status cohorts and assess the effects of the first economic stimulus payment. Our results show that marginalized groups faced greater food insecurity and had food-related outcomes worsen over time. Blacks, Hispanics, and individuals living in rural areas became less food secure as the pandemic progressed. However, receipt of a stimulus payment appears to have improved conditions. Rising food prices and persistent high unemployment have the potential to exacerbate food insecurity among marginalized and at-risk groups.

The Big Five model in rural Southeast Asia: Validation, stability, and its role in household income

OBJECTIVE

We investigate the applicability of the Big Five model in rural Southeast Asia and thereby challenge recent concerns about the validity of the model in developing countries.

METHOD

We use a novel data set on personality traits from rural Thailand and Vietnam (N = 3811 individuals). In our analysis, we (i) assess the factor structure of the data, (ii) test the internal consistency of the items, (iii) compare the traits across two consecutive survey waves, and (iv) employ regressions to demonstrate the economic relevance of the traits.

RESULTS

The results demonstrate a five-factor structure that fits the Big Five model. We observe changes in personality traits over time but Cohen's d coefficients only range between 0.06 and 0.21. The average rank-order stability, measured by the test-retest correlation of the Big Five between the two consecutive waves, lies at 0.21. Individual changes in personality traits over time relate to experienced shocks and appear to be largely independent of age, gender, and education. We further find that openness and emotional stability positively correlate with rural incomes.

CONCLUSIONS

While there is skepticism, pertaining to the use of personality trait models in developing countries, our study demonstrates that their importance and usage cannot be rejected.

Social and non-social categorisation in investment decisions and learning

Categorical processes allow us to make sense of the environment effortlessly by grouping stimuli sharing relevant features. Although these processes occur in both social and non-social contexts, motivational, affective, and epistemic factors specific to the social world may motivate individuation over categorisation of social compared with non-social stimuli. In one experiment, we tested this hypothesis by analysing the reliance on categorical versus individuating information when making investment decisions about social and non-social targets. In an adaptation of the iterative trust game, participants from three experimental groups had to predict the economic outcomes associated with either humans (i.e., social stimuli), artificial races (i.e., social-like stimuli), or artworks (i.e., non-social stimuli) to earn economic rewards. We observed that investment decisions with humans were initially biased by categorical information in the form of gender stereotypes, but later improved through an individuating learning approach. In contrast, decisions made with non-social stimuli were initially unbiased by categorical information, but the category-outcomes associations learned through repeated interactions were quickly used to categorise new targets. These results are discussed along with motivational and perceptual mechanisms involved in investment decisions and learning about social and non-social agents.

Preterm birth and educational disadvantage: Heterogeneous effects

Although preterm birth is the leading cause of perinatal morbidity and mortality in advanced economies, evidence about the consequences of prematurity in later life is limited. Using Swedish registers for cohorts born 1982-94 (N  =  1,087,750), we examine the effects of preterm birth on school grades at age 16 using sibling fixed effects models. We further examine how school grades are affected by degree of prematurity and the compensating roles of family socio-economic resources and characteristics of school districts. Our results show that the negative effects of preterm birth are observed mostly among children born extremely preterm (<28 weeks); children born moderately preterm (32-<37 weeks) suffer no ill effects. We do not find any evidence for a moderating effect of parental socio-economic resources. Children born extremely preterm and in the top decile of school districts achieve as good grades as children born at full term in an average school district.Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2022.2080247.

Hospital Expenditures Under Global Budgeting and Single-Payer Financing: An Economic Analysis, 2021-2030

U.S. hospitals provide large amounts of low-value care and devote inordinate resources to administration, while some hospitals leverage market power to realize large profits. Meanwhile, many rural and safety net hospitals are financially distressed. The coexistence of waste and want suggests that U.S. hospital financing is neither efficient nor equitable. We model the economic consequences of adopting the mode of hospital payment used in Canada and the U.S. Veterans Health Administration and proposed in the leading congressional single-payer Medicare-for-All bill: global budgeting. Our models assume increased utilization due to expanded and upgraded coverage; gradual reductions in administrative costs from simplified payment; and the elimination of hospital profits, with hospital capital expenditures funded by explicit grants rather than from profits or borrowing. We estimate that non-federal hospital operating budgets will total $17.2 trillion between 2021 and 2030 under current law versus $14.7 trillion under single-payer with global budgeting. This difference reflects $520 billion in foregone profits and $1,984 billion in reduced expenditures on hospital administration; expenditures on clinical operating budgets, however, would be higher than under current law, funded out of profits.

The Impact of Seguro Popular on the Progression of Disabilities Among Older Adults With Chronic Degenerative Diseases in Mexico

In a context of population aging, poverty, and inequalities including in the access to healthcare services, in 2004 Mexico initiated Seguro Popular (SP), a non-contributory health insurance providing coverage for informal sector workers excluded from social security. We analyze the impact of SP on the progression of functional limitations among adults aged over 50 with chronic degenerative diseases previously without stable health insurance. Panel data from the Mexican Health and Aging Study (MHAS) permit a difference-in-difference propensity score matching approach, comparing respondents before (2003) and after (2015) the implementation of SP. Findings suggest that SP affiliation in (or shortly before) 2012 has (weakly) slowed the progression of mobility, IADL, and ADL limitations, with a clearer effect in large urban centers. Reforms in the healthcare sector should address underlying structural barriers, reduce existing inequities, and provide effective access to high-quality services. with increased attention for long-term care needs, to guarantee healthy aging.

Loss aversion in the control of attention

Loss aversion is a psychological bias where an increase in loss is perceived as being larger than an equivalent increase in gain. In the present study, two experiments were conducted to explore whether attentional control reflects loss aversion. Participants performed a visual search task. On each trial, a red target and a green target were presented simultaneously, and participants were free to search for either one. Participants always gained points when they searched for a gain color target (e.g., red). However, they gained or lost points when they searched for a gain-loss color target (e.g., green). In Experiment 1, the expected values of the gain color and the gain-loss color were equal. Therefore, for maximizing the reward, participants did not need to preferably search for a particular color. However, results showed that participants searched for the gain color target more than the gain-loss color target, suggesting stronger attentional control for the gain color than the gain-loss color. In Experiment 2, even though the expected value of the gain-loss color was greater than that of the gain color, attention was allocated to the gain color more than to the gain-loss color. The results imply that attentional control can operate in accordance with the loss aversion principle when the boundary conditions for loss aversion in a repeated binary decision-making task were met.

The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries

OBJECTIVE

To examine indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries.

DATA SOURCES

2010-2018 Health and Retirement Study survey data linked to annual Medicare beneficiary summary files.

STUDY DESIGN

We estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. We compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states.

DATA COLLECTION/EXTRACTION METHODS

The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and residing in the community.

PRINCIPAL FINDINGS

ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage (95% CI: 0.020-0.176), a 4.4 percentage point increase in having any institutional outpatient spending (95% CI: 0.005-0.083), and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment (95% CI: -0.003 to 0.050, p = 0.079).

CONCLUSIONS

ACA Medicaid expansion was associated with more institutional outpatient spending among older low-income Medicare beneficiaries. Increased care costs should be weighed against potential benefits from increased realized access to care.

Links between early-life contextual factors and later-life cognition and the role of educational attainment

OBJECTIVE

Educational attainment is a well-documented predictor of later-life cognition, but less is known about upstream contextual factors. This study aimed to identify which early-life contextual factors uniquely predict later-life global cognition and whether educational attainment mediates these relationships.

METHOD

Participants were drawn from the Michigan Cognitive Aging Project (N = 485; Mage = 63.51; SDage = 3.13; 50% non-Hispanic Black). Early-life exposures included U.S. region of elementary school (Midwest, South, Northeast), average parental education, household composition (number of adults (1, 2, 3+), number of children), school racial demographics (predominantly White, predominantly Black, diverse), self-reported educational quality, and school type (public/private). Later-life global cognition was operationalized with a factor score derived from a comprehensive neuropsychological battery. Sequential mediation models controlling for sociodemographics estimated total, direct, and indirect effects of early-life contextual factors on cognition through educational attainment (years).

RESULTS

Higher educational quality, higher parental education, and attending a private school were each associated with better cognition; attending a predominantly Black or diverse school and reporting three or more adults in the household were associated with lower cognition. After accounting for educational attainment, associations remained for educational quality, school type, and reporting three or more adults in the household. Indirect effects through educational attainment were observed for school region, educational quality, school racial demographics, and parental education.

CONCLUSIONS

School factors appear to consistently predict later-life cognition more than household factors, highlighting the potential long-term benefits of school-level interventions for cognitive aging. Future research should consider additional mediators beyond educational attainment such as neighborhood resources and childhood adversity.

Understanding guilt-related interpersonal dysfunction in obsessive-compulsive personality disorder through computational modeling of two social interaction tasks

BACKGROUND

Obsessive-compulsive personality disorder (OCPD) is a high-prevalence personality disorder characterized by subtle but stable interpersonal dysfunction. There have been only limited studies addressing the behavioral patterns and cognitive features of OCPD in interpersonal contexts. The purpose of this study was to investigate how behaviors differ between OCPD individuals and healthy controls (HCs) in the context of guilt-related interpersonal responses.

METHOD

A total of 113 participants were recruited, including 46 who were identified as having OCPD and 67 HCs. Guilt-related interpersonal responses were manipulated and measured with two social interactive tasks: the Guilt Aversion Task, to assess how anticipatory guilt motivates cooperation; and the Guilt Compensation Task, to assess how experienced guilt induces compensation behaviors. The guilt aversion model and Fehr-Schmidt inequity aversion model were adopted to analyze decision-making in the Guilt Aversion Task and the Guilt Compensation Task, respectively.

RESULTS

Computational model-based results demonstrated that, compared with HCs, the OCPD group exhibited less guilt aversion when making cooperative decisions as well as less guilt-induced compensation after harming others.

CONCLUSION

Our findings indicate that individuals with OCPD tend to be less affected by guilt than HCs. These impairments in guilt-related responses may prevent adjustments in behaviors toward compliance with social norms and thus result in interpersonal dysfunctions.

Pair-switching rerandomization

Rerandomization discards assignments with covariates unbalanced in the treatment and control groups to improve estimation and inference efficiency. However, the acceptance-rejection sampling method used in rerandomization is computationally inefficient. As a result, it is time-consuming for rerandomization to draw numerous independent assignments, which are necessary for performing Fisher randomization tests and constructing randomization-based confidence intervals. To address this problem, we propose a pair-switching rerandomization (PSRR) method to draw balanced assignments efficiently. We obtain the unbiasedness and variance reduction of the difference-in-means estimator and show that the Fisher randomization tests are valid under PSRR. Moreover, we propose an exact approach to invert Fisher randomization tests to confidence intervals, which is faster than the existing methods. In addition, our method is applicable to both nonsequentially and sequentially randomized experiments. We conduct comprehensive simulation studies to compare the finite-sample performance of the proposed method with that of classical rerandomization. Simulation results indicate that PSRR leads to comparable power of Fisher randomization tests and is 3-23 times faster than classical rerandomization. Finally, we apply the PSRR method to analyze two clinical trial datasets, both of which demonstrate the advantages of our method.

Art Value Creation and Destruction

I present a theory of creative and destructive value state referring to abstract art. Value is a probabilistic state held as a mixture of its expectation and information forces that coexist in a give-and-take relationship. Expectations are driven by the disclosure of novel information about the value state of various events of desire. Each bit of accumulated information contributes to the improvement of perception up to a threshold level, beyond which begin conscious states. The desire to disclose a value state triggers a triadic system of evaluation which uses concepts, observables and approaches. While the triadic valuation mechanisms can be used to assess various commodities, the scope of this work is limited to the case of artworks, in particular abstract paintings. I assume that art value is basically mediated by the interplay between these value state mechanisms of creation and destruction. Expectations in artwork develop attraction by challenging its contemplator to evaluate (predict) its meaning. Once the relevant information, corresponding to its creative expectations, is acquired (and conditioned), emotional states of indifference, disinterest and desensitization develop.

Individual Differences in Implicit Bias Can Be Measured Reliably by Administering the Same Implicit Association Test Multiple Times

The use of the Implicit Association Test (IAT) as a measure of individual differences is stymied by insufficient test-retest reliability for assessing trait-level constructs. We assess the degree to which the IAT measures individual differences and test a method to improve its validity as a "trait" measure: aggregating across IATs. Across three studies, participants (total n = 960) completed multiple IATs in the same session or across multiple sessions. Using latent-variable models, we found that half of the variance in IAT scores reflects individual differences. Aggregating across multiple IATs approximately doubled the variance explained with explicit measures compared with a single IAT D-score. These findings show that IAT scores contain considerable noise and that a single IAT is inadequate to estimate trait bias. However, aggregation across multiple administrations can correct this and better estimate individual differences in implicit attitudes.

US Taxation of Gambling Winnings and Incentives to Bet

Sports betting is growing rapidly in the US after its legalization by the Supreme Court in 2018. This paper describes the treatment of gambling winnings and losses in the federal tax code and shows how the system may incentivize some gamblers to substantially increase the scale of their betting in order to have a chance to win. This incentive stems from the fact that gambling losses can only be deducted if taxpayers are filing for itemized deductions, meaning the scale of gambling losses has to be large enough to push a taxpayer's eligible deductions over the standard deduction. This incentive to engage in large-scale betting applies mostly to lower and middle-income households.

Dissociated modulations of intranasal vasopressin on prosocial learning between reward-seeking and punishment-avoidance

BACKGROUND

As an integral ingredient of human sociality, prosocial behavior requires learning what acts can benefit or harm others. However, it remains unknown how individuals adjust prosocial learning to avoid punishment or to pursue reward. Given that arginine vasopressin (AVP) is a neuropeptide that has been involved in modulating various social behaviors in mammals, it could be a crucial neurochemical facilitator that supports prosocial learning.

METHODS

In 50 placebo controls and 54 participants with AVP administration, we examined the modulation of AVP on the prosocial learning characterized by reward and punishment framework, as well as its underlying neurocomputational mechanisms combining computational modeling, event-related potentials and oscillations.

RESULTS

We found a self-bias that individuals learn to avoid punishment asymmetrically more severely than reward-seeking. Importantly, AVP increased behavioral performances and learning rates when making decisions to avoid losses for others and to obtain gains for self. These behavioral effects were underpinned by larger responses of stimulus-preceding negativity (SPN) to anticipation, as well as higher punishment-related feedback-related negativity (FRN) for prosocial learning and reward-related P300 for proself benefits, while FRN and P300 neural processes were integrated into theta (4-7 Hz) oscillation at the outcome evaluation stage.

CONCLUSIONS

These results suggest that AVP context-dependently up-regulates altruism for concerning others' losses and reward-seeking for self-oriented benefits. Our findings provide insight into the selectively modulatory roles of AVP in prosocial behaviors depending on learning contexts between proself reward-seeking and prosocial punishment-avoidance.

Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas

Using the 2021 Occupational Employment and Wage Statistics (OEWS) dataset, we calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US. We find that there are, on average, 32.9 home health aides per 1000 older adults (age 65+) in rural areas and 50.4 home health aides per 1000 older adults in urban areas. There are, on average, 20.9 nursing assistants per 1000 older adults in rural areas and 25.3 nursing assistants per 1000 older adults in urban areas. There is substantial regional variation. Greater investment needs to be made in improving wages and job quality for direct care workers to attract workers to these critical occupations, especially in rural areas where the need for direct care is greater.

Structure learning principles of stereotype change

Why, when, and how do stereotypes change? This paper develops a computational account based on the principles of structure learning: stereotypes are governed by probabilistic beliefs about the assignment of individuals to groups. Two aspects of this account are particularly important. First, groups are flexibly constructed based on the distribution of traits across individuals; groups are not fixed, nor are they assumed to map on to categories we have to provide to the model. This allows the model to explain the phenomena of group discovery and subtyping, whereby deviant individuals are segregated from a group, thus protecting the group's stereotype. Second, groups are hierarchically structured, such that groups can be nested. This allows the model to explain the phenomenon of subgrouping, whereby a collection of deviant individuals is organized into a refinement of the superordinate group. The structure learning account also sheds light on several factors that determine stereotype change, including perceived group variability, individual typicality, cognitive load, and sample size.

Introducing tomsup: Theory of mind simulations using Python

Theory of mind (ToM) is considered crucial for understanding social-cognitive abilities and impairments. However, verbal theories of the mechanisms underlying ToM are often criticized as under-specified and mutually incompatible. This leads to measures of ToM being unreliable, to the extent that even canonical experimental tasks do not require representation of others' mental states. There have been attempts at making computational models of ToM, but these are not easily available for broad research application. In order to help meet these challenges, we here introduce the Python package tomsup: Theory of mind simulations using Python. The package provides a computational eco-system for investigating and comparing computational models of hypothesized ToM mechanisms and for using them as experimental stimuli. The package notably includes an easy-to-use implementation of the variational recursive Bayesian k-ToM model developed by (Devaine, Hollard, & Daunizeau, 2014b) and of simpler non-recursive decision models, for comparison. We provide a series of tutorials on how to: (i) simulate agents relying on the k-ToM model and on a range of simpler types of mechanisms; (ii) employ those agents to generate online experimental stimuli; (iii) analyze the data generated in such experimental setup, and (iv) specify new custom ToM and heuristic cognitive models.

A systematic investigation into the reliability of inter-temporal choice model parameters

Decades of work have been dedicated to developing and testing models that characterize how people make inter-temporal choices. Although parameter estimates from these models are often interpreted as indices of latent components of the choice process, little work has been done to examine their reliability. This is problematic because estimation error can bias conclusions that are drawn from these parameter estimates. We examine the reliability of parameter estimates from 11 prominent models of inter-temporal choice by (a) fitting each model to data from three previous experiments with designs representative of those typically used to study inter-temporal choice, (b) examining the consistency of parameters estimated for the same person based on different choice sets, and (c) conducting a parameter recovery analysis. We find generally low correlations between parameters estimated for the same person from the different choice sets. Moreover, parameter recovery varies considerably between models and the experimental designs upon which parameter estimates are based. We conclude that many parameter estimates reported in previous research are likely unreliable and provide recommendations on how to enhance the reliability of inter-temporal choice models for measurement purposes.

Decision-making under risk and ambiguity in adults with Tourette syndrome

BACKGROUND

Tourette syndrome (TS) as well as its most common comorbidities are associated with a higher propensity for risky behaviour in everyday life. However, it is unclear whether this increased risk propensity in real-life contexts translates into a generally increased attitude towards risk. We aimed to assess decision-making under risk and ambiguity based on prospect theory by considering the effects of comorbidities and medication.

METHODS

Fifty-four individuals with TS and 32 healthy controls performed risk and ambiguity decision-making tasks under both gains and losses conditions. Behavioural and computational parameters were evaluated using (i) univariate analysis to determine parameters difference taking independently; (ii) supervised multivariate analysis to evaluate whether our parameters could jointly account for between-group differences (iii) unsupervised multivariate analysis to explore the potential presence of sub-groups.

RESULTS

Except for general 'noisier' (less consistent) decisions in TS, we showed no specific risk-taking behaviour in TS or any relation with tics severity or antipsychotic medication. However, the presence of comorbidities was associated with distortion of decision-making. Specifically, TS with obsessive-compulsive disorder comorbidity was associated with a higher risk-taking profile to increase gain and a higher risk-averse profile to decrease loss. TS with attention-deficit hyperactivity disorder comorbidity was associated with risk-seeking in the ambiguity context to reduce a potential loss.

CONCLUSIONS

Impaired valuation of risk and ambiguity was not related to TS per se. Our findings are important for clinical practice: the involvement of individuals with TS in real-life risky situations may actually rather result from other factors such as psychiatric comorbidities.

Children of immigrants: Racial assortative mating and the transition to adulthood

Few studies have followed immigrant-origin individuals from adolescence to adulthood or examined their spousal choices. Using longitudinal data from Add Health, we present a life-course model that examines the differences in racial assortative mating between children of immigrants and non-immigrants. The results reveal substantial variation in racial endogamy from generation to generation. Racial endogamy was highest in the third generation, but this is due entirely to high racial endogamy among whites. Out-marriage was most pronounced among first- and second-generation immigrants. Our life-course approach shows that the effects of race and generation on intermarriage were mediated by family background (e.g. language proficiency and residence) and educational attainment (at time of marriage), a finding largely indicative of processes of marital assimilation that unfold over time and generation. Evidence of acculturation and structural assimilation, however, could not fully account for the large, persistent, and uneven effects of race and generation on interracial marriage.

The Impact of Malpractice Damage Caps on C-section Rates and Alternative Approaches

About half of the states in the United States have had noneconomic damage caps in place for at least 8 years. National aggregate data shows that women are just as likely to give birth by cesarean section (C-section) in states with damage caps as in ones without. For the most recent year studied, the national C-section rate for births in states with damage caps was 33.04% compared with a 32.10% ratefor births in states without caps. Other initiatives (malpractice insurance reform, accessible public disclosure of hospital C-section rates, and improved compensation for vaginal delivery) should be considered to reduce C-section rates.

Experiences of the Flint Water Crisis Among Reproductive-Age Michigan Women in Communities Outside of Flint: Differences by Race and Ethnicity

We sought to understand how women in Michigan communities outside of Flint experienced the Flint water crisis, an avoidable public health disaster widely attributed to structural racism. Using survey data from 950 Michigan women aged 18-45 from communities outside of Flint, we examined racial and ethnic differences in personal connections to Flint, perceived knowledge about the water crisis, and beliefs about the role of anti-Black racism in the water crisis factors that could contribute to poor health via increased psychological stress. We found that White (OR = 0.32; 95% CI: 0.22, 0.46) and Hispanic (OR = 0.21; 95% CI: 0.09, 0.49) women had lower odds than Black women of having family or friends who lived in Flint during the water crisis. Compared to Black women, White women were less likely to be moderately or very knowledgeable about the water crisis (OR = 0.58; 95% CI: 0.41, 0.80). White women (OR = 0.26; 95% CI: 0.18, 0.37), Hispanic women (OR = 0.38; 95% CI: 0.21, 0.68), and women of other races (OR = 0.28; 95% CI: 0.15, 0.54) were less likely than Black women to agree that the water crisis happened because government officials wanted to hurt Flint residents. Among those who agreed, White women (OR = 0.47; 95% CI: 0.30, 0.74) and women of other races (OR = 0.33; 95% CI: 0.12, 0.90) were less likely than Black women to agree that government officials wanted to hurt people in Flint because most residents are Black. We conclude that the Flint water crisis was a racialized stressor, with potential implications for the health of reproductive-age Black women.

Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet

Introduction

Human health and wellbeing may depend on economic growth, the implication being that policymakers need to choose between population health and the health of ecosystems. Over two decades of low economic growth, Japan's life expectancy grew. Here we assess the temporal changes of subjective health and health inequality during the long-term low economic growth period.

Methods

Eight triennial cross-sectional nationally representative surveys in Japan over the period of economic stagnation from 1992 to 2013 were used (n = 625,262). Health is defined positively as wellbeing, and negatively as poor health, based on self-rated health. We used Slope and Relative Indices of Inequality to model inequalities in self-rated health based on household income. Temporal changes in health and health inequalities over time were examined separately for children/adolescents, working-age adults, young-old and old-old.

Results

At the end of the period of economic stagnation (2013), compared to the beginning (1992), the overall prevalence of wellbeing declined slightly in all age groups. However, poor health was stable or declined in the young-old and old-old, respectively, and increased only in working-age adults (Prevalence ratio: 1.14, 95% CI 1.08, 1.20, <0.001). Over time, inequality in wellbeing and poor self-rated health were observed in adults but less consistently for children, but the inequalities did not widen in any age group between the start and end of the stagnation period.

Conclusions

Although this study was a case study of one country, Japan, and inference to other countries cannot be made with certainty, the findings provide evidence that low economic growth over two decades did not inevitably translate to unfavourable population health. Japanese health inequalities according to income were stable during the study period. Therefore, this study highlighted the possibility that for high-income countries, low economic growth may be compatible with good population health.

California Hospitals' Rapidly Declining Traditional Medicare Operating Margins

In recent years, Medicare margins of U.S. short-term acute care hospitals participating in the inpatient prospective payment system (IPPS) have declined nationally by over 10 percentage points, from 2.2% in 2002 to -8.7% in 2019. This trend conceals critical regional variations, with recent studies documenting particularly low and negative margins in metropolitan areas with higher labor costs despite geographic adjustments by the Centers for Medicare & Medicaid Services (CMS). In this article, we describe recent trends in California hospitals' traditional fee-for-service Medicare operating margins compared to hospital operating margins across payers and changes in the CMS hospital wage index (HWI) used to adjust Medicare payments. We conduct an observational study of audited financial reports of IPPS-participating California hospitals using California Department of Health Care Access and Information and CMS data for years 2005-2020 (n = 4429 reports included in the analysis). We describe trends in financial measures by payer and investigate associations between HWI and traditional Medicare margins, focusing on the pre-COVID period of 2005 through 2019. During that period, California hospitals' statewide traditional Medicare operating margin declined from -27 to -40%, and financial shortfalls in caring for fee-for-service Medicare patients more than doubled ($4.1 billion in 2005 to $8.5 billion in 2019, both values in 2019 dollars). Meanwhile, operating margins from commercial managed care patients increased from 21% in 2005 to 38% in 2019. There was a stable negative association between HWI and traditional Medicare operating margins throughout the period (p = 0.000 in 2005; p < 0.0001 in 2006-2020), indicating that areas of California with higher health care wages had persistently worse traditional Medicare operating margins than areas with lower wages.

Dead Labor: Mortality Inequities by Class, Gender, and Race/Ethnicity in the United States, 1986-2019

Objectives. To estimate social class inequities in US mortality using a relational measure based on power over productive property and workers' labor. Methods. We used nationally representative 1986-2018 National Health Interview Survey data with mortality follow-up through December 31, 2019 (n = 911 850). First, using business-ownership, occupational, and employment-status data, we classified respondents as incorporated business owners (IBOs), unincorporated business owners (UBOs), managers, workers, or not in the labor force (NLFs). Next, using inverse-probability-weighted survival curves, we estimated class mortality inequities overall, after subdividing workers by employment status and occupation, and by period, gender, race/ethnicity, and education. Results. UBOs, workers, and NLFs had, respectively, 6.3 (95% confidence interval [CI] = -8.1, -4.6), 6.6 (95% CI = -8.1, -5.0), and 19.4 (95% CI = -21.0, -17.7) per 100 lower 34-year survival rates than IBOs. Mortality risk was especially high for unemployed, blue-collar, and service workers. Inequities increased over time and were greater among male, racially minoritized, and less-educated respondents. Conclusions. We estimated considerable mortality inequities by class, gender, and race/ethnicity. We also estimated that class mortality inequities are increasing, threatening population health. Public Health Implications. Addressing class inequities likely requires structural, worker-empowering interventions. (Am J Public Health. 2023;113(6):637-646. https://doi.org/10.2105/AJPH.2023.307227).

Association of a State Prescribing Limits Policy with Opioid Prescribing and Long-term Use: an Interrupted Time Series Analysis

BACKGROUND

Prescription opioids were a major initial driver of the opioid crisis. States have attempted to reduce overprescribing by enacting policies that limit opioid prescriptions, but the impacts of such policies on new prescribing and subsequent transitions to long-term use are not fully understood.

OBJECTIVE

To examine the association of implementation of a state prescribing limits policy with opioid prescribing and transitions to long-term opioid use.

DESIGN

Interrupted time series analyses assessing trends in new opioid prescriptions and long-term use before and after policy implementation.

PATIENTS

A total of 130,591 New Jersey Medicaid enrollees ages 18-64 who received an initial opioid prescription from January 2014 to December 2019.

INTERVENTIONS

New Jersey's opioid prescribing limit policy implemented in March 2017.

MAIN MEASURES

Total new opioid prescriptions, percentage of new prescriptions with >5 days' supply, and transition to long-term opioid use, defined as having opioid supply on day 90 after the initial prescription.

KEY RESULTS

Policy implementation was associated with a significant monthly increase in new opioid prescriptions of 0.86 per 10,000 enrollees, halving the pre-policy decline in the prescribing rate. Among new opioid prescriptions, the percentage with >5 days' supply decreased by about 1 percentage point (-0.76 percentage points, 95% CI -0.89, -0.62) following policy implementation. However, policy implementation was associated with a significant monthly increase in the rate of initial prescriptions with supply on day 90 (9.95 per 10,000 new prescriptions, 95% CI 4.80, 15.11) that reversed the downward pre-implementation trend.

CONCLUSIONS

The New Jersey policy was associated with a reduction in initial prescriptions with >5 days' supply, but not with an overall decline in new opioid prescriptions or in the rate at which initial prescriptions led to long-term use. Given their only modest benefits, policymakers and clinicians should carefully weigh potential unintended consequences of strict prescribing limits.