CCT Programs Research Articles

Effectiveness of a mobile application for independent computerized cognitive training in patients with mild cognitive impairment: study protocol for the NeNaE Study, a randomized controlled trial

BackgroundMild cognitive impairment (MCI) involves cognitive decline beyond typical age-related changes, but without significant daily activity disruption. It can encompass various cognitive domains as the causes of MCI are diverse. MCI as well as frequent comorbid neuropsychiatric conditions like depression and anxiety affect individuals’ quality of life. Early interventions are essential, and computerized cognitive training (cCT) is an established treatment method. This paper presents the protocol for the NeuroNation MED Effectiveness Study, evaluating the self-administered mobile cCT intervention (“NeuroNation MED”) in individuals with MCI to assess training effects on cognitive domains, health competence, neuropsychiatric symptoms, psychological well-being, and the general application usability.MethodsThis study protocol presents a single-blinded multicenter randomized controlled trial that will be carried out in six study centers in Germany and Luxembourg. We included adults with MCI (existing F06.7 ICD-10-GM diagnosis and TICS ≥ 21 and ≤ 32). The intervention group will use a mobile, multi-domain cCT (“NeuroNation MED”) for 12 weeks. Meanwhile, the wait list control group will receive standard medical care or no care. The eligibility of volunteers will be determined through a telephone screening. After completion of the baseline examination, patients will be randomly assigned to one of the experimental conditions in a 2:1 ratio. In total, 286 participants will be included in this study. The primary outcome is the change of cognitive performance measured by the index score of the screening module of the Neuropsychological Assessment Battery. Secondary outcomes are changes in the Cognitive Failures Questionnaire, Hospital Anxiety and Depression Scale, Health-49, Health Literacy Questionnaire, among others. All of the primary and secondary outcomes will be assessed at baseline and after the 12-week post-allocation period. Furthermore, the intervention group will undergo an assessment of the System Usability Scale, and the training data of the NeuroNation MED application will be analyzed.DiscussionThis study aims to assess the effectiveness of a mobile self-administered cCT in enhancing cognitive abilities among individuals diagnosed with MCI. Should the findings confirm the effectiveness of the NeuroNation MED app, it may confer possible benefits for the care management of patients with MCI, owing to the accessibility, cost-effectiveness, and home-based setting it provides. Specifically, the cCT program could provide patients with personalized cognitive training, educational resources, and relaxation techniques, enabling participants to independently engage in cognitive training sessions at home without further supervision.Trial registrationGerman Clinical Trials Register DRKS00025133. Registered on November 5, 2021.

Experimental Evidence from a Conditional Cash Transfer Program: Schooling, Learning, Fertility, and Labor Market Outcomes after 10 Years

Abstract Conditional cash transfer (CCT) programs are the antipoverty program of choice in many developing countries, aiming to improve human capital and break the intergenerational transmission of poverty. A decade after a randomized 3 year CCT program began, earlier exposure during primary school ages when children were at risk of dropout led to higher labor market participation for young men and women and higher earnings for men. The findings highlight the roles of the different CCT program components with variation in timing of access to nutrition, health, and education investments translating into substantial differential effects on learning outcomes for men and reproductive health outcomes for women.

Do conditional cash transfers create resilience against poverty? Long-run evidence from Jamaica

Conditional Cash Transfer programs (CCT) have become the prominent component of social assistance programs in many developing countries. A major objective of CCT programs is breaking the cycle of intergenerational poverty and building a population resilient to adverse shocks that may push a person into poverty. The literature to date has not provided conclusive evidence for the long-run impact of CCT programs on beneficiaries’ resilience against poverty. To fill this gap, I exploit the age-based eligibility thresholds and regional variation in the proportion of persons receiving benefits from the Jamaican CCT program to identify its long-run impact on resilience against poverty. I find that child beneficiaries of the program are up to 8.4 percentage points more resilient against poverty when they become adults than they would have been in the absence of the program. Furthermore, these benefits are only evident in females, and are realized after beneficiaries are in their early 20′s. Overall, this study provides further justification for the expansion of CCTs or similar programs targeting children living in less-developed countries.

Mixed-method study on the association between inclusion to conditional cash transfer program and the multiple faces of malnutrition in children and adolescents aged 3 to 19 years: a school-based evidence from Caraga Region, the Philippines

BackgroundThis study aimed to investigate the association between inclusion to Pantawid Pamilyang Pilipino Program (4Ps), a CCT program in the Philippines, and malnutrition in children and adolescents and examine the perceptions and experiences of parents and other stakeholders on how 4Ps influenced child nutrition.MethodsA concurrent mixed-method study was conducted in the Caraga Region, Philippines. Quantitative data from 5541 children and adolescents aged 3 to 19 were analyzed using multilevel mixed-effect logistic models. To allow in-depth understanding of the programmatic components that support the findings from the quantitative study, eight focused group discussions (FGDs) were concurrently conducted, cumulating 33 participants, including 4Ps parents, school coordinators/teachers, and school nurses. A constructivist grounded theory approach was used for analysis, and joint displays were employed to integrate quantitative and qualitative results.ResultsQuantitative findings revealed high rates of malnutrition, with significant rates of stunting (12.0%), wasting/thinness (9.4%), and overweight/obesity (16.4%) among children and adolescents. 4Ps beneficiaries had higher odds of stunting and overweight/obesity compared to non-4Ps beneficiaries (AOR = 1.43, 95%CI: 1.08–1.91; AOR = 1.21, 95%CI: 1.01–1.45, respectively). However, no significant association was observed between inclusion to 4Ps and concurrent stunting and wasting/thinness or overweight/obesity (AOR = 1.05, 95%CI: 0.72–1.55). Geographic variations were observed, with 4Ps children in Agusan del Sur having lower odds of stunting than those in Agusan del Norte (AOR = 0.41, 95%CI: 0.23–0.71). Age and gender also showed significant associations with malnutrition. The qualitative analysis provided insights into the challenges contributing to malnutrition, including child labor, sickness, long distances to school, limited access to healthy food, and larger families. Unintended consequences such as cash card mismanagement, inappropriate cash grant allocation, and falsification of school attendance were identified. However, teachers and parents demonstrated resilience by implementing adaptive approaches to enhance child nutrition.ConclusionsWhile 4Ps beneficiaries exhibit higher odds of stunting and overweight/obesity, the program’s association with malnutrition was significantly influenced by geographic variations. It is crucial for social protection programs to prioritize comprehensive support strategies that effectively counter unintended consequences and challenges faced by beneficiaries and other stakeholders and address malnutrition in children and adolescents.

Impact of unconditional cash transfers on household livelihood outcomes in Nigeria

Abstract In 2018, Nigeria began the implementation of a cash transfer programme (CCT) for poor and vulnerable people. We evaluated the impact of cash transfer on household livelihood outcomes in Nigeria. Using multistage cluster sampling methodology, beneficiaries and non-beneficiaries within the same locality were randomly selected to participate in a survey to assess the impact of cash transfer on food security and food diversity. When gender, marital status, educational status, and age were controlled, beneficiaries were about three times more likely than non-beneficiaries to report experiencing little or no hunger. Children 0–59 months of beneficiaries were twice likely to have at least three meals a day compared to children of non-beneficiaries. Difference in differences regression analysis showed that on the average, beneficiaries of the cash transfer significantly consumed more diverse food than non-beneficiaries. Beneficiaries of the CCT experienced fewer episodes of severe hunger, have more meal frequency, and higher household dietary diversity than non-beneficiaries. This shows that the CCT programme is effective and can directly mitigate adverse effects of malnutrition with its long-term negative impact on children and thus must be expanded to more vulnerable people across all states in Nigeria.

A qualitative evaluation of a conditional cash transfer programme in Mexico: recipients’ perspectives of long-term results

The Mexican conditional cash transfer programme (CCT), Prospera, was a leading poverty reduction strategy for over two decades. The programme, under the framework of CCT programmes, had two objectives with differing time horizons, short term alleviation of income poverty and a longer-term objective of breaking intergenerational poverty. The aim of this paper is to explore the recipients’ perspectives in relation to the CCT programme in Mexico and whether they perceived it achieved its long-term objectives. A qualitative method was adopted with 47 interviews conducted with recipients with over 15 years enrolment in the programme. Analysis results suggested that the recipients were aware of the long-term objectives of the programme, understanding education being key to breaking intergenerational poverty, and that they felt the programme had enabled children of recipients to break from cycles of poverty. The paper sought to highlight the value of qualitative evaluations to form part of future evaluations in measuring the long-term success of CCT programmes.

The impact of Conditional Cash Transfer program on stunting in under five year's poor children

Study objectiveAs stunting is the most perilous health and nutrition problem for children under five in rural poor households worldwide and CCT programs are normally used to reduce poverty through conditionalities, this study examines the effect of CCT program health conditionality on reducing stunting, considering the longer time perspective which lacks in most available evidence. Study designThis was quasi-experimental design. MethodsThe study used secondary household data kept by TASAF PSSN in Tanzania, coupled with corresponding children data from their respective clinic cards. The study used Regression Discontinuity Design (RDD) for inferential statistics regarding household stunting. ResultsChildren mothers are mostly non-educated with 33 % for control and 23 % for treatment ended in class seven. At 95 % CI and shorter time, the control group were better in stunting by 0.14 points compared to treatment albeit not significant. For longer time, TASAF CCT program through health conditionality compliance reported 0.31 points reduction in stunting significant at 95 % CI. ConclusionThe results reveal that for the short time, CCT health conditionality does not result in reducing stunting in under-five children. However, given the longer time (more than five years), CCT health conditionalities have the potential to reduce stunting in children and improve children's health status. The study recommends compliance with CCT program conditionalities as one among the means of improving under-five children's health status. Furthermore, the study urges policy makers to rely on longer-time children's health outcomes for policy decisions as shorter time reveals negative and non-significant.

Do Conditional Cash Transfers Reduce Fertility? Nationwide Evidence from Mexico

AbstractConditional cash transfer (CCT) programs, which link transfers to investment in human capital in poor families, have spread around the world over the past two decades. This paper studies the medium‐term effects of Progresa, the pioneering Mexican CCT program, on fertility using nationwide vital statistics combined with administrative data on program receipt. The effects of CCTs are likely to vary by age of the woman, and we study impacts by five‐year age intervals. We test and account for possible underreporting of births using indirect methods. We find that Progresa led to an important and statistically significant decline in teenage fertility and smaller, but still significant, effects on reducing the fertility of older women.

The Power of Lakshmi

<h3>Abstract</h3> Worldwide, 1.6 million girls are “missing” at birth every year. One policy tool to improve the sex ratio is a conditional cash transfer that pays parents to invest in daughters, but existing evidence on their effectiveness is sparse. Using a difference-in-differences framework, we evaluate the Dhanlakshmi scheme, an Indian CCT program that strongly encouraged girl births without restricting fertility. Dhanlakshmi improved the sex ratio at birth, with only a small fertility increase. The girl-birth effect was concentrated among the first two parities and partially persisted after the program was discontinued. Post-birth outcomes like immunization and education also improved.

Re‐evaluating the behavioral change from conditional cash transfers: Evidence from the Avancemos National Program in Costa Rica

AbstractConditional cash transfers (CCT) have become a common solution aiming to reduce poverty by increasing the human capital of children. In 2006, the Government of Costa Rica introduced Avancemos, a nationwide CCT program, with the premise that a monetary subsidy, conditional on school attendance, would offset adolescents' opportunity cost from working and increase secondary school completion. In this paper, we assess whether the program achieved its main objective of increasing secondary schooling and reducing adolescent labor, and we disentangle the mechanisms generating these effects. We used data from the Costa Rica National Household Survey (2006–2014) collected by the National Institute of Statistics and Censuses. The program effects are estimated through a propensity score matching technique. We find that for program beneficiaries, Avancemos led to increases of about 27% in attendance and 0.72 year of schooling, and a decrease of 6% in the likelihood of labor participation. We also present evidence that economic vulnerability is not the only or main cause for school dropout and argue that efforts complementary to CCT, such as improving instruction quality and offering more information on the returns to education, are needed to increase attendance and completion and to reduce child labor outcomes.

Can cross-cultural awareness programs help to lead? With the help of MIS

Purpose:The purpose of the study is to contribute to the issue of cross-cultural management and the contemporary management of cultural diversity. Furthermore, illustrate how diversity management may lead to a competitive advantage. Theoretical framework:This part mainly discusses the related theories to lay a solid foundation for the smooth implementation of theories. Besides, these theories will provide theoretical support for cross-cultural awareness. Design/methodology/approach:The researchers used a descriptive and explanatory strategy to detect cultural distinctions between Indian national and global cultures. The empirical findings are based on a qualitative case study of the Indian and international management of the company. The empirical data came from semi-structured interviews with people interested in cultural diversity and how to handle it collaboratively. Particular emphasis is on four aspects of cross-culture: hierarchy, time, gender equality, and relationships. Findings:The findings show that a culturally varied workforce enhances competitive advantage when managed appropriately. In addition, individuals from many cultural backgrounds will offer their perspectives, abilities, and concerns. Research implications:The model of central cross-cultural aspects is identified. Similarly, further studies are also required to ascertain the effectiveness of cross-cultural awareness programs. Practical implications:The MNCs should include this kind of training in their CCT programs to create team member awareness. It would make the expatriates more aware of the issues they will be facing, will motivate them to learn and acquire the necessary skills, and will familiarize them with By letting them know what to anticipate, you may reduce any potential stress, speed up the transition process, and support the earliest possible development of cross-cultural competency. Social implications :The social importance of this research is its potential increase in cross cultural awareness and acceptance of differences among cross cultural employees. In addition, it fosters a deep and broad knowledge of and respect for the myriad values and norms of individuals from diverse social groups who work with them. Originality/value :The study is an original effort to look at four cross-cultural aspects to see how problems in these areas could be alleviated. Understanding the cultural differences within these dimensions can help you better grasp how to manage these differences inside a European multinational firm with Indian operations.

A decade of conditional cash transfer programs for reproductive health in India: How did equality fare?

BackgroundSince 2005, India has implemented conditional cash transfer [CCT] programs to promote the uptake of institutional delivery services [ID]. The study aims to assess changes in wealth-based inequality in the use of ID and other maternal health care services during the first decade of Janani Suraksha Yojana and related CCT programs.MethodsData from two Demographic and Health Surveys were used to calculate changes in service inequality from 2005 to 2015–16 in the use of three or more antenatal care [ANC] visits, ID, and postnatal care [PNC]. The changes were assessed at the national level, within high and low performing states [HPS and LPS, respectively] and within urban and rural areas of each state category. Erreygers Index [EI] and Wagstaff Index [WI], superior to concentration index, were used to gain different insights into the nature of inequality. EI is an objective measure of inequality irrespective of prevalence while WI is a combined measure of inequality and the average distribution of an indicator that puts more weight on the poor.ResultsThe results suggest that wealth-based inequalities decreased significantly at the national level. For ID, both indices showed a decline in both HPS and LPS though the change in WI in HPS was insignificant. For ANC, there was a significant decrease in inequality using both indices in HPS but not in LPS. For PNC, there was a significant decrease in inequality using both indices in HPS, and when using WI in LPS, but not when using EI in LPS.ConclusionOverall, the first decade of India’s CCT programs saw an impressive reduction in EI for ID but less so for WI suggesting that the benefit of CCTs did not go disproportionately to the poor, which suggests that there is a need to reduce or eliminate the evident leakages. The improvement in uptake and inequality in ANC and PNC was not at par with ID, stressing the need to place greater focus on the continuum of care. The urban rural difference in HPS versus LPS in the changes in inequality reveals that infrastructure is important for CCTs to be more effective.

Pantawid Pamilyang Pilipino Program (4Ps) Beneficiaries: An Analysis of Their Satisfaction Levels

This study examined the difference in the satisfaction level of 4Ps beneficiaries in Barangay VI, Victorias City, Negros Occidental, Philippines between the year 2015 and year 2020. The design of the study used a descriptive comparative method of research. The participants were 216 from 2015, 250 from 2020, and were official 4Ps beneficiaries of Barangay VI, Victorias City, Negros Occidental in the specified years. Results were analyzed with frequency, percentage, mean, and T-test. The findings revealed that the majority of them were above 30 years old with 349 (74.89%), female with 425 (91.20%), married with 359 (77.04%), laborers with 268 (57.51%), with 1-3 number of children with 261 (56%), and high school level of educational attainment with 284 (60.95%). Further, it indicated that there was an increasing trend in the 4Ps parent-beneficiaries in 2020 with the following: above 30 years old (41.2%) widow (7.1%), single parent (9.9%), no work (17.4%), laborers (8.8%), college level (4.8%) and college graduates (0.1%). It revealed the decreasing trend in the year 2020 with the following 4Ps parent beneficiaries: 30 years old and above (46.8%) and married (13.5%). The satisfaction level of 4Ps beneficiaries to CCT has significantly increased to a high level of satisfaction by 2020. There was a significant difference in the satisfaction level of 4Ps parent- beneficiaries to the CCT program which revealed that the satisfaction level survey was higher in 2020 than in 2015 especially in terms of health grants and education grants. Lastly, it was recommended to provide sustainable programs that would enhance the living conditions and nutrition grants of locals.

Household Responses to Cash Transfers

This paper estimates a collective model of the household and investigates how parents reach decisions to allocate household resources. Using data from PROGRESA, we test the restrictions of collective rationality on a large variety of specifications and show that, contrary to previous results, this modeling approach cannot rationalize the household decision process. We provide some evidence that the observed inefficiency is driven by the group receiving the cash transfers. These results are consistent with the idea that a possible indirect effect of CCT programs may be to enhance disagreements between the spouses which trigger an inefficient allocation of their resources.

Maternal and Child Health Benefits of the Mamata Conditional Cash Transfer Program in Odisha, India.

Conditional cash transfers (CCTs) are demand-side interventions that link cash receipt to fulfilment of health-promoting conditions such as regular health check-ups and investment in human capital. In 2011, the Indian state of Odisha, implemented a statewide CCT program-the Mamata Scheme-towards improving maternal/child health outcomes and promoting health-seeking behavior. Mamata targets pregnant and lactating women aged ≥19 y, and provides a sizable financial incentive relative to household income levels. We aimed to longitudinally examine whether, and to what extent, initiation of the Mamata scheme corresponded with changes in health and nutrition outcomes in Odisha, relative to comparison states in India. Outcomes included maternal health service utilization [antenatal care (ANC), iron-folic acid supplementation, breastfeeding counseling, full child immunization, tetanus vaccination, vitamin A supplementation] and nutrition [anemia during pregnancy and stunting, anemia in children <5 y old (U5)]. Data on outcomes and covariates were obtained from 3 waves of India's National Family Health Surveys corresponding to the years 1999, 2006, and 2016. We used difference-in-differences (DID) estimation strategy to estimate the impact of the program. The pooled sampled size comprised >200,000 mother-child dyads. Tests of parallel trends indicated that preintervention trends were similar across all outcomes in Odisha with the exception of anemia. When comparing Odisha with other states for health services, DID models indicated that exposure to Mamata corresponded with increased odds of counseling for breastfeeding (OR: 2.74; 95% CI: 1.97, 3.80), ANC receipt (OR: 1.51; 95% CI: 1.15, 1.99), and full immunization (OR: 1.69; 95% CI: 1.37, 2.08). DID models also indicated decline in stunting (OR: 0.92; 95% CI: 0.84, 1.02) and anemia (OR: 0.62; 95% CI: 0.54, 0.71) among U5 children in Odisha following Mamata, relative to comparison states. Models comparing poor with nonpoor groups indicated the presence of heterogeneous effects. This study provides proof-of-concept for potential improvements in maternal and child nutrition outcomes following CCTs that incentivize health care utilization in India.

Methodological Designs Applied in the Development of Computer-Based Training Programs for the Cognitive Rehabilitation in People with Mild Cognitive Impairment (MCI) and Mild Dementia. Systematic Review.

In recent years, different computer-based cognitive training (CT) programs for people with dementia (PwD) have been developed following a psychosocial approach. Aim: This systematic review aims to identify the methodological designs applied in the development of computer-based training (CCT) programs for the rehabilitation of cognitive functioning in people with mild cognitive impairment (MCI) or mild dementia. Methods: A systematic review was conducted using the databases PubMed and PsycINFO. The search period was between 2000–2019. The study selection and data extraction processes were carried out by two independent reviewers. The protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020159027. Results: Thirteen studies met the inclusion criteria. The most frequently used methodological design in the development of CCT programs for people with MCI or mild dementia was the user-centered design (UCD). This design involves an interactive system characterized by the inclusion of end users from the initial stages of its development, throughout the establishment of functional requirements, and in the evaluation of the program’s usability and user-experience (UX). Conclusion: UCD was the most used methodological design for the development of CCT programs although there was quite some variation in how this design was applied. Recommendations for future studies about the development of CCT programs for people with MCI and mild dementia are given. Central focus should be the inclusion and active participation of end users from the initial stages of development.

Not all types of meditation are the same: Mediators of change in mindfulness and compassion meditation interventions

BackgroundThe general aim of the study was to examine the relative effectiveness and mediators of change in standardized mindfulness and compassion interventions. MethodsA sample of 431 participants enrolled in a Mindfulness-Based Stress Reduction program (MBSR = 277) and a Compassion Cultivation Training (CCT = 154). The assessment before and after the program included a set of outcomes and mediators measures. A three-step data analysis plan was followed: ANCOVAs, Reliable Change Index, and mediations (simple and multiple). ResultsBoth interventions yielded increased mindfulness, decentering, body awareness, and self-compassion. Yet, present-moment awareness improvements (i.e., decentering, and body awareness) were significantly larger in the MBSR than in CCT, whereas socio-emotional changes (i.e., common humanity and empathic concern) were larger in the CCT than in MBSR. The magnitude of effect sizes ranged from medium to large. Furthermore, both mindfulness and compassion interventions yielded similar changes in psychological distress (i.e., stress, anxiety, and depression), maladaptive cognitive processes (i.e., rumination and thought suppression), and well-being. The mediation models showed that although the MBSR program seemingly relies on changes in present-moment awareness mechanisms (i.e., decentering and body awareness) to reduce psychological distress and to improve well-being, the CCT program seemingly achieves the same positive outcomes through changes in socio-emotional mechanisms (i.e., common-humanity and empathy concern). LimitationsDue to our naturalistic design in real-world community setting, it was infeasible to randomly assign participants to conditions. ConclusionsOur results suggest that mindfulness and compassion programs operate through different pathways to reduce psychological distress and to promote well-being.

"Reexamining the Influence of Conditional Cash Transfers on Migration From a Gendered Lens": Comment.

In a recent article, "Reexamining the Influence of Conditional Cash Transfers on Migration From a Gendered Lens," Hughes (2019) claimed that conditional cash transfers, CCT, limit the likelihood of migration by women, compensating them for giving up an attractive migration option. I question the analysis that lies behind this claim. I argue that in seeking to understand the likelihood of women migrating if they participate in a CCT program, issues of selectivity, endogeneity, and optimization cannot be set aside. In particular, it is not that receiving CCT curtails a migration option; it is that not contemplating migration encourages women to accept CCT. And if a household perspective is brought to bear, then a household's free choices weaken the appeal of migration to women. This reduction in appeal does not arise from an exogenously imposed curb but rather from endogenously determined preferences.

Transfer program enforcement and children’s time allocation

We examine levels of enforcement of conditions for two transfer programs and estimate how they affect teenagers’ time allocation, and in particular, time devoted to school attendance, labor supply and home production. We develop a structural discrete choice model in which young individuals and their parents decide how to allocate their time, including whether to attend school. They also choose how many hours to work in the market, how much time to devote to home production and leisure activity. To estimate the model, we use household panel data which combines administrative records and surveys covering the period of 2005–2012 in Uruguay, during which two consecutive CCT programs were introduced with different designs. Our model captures the share of individuals who are in school, who are working, who are both studying and working, as well as those who neither study nor work; we also capture the share and number of hours devoted to market work and home production, and individuals’ GPA distribution. The policy experiments performed indicate that school attendance can be increased by raising the level of enforcement and by sending the cash transfer to the teenagers rather than to their parents.

Reexamining the Influence of Conditional Cash Transfers on Migration from a Gendered Lens: Comment

In a recent article, Reexamining the influence of conditional cash transfers on migration from a gendered lens, Hughes (2019) claimed that conditional cash transfers, CCT, limit the likelihood of migration by women, compensating them for giving up an attractive migration option. I question the analysis that lies behind this claim. I argue that in seeking to understand the likelihood of women migrating if they participate in a CCT program, issues of selectivity, endogeneity, and optimization cannot be set aside. In particular, it is not that receiving CCT curtails a migration option; it is that not contemplating migration encourages women to accept CCT. And if a household perspective is brought to bear, then a household's free choices weaken the appeal of migration to women. This reduction in appeal does not arise from an exogenously imposed curb but rather from endogenously determined preferences.