TOXIC MASCULINITY IS THE NORM

Domestic violence impacts nearly two-thirds of Californians

Majority support jail alternatives for perpetrators and state-funded survivor support

The Reis Group

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SAN FRANCISCO (OCTOBER 8, 2025) ­– Nearly two-thirds of Californians (63%) say they are affected by domestic violence, either directly or indirectly through a family member or friend and nearly one-third (31%) identify as survivors, according to new statewide survey commissioned by Blue Shield of California Foundation.

Additionally, three-quarters of Californians believe that domestic violence is preventable and back alternative strategies to jail, such as turning to programs that educate and rehabilitate those who caused harm and relying on mental health practitioners as first responders in non-violent incidents. The desire for jail alternatives was shared by the majority of those who identified as survivors, 70% of whom declined to report their abuse to the police.

The report also demonstrated widespread support for state-funded resources with 84% of respondents saying they support increased state investment in domestic violence services, expanded mental health care, assistance with benefit enrollment, job protections, and paid cash assistance for survivors.

“These findings make it clear that domestic violence is not only widespread—it is personal for far too many Californians,” said Debbie I. Chang, MPH, the Foundation’s president and CEO. “But they also highlight a hopeful truth: most people understand that supporting state-funded resources and alternatives to jail that go beyond punishment can create safer, healthier communities for every Californian.”

The research, which used a mixed-methods approach including focus groups and a survey of 2,459 adults 18 and over, was conducted in May, 2025 and provided a broad portrait of Californians facing challenging times: 42% said their households faced a negative life event such as job loss or serious illness in the last year; 82% want the state to help low-wage Californians access basic needs like health care, nutrition and housing; and strong majorities said they feel racism is on the rise, with immigrants, LGBTQ+ individuals and people of color facing increased discrimination.

This research was commissioned as part of an ongoing effort to document trends, attitudes, and barriers in Californians’ needs and experiences with domestic violence, economic insecurity, racial equity, and gender-based harm. The methodology was carefully created to capture diverse perspectives, including those of women, LGBTQ+ individuals, racial and ethnic minorities, economically insecure adults, and mixed-immigration status households. There was intentional oversampling to ensure representativeness from California’s diverse population. The survey included respondents (31%) who self-identified as survivors of domestic violence and those (10%) who self-identified as having committed abuse against a partner.

“This poll is not just a measurement tool—it’s a beacon and a reminder that even in turbulent times, it’s crucial to listen to one another,” said Chang. “Our mission is to end domestic violence and make California the healthiest state in the country. To achieve that, we know that we need to hear from Californians including those most affected by violence so we can create tangible positive change that is lasting.”

The findings also showed gaps in how Californians define domestic violence. Most Californians recognized domestic violence includes a range of behaviors including gaslighting (69%), financial control (68%), verbal (74%) and physical violence (76%). However, nearly one in four (24%) did not identify physical abuse (pushing, slapping, blocking or preventing one from leaving a room, punching the wall, or throwing things) as domestic violence. Similarly, 26% did not recognize sexual coercion or forced sex as abuse.

The poll, conducted by PerryUndem and the Center for Advancing Innovative Policy, was the third survey commissioned by the Foundation in the past decade on these topics. More information about the survey is available on the Foundation website.

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About Blue Shield of California Foundation

Blue Shield of California Foundation supports lasting and equitable solutions to make California the healthiest state and end domestic violence. When we work together to remove the barriers to health and well-being, especially for Californians most affected, we can create a more just and equitable future. For more information, visit blueshieldcafoundation.org, sign up for our monthly newsletter Intersections, and please join us on Twitter, LinkedIn, and Facebook.

AMERIKA

Could direct-to-consumer drug pricing compete with prescription insurance?

Study shows slightly higher out-of-pocket payments, significantly lower total costs

Ohio State University

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COLUMBUS, Ohio – A new study offers a glimpse at how direct-to-consumer pharmacy pricing could one day present stiff competition to the private prescription drug insurance model, researchers say.

A team led by researchers at The Ohio State University compared the annual out-of-pocket and total costs of 33 neurologic medications either covered by insurance and sold by commercial pharmacies or bought online through the Mark Cuban Cost Plus Drug Company. Out-of-pocket costs include copay, coinsurance and deductible charges, and total costs reflect all consumer out-of-pocket and insurance premium payments as well as what insurers pay.

Overall, direct-to-consumer out-of-pocket neurologic drug costs were 75% higher than for insured medicines at retail pharmacies, but the total annual costs of the drugs from Cuban’s online pharmacy were 431% lower than those sold by commercial pharmacies to insured patients.

Because health plan out-of-pocket costs are in addition to insurance premiums paid by beneficiaries, the findings suggest the direct-to-consumer pharmacy may offer uninsured patients similar pricing for medications without having to pay the premium.

The higher out-of-pocket costs at Cuban’s pharmacy reflected an average across the board, but many of the medications are inexpensive – so the higher price did not reflect a significant amount of money, said first author Amanda Gusovsky Chevalier, assistant professor in the Division of General Internal Medicine at Ohio State’s College of Medicine.

For 76% of the online pharmacy drugs, the difference in out-of-pocket payments was less than $200 per year.

“The difference was close to zero for a lot of these different medications,” Gusovsky Chevalier said. “The reason that’s notable is because this price that patients can get directly from a website is the same as the cost to patients who, on top of buying medications, are paying a premium for an insurance plan that’s probably coming out of their paycheck.

“So the cost you’re paying that is subsidized by your insurance provider is the same as what you could pay at the Mark Cuban pharmacy. This could be a great option for uninsured patients who are paying completely out of pocket.”

The study was published recently in JAMA Network Open.

Gusovsky Chevalier and colleagues had previously published an analysis of neurologic drug costs from commercial pharmaceutical and Medicare supplemental insurance claims databases from 2012-2021, enabling the team to calculate 2024 estimates for out-of-pocket and total costs of the medications. For this new study, those estimates were compared to prices posted on the Cost Plus Drug Company website on Dec. 10, 2024.

“I had heard about the Mark Cuban pharmacy through colleagues and thought it would be interesting to compare the costs because his pharmacy is very direct-to-consumer – they cut out the middleman and whatever is advertised on the website is what you’re paying for, and that’s your only cost,” she said.

The analysis included drugs used to manage 11 neurologic conditions, among them Alzheimer’s disease, multiple sclerosis (MS), peripheral neuropathy and Parkinson’s disease.

The highest-priced medications (annual costs) in the direct-to-consumer pharmacy – and therefore all paid out of pocket – were the MS drugs glatiramer acetate ($24,186) and fingolimod ($2,185), and cyclosporine ($2,185), a treatment for myasthenia gravis. All other medications examined in the study from the Mark Cuban pharmacy cost less than $635 per year.

The medications with the highest 2024 insurance plan annual out-of-pocket and total costs, respectively, were teriflunomide for MS ($286 and $11,739), droxidopa for orthostatic hypotension ($238 and $11,618) and fingolimod ($240 and $8,394).

Out-of-pocket costs for only two medications, teriflunomide and droxidopa, were lower (40% and 18%, respectively) in the direct-to-consumer pharmacy compared to commercial insurance plans. Eighteen of the 33 medications had lower total annual costs at Cuban’s pharmacy compared to private plans.

Those two drugs and one other MS medication, dimethyl fumarate, stood out for their markedly reduced total costs: Results estimated aggregate annual savings of at least $11 million each by using the direct-to-consumer pharmacy instead of commercial insurance plans at a retail pharmacy.

“Total costs represent system-level spending, and we look at them because we want to know how much money is moving around to be able to cover these medication costs,” Gusovsky Chevalier said.

The authors noted that there can be drawbacks to relying on a direct-to-consumer pharmacy – the Cost Plus online pharmacy listed only 33 of 79 commercially available neurologic medications at the time of the analysis. And patients who work both sides of the system to pay the lowest prices would risk having fragmented prescription records that could lead to unintended drug interactions.

Even so, the findings suggest direct-to-consumer online pharmacies may be an attractive alternative source of prescription medications, especially for patients who lack insurance coverage, the authors concluded.

“Our research has shown that the costs of medications just continue to rise through insurance plans, and it’s really important to find ways for patients to access medicines,” Gusovsky Chevalier said. “I think this adds to a larger body of evidence showing that these direct-to-consumer pharmacies have the potential to disrupt the market in some significant way in the future.

“It’s important for people to know that online pharmacies like this are available.”

Co-authors of the study include Chun Chieh Lin, Kevin Kerber and senior author James Burke of Ohio State; Evan Reynolds of Michigan State University; and Brian Callaghan of the University of Michigan.

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2025.27476 

Subject of Research

Not applicable

Article Title

Neurologic Medication Costs in a Direct-to-Consumer Pharmacy vs Commercial Insurance Plans

 

UTEP study reveals how financial pressure shapes NFL officiating

Judges’ and referee calls favored Kansas City Chiefs from 2015-2023

University of Texas at El Paso

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A new study led by Spencer Barnes, Ph.D., assistant professor of finance in the Woody L. Hunt College of Business at The University of Texas at El Paso, has uncovered how financial incentives may subtly shape officiating decisions in one of America’s most iconic institutions: the National Football League. By analyzing more than 13,000 penalty calls from 2015 to 2023, researchers found that postseason officiating has disproportionately favored the Patrick Mahomes–era Kansas City Chiefs, coinciding with their rise as one of the NFL’s most marketable franchises.

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Credit: The University of Texas at El Paso.

EL PASO, Texas (Oct. 8, 2025) – A new study from The University of Texas at El Paso has uncovered how financial incentives may subtly shape officiating decisions in one of America’s most iconic institutions: the National Football League. By analyzing more than 13,000 penalty calls from 2015 to 2023, researchers found that postseason officiating has disproportionately favored the Patrick Mahomes–era Kansas City Chiefs, coinciding with their rise as one of the NFL’s most marketable franchises.

Published in the journal Financial Review, the study provides one of the clearest empirical looks at how financial pressures can influence real-time rule enforcement, the UTEP research team said. Unlike traditional regulatory settings, NFL officiating — which is carried out by referees and judges — offers immediate and publicly visible decisions. This transparency offers a testbed for whether economic reliance on high-profile entities alters enforcement behavior — a phenomenon known as regulatory capture.

“Our findings suggest that when the league’s financial health is at stake, rule enforcement may subtly shift to protect market appeal,” said Spencer Barnes Ph.D., assistant professor of finance in UTEP’s Woody L. Hunt College of Business and the lead author of the study. “The fact that postseason penalties consistently favored one franchise, while similar dynasties showed no such pattern, points to the powerful role of financial incentives in shaping supposedly neutral decisions.”

The study shows that during the playoffs, which the research team identified as the NFL’s most commercially valuable period, penalties against opposing defenses of the Chiefs’ offense were significantly more likely to result in first downs, cover more yardage and fall into subjective categories such as roughing the passer or pass interference. Importantly, these effects were absent for the Tom Brady–era New England Patriots and other recent Super Bowl contenders, suggesting the phenomenon is unique to Kansas City’s emergence as a television ratings powerhouse.

This, Spencer explained, may be the result of financial pressures on the league stemming from the sharp decline in TV viewership and ratings during the politically charged 2015–2017 seasons, just before Patrick Mahomes became the Chiefs’ starting quarterback.

The implications extend beyond football, the research team says. The study draws parallels to financial markets, corporate governance and regulatory agencies, where dominant players may enjoy advantages not because of explicit corruption, but because institutions under pressure adapt to preserve stability and revenue.

“This research not only deepens our understanding of sports governance, but also illustrates a larger societal concern: when financial pressure weighs heavily, impartiality can erode,” said John Hadjimarcou, Ph.D., dean of UTEP’s Woody L. Hunt College of Business. “Spencer’s work demonstrates the power of academic inquiry to reveal hidden dynamics that affect fairness, competition and trust in institutions.”

About The University of Texas at El Paso

The University of Texas at El Paso is America’s leading Hispanic-serving university. Located at the westernmost tip of Texas, where three states and two countries converge along the Rio Grande, 84% of our 26,000 students are Hispanic, and more than half are the first in their families to go to college. UTEP offers 171 bachelor’s, master’s and doctoral degree programs at the only open-access, top-tier research university in America.

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Journal

Financial Review

DOI

10.1111/fire.70020 

Article Title

Under (Financial) Pressure

 

What makes a great coach?

It’s the courage to confront their mistakes, learn from their athletes and address team culture issues, researchers say

McGill University

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Successful sports coaches have some things in common, researchers from McGill University and the University of Queensland in Australia found. Notably, they engage in post-season introspection, focus on creating a good team culture and include their athletes in finding solutions to problems.

The researchers looked at the experiences of Canadian university-level head coaches of sports teams who had been at that level for at least 15 years and had records of success, including having won championships, but who then experienced a poor season.

The research team conducted extensive individual interviews with the seven coaches (two women, five men), asking about the strategies they had used to get their team back on track.

The centrality of self-reflection and team culture

“They all had different reasons for why it didn't go well, but they all practised critical self-reflection and figured out what they needed to do to fix the culture,” explained Gordon Bloom, professor and chair of the McGill Department of Kinesiology & Physical Education, a co-author of the study.

All participants had indeed returned to their prior level of excellence within two seasons of the difficult one.

“Even though they were among the most successful coaches in the country, they really felt this thirst for knowledge, asking 'What do I need to do better? Where do I get this information from? How can I learn?' instead of just saying 'Well, I was successful for the last five years, why should I change it now?',” Bloom said.

Several of the participants mentioned having consulted their athletes to learn more about what went wrong and how to go forward. Sometimes, rebuilding team spirit has also meant cutting disruptive athletes from the team, no matter how talented, he added.

Reconstruction strategies like involving organizational staff in creating time and tools for coaches to practise self-reflection during the season or building athlete leadership groups to facilitate communication and a shared vision can help sustain success in the long term, the study suggests.

The role of courage in leadership

The researchers framed their participants’ willingness to learn from failure as a form of courage. They also noted how this concept has been neglected in the literature on coaching, which has often put emphasis on other characteristics, such as confidence.

“Coaches, particularly at a high level, are seen as these saviours, these sort of enchanted people who always have the answers, are always great and achieve success,” explained Bloom.

In this high-pressure context, admitting and confronting mistakes can be difficult, he said.

“These coaches are not 'supposed' to talk like that, because if they do, it’s assumed the team's going to fail. It takes a lot of courage to say, 'Well, I wasn't really at my best this time, and I challenge myself to be better. '”

Can this teach us anything about effective leadership in other spheres of life?

The professor certainly thinks so.

“If you're working in a business or in any environment where you're leading people, there are going to be times when you don't do well. If you want to get back to the top, you have to be like these coaches, you have to self-reflect, you have to learn, you have to involve people in the process, and you have to be willing to change,” he said.

About the study

“From distress to success: Serial winning coaches’ strategies to reestablish adaptive culture and successful performance” by Madison M. Fraser, Gordon A. Bloom and Clifford J. Mallett was published in the Journal of Applied Sport Psychology.

This research was supported by the Social Sciences and Humanities Research Council of Canada (SSHRC).

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Journal

Journal of Applied Sport Psychology

DOI

10.1080/10413200.2025.2543751 

Method of Research

Survey

Subject of Research

People

Article Title

From distress to success: Serial winning coaches’ strategies to reestablish adaptive culture and successful performance