Psychological Sclence OnlineFirst,published on January 29.2014 as dol:10.1177/0956797613516148 Research Article Geographical Differences in Subjective Well-Being Predict Extraordinary Altruism 0.1177 567976155161 o SAGE Kristin M.Brethel-Haurwitz and Abigail A.Marsh Georgetown University Abstract ny donaonoory the anecedents of whicn are poony under e is known ence of pro nere is sigr it is u nt geograph variation in well-being predicts the prevalence of this form of extraordinary altruism.We calculated per nita rates of altruistic kidney donation across the United States and found that an index of subjective well-being predicted altruistic donation,even after we controlled for relevant sociodemographic variables. This relationship persisted at the state level and at the la relations promoted by societal factors that increase subjective well-being. ocial behvior.mpoa ondretedvn kidney donaion Received 7/31/13:Rev accepted 11/12/13 Altruistic kidney donation.or the donation of a kidney to well-being also shows strong regional variation and has a stranger,has been described as an act of "extraordinary been linked to common prosocial behaviors,such as vol unteering and charitable giving (Thoits Hewitt,2001) no Paymen except compensa exp vanation in wel tions in the United States since 1999 are maintained by vide a stranger with one of their 03: sey et a 2010 red by th sychological studies have been con ducted to assess the precursors of altruistic kidney the donor volunteers a kidney to an unknown recipient donation.nd most of these have employed retrospective Such a donation represents an intentional,costly behav S (B at benefiting an anony nonkin othe Norden 2008:Massev et al 2010)Th data ma Bat on.2010:Clavien Chapuisat.201 de Waal.2009) insufficient for capturing antecedents of altruism,which prone to self-report biases (Eisenberg 1983).Living kidney nding Author: donation in nied States in M 2013. ables.Subjective well-being may be one such variable: .mail:kb527georgetown.edu 11.201
Psychological Science 201X, Vol XX(X) 1–10 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0956797613516148 pss.sagepub.com Research Article Altruistic kidney donation, or the donation of a kidney to a stranger, has been described as an act of “extraordinary altruism” (Munson, 2002). Altruistic kidney donors receive no payment except compensation for medical bills, undergo exhaustive medical and psychiatric testing, may experience severe postsurgical pain, and are often treated with skepticism or even derision for their decision to provide a stranger with one of their own internal organs (Henderson et al., 2003; Massey et al., 2010). But little is known about the antecedents of this form of extraordinary altruism. Few psychological studies have been conducted to assess the precursors of altruistic kidney donation, and most of these have employed retrospective self-report data in small samples (Boulware et al., 2005; Henderson et al., 2003; Lennerling, Fehrman-Ekholm, & Norden, 2008; Massey et al., 2010). These data may be insufficient for capturing antecedents of altruism, which is notoriously prone to self-report biases (Eisenberg, 1983). Living kidney donation in the United States is unevenly distributed at the regional level (Matas et al., 2013), which suggests the importance of regional variables. Subjective well-being may be one such variable; well-being also shows strong regional variation and has been linked to common prosocial behaviors, such as volunteering and charitable giving (Thoits & Hewitt, 2001). We explored whether geographical variation in wellbeing predicts the prevalence of extraordinary altruism. Records on all nondirected (altruistic) kidney donations in the United States since 1999 are maintained by the Organ Procurement and Transplantation Network, which is administered by the United Network for Organ Sharing under contract with the U.S. Department of Health and Human Services. In a nondirected donation, the donor volunteers a kidney to an unknown recipient. Such a donation represents an intentional, costly behavior aimed at benefiting an anonymous, nonkin other, which satisfies the most stringent definitions of altruism (Batson, 2010; Clavien & Chapuisat, 2013; de Waal, 2009). 516148PSSXXX10.1177/0956797613516148Brethel-Haurwitz, MarshWell-Being and Altruism research-article2014 Corresponding Author: Kristin M. Brethel-Haurwitz, Department of Psychology, Georgetown University, White-Gravenor Hall, 3700 O St. N.W., Washington, DC 20057 E-mail: kb527@georgetown.edu Geographical Differences in Subjective Well-Being Predict Extraordinary Altruism Kristin M. Brethel-Haurwitz and Abigail A. Marsh Georgetown University Abstract Altruistic kidney donation is a form of extraordinary altruism, the antecedents of which are poorly understood. Although well-being is known to increase the incidence of prosocial behaviors and there is significant geographical variation in both well-being and altruistic kidney donation in the United States, it is unknown whether geographical variation in well-being predicts the prevalence of this form of extraordinary altruism. We calculated per capita rates of altruistic kidney donation across the United States and found that an index of subjective well-being predicted altruistic donation, even after we controlled for relevant sociodemographic variables. This relationship persisted at the state level and at the larger geographic regional level. Consistent with hypotheses about the relationship between objective and subjective well-being, results showed that subjective well-being mediated the relationship between increases in objective well-being metrics, such as income, and altruism. These results suggest that extraordinary altruism may be promoted by societal factors that increase subjective well-being. Keywords well-being, social behavior, altruism, prosocial nondirected living kidney donation Received 7/31/13; Revision accepted 11/12/13 Psychological Science OnlineFirst, published on January 29, 2014 as doi:10.1177/0956797613516148 Downloaded from pss.sagepub.com by Cai Xing on February 11, 2014
Bretbel-Haurwitz,Marsb Altruistic kidney donations cannot be readily explained others,supporting democracy:Aknin.Dunn.Norton by other dominant self-serving explanations for altruistic 2011;Diener Ryan,2009;Krueger,Hicks,McGue behavior,in luding kir selection, 00I cial behaviors also meet The of these donaio ey e nd thei normative nature have raised many questions about their Bove,2011;Bekkers Wiepking,2011).It remains unclear causes (Henderson et al.,2003). whether subjective well-being can also promote acts of evidence y altruism.This is sed quality of life (Kahneman.Diener. kidney donation is that such donations are exceedingly Schwarz,2003).Objective well-being,which reflects rare;per capita rates of altruistic kidney donation are les than 1 in 10,000.This base rate renders indivi can wa This ob sures that capture,in aggregate,associations Wascher,2003;Oswald Wu,2010).Subjective well- at the individual level (iener Tay.Oishi 2013)A elf rd engagement meaning.and numose and ng D tions and life satisfaction (Diener.2012:Ryan Deci .well-beingindex.com/).Gallup-Healthways hasc nducte 2001).A recently proposed"engine"model of well-being nationwide sampling of well-being since 2008.thereby incorporates these of well-being and creating the m s extensive ollection of well-being ing rep bat. nt inpu the co he index taps into more &C lead to voluntary.beneficent well-being outcomes and 2000 and includes both ex perienced and evaluative well activities (Jayawickreme,Forgeard,&Seligman 2012) being (i.e,self-reported well-being in the moment and Well-being outcomes are retrospectively),which is a recomme pursu thei .CO bute to geneind e06 hneman Riis Our aim in this study was to evaluate the relationshin changes in objective well-being would be anticipated to between this nationally representative index of well well-being.which would lead to being and per capita kidney in s to prom extrao for well-being outcomes.Donors con istently h desire to help another person as their primary motivation median income,age,and physical health,which may be for donating (Henderson et al. 2003: Lennerling associated with both well-being and altruistic donation sberg,Meyer, 201d are not hypothesized to drive the association between the two out exception,donors self-report that donation positively Method affected their psychological well-being and that the 2010 decision to donat again (Mass vant to our hypothe e in on P cally ne tha statistics provided by the United Network for Organ kidney donations between 1999 and 2010 (Organ Sharing (Matas et al., 2013).Together,these factors sup- Procurement and Transplantation Network,2011)and port the hypothesis that increases in well-being may pro ents well-being (Gallup 20 well-b less extreme prosocial behaviors at the individual wide demographic and economic information indices o level (spending money on others,volunteering)and at physical and mental health,and state characteristics of the community level (trusting others,cooperating with collectivism and religiosity
2 Brethel-Haurwitz, Marsh Altruistic kidney donations cannot be readily explained by other dominant self-serving explanations for altruistic behavior, including kin selection, reciprocity, or adherence to social norms (Batson, 2010; Massey et al., 2010). The rarity of these donations and their strongly counternormative nature have raised many questions about their causes (Henderson et al., 2003). Converging strands of evidence have suggested that well-being may promote altruistic kidney donation. Wellbeing is a broad construct that comprises objectively and subjectively assessed quality of life (Kahneman, Diener, & Schwarz, 2003). Objective well-being, which reflects objectively measured basic human needs (e.g., economic resources, access to clean water, and good health), affords individuals the opportunity to engage in activities that contribute to subjective well-being (Gabriel, Mattey, & Wascher, 2003; Oswald & Wu, 2010). Subjective wellbeing incorporates both eudemonic components, such as self-reported engagement, meaning, and purpose, and hedonic components, such as self-reported positive emotions and life satisfaction (Diener, 2012; Ryan & Deci, 2001). A recently proposed “engine” model of well-being incorporates these various elements of well-being and posits that objective indices of well-being represent input variables that promote subjective processes that, in turn, lead to voluntary, beneficent well-being outcomes and activities (Jayawickreme, Forgeard, & Seligman, 2012). Well-being outcomes are defined as outcomes that are pursued for their own sake, contribute to general wellbeing, and are characterized and measured independently of other outcomes. Under this model, positive changes in objective well-being would be anticipated to increase subjective well-being, which would lead to increases in well-being outcomes. Altruistic kidney donation satisfies these three criteria for well-being outcomes. Donors consistently report the desire to help another person as their primary motivation for donating (Henderson et al., 2003; Lennerling, Forsberg, Meyer, & Nyberg, 2004; Massey et al., 2010). They also report high levels of well-being after donation (Lennerling et al., 2008; Massey et al., 2010); nearly without exception, donors self-report that donation positively affected their psychological well-being and that they would make the same decision to donate again (Massey et al., 2010). Finally, altruistic kidney donation is a concrete outcome that can be independently measured using statistics provided by the United Network for Organ Sharing (Matas et al., 2013). Together, these factors support the hypothesis that increases in well-being may promote altruistic donation. Researchers have linked subjective well-being to less extreme prosocial behaviors at the individual level (spending money on others, volunteering) and at the community level (trusting others, cooperating with others, supporting democracy; Aknin, Dunn, & Norton, 2011; Diener & Ryan, 2009; Krueger, Hicks, & McGue, 2001). However, these prosocial behaviors also meet a range of self-serving goals, such as adherence to perceived social norms and enhancement of reputation (Bednall & Bove, 2011; Bekkers & Wiepking, 2011). It remains unclear whether subjective well-being can also promote acts of unambiguous and lifesaving extraordinary altruism. This is what we sought to determine in our study. One difficulty in identifying antecedents of altruistic kidney donation is that such donations are exceedingly rare; per capita rates of altruistic kidney donation are less than 1 in 10,000. This very low base rate renders individual-level assessments infeasible for capturing predictors of donation. This obstacle can be superseded by comparing regional measures that capture, in aggregate, associations at the individual level (Diener, Tay, & Oishi, 2013). A nationally representative regional assessment of subjective well-being in the United States recently became available: the Gallup-Healthways Well-Being Index (http://www .well-beingindex.com/). Gallup-Healthways has conducted nationwide sampling of well-being since 2008, thereby creating the most extensive collection of well-being data in the country. The index taps into more dimensions of wellbeing than does most past research (Diener & Seligman, 2004) and includes both experienced and evaluative wellbeing (i.e., self-reported well-being in the moment and retrospectively), which is a recommended approach, given the biases that affect each perspective (Kahneman & Riis, 2005). Our aim in this study was to evaluate the relationship between this nationally representative index of wellbeing and per capita altruistic kidney donations across states to establish whether well-being promotes extraordinary altruism. We assessed the relationship between these variables while controlling for covariates, including median income, age, and physical health, which may be associated with both well-being and altruistic donation but which are not hypothesized to drive the association between the two. Method We obtained data relevant to our hypotheses using publically available databases and previously published research. Variables included statistics on nondirected kidney donations between 1999 and 2010 (Organ Procurement and Transplantation Network, 2011) and statewide assessments of well-being (Gallup, 2012). We also accounted for variables that may be confounded with our primary variables of interest, including statewide demographic and economic information, indices of physical and mental health, and state characteristics of collectivism and religiosity. Downloaded from pss.sagepub.com by Cai Xing on February 11, 2014
Well-Being and Altruism Altruistic donations by state Indices of well-being by state Sharing and were ba The Gallup-Heaing Index.a component of up,2012 (2011 data as of lune 19.2011.These data included the States that comprises six components.The life state of residence for all nondirected kidney donors from component is based on the Cantril Ladder Scale (Cantril which ded ere av action 5 years in experience of smiling and laughter.worry.and othe emotional variables.Physical bealtb includes feeling well-rested and reported sick days. and ea thful The t ondenr's relationshin with his or her sunervisor lated for each state using the 2010 census data for the access indudes feeling safe and having enough money for population 18 and older as the population base The basic needs.Gallup-Healthways surveys a minimum inimun living kidn 1,000 adult es each day via botl ombined to only.)Thus,overall per capita donation rates repr sent each state's total number of donors from 1999 to 2010 Covariates by state by that s for stare in 2010 divided b Both well-being and altruistic donation may covary with total per capita don alth sta 0)an ach state's media Table 1.D ents. e of White,non-Hispanic res Demographic variable donors se Bureau 2000)and 2010 (US Census Bureau 2012)cen 535 56.0m sus data.We collected statistics on educational attainmen 420 43.98 000 through urea Age (years) h lated for the proportion of the population aged 18 and 35-4 25.3 older.Educa l-attainment statistics were for adults 32 age d 25 and olde an hor 65+ 251 hold inc ne (s Census Bur eau 201b)and Gini coef Race/ethnicity ficient,a measure of income inequality (Noss,2011;U.S Census Bureau, 2005) Because Black nic altruistic donors must ealt 30 physical-h 3.1 pass mental-and Asian de d/n ve 436 t0 days mental health through the Behavioral Risk Factor Surveillance System,a nationwide health survey con Control and Prevention 11,201
Well-Being and Altruism 3 Altruistic donations by state Statistics on altruistic kidney donation were provided by the United Network for Organ Sharing and were based on Organ Procurement and Transplantation Network (2011) data as of June 19, 2011. These data included the state of residence for all nondirected kidney donors from January 1999 to June 2011. Between 1999 and 2010, the most recent year for which complete data were available, 955 altruistic donations were recorded. Donors’ demographic information is presented in Table 1. All 955 donors’ states of origin were included in further analyses except for Washington, D.C., and Puerto Rico, for which scores on the Gallup-Healthways Well-Being Index and other key variables were unavailable. Per capita donations for the period from 1999 to 2010 were also calculated for each state using the 2010 census data for the population 18 and older as the population base. (The minimum age for eligibility for altruistic living kidney donation is 18; in addition, the Gallup-Healthways WellBeing Index includes responses of adults 18 and older only.) Thus, overall per capita donation rates represent each state’s total number of donors from 1999 to 2010 divided by that state’s 2010 adult population. Per capita donation rates for 2010 represent the total number of donors for a state in 2010 divided by the state’s adult population in 2010. We identified state-level correlates of total per capita donations by state as well as per capita donations for 2010 only. Indices of well-being by state The Gallup-Healthways Well-Being Index, a component of Gallup Daily Tracking (Gallup, 2012), is a state-level measure of self-reported subjective well-being in the United States that comprises six components. The life-satisfaction component is based on the Cantril Ladder Scale (Cantril, 1965) and evaluates life satisfaction at the current moment of the survey and expected life satisfaction 5 years in the future. Emotional health includes the respondent’s daily experience of smiling and laughter, worry, and other emotional variables. Physical health includes feeling well-rested and reported sick days. Healthy behavior includes exercise and eating a healthful diet. The workenvironment component includes job satisfaction and the respondent’s relationship with his or her supervisor. Basic access includes feeling safe and having enough money for basic needs. Gallup-Healthways surveys a minimum of 1,000 adults across the United States each day via both landlines and cell-phone lines; results of these surveys are then combined to create an annual index. Covariates by state Both well-being and altruistic donation may covary with sociodemographic variables that are not predicted to drive the well-being/altruism relationship, including age, sex, race, education, health status, and income (Boulware et al., 2005; Diener & Ryan, 2009). Our regression analyses therefore included as covariates each state’s median age, male-to-female sex ratio, proportion of the population with a high school degree or higher, and proportion of White, non-Hispanic residents. Data on race, sex, and median age were obtained from the U.S. Census Bureau; we used intercensal estimates from 1999 (U.S. Census Bureau, 2000) and 2010 (U.S. Census Bureau, 2012) census data. We collected statistics on educational attainment for 2000 through the U.S. Census Bureau (2006) and for 2010 through the U.S. Census Bureau (2011a) via the American Community Survey. Race and sex were calculated for the proportion of the population aged 18 and older. Educational-attainment statistics were for adults aged 25 and older. Economic variables included state-level median household income (U.S. Census Bureau, 2011b) and Gini coefficient, a measure of income inequality (Noss, 2011; U.S. Census Bureau, 2005). Because altruistic donors must also pass mental- and physical-health screenings, we included state averages for the number of days within the past 30 days that respondents reported poor physical or mental health through the Behavioral Risk Factor Surveillance System, a nationwide health survey conducted by the Centers for Disease Control and Prevention (United Health Foundation, 2013). Table 1. Demographics of Altruistic Living Kidney Donors in the United States (1999–2010) Demographic variable n Percentage of donors Sex Female 535 56.02 Male 420 43.98 Age (years) 18–24 50 5.24 25–34 169 17.70 35–44 242 25.34 45–54 312 32.67 55–64 158 16.54 65+ 24 2.51 Race/ethnicity White 878 91.94 Hispanic 24 2.51 Black 30 3.14 Asian 14 1.47 American Indian/Alaskan Native 3 0.31 Multiracial 6 0.63 Note: Data were drawn from the Organ Procurement and Transplantation Network (2011). Downloaded from pss.sagepub.com by Cai Xing on February 11, 2014
Bretbel-Haurwitz,Marsb State-level indices of collectivism-individualism and Bureau.7)=.83(p=.005),p7)=83(p=.005).Thes religiosity were also examined because of suggested results support the existence of a strong positive relation- links between thes variable and prosocial be ship between regional-leve well-being and the preva ntrol for the p survey of individuals conducted from 1993 to 1996,in collected we also c which states were ranked according to respondents' donation data from 2010 only.Although this variable i ieiocRtcftndnitaliandcolectinibehaios inherently more unstable because it relies on a smalle 2011G99 001 Gallup Daily Tracking (Gallup,2012).in which respon- These correlations were again replicated for the nine dents were asked the extent to which religion was an broader geographic regions,()=.83 (p=.006),p(7)= 85 5).which reaffirmed the stro ach sta s.On hip bet biased the observed association between well-being fied as "very religious and altruism,we next estimated a regression model pre altruistic-donation rates from Analysis strategy th Several strategies were used to examine the association following covariates:median houschold income.Gin between altruistic kidney donation and well-being at the coefficient,percentage of non-Hispanic Whites,sex ratio state level.In addition to investigating biva ducational tions phys we acco identify r otential contributions of sociodemogranhi altruism.B=0.58.(40)=236.p=023 (see Table 2 for economic,health,and social influences,including state results).Well-being also remained a significant predictor 0 capita donation rates when 2011 religiosity was the primary units of ana we als d as a cov te, 59,39 .50,P -023 raphic regions of the United States as defined set of covariates collected by the U.s.census Bureau). in1and 20.well-bein again predicted altruism,B=0.48,(40)=2.25.p=.030 (see Table 3 for results). In this well-being Results rem r o sm whe 10. State-level rates of altruistic kidne donation ae.B=04239=216. 037 Tog these findings suggest that the relatic nship between well from0to 76,which translates to per capita lonation rates being and altruism is not a function of basic sociodemo 0.000029(LUa graphic regional variation in religiosity Well-Being Indes d from 61.7(West virginia)to redicts that im (Hawaii;see Fig.1). ments in objective well-being result in subjective changes We first examined the bivariate association between hat promote well-being outcomes, such as altru 2010 state-leve -be 0 nog and er capita donation rate 3,201 gges s tha ective w (48)=52.001 (see Fig.2).To account for possible exa mined how positive changes in obiective measures o high-leverage outliers (in particular,Utah's donation rate well-being,which are known to promote subjective well- was 4.55 SD above the so conducted a ra eing (Di et al. donations <.001.1hs7S ve c 100 201 After controlling for baseline (1999)median income broader geographic regions defined by the U.S.Census we found that increases in median income from 1999 to
4 Brethel-Haurwitz, Marsh State-level indices of collectivism-individualism and religiosity were also examined because of suggested links between these variables and prosocial behavior (Henderson et al., 2003; Vandello & Cohen, 1999). The collectivism-individualism index was based on a national survey of individuals conducted from 1993 to 1996, in which states were ranked according to respondents’ endorsement of individualist and collectivist behaviors (Vandello & Cohen, 1999). The religiosity index was based on a 2011 Gallup survey, also a component of Gallup Daily Tracking (Gallup, 2012), in which respondents were asked the extent to which religion was an important aspect of their lives and the frequency with which they attended religious services. On the basis of responses to these questions, each state’s religiosity score was calculated as the percentage of respondents classified as “very religious.” Analysis strategy Several strategies were used to examine the association between altruistic kidney donation and well-being at the state level. In addition to investigating bivariate correlations between altruistic donations and well-being, we used multiple linear regression and mediation analyses to identify potential contributions of sociodemographic, economic, health, and social influences, including statelevel measures of collectivism and religiosity. The 50 states constituted the primary units of analysis. We also investigated associations at the regional level (i.e., the nine geographic regions of the United States as defined by the U.S. Census Bureau). Results State-level rates of altruistic kidney donation vary widely. Between 1999 and 2010, total donors per state ranged from 0 to 76, which translates to per capita donation rates ranging from 0 (Delaware, Mississippi) to 0.000029 (Utah; see Fig. 1). Scores from the 2010 Gallup-Healthways Well-Being Index ranged from 61.7 (West Virginia) to 71 (Hawaii; see Fig. 1). We first examined the bivariate association between 2010 state-level well-being and per capita donation rates from 1999 to 2010 and found a positive association between well-being and per capita altruistic donation, r(48) = .52, p < .001 (see Fig. 2). To account for possible high-leverage outliers (in particular, Utah’s donation rate was 4.55 SD above the mean), we also conducted a rankorder correlation, which yielded comparable results, ρ(48) = .70, p < .001. This pattern was also replicated when state-level data were collapsed into the nine broader geographic regions defined by the U.S. Census Bureau, r(7) = .83 (p = .005), ρ(7) = .83 (p = .005). These results support the existence of a strong positive relationship between regional-level well-being and the prevalence of extraordinary altruism. To control for the period during which the data were collected, we also conducted analyses using altruisticdonation data from 2010 only. Although this variable is inherently more unstable because it relies on a smaller sample, the pattern of observed results remained very similar, r(48) = .42 (p = .003), ρ(48) = .45 (p = .001). These correlations were again replicated for the nine broader geographic regions, r(7) = .83 (p = .006), ρ(7) = .83 (p = .005), which reaffirmed the strong positive relationship between regional well-being and altruism. To control for confounding variables that may have biased the observed association between well-being and altruism, we next estimated a regression model predicting per capita altruistic-donation rates from 1999 to 2010 from subjective well-being, as measured by Gallup-Healthways, with the additional inclusion of the following covariates: median household income, Gini coefficient, percentage of non-Hispanic Whites, sex ratio, median age, educational attainment, and indices of poor mental and physical health. Even after we accounted for covariates, well-being remained a significant predictor of altruism, β = 0.58, t(40) = 2.36, p = .023 (see Table 2 for results).1 Well-being also remained a significant predictor of per capita donation rates when 2011 religiosity was added as a covariate, β = 0.59, t(39) = 2.36, p = .023. When we performed this regression using the same set of covariates collected in 1999 and 2000, well-being again predicted altruism, β = 0.48, t(40) = 2.25, p = .030 (see Table 3 for results). In this model, well-being remained a significant predictor of altruism when collectivism (collected between 1993 and 1996) was added as a covariate, β = 0.42, t(39) = 2.16, p = .037. Together, these findings suggest that the relationship between wellbeing and altruism is not a function of basic sociodemographic factors, including regional variation in religiosity or collectivism-individualism. The engine model of well-being predicts that improvements in objective well-being result in subjective changes that promote well-being outcomes, such as altruism (Jayawickreme et al., 2012). This model suggests that subjective well-being mediates the relationship between objective well-being and altruism. To test this model, we examined how positive changes in objective measures of well-being, which are known to promote subjective wellbeing (Diener et al., 2013), influence altruistic donations. We considered positive changes in both median income and health status across states from 1999 to 2010. After controlling for baseline (1999) median income, we found that increases in median income from 1999 to Downloaded from pss.sagepub.com by Cai Xing on February 11, 2014
Well-Being and Altruism Per Capita Donation Rates Well-Being Scores (3 time p separate regressions with and without the inclusion of the test showed that subjective well-being mediated the 11,201
Well-Being and Altruism 5 2010 predicted rates of altruistic donations during that time period, β = 0.33, t(47) = 2.61, p = .012. We estimated separate regressions with and without the inclusion of our hypothesized mediator (well-being) and conducted a Sobel test; consistent with the engine model, results of the test showed that subjective well-being mediated the Quintiles 1 2 3 4 5 Per Capita Donation Rates Quintiles 1 2 3 4 5 Well-Being Scores Fig. 1. Per capita altruistic living kidney donation rates (1999–2010) and 2010 Gallup-Healthways Well-Being Index scores across states. Data on kidney-donation rates were drawn from the Organ Procurement and Transplantation Network (2011); Well-Being Index scores were drawn from Gallup (2012). Quintile 1 represents the highest well-being/altruistic donation rates. Downloaded from pss.sagepub.com by Cai Xing on February 11, 2014
6 Bretbel-Haurwitz,Marsb 72 71 70 69 68 WA 67 NJ● 65 品 62 0 0.000005 0.00001 0.000015 0.00002 0.000025 0.00003 Per Capita Altruistic-Donation Rate 1999-2010 路子为per pn山(1%-20 0)2 ap-ee- relationship between increases in income and altruism uistic Organ 8.39,46=1.35p=142.o05ce Fig.3 fo Predictor variable B 1(40) erall united Health Foundation health status.which includes both physical 031 165 and mental-health components(United Health Foundation Median income 0.40 2.63 econrd indom1to2010 aer 7020 0 Median age 03别 better overall health).However.subiective well-being did not mediate the relationship between improved health sta- Educational attainment -0.07 -0.23 tus and altruistic-donation rates,=-0.27.p=.79. 0.30 19 Discussion
6 Brethel-Haurwitz, Marsh AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY 61 62 63 64 65 66 67 68 69 70 71 72 0 0.000005 0.00001 0.000015 0.00002 0.000025 0.00003 2010 Well-Being Per Capita Altruistic-Donation Rate 1999–2010 Fig. 2. Correlation of state-level per capita rates of altruistic living kidney donation (1999–2010) with state-level 2010 Gallup-Healthways WellBeing Index scores (R2 = .27). Table 2. 2010 State-Level Subjective Well-Being and 2010 Sociodemographic Covariates as Predictors of Altruistic Organ Donation Between 1999 and 2010 Predictor variable β t(40) Well-being 0.58 2.36* Gini coefficienta –0.31 –1.65 Median income 0.40 2.63* Percentage non-Hispanic White 0.42 2.54* Male-to-female ratio –0.38 –2.36* Median age –0.34 –2.47* Educational attainment –0.07 –0.23 Poor mental health –0.01 –0.04 Poor physical health 0.30 1.19 Note: Overall model: R2 = .58, F(9, 40) = 6.22, p < .001. a Smaller Gini coefficients represent more equal distribution of income. *p < .05. relationship between increases in income and altruism, β = 0.19, t(46) = 1.35 (p = .184), z = 3.82 (p < .001; see Fig. 3 for the mediation model). We also found that increases in overall United Health Foundation health status, which includes both physicaland mental-health components (United Health Foundation, 2013), predicted increased altruism from 1999 to 2010 after we controlled for baseline (1999) health status, β = −0.28, t(47) = −2.39, p = .021 (lower health-status scores indicate better overall health). However, subjective well-being did not mediate the relationship between improved health status and altruistic-donation rates, z = −0.27, p = .79. Discussion The reduction of annual deaths from kidney disease is a matter of national urgency. Kidney disease is among the Downloaded from pss.sagepub.com by Cai Xing on February 11, 2014
Well-Being and Altruism 7 e-Level Subjective Well-Being and predicted altruistic donation and that this relationship dthe re Predictor variable unte B 40) for more than 25%of the regional variance in altruistic Well-being 2.42 Gini coefficient 0.20 -1.12 donation rates across the United States.Results showed hat the altruism sisted eve Median income 0.1 1.18 after we accounte 09 nd nh Median age 0.40 -3.36m mental health:these data reinforce the finding that it is Education specifically subjective well-being that promotes extraor- ment dinary altru m.The discovery well-being Poor physical heah 0.06 0.29 po n of in p05.p05 income and health status,respectively;positive change in objective leading causes of death in the united sta than 5.000 Americans die annually awaiting a kidney trans. in income and altruistic donation rates.Together.these plant (Matas et al.,2013).Increasing altruistic kidney data suggest that improvements in objective well-being donations has been posited as a viabl solution to this may in some cases result in impr wved subjective well. 2003E ham.Batty. g that promot rate of per capita altruistic donatior matched that of the ders the inverse causal pathwav hatahtuiic2hae most altruistic state (Utah),it could yield more than 900 donations increase regional well-being unlikely.It is additional donations annually and as many lives save more plausible th ooth well -being and altruistic dona Although researchers by external co at in todonate e.little is known about the antecedents of this donation among those individuals who are otherwise form of extraordinary altruism interested-such as poor health or poverty-drive We examined whether anges in both well-being and altruistic donation.We We d this pon eing covan Well-Being 0.43* 0.33 Improvement in Median Income Donation Rates 1999 Median Income 0.33 Sobel Test:Z 32,p<.001 ent on indicate significant paths（p<.05,“p<.o 当11,2014
Well-Being and Altruism 7 leading causes of death in the United States; more than 5,000 Americans die annually awaiting a kidney transplant (Matas et al., 2013). Increasing altruistic kidney donations has been posited as a viable solution to this serious and growing problem (Gilbert, Brigham, Batty, & Veatch, 2005; Henderson et al., 2003). If the nationwide rate of per capita altruistic donation matched that of the most altruistic state (Utah), it could yield more than 900 additional donations annually and as many lives saved. Although researchers have identified retrospective selfreported motives that affect individual donors’ decision to donate, little is known about the antecedents of this form of extraordinary altruism. We examined whether geographical differences in subjective well-being would predict the prevalence of altruistic kidney donation. We found that well-being predicted altruistic donation and that this relationship persisted at both the state and the regional level for altruistic donations during a single year (2010) and over the course of a decade (1999–2010). Well-being accounted for more than 25% of the regional variance in altruisticdonation rates across the United States. Results showed that the altruism/well-being relationship persisted even after we accounted for objective state-level differences in income, income inequality, education, and physical and mental health; these data reinforce the finding that it is specifically subjective well-being that promotes extraordinary altruism. The discovery that subjective well-being drives this effect was reinforced by the finding that positive changes in regional income and health status predicted altruistic donation after we controlled for baseline income and health status, respectively; positive changes in objective well-being are strong predictors of subjective well-being (Diener et al., 2013). Indeed, subjective wellbeing mediated the relationship between positive changes in income and altruistic-donation rates. Together, these data suggest that improvements in objective well-being may in some cases result in improved subjective wellbeing that promotes extraordinary altruism. The extreme rarity of altruistic kidney donation renders the inverse causal pathway—that altruistic kidney donations increase regional well-being—unlikely. It is more plausible that both well-being and altruistic donation are influenced by external covariates. One obvious possibility is that sociodemographic factors that impede donation among those individuals who are otherwise interested—such as poor health or poverty—drive changes in both well-being and altruistic donation. We addressed this possibility in our analyses by including these covariates in regression models. That accounting Table 3. 2010 State-Level Subjective Well-Being and 1999/2000 Sociodemographic Covariates as Predictors of Altruistic Organ Donation Between 1999 and 2010 Predictor variable β t(40) Well-being 0.50 2.42* Gini coefficienta –0.20 –1.12 Median income 0.17 1.18 Percentage non-Hispanic White 0.36 2.10* Male-to-female ratio –0.29 –1.94 Median age –0.40 –3.36*** Educational attainment –0.05 –0.16 Poor mental health 0.00 0.00 Poor physical health –0.06 –0.29 Note: Overall model: R2 = .59, F(9, 40) = 6.21, p < .001. a Smaller Gini coefficients represent more equal distribution of income. *p < .05. ***p < .005. Fig. 3. Mediation model showing the effect of improvement in median income on total donation rates as mediated by subjective well-being. Values are beta coefficients. For the association between improvement in median income and total donation rates, the beta coefficient in parentheses represents the total effect of improvement on donation rates, whereas the second beta coefficient represents the indirect effect of improvement on donation rates, after we accounted for well-being as a mediator. Asterisks indicate significant paths (*p < .05, **p < .01). Downloaded from pss.sagepub.com by Cai Xing on February 11, 2014
Bretbel-Haurwitz,Marsb for these variables did not eliminate the well-being/ of geographic variation in well-being and altruistic dona altruism relationship supports the direct relationship tion in the United States from year to year,as demon donation and by the similar relationships found betweer cial behavion the finding tha Dunn,Norton,2011:Dunn,Aknin,Norton,2008 changes in median income from 1999 to 2010 predicted Lyubomirsky,Sheldon,Schkade,2005)and that well- altruistic kidney donation,and that this effect was medi Hewitt.2001).However.these findings ated by well-b Thoits ing supports subective wellbeing as an edenta truist bet which represents a subset of prosocial acts that are aimed features of the well-being/altruism relationship using at assisting a needy,vulnerable other at a cost to the self present-day well-being statistics and regional variation in (Preston,2013). the of later altruistic kidney donations (Bednall Bove.2011:Bekkers Wiepking.2011).But period of the measure used here (9196)may some these mechanisms do not provide an adequate explana- what limit conclusions that can be drawn about the role unrecipr naccumulatic ing literature on the link between well-being and proso- ciality by suggesting that improved well-being may in differ from nondonors in their general altruistic motiva genuine aruism.Conversely.the ne a10 n be of thi 110/ con equential behavior and other related acts polled rep edthat the would consider altruistic dona Additionally.because our results were derived using a tion (Henderson et al.,2003),but the prevalence of actual nationally representative sample,we avoided perennial donations remains much lower.This difference suggests out un pref un be ence of at n students or online participar st that wvell-he may he one such vari That community-level wealth positively predicts altru- able.This observation is consistent with the conceptual ism is of particular inte ization of well-being as an engine, whereby positive ely rel changes in bjective well-being cont oute to of social class and wealth n sity in economic games and beliefs about donating to charity et al 2012)although we note as a caveat that the cor (Piff,Kraus,Cote, Cheng,Keltner,2010).Thus,ou relational data reported here cannot directly support finding paradox tha munity-l causal relationship This eve well-he impevel is in of actively the fact that wealth at the individual level affects proso- Seligman,2004).British Prime Minister David Cameror ciality in part via social comparsons.Thus,within a com- recently proclaimed the improvement of societal well r individuals may be less prosoctal eing to political cha ge of our times fit that it suggests that increases in community-level obiective mote well-being:an increase in lifesaving acts of extraor well-being may result in overall positive,rather than neg- dinary altruism Given that altruism itself promotes ative,downstrear effects on pros wel-being C snin,Dunn,Norton,2011),policies tha Galbp-Health eings is tha at the recency of the cle where ng may tive analyses of altruistic kidney donation during the past that,in tum,increases well-being.Such a cycle holds the decade.This issue is mitigated.however.by the stability promise of creating a "sustainable happiness"(Aknin. 20
8 Brethel-Haurwitz, Marsh for these variables did not eliminate the well-being/ altruism relationship supports the direct relationship between altruistic donation and subjective well-being. A substantial literature has confirmed both that prosocial behaviors increase well-being (Aknin, Sandstrom, Dunn, & Norton, 2011; Dunn, Aknin, & Norton, 2008; Lyubomirsky, Sheldon, & Schkade, 2005) and that wellbeing increases prosociality (Aknin, Dunn, & Norton, 2011; Thoits & Hewitt, 2001). However, these findings have not demonstrated that well-being increases altruism, which represents a subset of prosocial acts that are aimed at assisting a needy, vulnerable other at a cost to the self (Preston, 2013). Common prosocial behaviors, such as volunteering, result from a variety of processes, including adherence to social norms or anticipated reciprocity (Bednall & Bove, 2011; Bekkers & Wiepking, 2011). But these mechanisms do not provide an adequate explanation for altruistic kidney donation, which is a high-cost, nonnormative, unreciprocated altruistic behavior. The present findings therefore expand the scope of the existing literature on the link between well-being and prosociality by suggesting that improved well-being may in some cases increase genuine altruism. Conversely, the finding that altruistic kidney donation can be understood within this framework may illuminate the origins of this consequential behavior and other related acts of altruism. Additionally, because our results were derived using a nationally representative sample, we avoided perennial concerns about unusual features of prosocial behavior that may be observed only in samples of undergraduate students or online participants. That community-level wealth positively predicts altruism is of particular interest, given previous findings that some forms of prosocial behavior are inversely related to wealth. For example, subjective and objective estimates of social class and wealth negatively predict generosity in economic games and beliefs about donating to charity (Piff, Kraus, Cote, Cheng, & Keltner, 2010). Thus, our finding paradoxically indicates that community-level income may positively predict prosociality even while individual-level wealth does not. This result may relate to the fact that wealth at the individual level affects prosociality in part via social comparisons. Thus, within a community, wealthier individuals may be less prosocial even as the community as a whole becomes more prosocial as wealth increases. This is an important distinction because it suggests that increases in community-level objective well-being may result in overall positive, rather than negative, downstream effects on prosociality. A limitation of these findings is that the recency of the Gallup-Healthways Well-Being Index prevents prospective analyses of altruistic kidney donation during the past decade. This issue is mitigated, however, by the stability of geographic variation in well-being and altruistic donation in the United States from year to year, as demonstrated by the similar relationships found between well-being and altruism in assessed donations in 2010 and from 1999 to 2010. In addition, the finding that changes in median income from 1999 to 2010 predicted altruistic kidney donation, and that this effect was mediated by well-being, supports subjective well-being as an antecedent of altruistic kidney donation. Researchers in future studies may be better able to capture longitudinal features of the well-being/altruism relationship using present-day well-being statistics and regional variation in the prevalence of later altruistic kidney donations. If available, updated measures of collectivism across states would also be important to consider, given that the time period of the measure used here (1993–1996) may somewhat limit conclusions that can be drawn about the role of collectivism. Obviously, an accumulation of factors must contribute to the decision to donate a kidney altruistically. Previous studies have suggested that altruistic kidney donors may differ from nondonors in their general altruistic motivation, empathy, or relevant life experiences (Henderson et al., 2003; Massey et al., 2010). But other variables must also be at play. Between 11% and 54% of individuals polled reported that they would consider altruistic donation (Henderson et al., 2003), but the prevalence of actual donations remains much lower. This difference suggests the existence of additional variables that “nudge” potentially receptive individuals into actually donating. Our findings suggest that well-being may be one such variable. This observation is consistent with the conceptualization of well-being as an engine, whereby positive changes in objective well-being contribute to subjective processes that promote engagement in meaningful and autonomous behaviors, such as altruism (Jayawickreme et al., 2012), although we note as a caveat that the correlational data reported here cannot directly support causal relationships. Recognition of the importance of actively promoting well-being on a national level is increasing (Diener & Seligman, 2004). British Prime Minister David Cameron recently proclaimed the improvement of societal wellbeing to be “the central political challenge of our times” (Stratton, 2010). The findings reported here point to a concrete benefit that may derive from policies that promote well-being: an increase in lifesaving acts of extraordinary altruism. Given that altruism itself promotes well-being (Aknin, Dunn, & Norton, 2011), policies that promote well-being may help to generate a virtuous circle whereby increases in well-being promote altruism that, in turn, increases well-being. Such a cycle holds the promise of creating a “sustainable happiness” (Aknin, Downloaded from pss.sagepub.com by Cai Xing on February 11, 2014
Well-Being and Altruism .9 Dunn,Norton,2011)with broad benefits for altruists, their beneficiaries,and society at large Transfusion Medicine Revieus,25,317-334.doi:10.1016/ Author Contributions 011.04.00 p(2011).A1it Boulwvare.L Ratner,LE Troll.M.U.Chaudron,A.Yeung of the manuscript for submission. and risk taking nal o Acknowledgments 2005.00s96o d -61 of this Cantril.H.(5).The buman.New n C Chapu M2013)Am discipline nent.We thank Rebecca nings.Bi ology Pbilosopby,28, m de w m back into altruism Declaration of Conflicting Interests Diener.E.(2012).New findingsand future directions for sub American Psycbologist,67. Diener.E.Ryan.K.(2009).Subjective well-being:A general Funding This work was supported in part by a Templeton Positive Diener,E..Tay. .Oishi,S.(2013).Rising income and the Note 1.We excluded Utah (an outlier in altruistic donations)and reran ty that va les unique 16 doi:1012 Eisenberg.N.(1983).The relation be n empathy and altru cam 02 dymamis in ith wuderte ssues.Academi Gabriel,.A.Mattey,J.P.&Wascher,W.L(2005).Compensatin References dot:10.1016/S016-04620200007- ed from hup:/ Aknin.L.B.Dunn.E.W..Norton.M.I.(2011).Hap com//s-Sa erative donation.re and allocation of liv .A.I..Landolt,M.A..McDonald,M.F Barrable e17018.Retrieved from htp://www.plo .13719 Bats E1600-61 M5.00019 012 or e of f well-bx of General Psycbology Pbilo 16.0 11.2014
Well-Being and Altruism 9 Dunn, & Norton, 2011) with broad benefits for altruists, their beneficiaries, and society at large. Author Contributions A. A. Marsh developed the study concept. Both authors contributed to the study design. K. M. Brethel-Haurwitz acquired and analyzed the data under the supervision of A. A. Marsh. K. M. Brethel-Haurwitz drafted the manuscript, and A. A. Marsh provided critical revisions. Both authors approved the final version of the manuscript for submission. Acknowledgments The content of this article is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. We thank Rebecca Ryan for statistical guidance and helpful comments on earlier versions of the manuscript. Declaration of Conflicting Interests The authors declared that they had no conflicts of interest with respect to their authorship or the publication of this article. Funding This work was supported in part by a Templeton Positive Neuroscience Award to A. A. Marsh and by Health Resources and Services Administration Contract 2342005370011C. Note 1. We excluded Utah (an outlier in altruistic donations) and reran this regression to examine the possibility that variables unique to Utah, such as increased social capital resulting from shared religious affiliations, drove the well-being/altruism relationship. With Utah excluded, well-being became a stronger predictor of altruism, β = 0.79, t(39) = 3.40, p = .002, which suggests that although unusual dynamics in Utah may underlie the state’s unusually high rate of altruistic donation, any such dynamics do not explain the nationwide well-being/altruism relationship. References Aknin, L. B., Dunn, E. W., & Norton, M. I. (2011). 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