Valuing the future: temporal discounting of health and money

Sirens of stress: Financial risk, time preferences, and post-traumatic stress disorder: Evidence from the Israel-Hamas Conflict

This research explores the relationship between post-traumatic stress disorder (PTSD), resulting from intense violence during the "Guardian of the Walls" operation in 2021, and economic decision-making. We surveyed civilians in Israel who experienced Gaza rocket attacks to understand the influence of PTSD on their financial decisions. The results revealed an interesting trend: PTSD sufferers showed a preference for immediate consumption over future savings and demonstrated a decrease in their willingness to take economic risks. These findings are significant because they offer insight into how trauma affects financial decisions, and crucial information for those helping PTSD sufferers-their relatives and therapists. It is essential for them to be aware of these tendencies to provide appropriate advice and assistance, helping the victims cope with their PTSD and make effective financial decisions in their daily lives.

Perceived Social Support and Health-Related Quality of Life Among Hypertensive Patients: A Latent Profile Analysis and the Role of Delay Discounting and Living Alone

Background

Improving health-related quality of life (HRQoL) among hypertensive individuals has emerged as a significant public health issue. However, current research has ignored the individual heterogeneity of perceived social support (PSS) among hypertensive patients. The potential mechanism of delay discounting (DD), living alone, and PSS on HRQoL remains unclear, and further exploration is required.

Aim

This study aimed to ascertain PSS profiles among hypertensive patients and examine the hypotheses that DD mediates the relationship between PSS and HRQoL and that this mediating process is moderated by living alone in hypertensive patients.

Methods

A cross-sectional study was carried out in Jiangsu, China. In total, 1815 hypertensive patients completed socio-demographic and HRQoL questionnaires, a PSS scale, and a DD task. Data analyses included a latent profile analysis, χ2-test, Spearman correlation analysis, and PROCESS macro for regression analysis.

Results

Four potential PSS profiles were identified: lowest (3.2%), moderate-low (26.6%), moderate-high (42.4%), and highest (27.8%). DD mediated the association between PSS and HRQoL. The first half of this mediating process was moderated by living alone.

Conclusion

Our findings indicated that PSS, DD, and living alone significantly influence the HRQoL of individuals with hypertension. Healthcare professionals should consider variations in PSS among hypertensive patients and implement interventions to reduce DD by enhancing PSS, in order to improve the HRQoL of this population.

The Impact of Monetary Incentives on Delay Discounting Within a Year-Long Physical Activity Intervention

BACKGROUND

Delay discounting is the depreciation in a reward's perceived value as a function of the time until receipt. Monetary incentive programs that provide rewards contingent on meeting daily physical activity (PA) goals may change participants' delay discounting preferences.

PURPOSE

Determine if monetary incentives provided in close temporal proximity to meeting PA goals changed delay discounting, and if such changes mediated intervention effects.

METHODS

Inactive adults (n = 512) wore accelerometers during a 12-month intervention where they received proximal monetary incentives for meeting daily moderate-to-vigorous PA (MVPA) goals or delayed incentives for study participation. Delay discount rate and average MVPA were assessed at baseline, end of intervention, and a 24-month follow-up. Using structural equation modeling, we tested effects of proximal versus delayed rewards on delay discounting and whether any changes mediated intervention effects on MVPA. PA self-efficacy was also evaluated as a potential mediator, and both self-efficacy and delay discounting were assessed as potential moderators of intervention effects.

RESULTS

Proximal rewards significantly increased participants' delay discounting (β = 0.238, confidence interval [CI]: -0.078, 0.380), indicating greater sensitivity to reinforcement timing. This change did not mediate incentive-associated increases in MVPA at the end of the 12-month intervention (β = -0.016, CI: -0.053, 0.019) or at a 24-month follow-up (β = -0.020, CI: -0.059, 0.018). Moderation effects were not found.

CONCLUSIONS

Incentive-induced increases in delay discounting did not deleteriously impact MVPA. This finding may help assuage concerns about using monetary incentives for PA promotion, but further research regarding the consequences of changes in delay discounting is warranted.

Initial evidence of delay discounting's predictive utility for alcohol self-administration in ecologically valid contexts among young adults who drink heavily

BACKGROUND

While delay discounting is robustly associated with alcohol use disorder, whether discounting predicts real-time alcohol use behaviors is unclear. Existing support comes from laboratory studies using intravenous alcohol self-administration methods, thus limiting ecological validity and generalizability. The present study evaluated whether delay discounting predicted real-time alcohol use in naturalistic settings with and without probabilistic negative consequences for consuming larger amounts of alcohol.

METHODS

This secondary analysis utilized data from three laboratory alcohol self-administration studies with young adults who engaged in frequent heavy drinking (N=206, 45% female). Participants completed a delay discounting measure before an alcohol self-administration session in an actual or simulated bar with (n=187) or without (n=19) probabilistic negative consequences (compensation loss) tied to performance on cognitive and psychomotor tasks after alcohol self-administration. Bootstrapped (unstandardized) coefficient estimates and 95% confidence intervals were utilized due to the sample size discrepancy.

RESULTS

Multiple regressions revealed that delay discounting did not significantly predict estimated blood alcohol concentration (eBAC) or number of drinks consumed when procedures included probabilistic negative consequences. Among participants who completed procedures without probabilistic negative consequences, delay discounting was positively associated with peak eBAC.

CONCLUSION

Counter to hypotheses, steeper delay discounting did not predict real-time alcohol use in contexts with probabilistic negative consequences, whereas preliminary evidence suggests that delay discounting predicts real-time alcohol use behaviors in contexts without probabilistic negative consequences. The specific discounting task may have impacted study findings, thus future research should consider how the sign (gain vs. loss), outcome certainty, and delay relate to alcohol consumption.

Evidence accumulation is not essential for generating intertemporal preference: A comparison of dynamic cognitive models of matching tasks

Intertemporal preference has been investigated mainly with a choice paradigm. However, a matching paradigm might be more informative for a proper inference about intertemporal preference and a deep understanding of the underlying cognitive mechanisms. This research involved two empirical studies using the matching paradigm and compared various corresponding dynamic models. These models were developed under either the framework of decision field theory, an exemplar theory assuming evidence accumulation, or a non-evidence-accumulation framework built upon the well-established notions of random utility and discrimination threshold (i.e., the RUDT framework). Most of these models were alternative-based whereas the others were attribute-based ones. Participants in Study 1 were required to fill in the amount of an immediate stimulus to make it as attractive as a delayed stimulus, whereas those in Study 2 needed to accomplish a more general matching task in which either the payoff amount or delay length of one stimulus was missing. Consistent behavioral regularities regarding both matching values and response times were revealed in these studies. The results of model comparison favored in general the RUDT framework as well as an attribute-based perspective on intertemporal preference. In addition, the predicted matching values and response times of the best RUDT model were also highly correlated with the observed data and replicated most observed behavioral regularities. Together, this research and previous modeling work on intertemporal choice suggest that evidence accumulation is not essential for generating intertemporal preference. Future research should examine the validity of the new framework in other preferential decisions for a more stringent test of the framework.

Behavioral Analytics for Myopic Agents

Many multi-agent systems have a single coordinator providing incentives to a large number of agents. Two challenges faced by the coordinator are a finite budget from which to allocate incentives, and an initial lack of knowledge about the utility function of the agents. Here, we present a behavioral analytics approach for solving the coordinator's problem when the agents make decisions by maximizing utility functions that depend on prior system states, inputs, and other parameters that are initially unknown. Our behavioral analytics framework involves three steps: first, we develop a model that describes the decision-making process of an agent; second, we use data to estimate the model parameters for each agent and predict their future decisions; and third, we use these predictions to optimize a set of incentives that will be provided to each agent. The framework and approaches we propose in this paper can then adapt incentives as new information is collected. Furthermore, we prove that the incentives computed by this approach are asymptotically optimal with respect to a loss function that describes the coordinator's objective. We optimize incentives with a decomposition scheme, where each sub-problem solves the coordinator's problem for a single agent, and the master problem is a pure integer program. We conclude with a simulation study to evaluate the effectiveness of our approach for designing a personalized weight loss program. The results show that our approach maintains efficacy of the program while reducing its costs by up to 60%, while adaptive heuristics provide substantially less savings.

"Bitcoin now": temporal discounting in Bitcoin holders

Introduction

Cryptocurrency investment and trading are rapidly growing activities due to the development of applications and platforms that offer fast, continuous, and easy entry into the cryptocurrency world. To understand decision making in cryptocurrency holders, we assessed temporal discounting, that is, whether Bitcoin holders disregard rewards if they are distant in time and overvalue rewards if they are more immediate. Further, we compared performance between short-term investors (i.e., day-traders) vs. long-term investors.

Methods

Using an online survey, we invited 144 Bitcoin holders to answer temporal discounting questionnaires dealing with money ("Which do you prefer, that you get right now 20 USD in cash or 100 USD in a month?") and Bitcoin ("Which do you prefer, that you get right now 0.1 or 1 Bitcoin in a month?").

Results

Analysis demonstrated no significant differences between temporal discounting for money and Bitcoin. However, and critically, higher temporal discounting for both money and Bitcoin was observed in short-term investors compared with long-term investors. In a similar vein, significant positive correlations were observed between day trading and temporal discounting for both money and Bitcoin.

Discussion

These findings demonstrate how Bitcoin holders with short-term time horizons tend to prioritize immediate rewards over larger but delayed rewards. Future research can assess the neural basis of temporal discounting for cryptocurrencies.

"Ten euros now" temporal discounting in Huntington disease

BACKGROUND

When making decisions, one often faces a trade-off between immediate and long-term rewards. In these situations, people may prefer immediate over later rewards, even if immediate rewards are smaller than later ones; a phenomenon known as temporal discounting. In this study, we, for the first time, assessed temporal discounting in three populations: participants with manifest Huntington disease (HD), participants with premanifest HD, and control participants.

METHODS

Using the temporal discounting task, we invited participants to choose between small immediate amount of money vs. delayed, but larger amount of money (e.g., "Which do you prefer: you get 10 euros right now or 50 euros in a month?"). We also measured inhibition in order to test if it impacts discounting performance.

RESULTS

Analysis demonstrated higher temporal discounting (i.e., a preference for the immediate rewards) in participants with manifest HD compared to those with premanifest HD or control participants, but no significant differences were observed in participants with premanifest HD and control participants. Analysis also demonstrated significant correlations between temporal discounting and scores on an inhibition test in participants with manifest HD, but not in those with premanifest HD or in control participants.

DISCUSSION

We suggest that, when making decisions, patients with manifest HD may have difficulties with suppressing the temptation of smaller, but immediate, rewards.

"Ten dollars today or 50 dollars after one month?" Temporal discounting in Korsakoff syndrome

OBJECTIVE

Little research has investigated decision making in patients with Korsakoff syndrome (KS). Specifically, to our knowledge, there is a lack of research investigating whether patients with KS may tend to prefer immediate over future rewards (i.e., temporal discounting). Further, we investigated the relationship between temporal discounting and inhibition.

METHODS

We, for the first time, invited patients with KS and control participants to perform a temporal discounting task, in which they answered questions probing preferences between an immediate, but smaller amount of money, and a delayed, but larger amount of money (e.g., "would you prefer 10 dollars today or 50 dollars after one month?"). Furthermore, inhibition was measured using the Stroop Colour Word Test.

RESULTS

Analysis demonstrated higher temporal discounting in patients with KS than in control participants. Temporal discounting in both populations was significantly correlated with inhibition.

CONCLUSIONS

Patients with KS may have difficulties to suppress the temptation of smaller, but immediate, rewards.

Tuberculosis in a weak health system, conflict and fragile zone: The monetary value of human lives lost associated with deaths of persons older than 14 years in Somalia

BACKGROUND

Low tuberculosis (TB) detection and conflict and fragility have overburdened Somalia. This study estimated economic loss associated with TB deaths among persons aged >14 years.

METHOD

Using epidemiologic and economic data, we calculated the cost based on the framework of the World Health Organization guide of identifying the economic consequences of disease and injury. Baseline loss is the product of years of life lost, non-health expenditure, and number of deaths. Adjusting for conflict and fragility conditions and growth of non-health expenditure, we discounted the loss at 3% rate. We conducted a sensitivity analysis of epidemiologic and economic factors.

RESULTS

In 2017 values, the 9180 reported deaths result in a loss of US$ 44.77 million, a US$ 4877 per death over the discounted years. Conflict conditions would increase the loss by 5.3%, while simultaneous adjustment for conflict and attunement to growth of non-health expenditure would increase the burden by 54% to US$ 67.28 million. Male fatalities account for 59% of the burden. The baseline result is robust to input variations, although sensitivity analysis suggests conflict and fragility conditions account for greater uncertainty of the loss.

CONCLUSION

Stakeholders in the healthcare system should minimise the sizeable economic loss by taking measures to enhance surveillance of TB and security.

Discounting of outcomes in which immediate gains are followed by delayed losses

Previous discounting research has focused on relatively simple situations (e.g., choosing between immediate and delayed gains, or between immediate and delayed losses) and the relations among amount, delay, and subjective value in such situations are now well established. Many everyday choice situations, however, are more complex, involving alternatives that combine gains and losses. In two experiments, participants discounted a monetary outcome that combined an immediate gain with a delayed loss. Consistent with the discounting framework, the value of the combination was approximately equal to the difference between the (undiscounted) value of the immediate gain and the (discounted) value of the delayed loss. More precise predictions of the relative subjective value of the delayed loss component of a combination were given by the same hyperboloid function that describes discounting in simple choice situations where outcomes only involve gains or losses, not both. As in previous studies, when the outcome was a simple one consisting of only a delayed loss, discounting was not affected by the amount of that loss. Surprisingly, however, when the loss was preceded by a gain, the degree to which the combination was discounted was affected by the amount of the loss. Notably, discounting of the delayed loss component of the combination decreased with the amount of the loss in a fashion similar to that observed with simple delayed gains, where smaller amounts are discounted more steeply than larger amounts. Choice situations involving immediate gains followed by delayed losses pose iconic self-control problems, and the present findings support the application of the discounting framework to these important everyday problems.

Waiting is painful: The impact of anticipated dread on negative discounting in the loss domain

According to the positive time-discounting assumption of intertemporal decision-making, people prefer to undergo negative events in the future rather than in the present. However, negative discounting has been identified in the intertemporal choice and loss domains, which refers to people’s preference to experience negative events earlier rather than later. Studies have validated and supported the "anticipated dread" as an explanation for negative discounting. This study again explored the effect of anticipated dread on intertemporal choice using content analysis; that is, having participants identify anticipated dread among reasons for negative discounting. This study also validated the effect of anticipated dread on negative discounting by manipulating anticipated dread. This study adds empirical and direct evidence for the role of anticipated dread in negative discounting.

Delay discounting of money and health outcomes, and adherence to policy guidelines during the COVID-19 pandemic

Delay discounting refers to the observation that the subjective value of an outcome decreases as the delay to its receipt increases. It is well-established that steep delay discounting is related to various maladaptive behaviors, including poorer health-related choices. One of the current challenges of public health policies that emerged during the COVID-19 pandemic is to encourage preventive behaviors against infectious diseases. In this study, we aimed to explore possible underpinnings of adherence to COVID-19 related public health policy guidelines such as disinfection, distancing, and masks (DDM). Participants completed monetary and health discounting tasks across two outcome amounts in gain and loss conditions, and they provided self-report measures of adherence to the DDM policy. Contrary to the theoretically plausible prediction that higher discounting rates would be negatively associated with adherence to health-related public policy guidelines, we found no compelling evidence to support such statement. We discuss the potential weaknesses of declarative measurements of attitudes toward COVID-19 and consider using behavioral interventions for influencing discounting rates for complementing and enhancing current policy guidelines.

The Moderating Power of Impulsivity: A Systematic Literature Review Examining the Theory of Planned Behavior

The theory of planned behavior (TPB) states that behavioral intention is the best predictor of actual behavior change. However, intention explains only a portion of the variance in behavior. Of specific interest is the question of which moderating or mediating variables can be leveraged to aid health promotion interventions utilizing the tenets of behavioral economics (delay discounting and commitment contracts) in the intention–behavior pathway. Impulsivity has been postulated to fill this role and may be applied to multiple behaviors. We aim to determine if impulsivity moderates the association between intention and actual behavior in the TPB, to discover what other variables may moderate or mediate this association, and to apply the findings to future studies in the field of behavioral economics. To this end, a systematic review was conducted using the PubMed, PsychINFO, and Embase online databases. Eligible studies in peer-reviewed journals published prior to November 2021 were selected. Thirty-three studies were included in the final review, examining physical activity, diet, preventive health, mental health, addiction, and medication adherence behaviors. Three main concepts emerged: (1) impulsivity moderates the association between intention and behavior change; (2) self-efficacy moderates the association between intention and behavior change; and (3) planning and self-efficacy contribute to moderated mediation. This review demonstrates a gap in the literature regarding the application of the TPB to the intention–behavior pathway for health behaviors. Future studies in behavioral economics may leverage the variables of impulsivity, self-efficacy, and planning to predict follow-through in this area and to develop targeted change initiatives.

Testing the Effectiveness of Message Framing and Episodic Future Thinking in Promoting HPV Vaccination via Anticipated Regret

One of the greatest challenges in health communication is to persuade people to enact behavior whose consequences lie in the distant future. Could the persuasiveness of a health message be increased by highlighting future regret that one may experience? Using a 2 (framing: gain vs. loss) x 3 (temporal thinking: future-thinking vs. past-thinking vs. no-thinking) factorial design, this study tested the relative effectiveness of message framing and temporal thinking before exposure to a message promoting HPV vaccination. Results showed that having an opportunity to think about one's future and reading loss-framed message were both effective in producing stronger anticipated regret of not taking HPV vaccination. Anticipated regret, in turn, led to more favorable attitudes and greater intentions to take HPV vaccination. Interaction effects were observed such that gain-framed message combined with future-thinking produced the most favorable attitudes toward HPV vaccination. Potential explanations for these findings are offered, and their implications are discussed.

Delay Discounting of Monetary and Social Media Rewards: Magnitude and Trait Effects

Humans discount rewards as a function of the delay to their receipt. This tendency is referred to as delay discounting and has been extensively researched in the last decades. The magnitude effect (i.e., smaller rewards are discounted more steeply than larger rewards) and the trait effect (i.e., delay discounting of one reward type is predictive of delay discounting of other reward types) are two phenomena which have been consistently observed for a variety of reward types. Here, we wanted to investigate if these effects also occur in the context of the novel but widespread reward types of Instagram followers and likes and if delay discounting of these outcomes is related to self-control and Instagram screen time. In a within-subject online experiment, 214 Instagram users chose between smaller, immediate and larger, delayed amounts of hypothetical money, Instagram followers and likes. First, we found that the magnitude effect also applies to Instagram followers and likes. Second, delay discounting of all three reward types was correlated, providing further evidence for a trait influence of delay discounting. Third, no relationships were found between delay discounting and self-control as well as Instagram screen time, respectively. However, a user's average like count was related to delay discounting of Instagram likes.

Percent framing attenuates the magnitude effect in a preference-matching task of intertemporal choice

Research in intertemporal decisions shows that people value future gains less than equivalent but immediate gains by a factor known as the discount rate (i.e., people want a premium for waiting to receive a reward). A robust phenomenon in intertemporal decisions is the finding that the discount rate is larger for small gains than for large gains, termed the magnitude effect. However, the psychological underpinnings of this effect are not yet fully understood. One explanation proposes that intertemporal choices are driven by comparisons of features of the present and future choice options (e.g., information on rewards). According to this explanation, the hypothesis is that the magnitude effect is stronger when the absolute difference between present and future rewards is emphasized, compared to when their relative difference is emphasized. However, this hypothesis has only been tested using one task (the two-choice paradigm) and only for gains (i.e., not losses). It’s therefore unclear whether the findings that support the hypothesis can be generalized to different methodological paradigms (e.g., preference matching) and to the domain of losses. To address this question, we conducted experiments using the preference-matching method whereby the premium amounts that people could ask for were framed in terms of either currencies (emphasizing absolute differences) or percentages (emphasizing relative differences). We thus tested the robustness of the evidence in support of the hypothesis that percent framing, relative to currency framing, attenuates the magnitude effect in the domain of gains (Studies 1, 2, and 3) and in the domain of losses (Study 1, 3, and 4). The data were heavily skewed and the assumption of equal variances was violated. Therefore, in place of parametric statistical tests, we calculated and interpreted parametric and nonparametric standardized and unstandardized effect size estimates and their confidence intervals. Overall, the results support the hypothesis.

OUP accepted manuscript

Objective

Recent technological development along with the constraints imposed by the coronavirus disease 2019 (COVID-19) pandemic have led to increased availability of patient-generated health data. However, it is not well understood how to effectively integrate this new technology into large health systems. This article seeks to identify interventions to increase utilization of electronic blood glucose monitoring for patients with diabetes.

Materials and Methods

A large randomized controlled trial tested the impact of multiple interventions to promote use of electronic blood glucose tracking. The total study sample consisted of 7052 patients with diabetes across 68 providers at 20 selected primary care offices. The design included 2 stages: First, primary care practices were randomly assigned to have their providers receive education regarding blood glucose flowsheet orders. Then, patients in the treated practices were assigned to 1 of 4 reminder interventions.

Results

Provider education successfully increased provider take-up of an online blood glucose monitoring tool by 64 percentage points, while a comparison of reminder interventions revealed that emphasizing accountability to the provider encouraged patients to track their blood glucose online. An assessment of downstream outcomes revealed impacts of the interventions on prescribing behavior and A1c testing frequency.

Discussion

It is important to understand how health systems can practically promote take-up and awareness of emerging digital health alternatives or those with persistently low utilization in clinical settings.

Conclusion

These results indicate that provider training and support are critical first steps to promote utilization of patient-generated health data, and that patient communications can provide further motivation.

Determinants of Lifestyle Choices Among South Korean College Students: An Experimental Analysis

Purpose

Based on theoretical predictions from human capital theory, the aim of this exploratory study is to analyze the relationship between experimentally elicited, incentivized economic preference parameters, Big Five and Grit personality traits, cognitive ability, and the Alameda Seven lifestyles: smoking, drinking excessively, being overweight or obese, experiencing stress, following a healthy diet, exercising, and sleeping enough. In addition, self-reported general physical and mental health are analyzed.

Materials and Methods

Data collection took place in an incentivized paper-and-pencil experiment. Undergraduate students were recruited as subjects, with the requirement that they be freshmen, but no restrictions based on gender, major, or age. A pre-test and three experimental sessions were conducted in March and in April 2018, with a total of 178 subjects participating. After deleting observations with missing values, a total of n = 138 subjects remained. Regression analysis (multivariate probit models, resulting marginal effects and changes in predicted probabilities of adopting a lifestyle for “ideal types”) was used to analyze and compare the determinants of the Alameda Seven health behaviors.

Results

Findings suggest that preference parameters, a measure of cognitive ability, and Big Five personality traits are statistically significantly estimated in regressions for the determinants of adopting Alameda Seven health behaviors, but the Grit score is only statistically significantly estimated in a regression for the determinants of reported better general mental health.

Conclusion

The findings regarding preference parameters partly lend support to predictions from human capital theory and partly confirm previous findings in health psychology. Those results might be explained by the relatively small sample size and the inclusion of a measure of cognitive ability in addition to personality traits and preferences.

Exploring strategies to promote health services online: The role of contextual priming, digital ad type, and health threat orientation in determining the effectiveness of health service ads

Contextual congruence, health threat orientation, and digital advertisement type can influence the effectiveness of online health service ads. To examine these effects, a 2 × 2 × 2 online experiment was conducted with contextual similarity as a within-subjects factor. Results suggest that contextual similarity was positively associated with both attitude toward ads and purchase intention. The data also revealed an interaction effect between digital advertising type and health threat orientation: health ads to address issues of immediate concerns enhanced purchase intention, but only in the incongruent context. Implications of the study were also discussed.

Dreading the pain of others? Altruistic responses to others' pain underestimate dread

A dislike of waiting for pain, aptly termed 'dread', is so great that people will increase pain to avoid delaying it. However, despite many accounts of altruistic responses to pain in others, no previous studies have tested whether people take delay into account when attempting to ameliorate others' pain. We examined the impact of delay in 2 experiments where participants (total N = 130) specified the intensity and delay of pain either for themselves or another person. Participants were willing to increase the experimental pain of another participant to avoid delaying it, indicative of dread, though did so to a lesser extent than was the case for their own pain. We observed a similar attenuation in dread when participants chose the timing of a hypothetical painful medical treatment for a close friend or relative, but no such attenuation when participants chose for a more distant acquaintance. A model in which altruism is biased to privilege pain intensity over the dread of pain parsimoniously accounts for these findings. We refer to this underestimation of others' dread as a 'Dread Empathy Gap'.

Health Disparities: Impact of Health Disparities and Treatment Decision-Making Biases on Cancer Adverse Effects Among Black Cancer Survivors

BACKGROUND

Health disparities affect cancer incidence, treatment decisions, and adverse effects. Oncology providers may hold biases in the decision-making process, which can perpetuate health disparities.

OBJECTIVES

The purpose of this article is to describe health disparities across treatment decisions and adverse effects, describe decision-making biases, and provide suggestions for nurses to mitigate adverse outcomes.

METHODS

A scoping review of the literature was conducted.

FINDINGS

Factors affecting health disparities stem, in part, from structural racism and decision-making biases, such as implicit bias, which occurs when individuals have unconscious negative thoughts or feelings toward a particular group. Other decision-making biases, seemingly unrelated to race, include default bias, delay discounting bias, and availability bias. Nurses and nurse navigators can mitigate health disparities by providing culturally appropriate care, assessing health literacy, providing education regarding adverse effects, serving as patient advocates, empowering patients, evaluating personal level of disease knowledge, and monitoring and managing cancer treatment adverse effects.

Delay discounting and under-valuing of recent information predict poorer adherence to social distancing measures during the COVID-19 pandemic

The COVID-19 pandemic has brought about unprecedented global changes in individual and collective behaviour. To reduce the spread of the virus, public health bodies have promoted social distancing measures while attempting to mitigate their mental health consequences. The current study aimed to identify cognitive predictors of social distancing adherence and mental health symptoms, using computational models derived from delay discounting (the preference for smaller, immediate rewards over larger, delayed rewards) and patch foraging (the ability to trade-off between exploiting a known resource and exploring an unknown one). In a representative sample of the UK population (N = 442), we find that steeper delay discounting predicted poorer adherence to social distancing measures and greater sensitivity to reward magnitude during delay discounting predicted higher levels of anxiety symptoms. Furthermore, under-valuing recently sampled information during foraging independently predicted greater violation of lockdown guidance. Our results suggest that those who show greater discounting of delayed rewards struggle to maintain social distancing. Further, those who adapt faster to new information are better equipped to change their behaviour in response to public health measures. These findings can inform interventions that seek to increase compliance with social distancing measures whilst minimising negative repercussions for mental health.

Seven (weak and strong) helping effects systematically tested in separate evaluation, joint evaluation and forced choice

In ten studies (N = 9187), I systematically investigated the direction and size of seven helping effects (the identifiable-victim effect, proportion dominance effect, ingroup effect, existence effect, innocence effect, age effect and gender effect). All effects were tested in three decision modes (separate evaluation, joint evaluation and forced choice), and in their weak form (equal efficiency), or strong form (unequal efficiency). Participants read about one, or two, medical help projects and rated the attractiveness of and allocated resources to the project/projects, or choose which project to implement. The results show that the included help-situation attributes vary in their: (1) Evaluability – e.g., rescue proportion is the easiest to evaluate in separate evaluation. (2) Justifiability – e.g., people prefer to save fewer lives now rather than more lives in the future, but not fewer identified lives rather than more statistical lives. (3) Prominence – e.g., people express a preference to help females, but only when forced to choose.

Loss Aversion and Health Behaviors: Results from Two Incentivized Economic Experiments

Experimental research in health economics has analyzed the effects of economic preference parameters such as risk attitude and time preference on the probability of adopting risky health behaviors. However, the existing evidence is mixed and previous research often fails to include controls for other determinants of health behaviors such as personality traits. The aim of this research is to analyze the relationships between an incentivized measure of loss aversion and three health behaviors: smoking, binge drinking, and engaging in physical activity. Loss aversion is a preference measure that has been derived from prospect theory as an alternative approach to analyze decision-making under risk, such as the decision to invest in health capital, and has never been used in an analysis of the determinants of health behaviors before. Using two experimental samples of college students in the Republic of Korea and the United States of America, and controlling for Big Five personality traits and a host of individual-level control variables, there are no statistically significant relationships between loss aversion and the three aforementioned health behaviors, but relationships for Big Five conscientiousness, extraversion, agreeableness, and neuroticism. A candidate explanation might be lack of domain independence for loss aversion. Differences between the Korean and the US samples indicate the possibility of intercultural differences.

The effect of testosterone on economic risk-taking: A multi-study, multi-method investigation

Testosterone has been suggested to influence individuals' economic decision making, yet the effects of testosterone on economic behavior are not well-understood and existing research is equivocal. In response, in three studies, we examined the extent to which testosterone affected or was associated with several different facets of economic decision making. Study 1 was a double-blind, placebo-controlled, within-subjects study examining loss aversion and risk-taking (N = 26), whereas Study 2 was a larger double-blind, placebo-controlled, between-subjects study examining loss aversion and risk-taking behavior (N = 117). As a methodological compliment, Study 3 was a larger correlational design (N = 213) with a highly accurate measure of endogenous testosterone examining a wider range of economic behaviors and trait-like preferences. Broadly, the results of all three studies suggest no consistent relationship between testosterone and financial behavior or preferences. Although there were significant effects in specific cases, these findings did not replicate in other studies or would not remain significant when controlling for family-wise error rate. We consider potential contextual moderators that may determine under what circumstances testosterone affects economic decision making.

Decision Science Can Inform Clinical Trade-Offs Regarding Cardiotoxic Cancer Treatments

Cancer treatment-related cardiotoxicity (ie, heart failure, coronary artery disease, vascular diseases, arrhythmia) is a growing cancer survivorship concern within oncology practice; heart disease is the leading cause of noncancer death in cancer survivors and surpasses cancer as the leading cause of death for some cancers with higher survival rates. The issue of cardiotoxicity introduces a critical tradeoff that must be acknowledged and reconciled in clinical oncology practice: treating cancer aggressively and effectively in the present vs preventing future cardiotoxicity. Although many cancers must be treated as aggressively as possible, for others, multiple treatment options are available. Yet even when effective and less cardiotoxic treatments are available, they are not always chosen. Wariness to choose equally effective but less cardiotoxic treatment options may result in part from providers' and patients' reliance on "cognitive heuristics," or mental shortcuts that people (including, research shows, medical professionals) use to simplify complex judgments. These heuristics include delay discounting, availability and affect heuristics, and default bias. In the current commentary, we describe relevant research that illuminates how use of heuristics leads to biased medical decision making and translate how this research may apply when the tradeoff between aggressive cancer treatment and preventing future cardiotoxicity is considered. We discuss the implications of these biases in oncology practice, offer potential solutions to reduce bias, and call for future research in this area.

The neurodevelopment of delay discounting for monetary rewards in pre-adolescent children

Children are found to exhibit high degrees of delay discounting compared with adults in many delay discounting studies, which might be due to the asynchronous development of "bottom-up" and "top-down" neural systems. However, the temporal dynamics associated with the two systems in the development of delay discounting processes are not well known. In this study, we chose two age groups of participants and adopted event-related potential (ERP) techniques to investigate the neural dynamic differences between children and adults during delay discounting processes. Behavioral findings showed that children discounted more than adults and chose more immediate choices. Electrophysiological findings revealed that children exhibited longer neural processing (longer P2 latency) than adults during the early detection and identification phase. Children showed less cognitive control (smaller N2 amplitude) than adults over the middle frontal areas, and they devoted more neural effort (larger P3 amplitudes) to making final choices than adults. The factors of reward amount and time delay could influence the development of delay discounting in children.

Health and Wealth: The Importance for Lifestyle Medicine

Many people spend years dreaming about their retirement. Unfortunately, today's workers will likely work longer, suffer greater economic uncertainty, and might have poorer health status compared with retirees in previous generations. Preserving good health during the working years is associated with a more consistent employment record, greater financial resources, and reduced risk of disease. Making smart financial decisions as a younger adult also translates to improved finances in retirement. While many people are aware of these relationships, many continue to make poor health choices. Employers and lifestyle medicine professionals can both work to improve financial well-being in retirement. Employers can offer effective worksite financial wellness programs and promote participation in retirement savings programs. Physicians and other health providers can foster healthy behaviors, encourage preventive services compliance, and help adults foster overall financial and health well-being. Adopting a healthy lifestyle as early as possible would increase the likelihood that today's workers will enjoy financial security in retirement.

Social discounting of pain

Impatience can be formalized as a delay discount rate, describing how the subjective value of reward decreases as it is delayed. By analogy, selfishness can be formalized as a social discount rate, representing how the subjective value of rewarding another person decreases with increasing social distance. Delay and social discount rates for reward are correlated across individuals. However no previous work has examined whether this relationship also holds for aversive outcomes. Neither has previous work described a functional form for social discounting of pain in humans. This is a pertinent question, since preferences over aversive outcomes formally diverge from those for reward. We addressed this issue in an experiment in which healthy adult participants (N = 67) chose the timing and intensity of hypothetical pain for themselves and others. In keeping with previous studies, participants showed a strong preference for immediate over delayed pain. Participants showed greater concern for pain in close others than for their own pain, though this hyperaltruism was steeply discounted with increasing social distance. Impatience for pain and social discounting of pain were weakly correlated across individuals. Our results extend a link between impatience and selfishness to the aversive domain.

Examining the effect of underlying individual preferences for present over future on lung cancer screening participation: a cross-sectional analysis of a Korean National Cancer Screening Survey

OBJECTIVES

This study aimed to examine the effect of underlying individual preferences for the present over that for the future on lung cancer screening participation.

SETTING

We analysed the data from the Korean National Cancer Screening Survey in 2018.

PARTICIPANTS

4500 adults aged 20-74 years old participated in the study.

DESIGN

In this cross-sectional survey, multivariate logistic regression analysis was carried out to examine the association between subjects' intention to participate in lung cancer screening and individual preferences. The underlying individual preferences were measured on the basis of the self-reported general willingness to spend money now in order to save money in the future and general preferences with regard to financial planning.

PRIMARY OUTCOME MEASURE

Intention to participate in lung cancer screening.

RESULTS

Individuals eligible for lung cancer screening who place less value on their future were around four times less likely to report an intention to participate in lung cancer screening than were those who valued their future (OR 3.86, 95% CI 1.89 to 7.90). A present-biassed individual (one with a tendency for immediate gratification) was also about four times less likely to report an intention to participate in screening than an individual with no present bias (OR 0.26, 95% CI 0.12 to 0.57).

CONCLUSIONS

Underlying individual preferences regarding the present and future significantly affect individuals' intention to participate in lung cancer screening. Hence, provision of incentives may be necessary to encourage the targeted heavy smokers who may have a strong preferences for the present over future.

Moral preferences in helping dilemmas expressed by matching and forced choice

This paper asks whether moral preferences in eight medical dilemmas change as a function of how preferences are expressed, and how people choose when they are faced with two equally attractive help projects. In two large-scale studies, participants first read dilemmas where they “matched” two suggested helping projects (which varied on a single attribute) so that they became equally attractive. They did this by filling in a missing number (e.g., how many male patients must Project M save in order to be equally attractive as Project F which can save 100 female patients). Later, the same participants were asked to choose between the two equally attractive projects. We found robust evidence that people do not choose randomly, but instead tend to choose projects that help female (vs. male), children (vs. adult), innocent (vs. non-innocent), ingroup (vs. outgroup) and existing (vs. future) patients, and imply no (vs. some) risk of a harmful side-effect, even when these projects have been matched as equally attractive as, and save fewer patients than the contrasting project. We also found that some moral preferences are hidden when expressed with matching but apparent when expressed with forced choice. For example, 88–95% of the participants expressed that female and male patients are equally valuable when doing the matching task, but over 80% of them helped female patients in the choice task.

The Mental Landscape of Imagining Life Beyond the Current Life Span: Implications for Construal and Self-Continuity

Background and Objectives

With rapid advancements in medicine, technology, and nutrition, the future holds the possibility of longer and healthier lives. Despite garnering attention from myriad disciplines, psychological perspectives on life extension are scarce. In three studies, we addressed this gap by exploring key mental characteristics and psychological variables associated with simulating an expanded life span and thus an extremely distant future self.

Research Design and Methods

Three studies investigated the construal (i.e., valence, vividness, and visual perspective) of extremely distant future simulations and the extent to which participants felt connected to their future selves (i.e., self-continuity). Studies 1 and 2 investigated the characteristics of imagery associated with different ages ranging from near the current species maximum (e.g., 120, 150) to more highly hypothetical ages (e.g., 201, 501). Study 3 probed the mental construal of extreme aging among different populations (i.e., life-extension supporters, students, and Mechanical Turk workers). Studies also assessed participants’ general feelings about the ethicality and likelihood of techniques that halt or reverse biological aging to help individuals live beyond the current life expectancy.

Results

Participants in all studies reported being able to vividly imagine expanded aging scenarios (increased chronological, without biological, and aging), but these simulations were characterized by a decreased sense of connection to one’s future self (i.e., self-continuity) compared to a control condition. Temporal distance did not, however, impact ratings of self-continuity when comparing experimental conditions (i.e., imagining one’s self 120 vs 150 or 201 vs 501). Curiously, a sense of self-continuity (when simulating oneself well beyond the current life expectancy) remained intact for individuals who belonged to a community of life-extension supporters. The perceived likelihood and ethicality of extended life-span scenarios also varied significantly across different populations.

Discussion and Implications

The current work is the first to quantify the disconnect between one’s current and extremely distant (i.e., beyond the current life expectancy) future self. Given the behavioral implications of feeling disconnected from one’s future self (e.g., failing to save for retirement or care for one’s own physical health), these findings inform a critical barrier of extended life spans and provide insight into potential remedies (e.g., enhancing the perceived likelihood of living longer). Theoretical implications of hypotheticality and temporal distance, two key dimensions of Construal Level Theory, and their impact on the construal and self-continuity associated with future simulations are also discussed.

Measuring Time Preferences

We review research that measures time preferences-i.e., preferences over intertemporal tradeoffs. We distinguish between studies using financial flows, which we call "money earlier or later" (MEL) decisions and studies that use time-dated consumption/effort. Under different structural models, we show how to translate what MEL experiments directly measure (required rates of return for financial flows) into a discount function over utils. We summarize empirical regularities found in MEL studies and the predictive power of those studies. We explain why MEL choices are driven in part by some factors that are distinct from underlying time preferences.

Comparison of multiplicative and additive hyperbolic and hyperboloid discounting models in delayed lotteries involving gains and losses

Many day-to-day decisions may involve risky outcomes that occur at some delay after a decision has been made. We refer to such scenarios as delayed lotteries. Despite human choice often involves delayed lotteries, past research has primarily focused on decisions with delayed or risky outcomes. Comparatively, less research has explored how delay and probability interact to influence decisions. Within research on delayed lotteries, rigorous comparisons of models that describe choice from the discounting framework have not been conducted. We performed two experiments to determine how gain or loss outcomes are devalued when delayed and risky. Experiment 1 used delay and probability ranges similar to past research on delayed lotteries. Experiment 2 used individually calibrated delay and probability ranges. Ten discounting models were fit to the data using a genetic algorithm. Candidate models were derived from past research on discounting delayed or probabilistic outcomes. We found that participants' behavior was best described primarily by a three-parameter multiplicative model. Measures based on information criteria pointed to a solution in which only delay and probability were psychophysically scaled. Absolute measures based on residuals pointed to a solution in which amount, delay, and probability are simultaneously scaled. Our research suggests that separate scaling parameters for different discounting factors may not be necessary with delayed lotteries.

The discounted future: Relationship between temporal discounting and future thinking in Alzheimer's disease

Temporal discounting refers to the tendency to prefer smaller sooner rewards over larger later rewards. Prior research has reported temporal discounting in Alzheimer's disease (AD). We thus investigated, in this study, the relationship between temporal discounting and future thinking in AD. The study included 40 patients with AD and 42 control participants. We invited participants, on a temporal discounting task, to choose between an immediate but smaller or a delayed but larger amount of money (e.g. "would you prefer 10 dollars today or 50 dollars after one month?"). We also invited the participants to imagine events that may happen in the future, a task known as future thinking. Analysis demonstrated a bias toward immediate rewards (i.e. temporal discounting) as well as difficulties to imagine specific future events in patients with AD. Critically, temporal discounting and future thinking in AD were significantly correlated. Generally speaking, a lack of thinking about the future may lead to impulsive behavior. More specifically, decline in future thinking in AD may limit the ability of patients to project themselves in time to consider outcomes of their decisions, resulting in a tendency to devaluate future rewards in favor of more imminent ones (i.e. temporal discounting).

An Interdisciplinary Approach to Understanding the Psychological Impact of Different Grammaticalizations of the Future

Considering how fundamental and ubiquitous temporal information is in discourse (e.g., Zwaan & Radvansky, 1998), it seems rather surprising that the impact of the grammaticalization of the future on the way we perceive the future has only been scarcely studied. We argue that this may be due to its rather abstract nature and how it has been previously operationalized. In this review, we lay the foundation for studying the impact of the grammaticalization of the future on mental representations of the future by taking an interdisciplinary perspective, connecting cognitive sciences, linguistics, psycholinguistics, economics, and health psychology. More specifically, we argue that experimental psycholinguistics, combined with more applied domains, constitute a promising research avenue.

Delay discounting of different outcomes: Review and theory

Steep delay discounting is characterized by a preference for small immediate outcomes relative to larger delayed outcomes and is predictive of drug abuse, risky sexual behaviors, and other maladaptive behaviors. Nancy M. Petry was a pioneer in delay discounting research who demonstrated that people discount delayed monetary gains less steeply than they discount substances with abuse liability. Subsequent research found steep discounting for not only drugs, but other nonmonetary outcomes such as food, sex, and health. In this systematic review, we evaluate the hypotheses proposed to explain differences in discounting as a function of the type of outcome and explore the trait- and state-like nature of delay discounting. We found overwhelming evidence for the state-like quality of delay discounting: Consistent with Petry and others' work, nonmonetary outcomes are discounted more steeply than monetary outcomes. We propose two hypotheses that together may account for this effect: Decreasing Future Preference and Decreasing Future Worth. We also found clear evidence that delay discounting has trait-like qualities: People who steeply discount monetary outcomes steeply discount nonmonetary outcomes as well. The implication is that changing delay discounting for one outcome could change discounting for other outcomes.

Valuing Sequences of Lives Lost or Saved Over Time: Preference for Uniform Sequences

Policymakers often make decisions involving human-mortality risks and monetary outcomes that span across different time periods and horizons. Many projects or environmental-regulation policies involving risks to life, such as toxic exposures, are experienced over time. The preferences of individuals on lives lost or saved over time should be understood to implement effective policies. Using a within-subject survey design, we investigated our participants’ elicited preferences (in the form of ratings) for sequences of lives saved or lost over time at the participant level. The design of our study allowed us to directly observe the possible preference patterns of negative time discounting or a preference for spreading from the responses. Additionally, we embedded factors associated with three other prevalent anomalies of intertemporal choice (gain/loss asymmetry, short/long asymmetry, and the absolute magnitude effect) into our study for control. We find that our participants exhibit three of the anomalies: preference for spreading, absolute magnitude effect, and short/long-term asymmetry. Furthermore, fitting the data collected, Loewenstein and Prelec’s model for the valuation of sequences of outcomes allowed for a more thorough understanding of the factors influencing the individual participants’ preferences. Based on the results, the standard discounting model does not accurately reflect the value that some people place on sequences of mortality outcomes. Preferences for uniform sequences should be considered in policymaking rather than applying the standard discounting model.

Preference-based serial decisions are counterintuitively influenced by emotion regulation and conscientiousness

Our decisions have a temporally distributed order, and different choice orders (e.g., choosing preferred items first or last) can lead to vastly different experiences. We previously found two dominant strategies (favorite-first and favorite-last) in a preference-based serial choice setting (the 'sushi problem'). However, it remains unclear why these two opposite behavioral patterns arise: i.e., the mechanisms underlying them. Here we developed a novel serial-choice task, using pictures based on attractiveness, to test for a possible shared mechanism with delay discounting, the 'peak-end' bias (i.e., preference for experienced sequences that end well), or working-memory capacity. We also collected psychological and clinical metric data on personality, depression, anxiety, and emotion regulation. We again found the two dominant selection strategies. However, the results of the delay, peak-end bias, and memory capacity tasks were not related to serial choice, while two key psychological metrics were: emotion regulation and conscientiousness (with agreeableness also marginally related). Favorite-first strategists actually regulated emotions better, suggesting better tolerance of negative outcomes. Whereas participants with more varied strategies across trials were more conscientious (and perhaps agreeable), suggesting that they were less willing to settle for a single, simpler strategy. Our findings clarify mechanisms underlying serial choice and show that it may reflect a unique ability to organize choices into sequences of events.

The Consideration of Future Consequences: Evidence for Domain Specificity Across Five Life Domains

The consideration of future consequences (CFC) is a cognitive-motivational construct describing the extent to which individuals consider the future outcomes of behavior during decision-making. The current research examined the extent to which CFC may be a domain-specific, as opposed to global, temporal construct. Across three surveys, adults ( n = 498; 66.9% female; 41.2% students) completed the 14-item general CFC scale, five newly adapted domain-specific CFC scales, and self-report measures of behavior in five substantive domains (work, health, the environment, money, and college). Confirmatory factor analyses replicated the two-factor model in the CFC-14, supporting the distinction between CFC-Future and CFC-Immediate in domain-specific CFC-14 scales. Hierarchical regression analyses indicated that domain-specific, and not the general, CFC subscales were most strongly associated with the relevant domain-specific behavior and revealed differential patterns of association between domain-specific CFC subscales and behaviors in particular domains. The applied implications for behavioral interventions are discussed.

Indirect costs associated with deaths of children aged 0-14 years from measles in a weak health system and conflict and fragile zone: the case of Somalia

This study recognises periodic outbreaks of measles continue to affect conflict and fragile zones in the least developed countries. This study set out to provide evidence for the indirect costs or economic loss associated with measles-related deaths among children aged 0–14 years in Somalia. Using epidemiologic and economic data, the indirect cost was calculated based on the framework of the World Health Organisation guide of identifying the economic consequences of disease and injury. The baseline indirect cost was computed as the product of discounted future productive years of life lost (PYLL), non-health gross domestic product per capita (NHGDPPC) and the estimated total measles deaths (ETMD). The model was adjusted for conflict and fragility conditions and further extension considered a finite and stable upper limit growth of the instability-adjusted NHGDPPC. To discount future costs, a rate of 3% was applied. Using a ±20% variability assumption of the epidemiologic and economic factor inputs, a sensitivity analysis was conducted to account for uncertainty. In 2015 values, the ETMD of 3723 measles deaths of children aged 0–14 years could decrease non-health GDP of the country by $23.46 million, a potential loss of $6303 per death over the discounted PYLL. The loss would increase by 5.3% when adjusted for conflict and fragility conditions. Assuming growth, the future adjusted loss is expected to be $35.91 million in 2015 values. Girl-child deaths accounted for 51.2% of the burden. Results are robust to the variations in the model inputs, although sensitivity analyses suggest the proportion of total measles deaths and the discount rate accounted for greater uncertainty of the loss than do the proportion of growth and instability assumption. Conflict and fragility accounted for the least uncertainty, perhaps confirming their relative perpetuity in Somalia. Results show significant indirect cost related to measles deaths of children, exacerbated by conflict and fragility. This is an economic burden, but one which the health system, policy-makers, government and other stakeholders should be prepared to colossally discount by collectively taking measles surveillance and security measures now to reduce further deaths in the future.

Computational psychiatry of impulsivity and risk: how risk and time preferences interact in health and disease

Choice impulsivity is an important subcomponent of the broader construct of impulsivity and is a key feature of many psychiatric disorders. Choice impulsivity is typically quantified as temporal discounting, a well-documented phenomenon in which a reward's subjective value diminishes as the delay to its delivery is increased. However, an individual's proclivity to-or more commonly aversion to- risk can influence nearly all of the standard experimental tools available for measuring temporal discounting. Despite this interaction, risk preference is a behaviourally and neurobiologically distinct construct that relates to the economic notion of utility or subjective value. In this opinion piece, we discuss the mathematical relationship between risk preferences and time preferences, their neural implementation, and propose ways that research in psychiatry could, and perhaps should, aim to account for this relationship experimentally to better understand choice impulsivity and its clinical implications. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

Time preferences are reliable across time-horizons and verbal versus experiential tasks

Individual differences in delay-discounting correlate with important real world outcomes, for example education, income, drug use, and criminality. As such, delay-discounting has been extensively studied by economists, psychologists and neuroscientists to reveal its behavioral and biological mechanisms in both human and non-human animal models. However, two major methodological differences hinder comparing results across species. Human studies present long time-horizon options verbally, whereas animal studies employ experiential cues and short delays. To bridge these divides, we developed a novel language-free experiential task inspired by animal decision-making studies. We found that the ranks of subjects' time-preferences were reliable across both verbal/experiential and second/day differences. Yet, discount factors scaled dramatically across the tasks, indicating a strong effect of temporal context. Taken together, this indicates that individuals have a stable, but context-dependent, time-preference that can be reliably assessed using different methods, providing a foundation to bridge studies of time-preferences across species.

Editorial note

This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).

Behavioral Modeling in Weight Loss Interventions

Designing systems with human agents is difficult because it often requires models that characterize agents' responses to changes in the system's states and inputs. An example of this scenario occurs when designing treatments for obesity. While weight loss interventions through increasing physical activity and modifying diet have found success in reducing individuals' weight, such programs are difficult to maintain over long periods of time due to lack of patient adherence. A promising approach to increase adherence is through the personalization of treatments to each patient. In this paper, we make a contribution towards treatment personalization by developing a framework for predictive modeling using utility functions that depend upon both time-varying system states and motivational states evolving according to some modeled process corresponding to qualitative social science models of behavior change. Computing the predictive model requires solving a bilevel program, which we reformulate as a mixed-integer linear program (MILP). This reformulation provides the first (to our knowledge) formulation for Bayesian inference that uses empirical histograms as prior distributions. We study the predictive ability of our framework using a data set from a weight loss intervention, and our predictive model is validated by comparison to standard machine learning approaches. We conclude by describing how our predictive model could be used for optimization, unlike standard machine learning approaches which cannot.

The impact of financial strain on medication non-adherence: Influence of psychiatric medication use

Non-adherence to prescribed medications is a systemic public health concern. Financial strain, the extent to which an individual is unable to afford necessary items, may represent an important factor related to adherence. This study evaluated the association between financial strain and medication adherence as a function of medication type. Participants reporting a daily prescription for psychiatric or other chronic health conditions (N = 231) were sampled from the crowdsourcing website Amazon Mechanical Turk (mTurk). All participants completed measures of financial strain and other individual-difference factors related to adherence. Medication adherence was evaluated using a subjective scale (i.e., ARMS) and past month non-adherence rates. General financial strain showed a modest relationship with subjective scales of adherence, but not past month non-adherence rates. Medication-specific financial strain was associated with greater non-adherence, even after controlling for relevant demographic, socio-economic, and personality factors. Medication-specific financial strain also disproportionately affected individuals taking psychiatric medications relative to those not taking psychiatric medications. These findings emphasize the role that financial strain plays in medication adherence, and in particular, in psychiatric conditions. Future studies could design interventions targeting financial strain to improve clinical adherence, broadly, and psychiatric medication adherence, specifically.

Preferences, personality and health behaviors: results from an explorative economic experiment

This research note analyzes the relationship between experimentally elicited, incentivized economic preference parameters, personality traits, and three health behaviors: smoking, drinking, and physical activity. While there is a strand of economic research that uses proxy measures of risk and time preference that are not derived from an incentivized experiment and personality traits at the same time, and a considerably smaller one that uses experimentally elicited measures of risk and time preference only, the innovation of my work is to use experimentally elicited, incentivized preference measures and personality traits at the same time to explain a range of health behaviors. Findings presented in this paper suggest that personality traits seem to be more important determinants of health behaviors than economic preference parameters, and that Big Five personality traits, especially Agreeableness, seem to be more important determinants than the Grit score developed by Duckworth et al. (J Pers Soc Psychol 92(6):1087, 2007). When also controlling for a host of personality traits, risk preference is not related to the analyzed behaviors, but time preference is negatively related to smoking. When controlling for economic preferences and Big Five personality traits, the Grit score is unrelated to the analyzed health behaviors. Big Five openness is negatively related to the probability of engaging in physical activity, while Big Five agreeableness is negatively related to the probability of both drinking and binge drinking, but also to the probability of engaging in physical activity. Big Five neuroticism is negatively related to the probability of binge drinking.