Study Links Segregation and Lung Cancer Deaths in Blacks

African-Americans who live in highly segregated counties are considerably more likely to die from lung cancer than those in counties that are less segregated, a new study has found.

The study was the first to look at segregation as a factor in lung cancer mortality. Its authors said they could not fully explain why it worsens the odds of survival for African-Americans, but hypothesized that blacks in more segregated areas may be less likely to have health insurance or access to health care and specialty doctors. It is also possible that lower levels of education mean they are less likely to seek care early, when medical treatment could make a big difference. Racial bias in the health care system might also be a factor.

“If you want to learn about someone’s health, follow him home,” said Dr. Awori J. Hayanga, a heart and lung surgeon at the University of Pittsburgh Medical Center, who was the lead author of the study.

The study, published in JAMA Surgery on Wednesday, divided all counties in the country into three levels of segregation: high, medium and low. It found that lung cancer mortality rates, a ratio of deaths to a population, were about 20 percent higher for blacks who lived in the most segregated counties, than for blacks living in the least segregated counties.

Lung cancer is the top cause of preventable death in the United States. Blacks have the highest incidence of it and are also more likely to die from it. For every million black males, 860 will die from lung cancer, compared with 620 white males among every million white males. The rates were calculated over the period of the study, from 2003 to 2007.

The study drew on federal mortality data from that period, and segregation data from about a third of United States counties that had African-American populations large enough to measure. About 28 percent of the American population lives in counties with low segregation, 40 percent in counties with moderate segregation, and 32 percent in counties with high segregation.

The gap in outcomes persisted even after accounting for differences in smoking rates and socio-economic status, said Dr. Hayanga said.

For whites, high levels of segregation had the opposite effect, a finding that surprised the authors. Whites who lived in highly segregated counties had about 6 percent lower mortality rates from lung cancer than those who lived in the least segregated counties, though researchers pointed out that the difference was slight enough that it was not clear whether it was meaningful.

Dr. David Chang, director of outcomes research at the University of California San Diego Department of Surgery, who wrote an accompanying editorial, said he hoped that the study would focus attention on the environmental factors involved in the stark disparities in health outcomes in the United States because they lend themselves to change through policy. Medical researchers tend to focus on factors like the genetics and the behaviors of individuals that are harder to change.

“We don’t need drugs or genetic explanations to fix a lot of the health care problems we have,” he said.

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Boeing leads Dow lower; other indexes mixed

The Dow Jones industrial average closed lower, pulled down by a loss in Boeing stock following more problems with the company's new 787 aircraft.

The Dow lost 23 points to close at 13,511 Wednesday.

Japan's two biggest airlines grounded all their Boeing 787s for safety checks after one was forced to make an emergency landing.

The plane has been plagued by a series of problems this year, including a battery fire and fuel leaks.

The Standard & Poor's 500 index rose less than one point to 1,472, while the Nasdaq composite climbed six points to 3,117.

Goldman Sachs jumped 4 percent after its earnings nearly tripled. Other banks fell.

Falling stocks outnumbered rising ones on the New York Stock Exchange. Volume was relatively light at 3.1 billion shares.

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L.A. City Council drops $3-billion bond measure for this year

The Los Angeles City Council scrapped plans Tuesday for placing a $3-billion bond measure on the May 21 ballot, opting instead to consider it in a future election year.

Councilmen Mitchell Englander and Joe Buscaino, who had proposed the bond, said they would spend more time communicating with the public about the proposal before trying to send it to voters. "We're going to continue working on this, obviously," said Buscaino, whose district stretches from San Pedro to Watts.

The proposal, which would have increased property taxes for 20 years, had signatures from seven of the council's 15 members only two weeks ago. But in recent days, some on the council complained there hadn’t been enough outreach to the public.

Some neighborhood activists had warned that a protracted debate over the bond measure would doom passage of a proposed half-cent sales tax hike, which is on the March 5 ballot and being promoted as a way to eliminate potholes. The sales tax, known as Proposition A, is seen as a way of erasing a $220-million budget shortfall.

The search for street repair money is being driven, in part, by a fear that major sources of funding for road work are disappearing. Money from Proposition 1B, a state measure that provided $87 million for streets over a three-year period, runs out in June. Funding from President Obama’s stimulus package was depleted in summer.

A 2011 survey found that nearly one-third of the city’s streets are in D or F condition, the worst rating possible. With the current funding available, repairing those streets will take 60 years, city officials said.

The general fund, which pays for basic services, provides less than 1% of the money allocated by the city for street maintenance and repairs. Nevertheless, city officials have managed to increase the amount it spends on road work anyway, by tapping state and federal funding and special transportation taxes.

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Oxygen halts development of 'Babies' Mamas'

NEW YORK (AP) — Oxygen Media has pulled the plug on "All My Babies' Mamas," a reality special the network was developing about a musician who has fathered 11 children with 10 different mothers.

The network offered no reason for curtailing the project. In a statement issued Tuesday, Oxygen said that after reviewing the show's casting the decision was made "not to move forward."

The one-hour project would have featured Atlanta rap artist Shawty Lo, his children and their mothers.

"All My Babies' Mamas" was met with controversy after Oxygen announced it last month. At least one petition that called for Oxygen to shut it down has collected more than 37,000 signatures. The Parents Television Council called the concept "grotesquely irresponsible and exploitive.

In its statement, Oxygen promised to continue to develop "compelling content."

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Well: How to Go Vegan

When I first heard former President Bill Clinton talk about his vegan diet, I was inspired to make the switch myself. After all, if a man with a penchant for fast-food burgers and Southern cooking could go vegan, surely I could too.

At the grocery store, I stocked up on vegan foods, including almond milk (that was the presidential recommendation), and faux turkey and cheese to replicate my daughter’s favorite sandwich. But despite my good intentions, my cold-turkey attempt to give up, well, turkey (as well as other meats, dairy and eggs) didn’t go well. My daughter and I couldn’t stand the taste of almond milk, and the fake meat and cheese were unappealing.

Since then, I’ve spoken with numerous vegan chefs and diners who say it can be a challenge to change a lifetime of eating habits overnight. They offer the following advice for stocking your vegan pantry and finding replacements for key foods like cheese and other dairy products.

NONDAIRY MILK Taste all of them to find your favorite. Coconut and almond milks (particularly canned coconut milk) are thicker and good to use in cooking, while rice milk is thinner and is good for people who are allergic to nuts or soy. My daughter and I both prefer the taste of soy milk and use it in regular or vanilla flavor for fruit smoothies and breakfast cereal.

NONDAIRY CHEESE Cheese substitutes are available under the brand names Daiya, Tofutti and Follow Your Heart, among others, but many vegans say there’s no fake cheese that satisfies as well as the real thing. Rather than use a packaged product, vegan chefs prefer to make homemade substitutes using cashews, tofu, miso or nutritional yeast. At Candle 79, a popular New York vegan restaurant, the filling for saffron ravioli with wild mushrooms and cashew cheese is made with cashews soaked overnight and then blended with lemon juice, olive oil, water and salt.

THINK CREAMY, NOT CHEESY Creaminess and richness can often be achieved without a cheese substitute. For instance, Chloe Coscarelli, a vegan chef and the author of “Chloe’s Kitchen,” has created a pizza with caramelized onion and butternut squash that will make you forget it doesn’t have cheese; the secret is white-bean and garlic purée. She also offers a creamy, but dairy-free, avocado pesto pasta. My daughter and I have discovered we actually prefer the rich flavor of butternut squash ravioli, which can be found frozen and fresh in supermarkets, to cheese-filled ravioli.

NUTRITIONAL YEAST The name is unappetizing, but many vegan chefs swear by it: it’s a natural food with a roasted, nutty, cheeselike flavor. Ms. Coscarelli uses nutritional yeast flakes in her “best ever” baked macaroni and cheese (found in her cookbook). “I’ve served this to die-hard cheese lovers,” she told me, “and everyone agrees it is comparable, if not better.”

Susan Voisin’s Web site, Fat Free Vegan Kitchen, offers a nice primer on nutritional yeast, noting that it’s a fungus (think mushrooms!) that is grown on molasses and then harvested and dried with heat. (Baking yeast is an entirely different product.) Nutritional yeasts can be an acquired taste, she said, so start with small amounts, sprinkling on popcorn, stirring into mashed potatoes, grinding with almonds for a Parmesan substitute or combining with tofu to make an eggless omelet. It can be found in Whole Foods, in the bulk aisle of natural-foods markets or online.

BUTTER This is an easy fix. Vegan margarines like Earth Balance are made from a blend of oils and are free of trans fats. Varieties include soy-free, whipped and olive oil.

EGGS Ms. Coscarelli, who won the Food Network’s Cupcake Wars with vegan cupcakes, says vinegar and baking soda can help baked goods bind together and rise, creating a moist and fluffy cake without eggs. Cornstarch can substitute for eggs to thicken puddings and sauces. Vegan pancakes are made with a tablespoon of baking powder instead of eggs. Frittatas and omelets can be replicated with tofu.

Finally, don’t try to replicate your favorite meaty foods right away. If you love a juicy hamburger, meatloaf or ham sandwich, you are not going to find a meat-free version that tastes the same. Ms. Voisin advises new vegans to start slow and eat a few vegan meals a week. Stock your pantry with lots of grains, lentils and beans and pile your plate with vegetables. To veganize a recipe, start with a dish that is mostly vegan already — like spaghetti — and use vegetables or a meat substitute for the sauce.

“Trying to recapture something and find an exact substitute is really hard,” she said. “A lot of people will try a vegetarian meatloaf right after they become vegetarian, and they hate it. But after you get away from eating meat for a while, you’ll find you start to develop other tastes, and the flavor of a lentil loaf with seasonings will taste great to you. It won’t taste like meat loaf, but you’ll appreciate it for itself.”

Ms. Voisin notes that she became a vegetarian and then vegan while living in a small town in South Carolina; she now lives in Jackson, Miss.

“If I can be a vegan in these not-quite-vegan-centric places, you can do it anywhere,” she said. “I think people who try to do it all at once overnight are more apt to fail. It’s a learning process.”

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What are your tips for vegan cooking and eating? Share your suggestions on ingredients, recipes and strategies by posting a comment below or tweeting with the hashtag #vegantips.

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Stocks edge lower; Apple extends decline

Stocks edged lower on Wall Street Tuesday as tensions flared in Washington over increasing the country's borrowing limit.

Treasury Secretary Timothy Geithner told congressional leaders in a letter late Monday that the U.S. government will reach its borrowing limit as soon as mid-February, earlier than expected. Federal Reserve Chairman Ben Bernanke also commented on the issue Monday, saying it was one of the “critical fiscal watersheds” for the government in coming weeks.

The Dow Jones industrial average fell 11 points to 13,495 as of 1:52 p.m. EST, having been down as much as 61 points in early trading. The Standard and Poor's 500 dropped two points to 1,468, the Nasdaq composite index fell 13 points to 3,105.

President Barack Obama has criticized congressional Republicans for linking talks over raising the debt ceiling to ongoing budget negotiations. Obama said the consequences of the U.S. government defaulting on its debt would be disastrous and shouldn't be used as a bargaining chip to extract concessions on spending cuts.

“We are very concerned how the market is going to respond to all the news events that will be coming out of Washington over the next few months,” said Eric Wiegand, a senior portfolio manager at U.S. Bank Wealth Management. “It really comes down to the uncertainty and the risk of a further downgrade of our debt.”

Markets were roiled in the summer of 2011 as lawmakers haggled over an increase to the debt limit. The dispute cost the U.S. its AAA ranking from the credit-rating firm Standard and Poor's.

The U.S. fiscal crisis is still the biggest single individual risk facing investors, with 37 percent of investors naming it as the biggest worry, according to a survey of fund managers published by Bank of America Merrill Lynch Tuesday. The European debt crisis was cited as the biggest concern by 23 percent of those polled and a “hard landing” for the Chinese economy was third on the list with 12 percent.

Apple fell $14 to $487.50, its third daily drop. The stock hasn't closed below $500 in almost a year. Apple slumped 3.6 percent Monday on concern that demand for its iPhone 5 is slowing. Nomura analysts today lowered their target price for the stock to $530 from $660 and cut their estimates for iPhone sales this year.

Stocks dropped Tuesday despite a report that retail sales increased in December. Consumers bought more autos, furniture and clothing, despite worries about potential tax increases. Sales rose 0.5 percent in December from November, slightly better than November's 0.4 percent increase and the best showing since September, the Commerce Department said Tuesday.

Investors may be more concerned about January's retail figures now that the increase in the Social Security payroll tax has come into effect, said Doug Cote, chief market strategist at ING Investment Management.

The tax jumped back to 6.2 percent earlier this month after President Barack Obama failed to win renewal of the temporary 2 percentage point payroll tax cut that's been in place for two years, as part of a deal that stopped the U.S. going over the “fiscal cliff.”

“The market is kind of looking past it because of the change in the tax regime,” said ING's Cote. “Are consumers going to be able to spend like they did in December and in earlier years? … I think not.”

The outlook for manufacturing in New York state worsened in January, according to survey by the Federal Reserve Bank of New York. The bank's Empire State Manufacturing Survey produced a reading of minus 7.8 for the month, indicating contraction.

Both the S&P 500 and the Dow are up on the year, having surged in the first week of January after lawmakers reached a last-minute budget deal to stop the economy going over the “cliff.” The agreement prevented a series of tax increases and spending cuts that would probably have pushed the U.S. economy back into recession, according to economists.

Optimism about the outlook for global growth has also boosted stocks.

The S&P 500 is up 2.9 percent this year and closed at a five -year high of 1,472 last week. The 30-member Dow is up 3 percent since the start of 2013.

The yield on the 10-year Treasury price, which moves inversely to its price, fell 1 basis point to 1.83 percent.

Among other stocks making big moves;

— United Continental Holdings, the airline operator, fell 10 cents to $25.89 after JPMorgan cut its rating on the company to “neutral” from “overweight” to reflect the fact that the stock has already risen 40 percent in the past 12 months.

— Lululemon Athletica, a maker of yoga apparel, dropped $3.15 to $69.17 after its revenue forecast fell short of analysts' estimates.

— Given Imaging Ltd. fell $2.16 to $16 after the medical equipment company said it was no longer considering a sale. Also one of its largest shareholders plans to sell its stake.

— Facebook fell 51 cents to $30.42, paring its gains for the year to 14 percent, after the company unveiled a new search feature on Tuesday that lets users search their social connections for information about people, interests, photos and places.

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An Anaheim woman demands respect for her neighborhood

Yesenia Rojas, vibrant in her purple shawl, sang with a voice so powerful it rose above the rest of the procession as they shuffled down the damp Anaheim sidewalk.

"Era mexicana. Era mexicana," they sang with a statue of Our Lady of Guadalupe hoisted high, candlelight and street lamps illuminating their way. "Madrecita de los mexicanos."

The singsong serenade lauds the patroness, the mother of all Mexicans.

On this drizzly evening, Rojas led the group down Anna Drive, where she and her family have made their home.

In a city often defined by Disneyland and elegant sports venues, this street of working-class Latino immigrants has become an avatar of a lesser-known, voiceless Anaheim, one riddled with poverty and gangs.

When police shot and killed a 25-year-old alleged gang member who lived on Anna Drive, it stoked what had been a growing fire in the city. It was the latest in a spate of police shootings last year, which inflamed anger with law enforcement into a larger sense of resentment over ethnic and class fissures that divide Orange County's largest city.

Unrest — amplified by Occupy-connected protesters from outside the city — gripped Anaheim for days after the July shooting, followed by weeks of heated City Council meetings.

The wave of protesters demanding change has washed away, but Rojas has emerged in its wake. The 35-year-old mother of six, with short, wavy dark hair and a small frame that belies her force of will, has taken it upon herself to become the voice of Anna Drive.

Her family lives in a one-bedroom apartment just yards from where Manuel Diaz was shot that summer day. Rojas' 14-year-old daughter saw Diaz's body and has been traumatized since. Her mother can't let that go.

"I thought about leaving, and so did my husband, because of the children," she said. "But I said no. Because, first of all, we don't need to fear anyone, not even the police. The biggest thing right now is to stay on our feet and make things happen as a community. If we all leave, things won't change. They'll keep trampling us and humiliating us."

Rojas has a vision for her community that would seem bold if her wishes weren't so simple: She imagines playgrounds and community centers and political representation. But most of all, she sees respect for Anna Drive.

She balances two jobs, but she makes time for her community. She bends the ears of politicians. She organizes rallies encouraging her neighbors to register to vote and head to the polls. She plans events that she hopes will draw together a community that has grown accustomed to seeing itself as the backdrop of news cameras trying to highlight the city's ills.

And on this night, dozens gathered to pray a rosario in the tight courtyard outside her apartment, where the statue of the Virgin rested on an altar of roses and carnations.

As sirens echoed in the distance, the crowd stayed late into the night. They sang, they danced, they sipped cinnamon-spiced coffee.

And they prayed, petitioning the Virgin Mother for peace and for guidance.

"This is the community," Rojas said. "These are the people of Anna Drive."

::

Anna Drive, a collection of squat, modest apartment buildings, horseshoes off of a busy thoroughfare. On any given day, it pulses with life: children whipping down the sidewalk on scooters and skateboards, older boys tussling with one another and nanas and tatas watching it all unfold from chairs in their frontyards.

The street is clogged with cars and the vending truck that always seems to be parked along the same slice of curb, hawking snacks, produce and spices to the families who live on this stretch of tidy apartments and small, fenced-in lawns.

Rojas came to Anna Drive about a year ago, moving her family into the tight but comfortable apartment, its walls lined with family photographs. She was born in the Mexican state of Guanajuato, but she has lived much of her life in the flatlands of Anaheim. Her mother has lived in the same apartment, just a few blocks away, for decades.

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Study Shows Gender Bias in Wikipedia, Linux

Today in the age of the “brogrammer,” whose frat boy tendencies are glorified and sought after by cutting-edge online startups, women in tech often find themselves objectified and excluded — especially in communities like Wikipedia and open-source software, where women make up even less of the population (around 13 percent and 1 percent, respectively) than in more mainstream technical fields.

That was one of the facts Joseph Reagle, an assistant professor at Northeastern University, drew on for his study about “Free culture and the gender gap.” He discovered that just because a community (like Wikipedia) says that it’s open doesn’t mean that it isn’t hostile to women.

Free for all?

The “Free Encyclopedia” Wikipedia’s claim to fame is that anyone can edit and contribute to it. To keep errors from cropping up, it has policies that let anyone flag part of an article for review, and allow trusted editors to decide how to present something.

The process by which those editors decide, however, is often highly combative and alienating to women, who “are socialized to not be competitive and avoid conflict” according to Reagle. Sue Gardner, the Executive Director of the Wikimedia Foundation (the project behind Wikipedia), wrote a list of “Nine Reasons Women Don’t Edit Wikipedia,” in which she noted Wikipedia’s “fighty” and “contentious” culture, where loud and assertive people drive others out regardless of their competence.

“Otherwise commendable features”

Reagle found that Wikipedia’s values of radical freedom and openness actually led to a culture that is more closed off to women. He noted that “implicit” power structures existed, even in the absence of formal ones; and that imposing few restrictions on how people treat each other can lead to “a chaotic culture of undisciplined vandals,” which disenfranchises women from participation just as surely as if there were rules against women participating.

Similar dynamics exist in popular open-source software projects like the Linux kernel. Open-source luminaries like Eric Raymond are legendarily combative and hostile to “idiots,” even while they they tolerate abusive personalities who drive female contributors away. Reagle’s study quoted numerous female writers with experience working in Linux and open-source software, who called its community “cliquish and exclusionary” as well as “more competitive and fierce than most areas of programming.”

How to achieve equality

Wikipedia’s new Teahouse page is “a friendly place to help new editors,” which is designed especially to encourage women to participate. Meanwhile, women like Denise Paolucci are creating their own startups like Dreamwidth, which are based on existing open-source programming code. Unlike most “proprietary” code, it’s still free for women to do what they want with it — if they can overcome the obstacles in their way.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.

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Coroner releases new report on Natalie Wood death

LOS ANGELES (AP) — Some of the bruises found on Natalie Wood's body may have occurred before the actress drowned in the waters off Southern California more than 30 years ago, according to a newly released coroner's report on one of Hollywood's most mysterious deaths.

The case took another twist Monday when officials released a 10-page addendum to Wood's 1981 autopsy that cites unexplained bruises and scratches on Wood's face and arms as significant factors that led to officials changing her death certificate last year from a drowning to "drowning and other undetermined factors."

Officials were careful about their conclusions because they lacked several pieces of evidence for their review.

Bruises on Wood's arms, a scratch on her neck and superficial abrasions to the actress' face may have occurred before Wood ended up in the waters off Catalina Island in November 1981, but coroner's officials wrote they could not definitely determine when the injuries occurred.

The findings have not altered a sheriff's department investigation into Wood's death, which a spokesman described as ongoing.

Wood, 43, was on a yacht with her actor-husband Robert Wagner, co-star Christopher Walken and the boat captain on Thanksgiving weekend in 1981 before somehow ending up in the water. A dinghy that had been attached to the boat was found along the island's shoreline, but investigators could not locate it to review it last year.

Investigators initially reported that it had no scratches on its hull, and Wood's fingernails were not preserved for analysis.

Several of the original coroner's investigators who worked on the case were re-interviewed, and officials attempted to test some items taken during the investigation into Wood's death and an autopsy, but they could not be located.

"The location of the bruises, the multiplicity of the bruises, lack of head trauma, or facial bruising support bruising having occurred prior to entry in the water," the report states. "Since there are unanswered questions and limited additional evidence available for evaluation, it is opined by this Medical Examiner that the manner of death should be left as undetermined," Chief Medical Examiner Dr. Lakshmanan Sathyavagiswaran wrote in the report completed in June.

Officials also considered that Wood wasn't wearing a life jacket and had no history of suicide attempts and didn't leave a note as reasons to amend its report and the death certificate.

The report was released Monday after sheriff's officials released a security hold.

Sheriff's spokesman Steve Whitmore said the agency has known about the findings in the newly released autopsy report for several months and it does not change the status of the investigation, which remains open. He said Wagner is not considered a suspect in Wood's death.

Wood, famed for roles in such films as "West Side Story" and "Rebel Without a Cause," was nominated for three Academy Awards during her lifetime. Her death stunned the world and has remained one of Hollywood's most enduring mysteries. The original detective on the case, Wagner and Walken have all said they considered her death an accident.

Conflicting versions of what happened on the yacht have contributed to the mystery of how the actress died. Wood, Wagner and Walken had all been drinking heavily in the hours before the actress disappeared.

The newly released report states there are conflicting statements about when the boat's occupants discovered Wood was missing. The report estimates her time of death was around midnight, and she was reported missing at 1:30 a.m.

The renewed inquiry came after the boat's captain, Dennis Davern, told "48 Hours Mystery" and the "Today" show that he heard Wagner and Wood arguing the night of her disappearance and believed Wagner was to blame for her death.

Wagner wrote in a 2008 memoir that he and Walken argued that night. He wrote that Walken went to bed and he stayed up for a while, but when he went to bed, he noticed that his wife and a dinghy attached to the yacht were missing.

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Anthony McCartney can be reached at http://twitter.com/mccartneyAP

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Personal Best: Training Insights From Star Athletes

Of course elite athletes are naturally gifted. And of course they train hard and may have a phalanx of support staff — coaches, nutritionists, psychologists.

But they often have something else that gives them an edge: an insight, or even an epiphany, that vaults them from the middle of the pack to the podium.

I asked several star athletes about the single realization that made the difference for them. While every athlete’s tale is intensely personal, it turns out there are some common themes.

Stay Focused

Like many distance swimmers who spend endless hours in the pool, Natalie Coughlin, 30, used to daydream as she swam laps. She’d been a competitive swimmer for almost her entire life, and this was the way she — and many others — managed the boredom of practice.

But when she was in college, she realized that daydreaming was only a way to get in the miles; it was not allowing her to reach her potential. So she started to concentrate every moment of practice on what she was doing, staying focused and thinking about her technique.

“That’s when I really started improving,” she said. “The more I did it, the more success I had.”

In addition to her many victories, Ms. Coughlin won five medals in the 2008 Beijing Olympics, including a gold medal in the 100-meter backstroke.

Manage Your ‘Energy Pie’

In 1988, Steve Spence, then a 25-year-old self-coached distance runner, was admitted into the United States Long Distance Runner Olympic Development Program. It meant visiting David Martin, a physiologist at Georgia State University, several times a year for a battery of tests to measure Mr. Spence’s progress and to assess his diet.

During dinner at Dr. Martin’s favorite Chinese restaurant, he gave Mr. Spence some advice.

“There are always going to be runners who are faster than you,” he said. “There will always be runners more talented than you and runners who seem to be training harder than you. The key to beating them is to train harder and to learn how to most efficiently manage your energy pie.”

Energy pie? All the things that take time and energy — a job, hobbies, family, friends, and of course athletic training. “There is only so much room in the pie,” said Mr. Spence.

Dr. Martin’s advice was “a lecture on limiting distractions,” he added. “If I wanted to get to the next level, to be competitive on the world scene, I had to make running a priority.” So he quit graduate school and made running his profession. “I realized this is what I am doing for my job.”

It paid off. He came in third in the 1991 marathon world championships in Tokyo. He made the 2004 Olympic marathon team, coming in 12th in the race. Now he is head cross-country coach and assistant track coach at Shippensburg College in Pennsylvania. And he tells his teams to manage their energy pies.

Structure Your Training

Meredith Kessler was a natural athlete. In high school, she played field hockey and lacrosse. She was on the track team and the swimming team. She went to Syracuse University on a field hockey scholarship.

Then she began racing in Ironman triathlons, which require athletes to swim 2.4 miles, cycle 112 miles and then run a marathon (26.2 miles). Ms. Kessler loved it, but she was not winning any races. The former sports star was now in the middle of the pack.

But she also was working 60 hours a week at a San Francisco investment bank and trying to spend time with her husband and friends. Finally, six years ago, she asked Matt Dixon, a coach, if he could make her a better triathlete.

One thing that turned out to be crucial was to understand the principles of training. When she was coaching herself, Ms. Kessler did whatever she felt like, with no particular plan in mind. Mr. Dixon taught her that every workout has a purpose. One might focus on endurance, another on speed. And others, just as important, are for recovery.

“I had not won an Ironman until he put me on that structure,” said Ms. Kessler, 34. “That’s when I started winning.”

Another crucial change was to quit her job so she could devote herself to training. It took several years — she left banking only in April 2011 — but it made a huge difference. Now a professional athlete, with sponsors, she has won four Ironman championships and three 70.3 kilometer championships.

Ms. Kessler’s parents were mystified when she quit her job. She reminded them that they had always told her that it did not matter if she won. What mattered was that she did her best. She left the bank, she said, “to do my best.”

Take Risks

Helen Goodroad began competing as a figure skater when she was in fourth grade. Her dream was to be in the Olympics. She was athletic and graceful, but she did not really look like a figure skater. Ms. Goodroad grew to be 5 feet 11 inches.

“I was probably twice the size of any competitor,” she said. “I had to have custom-made skates starting when I was 10 years old.”

One day, when Helen was 17, a coach asked her to try a workout on an ergometer, a rowing machine. She was a natural — her power was phenomenal.

“He told me, ‘You could get a rowing scholarship to any school. You could go to the Olympics,’ ” said Ms. Goodroad. But that would mean giving up her dream, abandoning the sport she had devoted her life to and plunging into the unknown.

She decided to take the chance.

It was hard and she was terrified, but she got a rowing scholarship to Brown. In 1993, Ms. Goodroad was invited to train with the junior national team. Three years later, she made the under-23 national team, which won a world championship. (She rowed under her maiden name, Betancourt.)

It is so easy to stay in your comfort zone, Ms. Goodroad said. “But then you can get stale. You don’t go anywhere.” Leaving skating, leaving what she knew and loved, “helped me see that, ‘Wow, I could do a whole lot more than I ever thought I could.’ ”

Until this academic year, when she had a baby, Ms. Goodroad, who is 37, was a rowing coach at Princeton. She still runs to stay fit and plans to return to coaching.

The Other Guy Is Hurting Too

In 2006, when Brian Sell was racing in the United States Half Marathon Championships in Houston, he had a realization.

“I was neck-and-neck with two or three other guys with two miles to go,” he said. He started to doubt himself. What was he doing, struggling to keep up with men whose race times were better than his?

Suddenly, it came to him: Those other guys must be hurting as much as he was, or else they would not be staying with him — they would be pulling away.

“I made up my mind then to hang on, no matter what happened or how I was feeling,” said Mr. Sell. “Sure enough, in about half a mile, one guy dropped out and then another. I went on to win by 15 seconds or so, and every race since then, if a withering surge was thrown in, I made every effort to hang on to the guy surging.”

Mr. Sell made the 2008 Olympic marathon team and competed in the Beijing Olympics, where he came in 22nd. Now 33 years old, he is working as a scientist at Lancaster Laboratories in Pennsylvania.

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