Video Game Addictive Symptom Level, Use Intensity, and Hedonic Experience: Cross-sectional Questionnaire Study.

BACKGROUND: The effects of behavioral addiction to video games has received increasing attention in the literature, given increased use intensity among subgroups of video game players. OBJECTIVE: This study seeks to empirically determine the relationship between intensity of video gaming and hedonic experience of the player. METHODS: We conducted a survey of 835 individuals who regularly play video games to determine the relationship between intensity of use and hedonic experience. We divided the sample into quartiles by self-reported video game addictive symptom level (from the Internet Gaming Disorder Scale) and conducted polynomial regressions separately for each quartile. RESULTS: We found that the higher video game addictive symptom level groups experienced a U-shaped (curvilinear) relationship between hedonic experience and intensity of play, whereas groups with lower video game addictive symptom levels exhibited no such relationship. The coefficients for the highest addictive symptom level group (quartile 4) for marginal effects for hours played per week and hours played per week squared were significantly negative (P=.005) and significantly positive (P=.004), respectively. CONCLUSIONS: Our results are consistent with sensitization and tolerance theories, which suggest that high-symptom groups experience frustration and disappointment until they achieve excessive dopamine release, at which point their hedonic experience is expected to improve with additional play. Conversely, low-symptom groups experience no such fall-and-rise pattern. This result is consistent with the outcome that members of the latter group play the game for the direct experience, such that their hedonic experience is more directly related to events occurring in the game than to the increasingly elusive pursuit of excessive dopamine release. We also find that high-symptom groups spend substantially more time and money to support video game use and are much more likely to engage in video game use at the expense of other important activities, such as working, sleeping, and eating.

Age at League Entry and Early All-Cause Mortality among National Football League Players.

BACKGROUND: A growing body of research suggests that American football players are exposed to higher cumulative head impact risk as competition level rises. Related literature finds that head impacts absorbed by youth, adolescent, and emerging adult players are associated with elevated risk of long-term health problems (e.g., neurodegenerative disease onset). Most National Football League (NFL) players enter the League as emerging adults (18-24 years old), a period of continued cognitive and overall physical development. However, no prior research has studied the effect of age-at-entry on long-term NFL player health. Hypothesis/Purpose: This study assesses whether early NFL player age-at-entry is associated with increased risk of early all-cause mortality, controlling for player position, BMI, year-of-entry, birth year, and NFL Draft round (expected ability upon League entry). STUDY DESIGN: This retrospective cohort study included 9049 players who entered the NFL from 1970-2017 and subsequently played at least one game. The variables whether deceased, age-at-death, age-at-entry, and controls were collected from Pro Football Reference website, a leading data site for American football that has been used extensively in the literature. Data collection began on 13 July 2017, and follow-up ended on 1 July 2018. Statistical analysis was performed from 10 March 2020 to 3 August 2020. Data was validated by checking a large sub-sample of data points against alternative sources such as NFL.com and NFLsavant.com. METHODS: Cox proportional hazards regression models were used to examine variation in death hazard by NFL player age-at-entry, conditional upon a full set of controls. RESULTS: Conditional on controls, Cox regression results indicate that a one-year increase in age-at-entry was significantly associated with a 14% decreased hazard-of-death (H.R., 0.86; 95% CI, 0.74-0.98). Among relatively young entering players, the increased hazard appears to be concentrated in the first quartile of players by age at League entry (20.2 to 22.3 years). Players not in this quartile exhibited a decreased hazard-of-death (H.R., 0.74; 95% CI, 0.57-0.97) compared with players who entered at a relatively young (first quartile) age. CONCLUSION: An earlier age-at-entry is associated with an increased hazard-of-death among NFL players. Currently, the NFL regulates age-at-entry only indirectly by requiring players to be 3 years removed from high school before becoming NFL Draft-eligible. Implementing a minimum age at entry for NFL players of 22 years and 4 months at beginning of season is expected to result in reduced mortality. What is known about this subject? There are no prior studies on the effects of NFL player age-at-entry on early mortality risk. What this study adds to existing knowledge: This study determines whether entering the NFL at an age of physical and physiological development is related to early mortality risk.

The aggregation paradox for statistical rankings and nonparametric tests.

The relationship between social choice aggregation rules and non-parametric statistical tests has been established for several cases. An outstanding, general question at this intersection is whether there exists a non-parametric test that is consistent upon aggregation of data sets (not subject to Yule-Simpson Aggregation Paradox reversals for any ordinal data). Inconsistency has been shown for several non-parametric tests, where the property bears fundamentally upon robustness (ambiguity) of non-parametric test (social choice) results. Using the binomial(n, p = 0.5) random variable CDF, we prove that aggregation of r(≥2) constituent data sets-each rendering a qualitatively-equivalent sign test for matched pairs result-reinforces and strengthens constituent results (sign test consistency). Further, we prove that magnitude of sign test consistency strengthens in significance-level of constituent results (strong-form consistency). We then find preliminary evidence that sign test consistency is preserved for a generalized form of aggregation. Application data illustrate (in)consistency in non-parametric settings, and links with information aggregation mechanisms (as well as paradoxes thereof) are discussed.

Measuring individual worker output in a complementary team setting: Does regularized adjusted plus minus isolate individual NBA player contributions?

Adjusted plus minus (APM) measures have redefined our understanding of player value in basketball and hockey, where both are team games featuring player productivity spillovers. APM measures use seasonal play-by-play data to estimate individual player contributions. If a team's overall score margin success is figuratively represented by a pie, APM measures are well-designed to slice the pie and attribute individual contributions accordingly. However, they do not account for the possibility that better players can increase the overall size of the pie and thus increase the size of the slice (overall APM value) for teammates. Herein, we use data from NBA player-season Real Plus Minus (RPM)-a leading APM measure-for all recorded player-seasons from 2013-19 and player lineup data to test whether RPM is related to teammate quality. We run sets of linear fixed effect regression models to explain variation in RPM across player-seasons. We also employ a two-stage least square (2-SLS) method for robustness check. Both empirical approaches address potential endogeneity in the relationship of interest. We find strong evidence that RPM is related to on-court teammate quality. Despite adjusting for teammate and opponent quality, RPM does not control for complementarity effects. As such, RPM is not suited for out-of-sample prediction.

The alliance formation puzzle in contests with capacity-constraints: A test using American football reception-coverage contest data.

We utilize a contest-theoretic model to demonstrate a version of the alliance formation puzzle that aligns with reception-coverage contests in American football. Namely, secondary defenders can opt for single-coverage-1 v 1 contest. Alternatively, they can choose to ally-form double-coverage or 2 v 1 contest with exogenous intra-alliance prize division-when defending a given receiver. In our theoretical treatment, we find that defenses have a lower equilibrium success rate in preventing the receiver from "getting open" under double-coverage than under single-coverage in the absence of capacity constraints. We also find that this success rate paradox is a necessary condition for the alliance formation puzzle. We then test the theoretical treatment by analyzing 8,508 plays of NCAA and NFL game data within a set of fixed effects, logistic regression models that control for receiver, level-of-play, and season-of-play. We find that equilibrium level of defensive success rises significantly and substantially (p-value < 0.01 and marginal effect of between 13 and 17 percentage points) when moving from single-coverage to double-coverage, ceteris paribus. There is strong evidence that the necessary condition for the alliance formation puzzle does not hold in this setting. We conclude that sufficiently-binding physiological and training-based capacity constraints eliminate the alliance formation puzzle in this setting, as was shown theoretically by Konrad and Kovenock (2009). This empirical result suggests that other contest settings that regularly feature alliance, such as liquidity-constrained conflict, may not be puzzling.

Association of Professional Football Cumulative Head Impact Index Scores With All-Cause Mortality Among National Football League Players.

Importance: Long-term adverse health outcomes, particularly those associated with repetitive head impacts, are of growing concern among US-style football players in the US and Canada. Objective: To assess whether exposure to repetitive head impacts during a professional football career is associated with an increase in the risk of all-cause mortality. Design, Setting, and Participants: This retrospective cohort study included 13 912 players in the 1969 to 2017 National Football League (NFL) seasons. All cause-mortality up until July 1, 2018, was included. Data collection was performed from July 13, 2017, to July 1, 2018, as reported in the Pro Football Reference. Exposures: The main exposure was a professional football cumulative head impact index (pfCHII). The pfCHII was measured by combining cumulative padded practice time and games played summed during seasons of play reported in the Pro Football Reference and a player position risk adjustment from helmet accelerometer studies. Main Outcomes and Measures: Demographic characteristics except for the pfCHII were calculated for 14 366 players with complete follow-up. The pfCHII was calculated for 13 912 players (eliminating the 454 specials teams players). Cox proportional hazards regression was used to compare hazard ratios (HRs) of death by repetitive head impacts. Analyses were unadjusted and adjusted for birth year, body mass index, and height. Results: Among 14 366 NFL players who had follow-up for analysis, the mean (SD) age was 47.3 (14.8) years, the mean (SD) body mass index was 29.6 (3.9), and 763 of 14 366 players (5.3%) had died. Among 13 912 players in the pfCHII analysis, the median pfCHII was 32.63 (interquartile range, 13.71-66.12). A 1-log increase in pfCHII was significantly associated with an increased hazard of death for the 1969 to 2017 seasons (HR, 2.02; 95% CI, 1.21-3.37; P = .01) after adjustment. The quadratic pfCHII was also statistically significant (HR, 0.91; 95% CI, 0.85-0.98; P = .01), indicating that the hazard of death increased at a decreasing rate, whereas the pfCHII increased. Conclusions and Relevance: The findings suggest that an increase in repetitive head impacts is associated with an increased hazard of death among NFL players. Reduction in repetitive head impacts from playing football or other activities through additional rule and equipment changes may be associated with reduced mortality.

Mortality risk factors among National Football League players: An analysis using player career data.

In general, National Football League (NFL) players tend to live longer than the general population. However, little information exists about the long-term mortality risk in this population. Frequent, yet mild, head trauma may be associated with early mortality in this group of elite athletes. Therefore, career playing statistics can be used as a proxy for frequent head trauma. Using data from Pro Football Reference, we analyzed the association between age-at-death, position, and NFL seasons-played among 6,408 NFL players that were deceased as of July 1, 2018. The linear regression model allowing for a healthy worker effect demonstrated the best fit statistics (F-statistic = 9.95, p-value = 0.0016). The overall association of age-at-death and seasons-played is positive beginning at the 10.75 and 10.64 seasons-played point in our two models that feature seasons-played and seasons-played squared as explanatory variables. Previous research that does not account for this survivorship bias/healthy worker effect may not adequately describe mortality risk among NFL players.

A Systematic Review of Etiological Risk Factors Associated With Early Mortality Among National Football League Players.

BACKGROUND: Multiple risks predispose professional football players to adverse health outcomes and, in extreme cases, early death; however, our understanding of etiological risk factors related to early mortality is limited. PURPOSE: To identify etiological risk factors associated with all-cause and cause-specific mortality among National Football League (NFL) players. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: Articles examining all-cause and cause-specific mortality risk factors among previous NFL players were identified by systematically searching: PubMed, PsycINFO, Web of Science, and Google Scholar from 1990 to 2017. Study eligibility and quality were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: A total of 801 nonduplicated studies were identified through our search strategy. Of these, 9 studies examining 11 different risk factors were included in the systematic review. Overall, the risk of all-cause and cause-specific mortality was lower among NFL players than among the general male population in the United States. Nonwhite athletes, those in power positions, and those with a high playing-time body mass index (≥30 kg/m2) were associated with elevated all-cause and cardiovascular mortality risks. CONCLUSION: Methodological issues associated with the examined all-cause and cause-specific mortality risk factors preclude a definitive conclusion of etiological protective or risk effects. Comparison groups less prone to selection bias ("healthy worker effect") and a life-course approach to the evaluation of suspected risk factors are warranted to identify etiological factors associated with early mortality among NFL players.