The importance of specific health communication

Often people speak in general terms about the negative effects of smoking. Here's a highly specific risk: smoking at the time of breast surgery can cause nipples to fall off. When the doctor warned his patient in general terms, she didn't really listen. When he told her specifically that her nipples might fall off if she kept smoking, she said she had the motivation to stop right away. That's a very important lesson for health communication in general, but also hard to implement because when public health campaigns do show very specific things that can go wrong, there can be accusations of scare tactics, whether it's showing very specific problems from STIs or very specific problems from smoking.

What's the line between a scare tactic and effective communication?

Emerging adulthood and medical subject headings

Emerging adulthood has been recognized as a concept in sociology for over a decade, and is generally recognized as extending to age 30. Adolescent health research often extends up to age 25 because brain development continues until about that age. Last year I asked Alan Guttmacher, the head of the National Institute for Child Health and Development (NICHD), about the definition of adolescents for the purposes of NICHD funding, and he said that it's reasonable for research to go past age 18.

In view of that, I'm submitting a new manuscript today, and as I was choosing keywords, I was surprised to notice how they classify ages.

Adults are ages 19-44. Young adults, a term added in 2009, are ages 19-24.

My study is about the transition to adulthood --- how people get college degrees in early 20s and develop professionally in their late 20s and early 30s --- and it doesn't seem to fit into either of these categories. The study examines how the subjects are in the process of becoming adults, socially and economically, but according to the medical subject headers, they are already. It's striking to be reminded of how our systems of thought have changed in such a short time, and an indexing system naturally didn't catch up.

Public sector layoffs among African-Americans

Kathy Newman wrote about how low SES minorities rely on public sector jobs for social mobility in her book, No Shame in My Game. Newman studied young adults in Washington Heights and nearby areas who were employed in fast food restaurants, as well as some young adults who had applied but were not hired for fast food jobs. Jobs were scarce in the neighborhoods she studied, so that even these fast food jobs had a great deal of competition. Many youth, particularly African-Americans, studied for civil service exams, and regarded these jobs as one of their only ways to achieve a middle class existence, but even these jobs were hard to get. The relatives of her study participants who got civil service jobs were able to build middle class lives for themselves, move to the suburbs, and be role models for the rest of their families. Growing up in a diverse community, I knew at least one minority family who had achieved upward mobility thanks to a federal civil service job.

The current backlash against government, combined with tight budgets, has meant that many African-Americans with these coveted civil service jobs are in danger of losing them. That conclusion was self-evident, or should have been, but I hadn't seen the issue raised (and the issue hadn't occurred to me), until seeing this NY Times article.

People like to mock the government for having exacting requirements to document the procedures followed to ensure that there is no measurable discrimination. I don't how how much time I've spent filling out the EEOC paperwork for the dozens of faculty jobs I've applied for in my life, for instance, and the extensive other measures to make sure that people get treated equally. As much as everyone might mock these efforts, and I'm sure that they are imperfect and clunky, they do seem to have produced more equal opportunity for minorities than the private sector has been able to offer. The private sector may be more "efficient", but they are also less likely to hire people with distinctly minority-sounding names, according to randomized experiments, such as "Are Emily and Greg More Employable than Lakisha and Jamal?".

Publication bias and the result that got away

An economist writes about his would-have-been dissertation: he gathered the data, did a regression, and found no relationship. So his dissertation was on another topic. 8 years later, he publishes the null relationship. It's refreshing to see someone talking about how publication bias affected their own research, as opposed to the studies published in epidemiology journals that suggest publication bias in macro.

Gluten-free processed foods for the masses

NY Times published today a fluff piece whose title posed the question whether everyone should go gluten free. Rather than addressing the question in the title, they gave a portrait of a processed food company's endeavor to address this niche market.

I wish they had addressed the question of gluten posed in the title. I'm also baffled by the claim that there's no gluten-free food --- there's plenty of gluten-free food in every single supermarket, and there always has been. The types of processed foods that they address in the article should comprise no more than a few percent of a person's diet. Celiacs used to be lucky for being forced to eschew the processed food-like products that have taken over the standard American diet, such as breakfast cereal, canned soups, cookies, crackers, and frozen foods. With greater quantities of gluten-free processed foods, they are free to be as unhealthy as anyone else.

Jennifer Fox, the former foster child in Seattle who miscarried

There's a tragic story about a 19 year old formerly homeless young adult in the foster system who says that she miscarried after being kicked in the stomach repeatedly and pepper sprayed. That's excessive force regardless of gender and pregnancy, but another story says that she may have been lying about the miscarriage.

Reading the article, I don't see reason to doubt it given that it was documented by police earlier. She has no obligation to turn over her medical records to the press. And given that she has a foster mother who is abusive enough to call her names in the press, clearly she has little emotional support.

Regardless, I think she is an instructive case of the reason for the Occupy Protests. The research suggests that she'll have more chances in life if she waits a few years to get pregnant until she has attained a community college certificate and has a job and a husband. If she continued the pregnancy she would have higher chances of continued poverty and intimate partner violence.

Still, as a young adult in the foster system, which resources does she have to access higher education, and what chances does she believe she has to get a good job and find a worthwhile future other than as a mother? Most/all young adults who were in the foster system are eligible for Pell grants for community college to find a viable career, but few low SES young adults know that it's worthwhile to fill out the FAFSA or which classes to take in community college that will lead to a career in which they can have dignity and job security, and most community college guidance counselors have literally 500 students whom they're expected to advise so can't have help.

The current system gives disadvantaged young adults flimsy flip flops and then expects people to pull themselves up by the bootstraps.

Income inequality as a threat to adolescents and young adults

One of the core areas of adolescent health research is on the factors that prevent teens from developing into well-functioning adults: teen pregnancy, substance use, deviance. The assumption behind all of that research is that if teens don't engage in these behaviors, they will be able to become successful, educated, employed adults with families of their own. The current economic conditions threaten that transition to adulthood. Teens aren't assured of the chance to become productive adults, and it becomes more difficult to tell them to avoid risk behavior when their alternatives are so poor. If they have a high risk of unemployment, why not engage in risk behavior?

I recall Johns Hopkins Professor Laurie Zabin's story about working in the first federally funded birth control clinic, which was located in Baltimore in the early 1960s. An 18 year old Appalachian woman walked into the clinic asking for "a birth control" because she had just gotten a job with President Kennedy's Job Corps and for the first time in her life, she suddenly had a reason not to get pregnant.

With that thought, two stories related to income inequality and the Occupy Wall Street protests.

First, one of the markers of an advanced society is high quality infrastructure that the entire society can benefit from: clean/safe water systems, dependable electricity, and dependable and non-corrupt police. The marker of developing countries are private versions of these, such as private security guards and high walls and power generation because the main systems are not dependable. I thought of this while reading a story in the NYT Thursday Style section about how power generators have become a status symbol. The story didn't draw this conclusion, but it seems like an ominous sign of the direction of our society that a private electrical system is a status symbol in view of the lack of dependability of the public system. Particularly typical that many people in the article live in a NY suburb with many bankers.

Second, on police in the Occupy Wall Street protests, in NY and Berkeley and UC Davis: I keep reading the stories about students being beaten without provocation rather than just arrested, and it seems unbelievable. The former Poet Laureate of the United States visited the protest with his wife with the same type of disbelief. His wife got shoved to the ground while talking with an officer about non-violent protest. When he scolded the officer --- what kind of bastard shoves a 60-something year old woman, after all? --- he got beaten, and some of his colleagues got their ribs broken. I have seen similar reports of violence in NYC, UC Davis, and other cities, although not DC or Boston. Has this level of police brutality against non-violent protests been seen since the 1970s? Arguably, this brutality is even more perplexing because in contrast to the Vietnam protests where the police were not at risk of the draft, the protesters are directly fighting for the interests of the police --- fair pay, unionization, and more public spending including on police and the materials they need to do their jobs.

Former Baltimore police officer and sociologist Peter Moskos notes that attacking people without provocation is part of police training that teaches a hands-off approach: if people don't obey orders, they get maced. Smart police don't use this method, however:

Of course we didn’t do it this way, the way were taught. Baltimore police officers are too smart to start urban race riots based on some dumb-ass training. So what did we do to gain compliance? We grabbed people. Hands on. Like real police. And we were good at it....
if police need to remove these students, then the police can go in four officers to one protester and remove them. Lift them up and take them away. Maybe you need one or two more officers with a threatening baton to keep others from getting involved. It really can be that simple.

Exam strategies and meta-education

The humor site Cracked has a good exam study strategies article. When someone posted this piece on facebook, several faculty members mentioned that they often accumulate more materials than they read.

How many students learn how to learn? Would we have better exam outcomes if we taught students explicitly how to study?

I recall that research shows that such study strategy courses pay off in students doing well in their other courses, but still few students have the opportunity to take such meta-education courses: courses in how to study, learn, and benefit the most from coursework. Instead, students are left on their own to figure out by trial and error and possibly wasting the courses where they do less well because they aren't sure what to do. I know students find these types of courses to be tedious, or they feel like they ought to already know this material, so they act blase about learning the material. I remember feeling that way about Freshman Advisory class in high school, where they taught us how to study before our first exams as we rolled our eyes. The usual tips like don't study in front of the TV or in bed, but the tips stayed with me and every time that I tried to study in bed, I would remind myself that probably it would be a better idea to move to my desk. Although I wouldn't always.

Debunking miracle schools

Diane Ravitch addresses the phenomenon of miracle schools succinctly:

The subtext [of the concept of 'miracle schools'] is that poverty and resources are not actually problems for urban schools; if they could just test more often and fire more teachers, the corporate reformers imply, then test scores would soar. This analysis suggests that schools enrolling the neediest students do not need more resources, and it rationalizes the current trend of draconian budget cuts for public education.

Apparently there is a blog evaluating the claims of miracle schools and finding that really they aren't.

Americans like the idea of "miracle schools" for the same reason that we like movies about the underdog baseball team winning or the guy in the mail room running the company. Probably not unrelated is how appealing Americans find the concept of achievement without hard work. In reality, resources matter. Giving too much credence to the ideas of miracle schools because we like the narrative could end up depriving >99% of disadvantaged children of the chance to learn and advance, just because we like the narrative of the <1% who succeed despite the bad odds. And it's way cheaper in the short run, even if more expensive in the long run.

Turning the tables on survey research

Just got off the phone with the Gallup pollster. I am one of their ~1000 person sample on their current health survey. When they asked my profession, I said that I was a survey researcher with health topics, and we both laughed. The coincidence was uncanny.

They ask important questions like approval of the president towards the beginning, along with the 1 question health assessment. They asked if I felt like I was treated with respect at work yesterday, a couple of other working conditions questions, income, and hours, personal stock market investment, as well as pessimism/optimism about economic growth, stock market, personal investment, employment, inflation. Also asked contextual questions such as satisfaction with neighborhood quality, safety, commute time to work.

The questions were of course cursory, such as giving only 2 or 3 option answers (satisfied or not, sometimes a neutral option). No questions had branching options, so every question was asked to every respondent, so only missing data should be due to people hanging up in the middle. The stock market investment quantity was phrased on a logarithmic scale, so above or below 10k, and then presumably other questions.

A couple of the questions were surprisingly badly worded, such as this double-barreled question, "Are you satisfied with the price and availability of fresh fruits and vegetables in your neighborhood?" Lots of availability but high prices here in Dupont Circle.

Short questions require respondents to define the categories themselves. For instance, they asked how many days out of the last 7 days have I exercised. I don't consider walking to be exercise, even walking for 5 miles. I haven't lifted weights or swam in the past week, so I said that I haven't exercised at all. In retrospect, probably it would have been more accurate to say a few days since I have walked more than 5 miles a few times this week.

Two questions I would have been interested in is whether people have a pet, since that goes with the health theme --- people with pets may have better health situation, and everyone likes to hear about pets. Another question is whether single people have a steady romantic relationship since "single" is a big and diverse category, and having a romantic partner could affect health and health outcomes. Of course I would have also liked to know whether people had sex recently, and whether they have safe sex, but I know that Gallup wouldn't do that.

Altogether, it was a 14 minute survey, and they are gathering a dataset that could furnish many papers on the connection between working conditions, attitudes towards the broader economy, political attitudes, and both mental and physical health. I wonder whether they will use the data for that purpose, or if they will just do the univariate and basic bivariate summaries. For sure, I'd appreciate the chance to analyze the data, if I could ever find the time.

The Chicago Tribune is unprepared for college

The Chicago Tribune published today an article with a plausible headline --- public high school students are unprepared for college --- but their logic is suspect. A state law required public universities to publish the average freshman year GPAs for students from each high school, and the Tribune has published their interpretation of the data. For each university, the Tribune plotted the high school grade point averages (GPAs) of incoming students versus their average GPA in colleges. They conclude that if students have a lower GPA in freshman year of college than high school, that implies that students were unprepared.

It seems obvious to me that college GPAs are lower than high school GPAs. About 50% of Harvard students were ranked 1 or 2 in their high school graduating class, and probably over 80% had a GPA of 4.0, and yet college GPAs are way lower. Further, college GPAs come from a wide variety of courses, so they're even harder to interpret than high school GPAs. Engineering students have lower GPAs than humanities majors, so a really good high school that sends most of its students to major in engineering might look worse than a mediocre high school that sends most of its students to major in humanities. If college GPAs weren't lower than high school GPA, I would think that the students weren't challenging themselves enough. Finally, high schools with disadvantaged students can be expected to have lower college GPAs not because the students are poorly prepared by their high schools but because the students were disadvantaged.


The report itself is more useful, and it provides a good comparison of the students from each high school that tend to attend each school. Not a comparison of the high schools themselves, of course: enormously confounded by the which students from each school tend to attend the state universities. It does break down GPA by subject. A high school that sends its best students to the University of Illinois at Urbana-Champaign will look like a better high school who sends its best students out of state. Still interesting.

The Tribune's assumption that having a lower GPA in freshman year of college than high school implies that students weren't prepared conflates many issues in an illusion that a few numbers can summarize a high school without any statistical assistance. Is this a reminder that a weak attempt at evidence-based decision-making is worse than none at all?

College students in sex work

It's not new for college students to engage in allied sex work fields: in the late 1960s or early 70s, my father had a student who was a Harvard student working as a stripper. I wonder if the economy has made this work more common or has increased attention.

This article seems to be in a U Penn publication on 3 Penn students: 2 women who worked in fetishist contexts (foot fetish and dominatrix) and a gay man engaging in traditional sex work. The three students say that they find their work empowering, which isn't surprising especially for the two women who are both acting as dominatrices of older accomplished men. (Who exactly is in charge in a dominatrix scenario --- the man who pays and dictates terms or the woman who executes the scenario --- is an interesting question, which I assume has already been discussed in the women's studies literature.) Whether or not they truly feel empowered by their sex work, their sexualities and maturation seem tied to their work. At least one student describes the sex work as empowering not for the experience of domination but because they know they can support themselves, and it's surprising not to see them engaging in any reflection about whether that ability to earn money from sex is truly economically empowering. No mention of STI or health risks.

This article on the larger context: many women with Harvard and other Ivy email addresses seem to be seeking sugar daddies. The women they interview don't even find as much money as they expected: one just gets some money for a one-time rendez-vous that was never repeated, so basically they're just doing old-fashioned high-risk sex work rather than the "arrangements" publicized on the websites. A huge contrast with the Penn article, which paints a rosier picture.

Both articles are about educated Americans, mostly women, but they seem to have similar tropes to less educated Americans and women from developing countries: only some participants in these relationships call them what they are, and only some acknowledge the coercion and how much they may give up by participating in these exchanges.

MSM sugar daddies in India

This article covers Indian male college students who are part-time sex workers with upper class clients. The narrative is like that in the more educated classes Africa (female university students in Zimbabwe) or the US (a recent Huffington post article.)

To me, the remarkable part is how frankly these students call themselves sex workers. While normally pejorative, that sex worker label may serve an important role for males who consider themselves heterosexual and want to distance themselves from their "work." Unfortunately, engaging in more likely than not unprotected receptive sex that they're being paid for doesn't mitigate the disease risks to their female partners who will likely never know about their part-time jobs.

Let everyone serve in the military

With the end of Don't Ask Don't Tell, it turns out that there is one group of adolescents and young adults barred from serving in the US military: d/Deaf and disabled. I had no idea that the US barred them and that most countries allowed. I would ask why there is not more awareness, except I know the answer: disabled issues are often invisible. When will disabled rights acquire the same cachet as minority or gay rights?

Is parents' aversion to teens' sexuality an extension of incest norms?

Amy Schalet has an op-ed today about parents allowing a teen to have their boyfriend/girlfriend sleep over. I think she's right that it's partially related to sex education, but I think that answer is too facile.

Another issue that she doesn't mention in her op-ed: parents' aversion to thinking about teens' sexuality may also be about incest norms. I have known Dutch young adults who had their opposite sex parent sleep with them when the parent came to visit, and that would never be done in the US as well. Many Americans would find this unusual, at minimum.

Even the most liberal parents are comfortable with their teens' having premarital sex but hope that won't be until after the teens go away to college, and they are uncomfortable teaching their teens about condoms because they're afraid that sends the wrong message that sex now is okay. One question is whether the key ingredient there is the developmental stage represented by being 18 and at college, or whether the key is being AWAY at college. Are parents of boarding school teens relatively accepting with their teens having sex at age 16 since they're out of the house?

Conversely, what many Americans find strange about virginity pledges is how they violate incest norms by drawing the wrong kind of parental attention to teens' sexuality, such as this piece also this week in the NYT. (As an aside, the author also exhibits an all/nothing view about her "purity ring", saying that for awhile she felt that she had to take it off once she had sex, thus making her sexuality even less private than it would have been in a more liberal setting.)

Certainly in some cases, there's a prudery element, but I think it's a broader cultural phenomenon about whom Americans are comfortable talking about sex with, possibly relating to incest norms, which seem to differ between here and the Netherlands.

Plenty of Syph: Fun public health campaign

The Health Department in Alberta, Canada, has a very cute syphilis awareness website: Plenty of Syph, like Plenty of Fish, but where all the singles have syphilis. Some of the pictures show a really nice oral primary syphilis chancre, a few have a secondary stage rash on a chest, and a few even have tertiary syphilis with gummas around the mouth. Very cute. (The mouth is unsurprisingly a relatively rare location for a syphilis sore, maybe just 10% of the time for primary syphilis. And not sure how common it is to get to tertiary syphilis.)

Medical system biases

A respectably sized randomized trial finds transcendental meditation has enormous effects on heart attack mortality, decreasing by half. Among the most vulnerable or the most involved in meditation, mortality decreased by 2/3rds. That would be huge even for a drug. As one of the study authors said, "The effect is as large or larger than major categories of drug treatment for cardiovascular disease."

Nonetheless, in spite of the much larger effect from meditation than any drug therapy, the article paraphrases the researchers as saying that the meditation should complement rather than replace drug treatment. If we believe that randomized trials yield correct information that can be used for treatment, why limit the results in this way?

Yes, the results need to be replicated a few times in different populations, etc., but my suspicion is that even after they are replicated (possibly with smaller effect sizes), the "don't stop taking drugs" message will remain.

Given recent results about increased risk of type 2 diabetes from statins and indications of memory problems from statins, those who advocate drugs need to defend their choice more. It seems that there's an implicit bias that treatment within the medical system must be healthier. Similar to the implicit bias against fat that caused Ancel Keys's views to prevail; now new studies that low-fat diets contribute to unhealthy weight gain are rarely publicized.

UPDATE: Now the article has been held back from publication due to last minute data, and the Telegraph took down the article. Wonder why.

Cognitive dissonance in faculty recruiting

The University of South Carolina has what I understand to be a very high quality School of Public Health. They are looking for a tenure-track faculty member with a description that matches my own research fairly well, studying "sexualities, sexual behavior, sexually transmitted infections, HIV/AIDS, teenage pregnancy, LGBT disparities or other sexuality and health issues." Particularly, they want someone who advocates and engages with community, state, national, and global organizations.

I checked their sex ed laws, and according to this profile, they are one of 7 states in the US to prohibit positive depictions of homosexuality in public schools, not a favorable start for any researcher who studies LGBT issues to advocate or engage with the community and local institutions. They also prohibit contraception information other than in the context of future family planning, which is better than nothing. SC is also one of the minority of states to apply for the federal abstinence-only sex education funding, meaning that the programs funded by that funding cannot even mention contraception in any positive way at all.

On the bright side, they also applied for the federal evidence-based sex education and pregnancy prevention funds, which they could certainly use since SC has the third highest gonorrhea rate in the country, and 8% of women ages 15-19 get pregnant each year, and 5% give birth. Looking at the gap between pregnancy and birth rates, it's particularly remarkable because 72% of SC women live in a county without an abortion provider (93% of counties lack an abortion provider), Medicaid does not fund abortions, they mandate a 24 hour waiting period and all procedures 12 weeks and after are a felony with mandatory minimum of 5 years in jail and/or $5000 fine.

Thanks to NARAL and Kaiser for the facts. The SC ACLU also has a long access guide listing all the sexuality, family planning, and related resources (e.g., PFLAG) in the state and neighboring states. So the state fortunately has some resources, even if they get an F by NARAL.

When statistics doesn't cooperate: ratios of regression coefficients.

Everyone knows that there's error in all statistical estimates, but we don't always think about all the implications of that error. Gelman makes the important point about ratios of (among other things) regression coefficients, with implications for instrumental variables (and a cringe-inducing published example). He notes that the ratio of two normal-like variables is Cauchy-like; my recollection from Don Rubin's causal inference class is that he criticized instrumental variables on the grounds that Cauchy distributions have infinite variance, which fills in why Gelman notes that in theory ratios of regression coefficients can take on absurdly large and useless values like 100,000.

The published example comparing regression coefficients is something that people do all the time in conversation without even thinking about it.

Gelman says that the post was really time-consuming to write, so perhaps it counts as a few posts. I agree that it should. In fact, someone could review papers in top journals in the past 5 years and document how frequently this error is made, and that would be a good project.

Do people report embarrassing facts?

I've done some work in whether people report facts about themselves that are sensitive or embarrassing, and it seems that generally people report a surprising amount of sensitive information. Something that I've found fascinating is how people will reveal sensitive information when it's not called for on the humor blog "Damn you autocorrect". Usually, the cases are innocuous or not-so-innocuous, but occasionally the autocorrect will falsely "reveal" information (by correcting text to something not meant) that will induce the correspondent to reveal information that they would not have otherwise said.

Here are the examples:

• Person reveals herpes infection.
  
• Girlfriend reveals interest in breaking up.
  
• Mother reveals that parents suspect son is gay.
  
• Person reveals that she's heard her friend is well-endowed.
  

Only 4 examples and presumably it doesn't always "work" (that is, reveal information that would otherwise be hidden and not revealed on a survey), but I wonder if this could be harnessed somehow as a survey device.

Making statistics adorable: plushy edition

I got a wonderful gift of a plushie Beta distribution, definitely a way to make statistics more adorable. Very sweet, and the beta is wearing a dapper monocle.

They need comedy help in the poster department for catchier/funnier slogans. They also have a poster of relationships between statistical distributions (the third page of this document,) which could be extremely helpful but takes some cognitive effort to figure out which arrows are labeled with what.

Vaginismus: Blame the victim

I've been eagerly reading this blog on vaginismus. The writer has been married over a year without sex. She has visited a sex therapy clinic, and seems to be making progress.

Many of the commenters blame the writer's religion for her problems. When bystanders are confronted with a really difficult situation, some will go to extreme lengths to convince themselves that it could never happen to them. They may think that being in an unconsummated marriage for over a year seems so extremely difficult, there must be some reason that it happened to her and not to other people they know. Presumably it could happen to anyone.

Some criticisms relate to ignorance, but there are so many issues that people never need to think about. How many women know what the hymen looks like? I study sexual initiation, but the anatomical details have never been relevant to me professionally, and I didn't know what the hymen looked like until I saw the above pictures.

How frivolous is sexuality?

On the Society for Adolescent Medicine mailing list, there's a discussion about a pediatrician's 14 year old male patient who has frequent bilateral testicular pain relieved by masturbation. An instantly familiar diagnosis and remarkably not attested in the medical literature. A correspondent forwarded a 11 year old paper from the journal Pediatrics, "Blue Balls": A Diagnostic Consideration in Testiculoscrotal Pain in Young Adults: A Case Report and Discussion (106:4, October 2000, page 843), with accompanying letters. Featured prominently is the fact that masturbation is a good answer, and that Dr. Jocelyn Elders lost her job for advocating teaching masturbation. The upshot of both the paper and the mailing list discussion is that no one knows anything: the only way available for doctors to address the issue was to suggest ruling out serious medical conditions.

When discussing sexuality issues without severe medical consequences, there's a real uncertainty or self-consciousness: some may see sexuality as existing outside the realm of health and medicine, and dealing with sexuality risks being seen as frivolous. Sexuality is certainly part of health, but when will sexuality be treated as part of health?

Raising kids to deal with frustration

Interesting article by Lori Gottlieb about the neuroses of children with overly involved parents. Frustration and failure is a natural part of growing up, and parents who shield their kids from these negative feelings inhibit their children's abilities to deal with them later.

“'Happiness as a byproduct of living your life is a great thing,' Barry Schwartz, a professor of social theory at Swarthmore College, told me. 'But happiness as a goal is a recipe for disaster.' It’s precisely this goal, though, that many modern parents focus on obsessively—only to see it backfire. Observing this phenomenon, my colleagues and I began to wonder: Could it be that by protecting our kids from unhappiness as children, we’re depriving them of happiness as adults?"


Teaching offspring how to deal with negative feelings apparently occurs in other species as well, not just humans --- perhaps implying that modern parents' attention to happiness is even more maladaptive. I've read that mother cats will deny their kittens the chance to nurse or stop their kittens from nursing before the kittens are done to accustom their kittens to frustration, and kittens who didn't have this experience will grow up to be cats who get frustrated more easily (sharp exhales when something goes wrong.) Apparently, this inability to deal with frustration happens more with cats who grow up without mothers to teach them how to deal with negative emotions; I don't know whether there are overly indulgent mother cats.

This phenomenon of overly attentive parents coincides with the advent of emerging adulthood. Simultaneously, the research finds emerging adulthood is often positive with, for example, better marriage outcomes among those who waited to marry.

Sleeping with subordinates

Most of the reaction that I've seen about Weinergate has been variations on what should or shouldn't happen now. Maureen Dowd's take on Weinergate focuses on what men get out of these power differential relationships where men marry up/equal and then cheat down, in yet another illustration of the sexual economy.

Sex with the help (Schwarzenegger and Strauss-Kahn) has a storied and ancient history. Sex with the secretary or work subordinate (Clinton, Gingrich, Edwards) is retro if not ancient. Perhaps the internet difference is not the lack of physical contact, but the wider range of subordinates it allows contact with: blackjack dealer, porn star, college students, and single moms. If this "cheating down" is more about power than sex --- or about insecurity seeking external validation for being a "geek who buffed up" --- the physical acts are beside the point.

Dowd emphasizes the marrying up aspect of these cases of adultery, certainly true in socioeconomic terms, but adultery by high-ranking men has often been about complementing their wives' high socioeconomic status with the reproductive potential of younger women.

In pseudo-economic terms, men have different preferences in different contexts: intelligence and status in public; youth in private. The trophy wife is such a laughable stereotype, and men have gotten used to similarly well-educated wives, that wives are almost always within socially acceptable age and education limits. (Another example of inconsistent preferences is men who are attracted to overweight women in private but would never commit to one in public.)

Few equal status women would agree to an illicit relationship, and as Dowd points out, some lower status women are put off by how pitiful the man seems. Sometimes the lower status women will sometimes accept the sketchy and possibly unsafe sex with a higher status man over the straight-forward relationship with a same status man. Before this current scandal, have we ever found out just how many women turned down these other adulterers and saw them as pitifully validation-seeking? An interesting question is how to interpret the adulterous relationships where the partners are closer in status (e.g., Edwards) --- a sign of healthier self-esteem?

Tables are better than plots (April Fools) and other reading

• A several participant discussion of plots vs. tables begins with a 5 page piece by Andrew Gelman about why tables are better than plots, concluding with "I recommend using Excel, which has some really nice defaults as well as options such as those 3-D colored bar charts." April Fools! The remaining pieces knock down the straw man.
  
• At Society for Research on Child Development this March, I asked NICHD head Alan Guttmacher for the current scope of the "child health and development" that his institute covers since some say that adolescence extends until 25 because the brain is not fully developed until then. He said that age 25 is a fine age to use as the end of child development. The National Campaign has issued areport on young adulthood describing this changing stage of life.
  
• AP grading and what it's like to grade AP exams. I was surprised that 85-90% of these history exams were written by 9th and 10th graders.
  
• Humor in romantic relationships: women have more romantic interest in online dating profiles that are funny (in their opinion) than not funny. No difference for men's assessment of women. Practical implications aside (Do any men like me for my sense of humor?), this study is a great example of how gender could be used as a counterfactual, even though they didn't use it here. Now that people are frequently represented not just by resumes (as in studies of racial discrimination in choosing interview candidates) but by electronic profiles on facebook or dating sites, we can alter gender or other immutable characteristics on the electronic profiles and infer causal effects.
  
• Seating location and voting behavior on FDA advisory committees: those who speak later may have less influence on the vote, perhaps attributable to seating location.
  

Attractiveness ratings

A Psychology Today article about attractiveness ratings in the Add Health data has yielded some interesting responses: that it's wrong offensive inanity and apparently not unprecedented awfulness that can't be replicated in reanalysis and could cause the author to join the Bell Curve author at a conservative think-tank and become an anti-PC crusader.

One aspect that I've not seen discussed is whether the author has anything in common with his research targets given that in other contexts, it's been widely noted that both African-American women (the target of the original article) and Asian men (like the author) are marginalized in the dating marketplace: e.g., on this African-American dating website, OK Cupid's data analysis, and a roundtable where I presented at American Sociological Association included a paper about how gender stereotypes hurt Asian-American men because Asians in general are considered "feminine" and African-American women because African-Americans in general are considered "masculine": hyperfeminine women and hypermasculine men are considered desirable, but feminine men and masculine women are not. Separate research documents how Asian men may feel emasculated, and allegedly business research documents issues with incorrect condom sizes in Asia.

Marginalization is a well-known explanation for bigotry, although of course not an excuse.

Would-be position

My faculty homepage at Stony Brook Medical School, which cancelled my position due to NY State funding cuts. Sigh.

Changing biomarkers may not reduce disease risk

A drug that successfully raises HDL and lowers triglycerides does not reduce heart disease risk. One scientist quoted in the NY Times said that this study indicates that changing biomarkers for disease is not the same thing as preventing the disease. While obvious to many people outside the biomedical world, it's lovely to hear someone from the biomedical complex say that.

Oddly, many folks quoted in the article said that regardless of the study, people should still take the drug or at least talk with their doctor about discontinuing it. Which is a lot like what came out of the National Preventive Services Task Force's report about mammograms for younger women: we want to learn from evidence, but not shake things up.

Throughout the article, different people kept saying that the study implies that raising HDL does not improve heart disease risk, but really they seemed to mean that raising HDL through drugs doesn't work, but as far as I know raising it through exercise and diet does improve heart disease risk.

Everyone already knows the answer: stop eating processed food, start cooking, and exercise. There are no easy answers, but I think that Men's Health magazine has better heart disease prevention than most medical journals. The sooner we get past the nutritional fads that elevate processed foods above unprocessed foods, and use drugs as a short-cut, the healthier we'll be. Isn't it crazy that during the 90s, people saw coconut and chicken with skin and whole milk as dangerous, and pasta and bread and low fat sweetened yogurt as healthy?

Commitment devices versus treatments

Andrew Gelman has an interesting point in a blog entry about religious commitment devices, such as a WWJD bracelet. He says that the bracelet is not a treatment, but rather it goes along with a set of behaviors and commitments, and it's a sign of that. This issue of commitment devices applies as well to my virginity pledge work: like the WWJD bracelent, the pledge may not be an intervention, but rather it could be a sign that someone has a certain identity, so the pledge itself isn't important.

Conversely, Gelman's argument could be critiqued on the grounds that there are folks who have the set of attitudes and behaviors, some of whom have the bracelet and others of them who don't, and conceivably, it would be possible to balance the two groups and get a treatment effect. Whether the treatment effect of wearing a WWJD bracelet could possibly be meaningful is a good question.

More thought needed.

Emerging Adulthood in the Onion

According to the Onion, emerging adulthood never ends, and the country is down to its last 100 adults. The article does raise a serious point. When politicians cite emerging adulthood as a sign of the decline of civilization, do they wonder at what kind of model modern politics sets for adolescents and young adults?

In other Onion news, the Planned Parenthood Abortionplex in Kansas is finally open, offering movies, pedicures, shops, and a million abortions a month. I wonder how many people will think that this article is serious.

** UPDATE ***
Some people do think the Onion article about the abortionplex was literal, such as this person who says REPENT AMERICA.

Romanticizing religious strictures

David Brooks on Friday wrote about the merits of what he calls "rigorous theology." Moderate feel-good religion doesn't cut it, he says. He says that more rigorous religion is what motivates people to behave sexually, and that if Mormons refrain from coffee, that willpower must extend to the rest of their lives. Even setting aside the implicit "without god all is permitted" issue, his premise is dubious. The abstinence movement shows clear examples of religion not motivating people to behave sexually. Evangelical sociologist Mark Regnerus's book about evangelical teens describes how they compartmentalize their sexual behavior from the rest of their religiosity.

As for whether discipline in one area extends to others: I'm not aware of any research of the sort. My understanding of the psychology literature is that willpower is limited: if one is exerting willpower in one area, one has less will power for other efforts. On the other hand, a life-long dietary adherence requires no willpower at all. It's just habit, and habit requires no thought. In fact, people who break dietary restrictions for the first time describe the will-power that it takes to take that first habit-breaking step.

David Brooks keeps kosher himself, so I would think that he would have realized that habitual dietary laws don't impact will-power at all. Perhaps in the throes of Passover bread deprivation (his op-ed was published on the 4th day of Passover), he wanted to believe that his week without bread was bettering himself. Now that he can go back to bread, perhaps Brooks will realize how much he was romanticizing religious strictures. Or perhaps he'll continue keeping Passover for another month because the first week was so rigorous.

Contraception and Casual sex

Gail Collins writes about the uneasy relationship between social conservatives and contraception. She cites two arguments that social conservatives make about contraception: the first relies on incorrect biology and the second reflects uneasiness with casual sex.

Collins spends more time on the incorrect biology argument, but I think that the social conservatives are more motivated by their unease with casual sex. The incorrect biology is not literally true in any way, but social conservatives may believe that the biology is metaphorically true. That is, many forces within the modern world are inhibiting committed relationships and family formation, and they hypothesize that one of the forces is contraception, which is a logical fallacy, but the emotional argument is understandable.

Social conservatives are terribly troubled by the state of modern sexual ethics, or the lack thereof. Their nostalgia is to some extent false: premarital sex and casual sex were not invented with the birth control pill, and the decline of marriage is explained by a myriad of social, economic, and demographic factors.

Nonetheless, their argument has a real kernel of truth that few deal with because it violates third wave feminism: casual sex is more common than it used to be, and all the research I'm aware of finds that casual sex has more negatives than positives (click on the casual sex label for my earlier summaries of that research).

Casual sex occurs between closed doors, both liberals and conservatives have casual sex, and I know of no policy that would decrease casual sex. Given its murky origins, it's not surprising that social conservatives are indiscriminate in the policies and theories that they scapegoat to explain casual sex. Sex education, family planning, emergency contraception, abortion, and Arnett's theory of emerging adulthood do not cause casual sex, and casual sex probably does not inhibit family formation. Social conservatives just cannot think of better explanations, especially given the relative paucity of research on casual sex. Liberals fear that attacks on casual sex are disguised attacks on reproductive rights, rather than seeing that for many the opposite is true: casual sex is the enemy, and reproductive rights are the scapegoat.

And so we have these repeated battles that really all stem from the same thing: unease with casual sex and delayed family formation.

Most people having this dialogue are married, and most married people have long been insulated from the world of singles and their sexual decisions. Instead, they take sides based on their other political beliefs.

The married social conservatives believe that casual sex comes from liberals, not realizing how much exists organically among conservatives and how many liberals have wholesome sexual ethics and are eager to marry. The married liberals believe that casual sex does no harm as long as both the sex and its casualness are consensual, as if such consent were truly possible. My understanding of the qualitative research (Bogle's Hooking Up) is that women may freely consent to casual sex only within limited circumstances (e.g., experimentation), but see it as second best outside those circumstances; conversely, women create the circumstances that enable casual sex by discounting many men, artificially narrowing their dating pool, giving more power to the few men considered "good catches."

Both married liberals and conservatives have apparently forgotten, or maybe they never experienced, the dating market that makes all of these issues so complicated. We can agree on one thing: most people want to get married and have extremely high expectations for marriage, but the path to marriage is murky for myriad reasons. Until we know otherwise, probably the best we can do is practice good sexual ethics and help individuals wherever we can.

At a policy level, the marriage and family formation research indicates that economic factors inhibit marriage among lower income groups, and the decline of unions, widening income inequality, and reduction in good jobs are likely responsible. If we invested the trillions of dollars needed to upgrade our infrastructure from a D to a B, providing jobs for lower income groups, that could help the country both economically (e.g., improved productivity due to reduction in accidents and water main breaks) and socially (by giving income and good jobs to (mostly) men, some of whom would marry their female companions.)

Origins of eating disorders among religious teens

This NY Times article about eating disorders among Orthodox Jews raises some theories about the origins of eating disorders in this population, but I think there are some other possibilities.

Modesty may make it harder to dress well for women who are even slightly overweight. Thin women look fine in a wide range of clothes, but slightly overweight women need to be creative in ways that don't always work with modesty restrictions --- showing cleavage is a good way for men not to notice extra fat elsewhere.

Also I suspect that being sexually involved is helpful for overweight women and their partners to feel good about their bodies. For religious women, that reinforcement isn't available. Religious men who have no experience either way may assume that thin women are better in bed. Alternatively, thin partners are more socially valued, and the social value may bring gratification pre-marriage. Likewise, religious women cannot feel sexy or sexually empowered by sexual activity. They may feel sexually empowered about how thin their bodies are, so they may seek thinness as their primary form of feeling sexy.

Because these alternative outlets for feeling desirable are not available to Orthodox teens, they need to find other ways of feeling good about themselves. I wonder whether the types of exercise that are incompatible with anorexia, such as weight lifting where it's important to eat minimum amounts of protein (0.5-1 g protein per pound of body weight) and to be moderate in quantity of exercise (every other day, at most), would be helpful. Gymnastics, dancing, rock climbing, and other ways of using that strength could also be helpful in helping teen women feel confident about their bodies, and also staying healthy.

Meanwhile, teen males also need to change their attitudes and how they perceive women of different sizes. That's harder, especially if they do not interact much with the opposite sex.

Thursday, April 7, 2011

Song about breaking religious sex rules

I'm so proud of our University of Maryland undergraduates who wrote this song, called "I just broke Shomer." (i.e., touched a girl, against some interpretations of Jewish law that disallow touching the opposite sex until marriage.) It reminds me of my friends' 2005 song "No one's really shomer negiah."

Rediscovering second wave feminism

My college friend Jonathan Liu wrote an incredibly inspiring piece about the sacrifices he made by choosing to be a stay-at-home dad that also applies to making any life decisions: once you make a decision, don't keep looking at all the decisions because "the grass is greener where you tend it." (I'm sure he's not the first to say it, but I've never heard it before, and it's a wonderful saying and a vital point for anyone making any decision.)

His piece was in reaction to another piece by a mother who went part-time in her career after becoming a parent, but who divorced and now wishes that she had been more active in her career. The trend of the last decade for highly educated women to become stay at home moms was treated as a third wave feminist phenomenon --- the trope went that second wavers overemphasized career at the expense of family, but third wave feminists can be confident in their position enough to take time out of their careers to raise their children. (Likewise, some third wavers thought that second wavers were too sexually conservative, and thought that the circumstances had changed enough that it was safe to be promiscuous, but even setting aside questions of the sexual double standard, third wave feminism hasn't erased the economic factors at play in the sexual marketplace, which I've discussed in previous posts about hooking up.)

The third wavers certainly have a point --- some latch-key kids of the past wish their parents had been around for them, and the third wave stay at home phenomenon tries to rectify this. But truly this article just points to where the second wavers were right: economic forces can't be ignored. Women who have prestigious and/or well-paid careers outside the home in addition to children have a more secure position if their marriages fail, as many marriages do --- marriages don't have a 50% failure rate as many say, and everyone has to work to make their marriage as good as possible to avoid divorce, but divorce is certainly common enough to be worth thinking about. And it might even be that women who work outside the home in good jobs might even be less likely to get divorced. I'm not aware of the research on that point, but my knowledge of the research says that they are better off on a range of other metrics.

None of this is to say that anyone's choice is right or wrong. That's an individual decision. To the contrary, as Jonathan said, everyone has to be aware of the true costs of their decision, rather than believing that one choice or the other is an optimal choice. There is no optimal choice in general, but each individual has to figure out what is best for them. Second wave feminism is not a religion, and there's no virtue in adhering to its foundational "tenets" out of blind faith. But there are reasons why stay at home moms of previous generations were not content to stay at home and put their careers second. Many circumstances have changed, every family is different, and so on, but these reasons have certainly not expired. The modern world has made so many things possible, but widows and divorcees are still worse off than married women, working women with good careers are still better insulated from hardship, and second wave classics like the Women's Room are still relevant.