The psychology and policy of overcoming economic inequality.

Recent arguments claim that behavioral science has focused - to its detriment - on the individual over the system when construing behavioral interventions. In this commentary, we argue that tackling economic inequality using both framings in tandem is invaluable. By studying individuals who have overcome inequality, "positive deviants," and the system limitations they navigate, we offer potentially greater policy solutions.

The persistence of cognitive biases in financial decisions across economic groups.

While economic inequality continues to rise within countries, efforts to address it have been largely ineffective, particularly those involving behavioral approaches. It is often implied but not tested that choice patterns among low-income individuals may be a factor impeding behavioral interventions aimed at improving upward economic mobility. To test this, we assessed rates of ten cognitive biases across nearly 5000 participants from 27 countries. Our analyses were primarily focused on 1458 individuals that were either low-income adults or individuals who grew up in disadvantaged households but had above-average financial well-being as adults, known as positive deviants. Using discrete and complex models, we find evidence of no differences within or between groups or countries. We therefore conclude that choices impeded by cognitive biases alone cannot explain why some individuals do not experience upward economic mobility. Policies must combine both behavioral and structural interventions to improve financial well-being across populations.

Early Sport Specialization Among Former National Collegiate Athletic Association Athletes: Trends, Scholarship Attainment, Injury, and Attrition.

BACKGROUND: Many youth athletes focus on 1 sport to gain a competitive advantage, but early sport specialization may increase risk of overuse injuries and burnout. College athletes have successfully achieved advanced status; therefore, the study of their specialization patterns is a method to assess how specialization affects an athletic career. PURPOSE: To determine trends in sport specialization by sex, sport, and decade of participation in National Collegiate Athletic Association (NCAA) athletes and assess the effect of specialization on scholarship attainment, injury, and attrition. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: An electronic survey was distributed to NCAA athletes who participated from 1960 to 2018. Survey topics included sex, sport, decade of participation, scholarship status, ≥30-day time-loss injuries sustained in college, orthopaedic surgery in college, career length, and age of single-sport specialization. Early specialization was defined as specialization in a single sport before age 15 years. Rates of early specialization were calculated for each sport, sex, individual and team sports, and decade of participation. Rates of scholarship attainment, injury, and attrition were compared between groups. Univariate associations were queried with logistic regression analysis to determine predictors of specialization, scholarship attainment, injury, and early attrition. RESULTS: Of 1550 athletes who participated (17% response rate), 544 (35.1%) were women. Overall, 18.1% of athletes specialized before age 15 years (n = 281). Athletes in gymnastics, tennis, swimming and diving, and soccer were significantly more likely to specialize early, whereas football and baseball athletes were more likely to specialize late (P < .05 for all groups). Early specialization was more common among women (23.4% vs 15.2%; odds ratio, 1.72; P < .01). There was a trend toward earlier specialization for recent college graduates, with graduates from the last decade more likely to be classified as early specialization than those from previous decades (P = .036). Scholarship attainment was overall equivalent between groups. Time-loss injuries, lower extremity injuries, and orthopaedic surgery in college were not statistically different between groups. Career lengths were similar, but burnout was more common among early specialization athletes (10.5% vs 7.0%; odds ratio, 3.76; P < .01). CONCLUSION: Less than one-fifth of NCAA athletes surveyed specialized before age 15 years, and neither scholarship attainment nor time-loss injury rate was affected by early specialization. Early specialization is on the rise but is associated with increased burnout.

Improving Adherence to Care Recommendations Using a Community Health Worker (CHW) Intervention with the Pediatric Medical Home.

While CHW interventions improve health outcomes, evidence identifying specific domains of CHW-delivered support resulting in positive outcomes is limited. Our goals were to identify domains of CHW-delivered support that assist families with adhering to recommended pediatric care; and, to identify predictors of successful completion of an enriched medical home intervention (EMHI) using trained CHWs making home visits to provide health education and support positive health behaviors. We performed a prospective descriptive study of 88 families participating in a protocol-based EMHI. Completers (N = 46) finished the program with mutual agreement that the family can independently adhere to recommended clinical care. Non-completers (N = 42) were lost to follow-up or dropped out of the program before reaching this milestone. Using Grounded Theory, two trained coders evaluated CHW tasks recorded in an electronic database and classified these tasks across 17 domains. We assessed predictors of EMHI completion using logistic regression. The 88 EMHI participants were primarily <24 months of age (80 %), Hispanic (56 %), and Medicaid enrollees (67 %). Hispanic families (OR = 2.76, p = 0.04) and those with self-reported program goals to 'facilitate family's creation of a system to keep track of child's medical information' (OR = 3.11, p = 0.02) or a 'newborn-specific goal' (OR = 3.21, p = 0.04), such as feeding and safety tips, were more likely to complete the EMHI compared to their counterparts. The most consistent CHW tasks were supporting medical appointments, medication maintenance, and providing health education. CHW interventions designed to improve health behavior outcomes of 'at-risk' families, including Medicaid enrollees, may benefit from support in goal-setting and strategies to systematically manage their child's medical care.

Bornyl cinnamate inhibits inflammation-associated gene expression in macrophage cells through suppression of nuclear factor-κB signaling pathway.

Formosan sweetgum (Liquidamber formosana) is an endemic tree species. Various parts of this tree are used as a traditional Chinese medicine for treating pain, inflammation, and rheumatic disorders. In this study, we investigated the anti-inflammatory potential of bornyl cinnamate, a cinnamic acid derivative from the essential oil of L. formosana. Pretreatment with bornyl cinnamate significantly inhibited lipopolysaccharide-induced proinflammatory molecules, including nitric oxide, prostaglandin-E2, tumor necrosis factor α, and interleukin-1ß production, in murine macrophage RAW 264.7 cells. RT-PCR and immunoblotting analysis revealed that the inhibition of the proinflammatory molecules occurred through the downregulation of their corresponding mediator genes. Immunofluorescence and luciferase reporter assays revealed that the inhibition of proinflammatory genes by bornyl cinnamate was caused by the suppression of nuclear translocation and transcriptional activation of the redox-sensitive transcription factor nuclear factor κB. In addition, bornyl cinnamate increased the protein stability of the inhibitor of nuclear factor κB, an endogenous repressor of nuclear factor κB, through inhibition of its phosphorylation and proteasomal degradation. Furthermore, bornyl cinnamate significantly blocked the lipopolysaccharide-induced activation of I-κB kinase α, an upstream kinase of the inhibitor of nuclear factor κB α. Taken together, these results suggest that bornyl cinnamate could inhibit proinflammatory molecules through the suppression of the redox-sensitive nuclear factor κB signaling pathway.