Why March Madness is a perfect storm for betting

UTA researchers say big sporting events and peer influence can push young adults to bet

University of Texas at Arlington

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Sports betting continues to explode across the country. Online gambling platforms have become mainstream, are heavily marketed by celebrities and star athletes—and increasingly popular among young adults.

With online bracket tournaments, office pools and gambling websites accompanying wall-to-wall games, March Madness—the NCAA men’s and women’s national basketball championship tournaments that begin on March 17 and 20, respectively—creates a perfect storm for betting.

Unversity of Texas at Arlington social work professors Melissa Lewis and Dana Litt, who lead UTA’s Studying Alcohol and Related Risks Lab, offered insight into the surge in sports betting and strategies bettors can use to to avoid slipping into harmful patterns.

“When you look at how March Madness is advertised on social media and in groups, it creates the perception that everyone is doing it,” Dr. Lewis said. “That may not affect people who already plan to bet, but it can definitely influence those who haven’t done it before and are willing to try because it now seems so normative.”

The UT Arlington researchers contributed to a new study examining the drivers of sports gambling behavior. It found that people are far more likely to place bets during weeks with major sporting events when they believe their friends are doing the same.

The study, led by researchers from the University of Washington and published in the Journal of Gambling Studies, followed the betting patterns of 210 individuals ages 18 to 29 over a one-year period. Most of the participants, 77.1%, were male and completed surveys every two weeks about their sports betting activity.

Lewis and Dr. Litt helped apply the Prototype Willingness Model (PWM), a behavioral framework developed in the 1990s to assess health-risk behaviors. The model distinguishes between a tie to a “reasoned pathway”—I plan to bet—and a “social reaction pathway”—I might bet if the right situation arises.

“Some individuals plan their betting throughout the year, while others are open to gambling but haven’t had the right context,” Lewis said. “March Madness provides that context: It’s one of the biggest betting events of the year and heavily involves young adults and college students.”

Litt said the findings mirror research on alcohol use, where behaviors can stem from both deliberate planning or from social reactions.

“All of that matters because interventions for someone with strong intentions differ from interventions for someone who is simply willing if a friend suggests placing a bet,” Litt said. “Understanding why people choose to engage is what helps design effective interventions.”

Early intervention is key, the researchers added, as risky behaviors such as sports gambling can be associated with depression, anxiety, increased substance use and other harmful outcomes.

Expert tips for safer sports betting

1. Set a budget: Use only entertainment funds, never money for essentials such as rent or groceries. It’s not always one big loss that creates financial concerns; often, it’s repeated small losses. When you add them up at the end of something like March Madness, it can have significant consequences.
2. Bet with a clear mind: Avoid betting after drinking or when emotionally reacting to a loss—or a win. Take breaks between bets so each decision is independent rather than driven by emotions.
3. Understand the odds: Placing more bets does not increase the chances of winning. Remember, the house always wins in the long run. People often go for bigger bets because the potential payout seems exciting, but they don’t realize the odds are much lower.
4. Seek help: If betting feels uncontrollable or causes stress, consult professional support. Gamblers Anonymous offers 24/7 confidential help at 909-931-9056.

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Journal

Journal of Gambling Studies

DOI

10.1007/s10899-026-10477-4 

Method of Research

Survey

Subject of Research

People

Article Title

The Prototype Willingness Model of Sports Betting: A Yearlong Within-Person Study of Young Adults

 

Breast cancer stage at diagnosis differs sharply across rural US regions

Geography, race, and insurance status strongly influence stage at diagnosis among rural populations, a national study finds

American College of Surgeons

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Key Takeaways

• While women living in rural regions are known to face a higher risk of advanced breast cancer, a new analysis found that even within rural America, outcomes differ sharply based on region and other factors.
• Women living in the South, Black and Hispanic women, and women without insurance are significantly more likely to be diagnosed with Stage 3 or 4 breast cancer.
• Region-specific solutions, including rural surgeon training and targeted health policies, may help reduce disparities.

CHICAGO — Where a woman lives significantly affects whether her breast cancer is diagnosed at an early or late stage, according to a national analysis published in the Journal of the American College of Surgeons (JACS). Researchers found prominent geographic variations within rural regions across the United States, and that race and insurance status also strongly influenced a woman’s stage of breast cancer at diagnosis.

“The geographic disparities were quite striking,” said Omolade Sogade, MD, MPHS, lead author of the study, and a resident in the Department of Surgery at Washington University in St. Louis, Missouri. “We found the highest rates of disparities in the South, and that even among different rural regions across the country, a woman’s geographic residence was one important factor impacting her risk of being diagnosed with advanced-stage breast cancer.”

While women in rural areas are known to face a higher risk of advanced breast cancer, less is understood about geographic differences within rural communities and the factors driving these disparities. Using the American College of Surgeons (ACS) National Cancer Database, researchers analyzed data from 52,287 rural women diagnosed with breast cancer between 2004 and 2021. Counties were defined as rural if they had no towns or cities, or if their largest town had fewer than 2,500 residents. The researchers used the U.S. Census regions and divisions to categorize rural areas.

Characteristics of Rural Breast Cancer Patients

Among rural patients, 13.6% were diagnosed with advanced breast cancer (Stage 3 or 4) compared with 12% of patients in non-rural areas.

Most rural patients were White (84%), between the ages of 50 and 69 at diagnosis (53%), and residing in the West North Central, South Atlantic, and East South Central regions (67%). The majority of patients were covered by Medicare (47%) or private insurance (39%), and more than half (62%) lived in areas in the lower half of income distribution (median income of less than $57,856).

About half of the patients received treatment at a comprehensive community cancer program. After adjusting for other factors, facility type was not associated with advanced-stage diagnosis.

Geographic Differences Within Rural Regions

Using the West North Central region (Iowa to the Dakotas) as a statistical reference point, the researchers found that:

• Women in the East South Central region (Alabama, Kentucky, Mississippi, Tennessee) were about 34% more likely to be diagnosed with Stage 4 breast cancer.
• Women in the West South Central region (Arkansas, Louisiana, Oklahoma, Texas) were 33% more likely to receive a Stage 4 breast cancer diagnosis.

Racial Disparities

Compared with White women:

• Black women were 58% more likely to be diagnosed with Stage 3 breast cancer and 28% more likely to be diagnosed with Stage 4 breast cancer.
• Hispanic women were 52% more likely to be diagnosed with Stage 3 breast cancer.

Insurance Status and Risk

Insurance coverage strongly influenced the stage at diagnosis.

• Compared with patients with private insurance, women without insurance were about twice as likely to be diagnosed with Stage 3 breast cancer and nearly four times as likely to be diagnosed with Stage 4 breast cancer.
• Medicaid coverage offered some protection but was still associated with an elevated risk of developing advanced breast cancer; women with Medicaid were nearly three times as likely as patients with private insurance to be diagnosed with Stage 4 breast cancer.

Breast cancer is highly treatable when detected early, but outcomes decline sharply with advanced-stage disease. According to the American Cancer Society, five-year survival rates for patients with breast cancer range from 87% to 99% when the disease has not spread beyond nearby lymph nodes, dropping to around 33% in advanced stages.

Addressing Gaps in Rural Communities

Several factors likely contribute to later breast cancer diagnoses in rural areas. Approximately 60% of rural counties lack an active general surgeon, and only about 3% of oncologists primarily practice in rural communities, the authors noted. Long travel distances, workforce shortages, limited access to screening, and reduced health literacy may further delay diagnosis.

The authors emphasize that solutions must be multifaceted and region-specific. Expanding access to screening, strengthening the rural surgical workforce, and tailoring health policies to meet local needs are critical steps. Programs such as fellowships offered through the ACS Rural Surgery Program aim to train surgeons committed to rural practice.

“Cancer disparities in rural areas are complex and driven by multiple factors,” said senior author Julie Margenthaler, MD, FACS, an ACS Governor, and professor of surgery and director of breast surgical services at the Washington University School of Medicine in St. Louis, Missouri. “Effective solutions must be tailored to the region and informed by a deep understanding of local barriers and the community’s specific needs. Surgical training is essential, but prevention, early detection, and providing comprehensive cancer care are equally important.”

The study relied on hospital-level data from the National Cancer Database and may not capture individual factors contributing to delayed diagnoses, the authors noted. Larger population-level analyses may reveal patient-specific barriers that hinder timely breast cancer detection in rural communities.

The findings were presented at the 137th Annual Meeting of the Southern Surgical Association (Hot Springs, Virginia, December 2025) and are published as an article in press on the JACS website.

Citation: Sogade O and Margenthaler J. Evaluating factors associated with advanced-stage breast cancer presentation in rural patients in the National Cancer Database. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001759

# # #

About the American College of Surgeons
The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has more than 95,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the ACS.   

Follow the ACS on social media: X | Instagram | YouTube | LinkedIn | Facebook 

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Journal

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000001759 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Evaluating factors associated with advanced-stage breast cancer presentation in rural patients in the National Cancer Database

Article Publication Date

11-Mar-2026

COI Statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. OOS received support from the Washington University School of Medicine StARR Program in Cross-Disciplinary Oncology Clinician-Scientist Training R38 CA 255575, from the National Cancer Institute (NCI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funder had no role in the study design; data collection, analysis, or interpretation; writing of the report; or decision to submit this article for publication.

 

Subaquatic Sovereigns: New research shows how Bumble Bee Queens can survive underwater for a week

University of Ottawa

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Throughout winter, bumble bee queens lie buried underground in diapause, in a hibernation-like state, in a form of overwintering. But as snow melts and heavy rains soak the ground each spring those underground chambers fill with water, it was assumed that the bees who hadn’t yet awoken from their slumber, drowned. Now new research from the University of Ottawa shows that these queens can survive being submerged for over a week, thanks to a mix of physiological mechanisms.

The study, led by Professor Charles-Antoine Darveau, full professor in Comparative Physiology in the Department of Biology at uOttawa, reveals how these vital pollinators’ remarkable flooding-tolerance strategy may be crucial as extreme weather events become more frequent.

 

Life underground and underwater

Bumble bee queens spend winter in diapause, a hibernation-like state, buried in the soil. When spring flooding occurs, they can become trapped underwater.

“This study started from a discussion with my co-author and postdoctoral researcher, Sabrina Rondeau, whose recent findings showed that these queens can survive submersion for over a week, which is extraordinary for a terrestrial insect,” says Professor Darveau. “We wanted to understand how that’s even possible.”

To find out, the research team, including honours student Skyelar L. Rojas, recreated winter conditions in the lab. Queens were placed in diapause for four to five months before being submerged underwater for eight days. Throughout the experiment, researchers monitored their metabolic rate and physiological changes.

 

Breathing underwater

What they discovered was striking. Even underwater, the queens continued exchanging gases. In effect, breathing while maintaining an exceptionally low metabolic rate.

“The first key is metabolic depression,” explains Professor Darveau. “Their metabolism is already extremely low during diapause. That low energy demand makes survival possible.”

But that wasn’t the whole story. The team also detected significant accumulation of lactic acid in the bees’ bodies, evidence that they were producing energy without oxygen through anaerobic metabolism.

“They’re not relying on just one strategy,” Darveau says. “They combine underwater gas exchange with anaerobic metabolism. That flexibility is what allows them to survive these extreme conditions.”

 

The cost of survival

Surviving underwater comes at a price. After eight days of submersion, once the queens were removed from the water, their metabolic rate spiked dramatically for two to three days.

“That surge in metabolism coincides with clearing the accumulated lactate,” reveals Professor Darveau. “It’s essentially a recovery phase. After about a week, their metabolism returns to normal diapause levels.”

 

Weathering climate change

Bumble bee queens are the founders of future colonies. If they don’t survive winter and early spring, entire colonies are lost.

“This study shows how resilient these pollinators are,” Darveau clarifies. “Understanding these mechanisms helps us predict how bumble bee populations might cope with increasingly frequent spring floods.”

As climate change continues to reshape seasonal patterns, the ability of a tiny, hibernating queen to quietly endure days underwater may prove more important than ever.

The study, titled “Diapausing bumble bee queens avoid drowning by using underwater respiration, anaerobic metabolism and profound metabolic depression”, is published in The Royal Society Publishing.

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Journal

Proceedings of the Royal Society B Biological Sciences

DOI

10.1098/rspb.2025.3141 

Method of Research

Experimental study

Subject of Research

Animals

Article Title

Diapausing bumble bee queens avoid drowning by using underwater respiration, anaerobic metabolism and profound metabolic depression

Article Publication Date

11-Mar-2026