Following the people and events that make up the research community at Duke

Category: Behavior/Psychology Page 1 of 24

Benefits of Childhood Mental Health Intervention ‘Ripple Across Generations’

Even before the COVID-19 pandemic, mental health challenges were the leading cause of poor life outcomes in young people. As many as 1 in 5 U.S. children aged 3 to 17 have a mental, emotional, developmental or behavioral disorder, according to the Centers for Disease Control and Prevention.

Now, that crisis has been exacerbated. Symptoms of depression and anxiety for children and adolescents have doubled during the pandemic.

Seventy percent of U.S. public schools reported an increase in the number of children seeking mental health services during the pandemic and many have struggled to meet the needs of those students, according to the latest federal data.

As the Biden administration and Congress consider policies and programs that could help curb these mental health challenges that children face, a group of Duke researchers may already have one answer.

Eighteen years after administering an intensive childhood intervention program called Fast Track, a group of Sanford School of Public Policy scholars has found that it not only proved effective at reducing conduct problems and juvenile arrests in childhood, it also improved family outcomes when the original children grow up and become parents themselves.

Their followup findings, which appeared in June in the Journal of Child Psychology and Psychiatry, show that girls who received the Fast Track intervention during first through 10th grades had improvements in several aspects of their family environments 18 years later.

Specifically, Fast Track reduced food insecurity in the mothers’ family environments, and lessened the mothers’ depression, alcohol and drug problems, and their use of corporal punishment.

“We knew the Fast Track early childhood intervention was successful at reducing aggressive behavior in childhood and criminal arrests in young adulthood,” said Drew Rothenberg, research scientist at the Duke Center for Child and Family Policy and lead author on the study.

“This research demonstrates that the early intervention doesn’t just benefit the children receiving the services,” he added. “It also improves the family environments those child form as adults, benefiting their own children. In other words, it looks like the effects of early intervention can ripple across generations.”

Drew Rothenberg

According to Rothenberg, the beneficial effects of Fast Track are just as large as those seen in prevention programs that only affect a single generation.

“Impressively, these beneficial effects were also almost as big as those seen immediately after the end of the Fast Track intervention 18 years earlier,” Rothenberg said. “Therefore, for mothers, Fast Track’s effects appear powerful across two generations of homes and are much longer-lasting than previous research suggested.”

“Surprisingly, the benefits of the Fast Track intervention on family environments formed as adults found for mothers did not extend to fathers,” said study co-author Jennifer Lansford, research professor at the Duke Sanford School of Public Policy and director of the Duke Center for Child and Family Policy.

Jennifer Lansford, Director of Duke Center for Child and Family Policy

“Even in contemporary society, women are still tasked with a greater proportion of child-rearing responsibility, and still more often called to create family routines and climate,” Lansford said. “Therefore, the beneficial Fast Track effects on reducing corporal punishment and increasing family food security may emerge only in mothers because mothers are still primarily responsible for the provision of parenting and procurement of resources for family meals, and consequently more likely to benefit from such intervention.”

Rothenberg said the findings suggest childhood mental health interventions can break maladaptive cycles and promote the development of healthy family environments when those children grow up and start their own families.

 “With this evidence, we also demonstrate that investing in early childhood interventions won’t just pay off for today’s children but also for generations of children to come,” Rothenberg said.

Researchers surveyed 400 Fast Track participants who were now parents at age 34 about aspects of their current family environment. They wanted to assess whether parent substance use problems, depression, romantic partner violence, parent warmth, parent use of physical aggression and corporal punishment, family chaos, and food insecurity were better for adults who had participated in Fast Track as children than for adults who had been in the control group.

“We designed the Fast Track program to improve emotional awareness and interpersonal competence among children at high risk for peer conflict, antisocial and delinquent behaviors and life-course failure,” said study co-author Kenneth Dodge, the William McDougall Distinguished Professor of Public Policy Studies at the Duke Sanford School of Public Policy. Dodge is a member of the Conduct Problems Prevention Research Group that created the Fast Track program.

Participants had been drawn from high-risk elementary schools in Durham, North Carolina, Nashville, Tennessee, rural Pennsylvania and Seattle, Washington. Starting in first grade, students were randomly assigned to either receive Fast Track or be followed as a control group. Students who received the Fast Track intervention received social skills training, tutoring, and a social-emotional learning curriculum taught by teachers. Their parents received training in techniques to help the students manage their behavior. 

The Fast Track project has been supported since 1991 by National Institute of Mental Health (NIMH) Grants R18MH48043, R18MH50951, R18MH50952, R18MH50953, R01MH062988, K05MH00797, and K05MH01027; National Institute on Drug Abuse (NIDA) Grants R01DA016903, K05DA15226, RC1DA028248, and P30DA023026; National Institute of Child Health and Human Development Grant R01HD093651; and Department of Education Grant S184U30002.

CITATION: “Intergenerational Effects Of The Fast Track Intervention on the Home Environment: A Randomized Control Trial,” William Andrew Rothenberg, Jennifer E. Lansford, Jennifer Godwin, Kenneth A. Dodge, William E. Copeland, Candice L. Odgers, Robert J. McMahon, Natalie Goluter, and Conduct Problems Prevention Research Group. Journal of Child Psychology and Psychiatry, June 15, 2022. DOI: 10.1111/jcpp.13648

Post by Sarah Brantley, communications director for Duke’s Center for Child and Family Policy

“Brains are Weird… and the World is Difficult”

Institute for Consumer Money Management, and Duke University’s Center for Advanced Hindsight.

Intending to do the right thing doesn’t always lead to actually doing it, a tendency formally known as the “intention-behavior gap.” We can intend to go to bed early and still go to bed late. We can want to exercise and still choose not to. We can recognize the importance of saving extra money and still choose to spend it instead. So why is it so hard to change our behavior? Because, says Jonathan Corbin, Ph.D., “brains are weird” and “the world is difficult.”

Corbin is a senior behavioral researcher at the Center for Advanced Hindsight at Duke University. The Center for Advanced Hindsight recently partnered with NOVA Labs, Thought Cafè, and the Institute for Consumer Money Management to create the NOVA Financial Lab, a group of financial literacy games targeted at adolescents and emerging adults. In each game, players practice managing money while taking care of a pet. You may never have to sneak a cat into a concert or prepare a retirement plan for a dog in real life, but you will need to understand concepts like budgeting, interest, and debt. “What we hope people start to do,” Corbin says, “is really think about, ‘What decisions should I make now to make better decisions later?’”

Essentially, “Money spent now is money that can’t be spent later.” As intuitive as that might seem, “The way we think about money is relative, and it’s not linear.” When you’re already spending thousands of dollars on a car, for instance, an extra five hundred dollars for a feature you may or may not need “feels like a very small amount of money,” but in a different situation, its value can seem higher. How many times, Corbin points out, could you go out to eat with five hundred dollars?

The three games combine financial literacy with behavioral science to explore why people make the decisions they do and how they can start to make better ones.
Source: https://advanced-hindsight.com/wp-content/uploads/2022/03/CAH-NOVA.pdf

There are three games: Shopportunity Cost, Budget Busters, and Exponential Potential. (“One of the people from PBS helped us come up with these cute names,” Corbin says.) They each involve different skills, but they all focus on “financial literacy from a behavioral science perspective.” Players have to contend with both external obstacles and common behavioral biases to make financial decisions for a pet. “I always choose the dog,” Corbin adds, “but I understand other people might choose the cat.” (I chose the cat.)

The first game, Shopportunity Cost, focuses on short-term financial planning. It involves dressing a pet up like a person in order to sneak them into a concert for the night. “You have to make decisions that optimize the pet’s happiness while also being able to make it to the concert and back home,” but you have a limited amount of money to spend. If you spend too much money too soon, you’ll run out, but if you’re too frugal, your pet won’t enjoy the evening. As goofy as the concert scenario is, it introduces players to an important concept known as opportunity cost, which refers to the potential benefits we miss out on when we choose one alternative over another. Say you’re debating between a $50 outfit and a $30 one. The opportunity cost of choosing the more expensive outfit is $20, but shoppers don’t always consider that. “Opportunity cost neglect is the simple idea that when we’re faced with financial decisions, we tend not to consider alternative uses for that money.” Reframing the $30 outfit as “a $30 dress that I’m okay with plus 20 extra dollars” that could be spent elsewhere might lead you to choose the cheaper outfit. Or it might not. “Sometimes you want the $50 outfit, and that’s perfectly fine… but a lot of the time that might not be the right decision.” Like many things, taking opportunity cost into account is a balancing act. “We shouldn’t obsess over every possible opportunity that there is,” Corbin cautions, but “consider[ing] opportunity costs can lead to better financial decisions.”

Budget Busters, meanwhile, involves medium-term planning. Players have to manage checking, credit, and savings accounts while caring for their pet over a six-month period. Along with purchasing essential and non-essential items to attend to their pet’s basic needs and happiness, players have to contend with unforeseen circumstances like medical emergencies. The game introduces people to the 50-30-20 rule, a budgeting concept that involves devoting 50% of income to essentials, 30% to non-essentials, and 20% to savings. Budget Busters also explores the principle of mental accounting, the idea that aside from formal budgets, we have “categories in our head” that change our perception of money. “Let’s say you get birthday money from your relative. That money tends to be a different kind of spending money to you than money you get from your paycheck,” Corbin explains, because “money feels different in different contexts.” 

There are parallels in Budget Busters. Sometimes players receive unexpected windfalls like gifts or prizes. (My cat won $40 for being “Best in Show” at the local pet pageant.) Players get to decide whether to use the extra money on a “fun” item for their pet or put it into savings. Corbin says “gift money” is a classic example of a misleading mental account. “We tend to overspend… because it feels like it’s not even our money in a way.” In reality, though, money has “fungibility,” meaning it’s “exchangeable… across any account.” In other words, “money is money,” regardless of where it comes from.  A $10 bill, for instance, can be exchanged for two fives without changing its value. (Non-fungible tokens, or NFTs, lack this property. “You can’t exchange the picture of a cat you bought from the internet for Chipotle.”) Like Shopportunity Cost, Budget Busters focuses on both traditional financial concepts and common behavioral tendencies that affect decision-making. “None of these things are necessarily bad,” Corbin emphasizes, “but they’re things that one should be aware of… when that natural proclivity may be swaying them in the wrong way.”

Budget Busters, which focuses on monthly budgeting, also encourages players to look closely at discounts when shopping. “Sometimes the discount that looks really good from a  percentage-off perspective isn’t actually the better discount” in terms of overall budgeting and total amount of money saved, Corbin warns.

The last game, Exponential Potential, explores concepts like compound interest, debt, and investment. The premise of the game involves traveling back in time to balance debts and investments. The goal is to make your pet a millionaire. By showing players how investment decisions can affect future net worth, the game seeks to increase understanding of processes involving exponential growth. Exponential Potential introduces the concept of exponential growth bias. According to Corbin,  “We tend to underestimate things that grow exponentially.” He cites the coronavirus pandemic as an example: “Even the people who were making the graphs of Covid’s growth… it’s really hard for them to figure out how to show that to people.” Log-transformed graphs are one option, but they can be deceptive by making the slope look flatter. Similarly, when dealing with exponential growth in the financial world, “People are going to underestimate how badly they’re going to get burned” by debt, but they may also underestimate how much they’ll benefit by saving for retirement.

With compound interest, for instance, “The interest gets applied both to principle and to interest from the last time, and that’s where exponential growth happens.” In the game, players have the opportunity to adjust how much money to put toward paying off debts, investing, and saving for retirement each month. Then they travel decades into the future to see how their decisions have affected their pet’s net worth.  “We’re hoping that that kind of feedback allows you to think through… what you might have done wrong and try to correct,” Corbin says. Once again, though, raw numbers aren’t the only factor at play. “We just want people to understand what the optimal way to do this is, and if there’s a better way for them to do that psychologically, that’s fine.” Debt account aversion, for example, refers to the fact that people want to have fewer debt accounts, meaning they are often eager to pay off accounts in full when they can. Some financial advisers suggest that “because they think it’ll get the ball rolling and you’ll be more likely to pay off the next one.” According to Corbin, there isn’t a lot of evidence for that, and sometimes paying everything off at the outset isn’t ideal. For instance, “It is optimal to start thinking about retirement as soon as you can… but if you’re delaying putting money into retirement because you’re so concerned with your student loan debt,” that can be problematic. Still, Corbin understands the appeal of closing debt accounts. “I am risk-averse, which means if I have a debt I’m probably going to put more money toward that debt that I necessarily should given what the interest rates are and what I could potentially make by investing that money instead.” Financially speaking, “There’s a decent likelihood that I should just pay the minimum on my mortgage… [but] I’ve decided I’m willing to trade off those future gains for the peace of mind that if something goes wrong… I’ll be ahead on my mortgage payment.” Even in Exponential Potential, the right choices aren’t always clear-cut. Corbin describes it as a “sandbox approach” where players are given more opportunity to play around. “This is the trickiest game because there’s no perfect answer for anything,” he says. “Everything has risk.”

Another bias that can affect our financial decisions is known as present bias, the tendency to discount the future in favor of the present. Corbin offers the everyday example of staying up too late. “Nighttime Me wants to stay up and read…. Morning Me is going to be really ticked off at Nighttime Me when they’re exhausted and don’t want to get up.” Research suggests that people can have a harder time identifying with their future selves. That can easily affect our financial decisions, too. “I’m going to let future me worry about that. That guy. Whoever that is.” However, “If you can get people to identify more with that person,” they can sometimes make better decisions. Ultimately, “The game isn’t trying to force people to become investment robots.” We are biased for the present because we live in it, and that’s normal. The purpose of the game is simply “to nudge people… to worry just a little more about the future.”

“Money is basically for safety, security, and happiness,” Corbin says. The ultimate objective is to balance needs, wants, and savings to achieve those three goals both in the present and the future.

By Sophie Cox
By Sophie Cox

C is For Cookie (and for Circles of Care)

Anyone remember the Sesame Street episode where Big Bird tackles the opioid crisis?

Me neither. However, that isn’t to say that Sesame Street isn’t doing its part to help parents and children alike to cope with this, among other pressing issues that plague our society.

Jeanette Betancourt, Ed. D. is Senior Vice President for U.S. Social Impact at Sesame Workshop, a division of the Sesame Street organization striving to positively impact children’s early learning, health, and well-being. Betancourt is deeply involved in the Sesame Street in Communities initiative (ssic.org), which she came to discuss with the Sanford School of Public Policy on January 18th.

Sesame Street in Communities aims to bring public awareness to prominent societal issues in what Betancourt labels a “non-stigmatizing way.” Their efforts are specifically targeted to impact children coping with traumatic experiences and their families – resources on the Sesame Street in Communities website span from Elmo’s Special-Special Comfort video for children who have fallen victim to violence, to Abby’s Expressing Feelings video for children divided between divorced parents.

Not all the videos are as heavy as one might think: some of the content promotes behavioral routines, such as tooth-brushing or schedule-making, designed to build children a more stable foundation that they can use to tackle trauma, should it arise.

Some of the most recent resources posted to the Sesame Street in Communities website.

Betancourt says that their strategy hinges heavily upon leveling, or presenting the same messaging in a variety of mediums (videos, storybooks, live-action films), for more complete comprehension. This is reflected heavily on their website: their Autism series alone includes multiple workshops, printables, articles, videos, interactives, and storybooks. The content and learning strategies promoted by Sesame Street in Communities are all founded upon clinical research, developmental psychology, and other forms of testing to ensure that they have a measurable impact on young children and their families.

Sesame Street' Introduces 2 New Black Muppets To Teach Kids About Racial  Literacy | CafeMom.com
Wes and Elijah Walker, the faces of the Coming Together: Racial Justice project.

One of the most recent initiatives described by Betancourt is the Coming Together: Racial Justice project. In this series of content (found on ssic.org), the viewer is introduced to the Wes and Elijah Walker, two humanoid Muppets that, according to Betancourt, are intended to represent the Black experience.

In the video, five-year old Wes and his father Elijah are sitting in the park when they are approached by Elmo, who wants to know about the pigmentation of their skin. Elijah explains to Elmo that all humans have different amounts of melanin in their skin, hence why some individuals have lighter or darker skin. Elijah also tells Elmo that, even though their skin may look different, “we’re all part of the human race.”

To make this concept easier for children to understand, Elijah connects this to the color of the changing leaves in the park, telling Elmo that leaves of different colors all came from the same tree.

If you know a child or a family that could benefit from such materials, more information can be found on ssic.org.

Post by Rebecca Williamson, Class of 2022

Opening the Black Box: Duke Researchers Discuss Bias in AI

Artificial intelligence has not only inherited many of the strongest capabilities of the human brain, but it has also proven to use them more efficiently and effectively. Object recognition, map navigation, and speech translation are just a few of the many skills that modern AI programs have mastered, and the list will not stop growing anytime soon.

Unfortunately, AI has also magnified one of humanity’s least desirable traits: bias. In recent years, algorithms influenced by bias have often caused more problems than they sought to fix.

When Google’s image recognition AI was found to be classifying some Black people as gorillas in 2015, the only consolation for those affected was that AI is improving at a rapid pace, and thus, incidents of bias would hopefully begin to disappear. Six years later, when Facebook’s AI made virtually the exact same mistake by labeling a video of Black men as “primates,” both tech fanatics and casual observers could see a fundamental flaw in the industry.

Jacky Alciné’s tweet exposing Google’s racist AI algorithm enraged thousands in 2015.


On November 17th, 2021, two hundred Duke Alumni living in all corners of the world – from Pittsburgh to Istanbul and everywhere in between – assembled virtually to learn about the future of algorithms, AI, and bias. The webinar, which was hosted by the Duke Alumni Association’s Forever Learning Institute, gave four esteemed Duke professors a chance to discuss their view of bias in the artificial intelligence world.

Dr. Stacy Tantum, Bell-Rhodes Associate Professor of the Practice of Electrical and Computer Engineering, was the first to mention the instances of racial bias in image classification systems. According to Tantum, early facial recognition did not work well for people of darker skin tones because the underlying training data – observations that inform the model’s learning process – did not have a broad representation of all skin tones. She further echoed the importance of model transparency, noting that if an engineer treats an AI as a “black box” – or a decision-making process that does not need to be explained – then they cannot reasonably assert that the AI is unbiased.

Stacy Tantum, who has introduced case studies on ethics to students in her Intro to Machine Learning Class, echoes the importance of teaching bias in AI classrooms.

While Tantum emphasized the importance of supervision of algorithm generation, Dr. David Hoffman – Steed Family Professor of the Practice of Cybersecurity Policy at the Sanford School of Public Policy – explained the integration of algorithm explainability and privacy. He pointed to the emergence of regulatory legislation in other countries that ensure restrictions, accountability, and supervision of personal data in cybersecurity applications. Said Hoffman, “If we can’t answer the privacy question, we can’t put appropriate controls and protections in place.”

To discuss the implications of blurry privacy regulations, Dr. Manju Puri – J.B. Fuqua Professor of Finance at the Fuqua School of Business – discussed how the big data feeding modern AI algorithms impact each person’s digital footprint. Puri noted that data about a person’s phone usage patterns can be used by banks to decide whether that person should receive a loan. “People who call their mother every day tend to default less, and people who walk the same path every day tend to default less.” She contends that the biggest question is how to behave in a digital world where every action can be used against us.

Dr. Philip Napoli has observed behaviors in the digital world for several years as James R. Shepley Professor of Public Policy at the Sanford School, specifically focusing on self-reinforcing cycles of social media algorithms. He contends that Facebook’s algorithms, in particular, reward content that gets people angry, which motivates news organizations and political parties to post galvanizing content that will swoop through the feeds of millions. His work shows that AI algorithms can not only impact the behaviors of individuals, but also massive organizations.

At the end of the panel, there was one firm point of agreement between all speakers: AI is tremendously powerful. Hoffman even contended that there is a risk associated with not using artificial intelligence, which has proven to be a revolutionary tool in healthcare, finance, and security, among other fields. However, while proven to be immensely impactful, AI is not guaranteed to have a positive impact in all use cases – rather, as shown by failed image recognition platforms and racist healthcare algorithms that impacted millions of Black people, AI can be incredibly harmful.

Thus, while many in the AI community dream of a world where algorithms can be an unquestionable force for good, the underlying technology has a long way to go. What stands between the status quo and that idealistic future is not more data or more code, but less bias in data and code.

Post by Shariar Vaez-Ghaemi, Class of 2025


What Happens When You Give People Money?

What happens when you give people money? Dr. Aisha Nyandoro and Natalie Foster know: through their research, they’ve seen the impacts of guaranteed income firsthand.

On November 9, as part of the Duke Center for Child and Family Policy’s Sulzberger Distinguished Lecture series, these experts discussed their work and what we can learn from it at “What Happens When You Give People Money: The Future of Economic Security for Children and Families.”

Natalie Foster

Foster, co-founder and co-chair of the Economic Security Project, began with the big idea of guaranteed income. Before the pandemic, wealth and income inequality were at all-time highs — disparities that “can be traced back to the origins of racialized capitalism.” But recently, things have gotten even harder. Wages have remained stagnant despite increases in productivity — and despite inflation, making it harder to afford things like rent. Foster denounced the “strong ideology that says that lack of security in this system is a personal failing. That if you can’t pull yourself up, there’s something wrong with you.” There’s something wrong with the system, Foster said. “People are working. The economy isn’t.”

Foster explained that the 1996 “Personal Responsibility and Work Opportunity Reconciliation Act” fundamentally changed welfare by converting the old New Deal-era unlimited grant program into the flat-funded block grant we now know as TANF, leaving determination of eligibility to state discretion and generally “making welfare more punitive.” The Act, Foster said, was built on racist stereotypes, like that of the welfare queen. To make matters worse, it was passed against the backdrop of a persistent devaluation of the labor of people of color

Foster said that even though there didn’t appear to be room in these political conditions to do things differently, she had the “audacity to imagine something else: the ‘adjacent possible.’” She wanted to give cash to people directly, ensuring an income floor regardless of whatever crises that may abound.

Foster worked with the mayor of Stockton, California on the Stockton Economic Empowerment Demonstration (SEED), which provided 125 Stockton residents with $500 monthly payments for two years. 

Dr. Aisha Nyandoro

Foster was connected by a mutual friend to Nyandoro, the CEO of Springboard to Opportunities. Nyandoro had launched The Magnolia Mother’s Trust, which provides low-income Black mothers in Jackson, Mississippi with $1,000 monthly payments for one year. 

With The Magnolia Mother’s Trust, Nyandoro sought to shift away from economic policy “rooted in ‘what is,’ and toward ‘what could be.’” This concept has a rich history, she said, and includes the work of Martin Luther King Jr. and the Black Panthers. She had a specific ‘what if’ in mind: “What if when Black women told us what they needed, we believed them?” What if we sought to overturn the very structures that keep these people down, and subverted the “paternalistic nature of the social safety net”? 

Nyandoro stated that as a researcher, when she has questions, she “goes back to the people.” When she did, she found that although people’s needs were individual, “cash was ubiquitous” — cash was a solution that could address every single one of the problems that she heard. Giving cash directly could help combat a system that “penalizes people for being poor, rather than trying to lift them out of poverty.” 

Why low-income Black mothers? Nyandoro explained that in order to do the work of economic liberation, one must identify what’s wrong with the system. In this case, that meant identifying those who are the most negatively impacted by the system, and using what limited resources are available to help them specifically.

Nyandoro turned to her findings: giving people cash works. These mothers are often working tirelessly, holding down two or three jobs and struggling to make ends meet. After receiving the money, people continue to work and often do so at higher rates (a major fear of opponents of guaranteed income). As a result, their income is often doubled — with life-changing results

Beyond the numbers, Nyandoro emphasized that “we are seeing joy. We don’t talk about joy enough as it relates to Black women.” This money allowed Black women to feel free, to be entrepreneurial: to “dare to dream for the first time — for themselves and for their families.” 

She referenced Chimamanda Ngozi Adichie’s famous speech “The Danger of a Single Story,” explaining that in order to change the narrative, “we need to change the narrator.” It’s time to think about whose voices we center.

In Jackson, Mississippi and Stockton, California, the pair had carried out research about the ‘adjacent possible.’ They’d used cities and states as “laboratories in democracy.” Foster said that their work was paving the way for gradual advances in guaranteed income — slowly, but surely. Then, the pandemic hit.

Suddenly, ideas that had recently been dismissed as too radical were viewed as necessary. Often unable to work, people needed money fast in order to put food on the table and cover their most urgent needs. The federal government rose to the challenge with the American Rescue Plan, providing stimulus checks and pandemic unemployment insurance, plus expanding the Child Tax Credit. “The ‘adjacent possible’”, Foster said, “had become the possible.”

The country saw an “immediate drop in poverty.” The pandemic was revealing, said Foster. It revealed that cash provides time, stress reduction, and resilience. It revealed that cash serves as a tool to create economic security and “build back better.” Above all, it revealed that “poverty is a policy choice that we’re currently making. We could make a different policy choice in order to eliminate it.”

The pandemic also revealed that stimulus checks and the Child Tax Credit were “very popular policies.” Nyandoro has observed support in the form of petitions for monthly cash transfers, the founding of organizations like Mayors for a Guaranteed Income and Guaranteed Income Community of Practice, and the launch of over a hundred guaranteed income pilots of some sort. All these efforts, Nyandoro said, are pushing toward “the same North Star”: centering the needs of families and achieving economic liberation through federal policy.

Foster turned the discussion toward next steps: “these victories have been immense, but could disappear” if the Build Back Better Act does not pass. The Act includes a year-long extension of the expanded Child Tax Credit, a key instantiation of guaranteed income. The Child Tax Credit has bipartisan support

If the extension of the Child Tax Credit passes, then according to Foster, guaranteed income is one step closer to becoming a cornerstone of social policy. This would be a “nail in the coffin of the way we’ve done policy for the last fifty years — that you’re only worth what you do in the world. Every human has dignity and worth, and we have the opportunity to build a policy that says just that.” 

Nyandoro agreed with Foster. As an anti-poverty advocate, she believes in a world without poverty: a world where “everyone can have a life of dignity for themselves and their families.” She believes that the ‘adjacent possible’ is achievable if “we can move beyond our own individual needs in order to view life as a collective, where prosperity is shared rather than hoarded.” She ended by quoting Toni Morrison: “if you have some power, then your job is to empower someone else.”

Last Friday, the House voted to pass the Build Back Better Act, which now heads to the Senate.

Post by Zella Hanson

Duke has 38 of the World’s Most Highly-Cited Scientists

Peak achievement in the sciences isn’t measured by stopwatches or goals scored, it goes by citations – the number of times other scientists have referenced your findings in their own academic papers. A high number of citations is an indication that a particular work was influential in moving the field forward.

Nobel laureate Bob Lefkowitz made the list in two categories this year.

And the peak of this peak is the annual “Highly Cited Researchers” list produced each year by the folks at Clarivate, who run the Institute for Scientific Information. The names on this list are drawn from publications that rank in the top 1% by citations for field and publication year in the Web of Science™ citation index – the most-cited of the cited.

Duke has 38 names on the highly cited list this year — including Bob Lefkowitz twice because he’s just that good — and two colleagues at the Duke NUS Medical School in Singapore. In all, the 2021 list includes 6,602 researchers from more than 70 countries.

The ISI says that US scientists are a little less than 40 percent of the highly cited list this year – and dropping. Chinese researchers are gaining, having nearly doubled their presence on the roster in the last four years.

“The headline story is one of sizeable gains for Mainland China and a decline for the United States, particularly when you look at the trends over the last four years,” said a statement from David Pendlebury, Senior Citation Analyst at the Institute for Scientific Information. “(This reflects) a transformational rebalancing of scientific and scholarly contributions at the top level through the globalization of the research enterprise.”

Without further ado, let’s see who our champions are!

Biology and Biochemistry

Charles A. Gersbach

Robert J. Lefkowitz

Clinical Medicine

Pamela S. Douglas

Christopher Bull Granger

Adrian F. Hernandez

Manesh R.Patel

Eric D. Peterson

Cross-Field

Richard Becker

Antonio Bertoletti (NUS)

Yiran Chen

Stefano Curtarolo

Derek J. Hausenloy (NUS)

Ru-Rong Ji

Jie Liu

Jason W. Locasale

David B. Mitzi

Christopher B. Newgard

Ram Oren

David R. Smith

Heather M. Stapleton

Avner Vengosh

Mark R. Wiesner

Environment and Ecology

Emily S. Bernhardt

Geosciences

Drew T. Shindell

Immunology

Edward A. Miao

Microbiology

Barton F. Haynes

Neuroscience and Behavior

Quinn T. Ostrom

Pharmacology and Toxicology

Robert J. Lefkowitz

Plant and Animal Science

Xinnian Dong

Sheng Yang He

Philip N. Benfey

Psychiatry and Psychology

Avshalom Caspi

E. Jane Costello

Honalee Harrington

Renate M. Houts

Terrie E. Moffitt

Social Sciences

Michael J. Pencina

Bryce B. Reeve

John W. Williams

Post by Karl Bates

How is Universal Healthcare Like the Waterboarding Debate?

The Duke Medical Ethics Journal (DMEJ) is an undergraduate publication started in Spring of 2020 that examines conversations around universal patient-doctor responsibility. In other words, they’re training the next generation of healthcare providers to ask big questions and make informed decisions. So, we owe them a huge thank-you in advance. 

On Sunday, October 24th, DMEJ hosted Dr. Gopal Sreenivasan to speak with current members. The event was open to the public as part of the club’s mission to promote ethical practices across all fields. Dr. Sreenivasan is a moral philosopher, but he is also a professor of medicine at Duke Medical School. His position as the “Crown Professor of Ethics at the Trent Center for Bioethics, Humanities & History of Medicine,” is part of an initiative to connect societal arts and sciences aspects of Duke University to the Medical School. 

Dr. Gopal Sreenivasan

“Today, I want to talk to you all about the human right to health,” he opened. 

Sreenivasan’s talk was focused on the question of how individual countries can provide healthcare or insure health.  “One division within the human right to health is the division between health and healthcare,” he clarified. “Another is the difference between a regular right and a human right.” 

As a philosopher, Sreenivasan took the issue of access to health and placed it on a universal scale. He addressed the social determinants of health (callback time!) as part of the solution, alongside more direct-but-still-indirect healthcare actions like vaccinations. His conclusion? We are ultimately moving away from the narrative that we have a right to healthcare and towards the narrative that we have a human right to health

“You have a right to health, but that does not necessarily mean you are going to be healthy. There are still factors that affect this which are under no one’s control. It doesn’t mean that if you don’t live to be 80 or 85 that your right has been violated. But you’re still entitled to a broader range of things than just health.”

To help illustrate this for my fellow visual learners, I’ve made a fun little visual aid. 

Sreenivasan laid out a verbal map to demonstrate the confusion policy makers face about addressing the wellbeing of their constituents. If you believe healthcare is a right, you believe the government has a different role to play than if you believe health is a right. You may expect less of them in terms of handling indirect factors like social determinants and vaccines. If you believe healthcare is a human right, you expect all governments to provide healthcare access universally. This is different from Sreenivasan’s preferred view: health is a human right. All people are entitled to all aspects of their health being addressed all the time in every way in every place. 

The word human in “human right” indicates universality the same way removing the care from “healthcare” does; they both broaden the scope. 

After that lovely philosophical grammatical discussion (Do colorless green ideas sleep furiously?) as our foundation, Sreenivasan moved on to a challenging analogy: waterboarding

“It does not belong to the nature of a right that everyone has to have it. But it does seem to belong to the nature of a human right that everyone has to have it. Take the human right to not be tortured, for example.”

Your moral view may differ on whether or not it is a human right not to be tortured. You may think the right should apply to all people, or no people, or only some people. But you also may think that the right should apply to only certain aspects of torture; maybe you think that specifically waterboarding doesn’t count.

(The debate around whether or not waterboarding counts as torture and whether or not it is prohibited under human rights legislation is one that has been around for a long time. Torture has been banned by multiple American presidents in multiple environments, but the language around waterboarding in particular is highly controversial. You can read more about the debate here.)

“It’s not that some people have a human right not to be tortured which protects them from waterboarding, and other people have a human right not to be tortured but it is somehow lesser and does not protect them from waterboarding. You can’t pick and choose the content based on the person for whom the right belongs.”

So, how is the waterboarding debate like universal healthcare?

For one, it’s a matter of exclusion. It’s a matter of moral philosophy. It’s a matter of definition. 

The question of whether there should be universal healthcare goes far beyond the question of whether healthcare is a right. 

How do we improve access? Who is at fault for rising drug prices? How is America’s healthcare system different than other countries? These questions must start with questions of definition. Who is our target audience? Who is included? Who is excluded? What is included? What is excluded? 

“It seems intuitive that human rights are all or nothing.” Sreenivasan explained. “Either everyone has them or no one has them. But then you must say that their content also has to be the same.”

Post by Olivia Ares, Class 2025

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School Segregation & Culture War: Color of Education 2021

Mary Hassdyk

Perhaps you’ve heard of the 1619 Project. A Pulitzer Prize-winning New York Times journalism project which sought to place “the consequences of slavery and the contributions of Black Americans at the very center of our national narrative,” the project has been controversial and is thought to have sparked the current debate over critical race theory in the classroom.

Its creator, Nikole Hannah-Jones, spoke at the Color of Education virtual summit on October 26. She discussed her journalistic research on systemic racial inequities in the education system, as well as the 1619 Project and the struggle over teaching race in the classroom.

Nikole Hannah-Jones

Hannah-Jones defined the public school as an “intimate place” where young members of society come together to “exchange ideas and culture, meeting across class and race.” The public school serves to create community, which, she stressed, is necessary for a healthy democracy. “A sense of community prevents polarization,” she said. “I know that a person who’s different from me still wants, fundamentally, the same things.” That gives us more of an opportunity to solve political problems without hostility. 

Instead, she often sees “segregated” low-income mostly-Black schools and “integrated” mostly-white schools, separated by a disturbing chasm of resources and opportunity. (She’s written about this in several Times pieces.) She remarked that “this bifurcation doesn’t serve our democracy and it doesn’t serve humanity.”

But that’s been a problem since before Brown v. Board of Education. What’s changed in the last few years, according to Hannah-Jones, is that in the wake of last year’s Black Lives Matter protests, there is now a “culture war” being waged over critical race theory. 

Critical race theory is an academic framework that examines the intersection of race with law and public policy. The theory is controversial: many fear the fundamental critique of the US legal and economic system that the theory ultimately implies. (In 2020, whereas white conservatives and more moderate liberals tended to blame fatal incidents of police brutality on “a few bad apples,” the viewpoint consistent with critical race theory is that “the problem is the barrel and the systems that produce it.”)

Laws banning the teaching of critical race theory have already been passed or are in the works in several states, including here in North Carolina, where Governor Roy Cooper recently vetoed a bill which sought to regulate the teaching of several race-related concepts, including whether “a meritocracy is inherently racist or sexist.”

There’s also historical revisionism, known pejoratively as ‘revisionist history’: the reinterpretation of orthodox views surrounding historical events, or, according to fellow Times contributor and historian Timothy Snyder, “the parts of history that challenge leaders’ sense of righteousness or make their supporters uncomfortable.” (Snyder says that in the US, “the ‘revisionists’ are people who write about race.”) 

Critical race theory ultimately requires some revisionism — to critically examine the intersection of race with the laws and policy of the current moment, we must critically examine how we got here, and that means taking another look at the US’ legal history, war history, even its history of infrastructure. Critical race theory is usually taught in college humanities classes. (Kimberlé Crenshaw coined the term in the 1980s, and her work is decidedly college level — I’ve read her here at Duke, but certainly not before.) But because critical race theory and revisionism are linked, it’s come to pass that any K-12 effort to teach about how racism has informed US history now gets labeled as “critical race theory” by adversaries of these efforts. 

Critical race theory has become a buzzword — and in many circles, it’s a bad word. These days, if a parent thinks you’re teaching critical race theory, you might soon find yourself without a job. (The summit required a passcode and was not recorded for fear that educators participating might be “outed as believers” in critical race theory and subsequently maligned.)

Along with educators in the Zoom comments, Hannah-Jones discussed this problem: teachers are getting accused of teaching “critical race theory”; the term is being used as a weapon and to imply wrongdoing; and it seems that parents, legislators, and even some educators don’t know what it actually means. 

Hannah-Jones asserted that this is “how propaganda works.” The term “critical race theory” is being used to produce fear and automatic condemnation, which distracts from the content of the theory and shuts down further (more rational) conversation. Hannah-Jones gave some advice to educators: “When a parent says, ‘I do not want my child to learn critical race theory,’ Ask them what they think that it is. They don’t know. And then you get to say, ‘Well, no, that’s history. Well, no, that’s anti-slavery.’ You get the point.”

Hannah-Jones explained that “as educators, you have to have these conversations with people.” Parents don’t necessarily know what their children are learning in school — and that can be a source of anxiety. So when “bad-faith actors are fear mongering, saying ‘Don’t you know what terrible things your kids are learning?’” it’s all too easy for parents to become distraught and distrust their child’s teacher.

Moving to discussing other issues in education, Hannah-Jones emphasized that schools are generationally deprived of resources, which is a problem that “can’t be fixed overnight.” She’s seen parents trying to advocate for their children and failing because they lack proximity to social, political, or legal power. “Maybe they can’t come to PTA because they’re a single mother, or they work at Popeyes — they get dismissed,” she said. “There’s no meeting with the superintendent. They can’t call the media in.” And when power dictates one’s ability to make change, the generational deprivation of resources can only continue.

Jayden Grant, a senior at Falls Lake Academy, asked Hannah-Jones how to ensure that these issues are addressed on the level of charter and private schools, which aren’t governed by the same policies. 

Hannah-Jones replied that she is fundamentally opposed to charter and private schools, viewing them as “undemocratic by design.” As such, “holding them accountable” is only possible through public advocacy, namely through the media. Students have the strongest voice, she told Jayden. They’re the reason these schools exist in the first place; it’s up to them to challenge policies or actions they see as unfair and make the public aware. 

On that note, Hannah-Jones brought the conversation back to the question of which version of our collective past will be taught in the K-12 classroom. Hannah-Jones said that based on the feedback she’s gotten and conversations she’s had, the 1619 project has inspired kids. It’s made them excited about history and learning in general. She denounced the neoliberal “privatization and commodification of education,” stating that often, parents wrongly view themselves as consumers. “We need to center kids in these discussions,” she said.

Hannah-Jones wrapped up the discussion with a call to action. She told the audience to “get angry” that authors like Ruby Bridges and Toni Morrison are being blacklisted, because “that is the same kind of thinking that’s led to the inequality we see now.” She claimed that “people wouldn’t be freaking out about the 1619 Project if it wasn’t having an effect,” but the Project is making waves, because “those who control the stories about who we are control the culture.” And the culture Hannah-Jones wants to see is one which sees the “least of us as just as deserving as anyone else.”

Professor Emeritus at UNC Harry Amana had the last word, saying that one cannot be an educator without being an optimist. That’s because, as an educator, you believe that “if people knew better, they would do better.” 

Maybe one day, we all will.

Post by Zella Hanson

Leadership As ‘Groundskeeping,’ Not ‘Gatekeeping,’ and Other “Lessons From Plants”

Dr. Beronda Montgomery, author of Lessons from Plants, recently spoke at Duke University. (Photos: Marie Claire Chelini, Biology Dept.)

Plants do not passively exist, leaving their survival to the whims of fate; they notice their environments and respond accordingly, says Dr. Beronda Montgomery, a professor, writer, science communicator, and researcher from Michigan State University who studies plants and what we can learn from them.

She visited Duke last week to talk about her recently published book, Lessons from Plants, and the inspiration behind it.

Plants perceive and respond to their surroundings in myriad ways, from turning toward a light source to reacting to differences in temperature, humidity, and nutrient availability. Even the same stimulus can cause different reactions in different situations, said Montgomery, whose research involves photosynthetic organisms, especially Arabidopsis plants and cyanobacteria. She is broadly interested in how organisms respond to and are affected by their environments.

For example, light can serve as either a “go signal” or a “stop signal,” depending how much of it is available. In low light conditions, plants invest more energy in stem elongation as they seek light. When they have sufficient light, on the other hand, plants undergo “de-etiolation,” creating shorter stems and better developed leaves.

Montgomery doesn’t just learn about plants; she learns from them as well. And in some cases, she says, plants might make better teachers than humans.

Montgomery spoke in the Penn Pavilion at Duke.

One area Montgomery has written about extensively, both in Lessons from Plants and elsewhere, is equity. As she points out, “Equal aptitude can result in different outcomes depending on environment.” According to Montgomery, “Humans, by and large, have an expectation of growth for plants,” so when something goes wrong, we look to external factors. We blame the caretaker, not personal defects in the plant. With humans, on the other hand, “We recruit people… who have demonstrated success elsewhere,” fueling a vicious cycle that can exacerbate inequities and limit opportunities. Montgomery talks about “the need to move from leadership as gatekeeping to groundskeeping.”

When students or employees struggle, she believes we should scrutinize mentors and caregivers instead of automatically attributing failure to personal defects. After all, “We would never say… ‘let me teach you to have turgid leaves’ to a plant” or tell it to simply try harder. We don’t eliminate houseplants that aren’t thriving. We ask ourselves what they need—whether it’s light, fertilizer, or water—and make changes accordingly.

“What would happen,” Montgomery asks, “if we saw things like equity as essential to our existence?” She stresses that questions like these can’t remain hypothetical. She points to a quote in Breathe, a book by Imani Perry, that captures the importance of applying what we learn: “Awareness is not a virtue in and of itself, not without a moral imperative.”

Nevertheless, Montgomery believes that “We have to live in the system we have while we transform it.” Sometimes, just as managed fires can make forests healthier and safer, there is a need for “intentional disruption” in the human world. “We seem to want change without change,” when we should instead be embracing the process of change as well as the result. “Change doesn’t mean that what happened in the past was all evil. It just means that we have to keep moving.” Moving forward is something plants do well. Season by season, year by year, they keep growing. Montgomery speaks of the tulips that helped bring her peace during a period of personal and collective grief. In spite of everything, the tulips she had planted in the fall came up in the springtime, ready for warmer weather.

Plants don’t just respond to change; they prepare for it. In the fall, when deciduous trees lose their leaves, they are “actively prepar[ing] for rest,” something Montgomery thinks we could all learn from.

Hope, according to Montgomery, means that “some things have to die, and some live,” and that “despite what’s going on around you, you have to find the power and strength to go on.”

“I aspire to hope,” she says.

Montgomery also did a book signing for Lessons from Plants which was published in April of this year.

Montgomery says her guiding life principle is reciprocity. It seems fitting, then, that she has taught her son to appreciate plants from an early age, just as her mother did for her. When Montgomery’s son was nine months old, she planted a tree in his honor with the idea that he would be its steward. Sometimes, her son was taller than the tree. Other times, it was the other way around. When Montgomery’s son was seven, the tree became ill, but they treated it successfully, prompting conversations about sickness and recovery and what it means to care for something. Throughout his childhood, her son’s tree remained a valuable conversation starter. It still is.

“He’s a second-year student in college, and he still asks about his tree.”

Post by Sophie Cox, Class of 2025

Dr. Laura Richman is Defining Health by its Social Determinates

In 2010, the Affordable Care Act sparked a nationwide debate on the extent of responsibility the American government has over our healthcare. But Dr. Laura Richman has been asking that question since long before that. 

Richman is a health psychologist. “I examine psychosocial factors that have an impact on health behaviors and health outcomes,” she explains, sitting across from me at the Law School café. (Neither of us were wearing a cardigan. It was rather hot outside). 

Laura Richman Ph.D. is an associate professor in population health sciences. (image: Scholars@Duke)

Richman is an associate professor at Duke in the Population Health Sciences, an associate of the Duke Initiative for Science & Society, and, coincidentally, my professor in the Science & the Public FOCUS cluster. She co-teaches the course Science, Law, and Policy with Dr. Yousef Zafar, in which we examine the social determinants of health through the lens of cancer screening, diagnosis, and treatment.

After graduating from the University of Virginia in 1997 with a Ph.D. in social psychology, Richman worked at a sort of think-tank for health professionals collaborating on social issues. This inspired her to pursue health research through the lens of social determinants.

“There was a lot of work on substance use, on mental health, on behavioral disorders. That certainly contributed to my continued interest in factors that have an influence on these [health] outcomes,” she said. 

Continuing in this work, she became a research associate at the School of Public Health at Harvard University; Richman described her time at Harvard as “exciting,” which is not a word used by many to describe empirical research environments. “Certainly there’s that really robust relationship between low income, low education, low job status and poor health outcomes, but a lot of those pathways— like the ones we talk about in class, Olivia— had not been studied.” 

She’s referring to the public health concept of ‘upstream’ and ‘downstream’ solutions. (The river parable goes as follows: when you observe a trend in people drowning in a certain river, you are presented with different ways of solving the problem. You can start pulling people out of the river and saving them one at a time, which is called a “downstream” solution in public health. You can also prevent people from falling into the river, which is called an “upstream” solution.)

(courtesy of SaludAmerica!)

Richman’s professional research explores another crucial social determinant of health we discussed in class: perceived versus actual discrimination. She asked whether marginalization — objectively or subjectively — can affect functioning, “both psychologically and cognitively. Like, how does it affect their thought processes? Their decision-making? Then, how does that affect their health?” You can read her study here

One thing I noted immediately was Richman’s affinity for creative research design. In a lab she headed at Duke, she conducted one experiment with a student that tested the aforementioned effect of marginalization on health decisions. They provided subjects with a choice between unhealthy and healthy snack options after watching a video of, reading a passage about, or imagining members of their community experience discrimination.

In one study we read for Science, Law, and Policy, the stress effect of discrimination towards Arabic-named individuals after 9/11 was measured through the birth outcomes of Arabic-named mothers pregnant during that time. When I asked her about this, she said, “Particularly working with students, I think that they just bring so much energy and creativity to the research. Surveys serve their purpose — I think they’re really important, but I think there are just lots of opportunities to do more with research designs and research questions. I like trying to approach things from a different angle.” 

Richman is also working on a book. She is studying relational health — health as determined by the opioid epidemic, the obesity crisis, and social isolation associated with aging. She hopes her project will be used in classrooms (and by the interested layman), and that the value of social determinants of health is reflected in increased funding dollars, more people interested in health disparities, more focus in medical education on the screening and referral system, and stimulating dialogue among people in positions of power on a policy level.

Post by Olivia Ares, Class of 2025

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