Opportunity costs of reward delays and the discounting of hypothetical money and cigarettes

Methamphetamine increases risky choice in rats, but only when magnitude and probability of reinforcement are manipulated within a session

Risky choice is associated with maladaptive behaviors, particularly substance use disorders. Current animal models of risky choice are often confounded by other constructs like behavioral flexibility and suboptimal choice. The purpose of the current experiment was to determine if the psychostimulant methamphetamine, a drug whose popularity has increased in recent years, increases risky choice in an equivalent expected value (EEV) task. In the EEV task, rats are given a choice between two reinforcer alternatives that differ in magnitude and probability of delivery, but have equivalent expected value. Forty-eight Sprague Dawley rats were tested in three versions of the EEV task. In the first version of the EEV task, both reinforcer magnitude and probability were adjusted across blocks of trials for both alternatives. In the second and the third versions of the EEV task, reinforcer magnitude was held constant across each block of trials (either 1 vs. 2 pellets or 4 vs. 5 pellets). We found that male rats preferred the "riskier" option, except when reinforcer magnitudes were held constant at 4 and 5 pellets across each block of trials. Methamphetamine (0.5 mg/kg) increased preference for the risky option in both males and females, but only when both reinforcer magnitude and probability were manipulated across blocks of trials for each alternative. The current results demonstrate that both magnitude of reinforcement and probability of reinforcement interact to influence risky choice. Overall, this study provides additional support for using reinforcers with expected value to measure risky choice.

The Use of Nonmonetary Outcomes in Health-Related Delay Discounting Research: Review and Recommendations

Delay discounting (DD) refers to the tendency to devalue an outcome as a function of its delay. Most contemporary human DD research uses hypothetical money to assess individual rates of DD. However, nonmonetary outcomes such as food, substances of misuse, and sexual outcomes have been used as well, and have advantages because of their connections to health. This article reviews the literature on the use of nonmonetary outcomes of food, drugs, and sexual outcomes in relation to health and reinforcer pathologies such as substance use disorders, obesity, and sexual risk behaviors, respectively, and makes a case for their use in discounting research. First, food, substances, and sex may be more ecologically valid outcomes than money in terms of their connections to health problems and reinforcer pathologies. Second, consistent trends in commodity-specific (i.e., domain) effects, in which nonmonetary outcomes are discounted more steeply than money, enhance variation in discounting values. Third, commodity-specific changes in discounting with treatments designed to change health choices are described. Finally, methodological trends such as test-retest reliability, magnitude effects, the use of hypothetical versus real outcomes, and age-related effects are discussed in relation to the three outcome types and compared to trends with monetary discounting. Limitations that center around individual preferences, nonsystematic data, and deprivation are discussed. We argue that researchers can enhance their DD research, especially those related to health problems and reinforcer pathologies, with the use of nonmonetary outcomes. Recommendations for future directions of research are delineated.

Designing and Validating a Novel Method for Assessing Delay Discounting Associated With Health Behaviors: Ecological Momentary Assessment Study

BACKGROUND

Delay discounting quantifies an individual's preference for smaller, short-term rewards over larger, long-term rewards and represents a transdiagnostic factor associated with numerous adverse health outcomes. Rather than a fixed trait, delay discounting may vary over time and place, influenced by individual and contextual factors. Continuous, real-time measurement could inform adaptive interventions for various health conditions.

OBJECTIVE

The goals of this paper are 2-fold. First, we present and validate a novel, short, ecological momentary assessment (EMA)-based delay discounting scale we developed. Second, we assess this tool's ability to reproduce known associations between delay discounting and health behaviors (ie, substance use and craving) using a convenience-based sample.

METHODS

Participants (N=97) were adults (age range 18-71 years), recruited on social media. In phase 1, data were collected on participant sociodemographic characteristics, and delay discounting was evaluated via the traditional Monetary Choice Questionnaire (MCQ) and our novel method (ie, 7-item time-selection and 7-item monetary-selection scales). During phase 2 (approximately 6 months later), participants completed the MCQ, our novel delay discounting measures, and health outcomes questions. The correlations between our method and the traditional MCQ within and across phases were examined. For scale reduction, a random number of items were iteratively selected, and the correlation between the full and random scales was assessed. We then examined the association between our time- and monetary-selection scales assessed during phase 2 and the percentage of assessments that participants endorsed using or craving alcohol, tobacco, or cannabis.

RESULTS

In total, 6 of the 7 individual time-selection items were highly correlated with the full scale (r>0.89). Both time-selection (r=0.71; P<.001) and monetary-selection (r=0.66; P<.001) delay discounting rates had high test-retest reliability across phases 1 and 2. Phase 1 MCQ delay discounting function highly correlated with phase 1 (r=0.76; P<.001) and phase 2 (r=0.45; P<.001) time-selection delay discounting scales. One or more randomly chosen time-selection items were highly correlated with the full scale (r>0.94). Greater delay discounting measured via the time-selection measure (adjusted mean difference=5.89, 95% CI 1.99-9.79), but not the monetary-selection scale (adjusted mean difference=-0.62, 95% CI -3.57 to 2.32), was associated with more past-hour tobacco use endorsement in follow-up surveys.

CONCLUSIONS

This study evaluated a novel EMA-based scale's ability to validly and reliably assess delay discounting. By measuring delay discounting with fewer items and in situ via EMA in natural environments, researchers may be better able to identify individuals at risk for poor health outcomes.

Reduced access to reinforcement drives delay discounting during experienced delays

Rewards lose value as a function of delay. Previous studies suggest that delays have a bigger effect on reward value when people must wait during the delay. However, whether delays involve waiting or postponing has often been confounded with whether choices are about hypothetical or real rewards. The current study characterized the effects of waiting and postponing in hypothetical and experiential choice contexts separately. In Experiment 1 we observed steeper delay discounting for waiting than for postponing in choices about both hypothetical money and about experienced computer game points. Two factors potentially contributing to steeper discounting in choices about waiting are reduced access to other rewards and direct costs of waiting. In Experiment 2, we adapted the experiential delay-discounting task to manipulate each factor separately. Reduced access to other reinforcers had a bigger effect on delay discounting than direct costs of waiting. These results underscore the importance of considering the unique influence of waiting and associated opportunity costs in both basic delay-discounting research and in applied contexts.

Individual differences in degree of discounting, Do different procedures and measures assess the same construct?

The present study compared the two most prominent procedures for measuring delay discounting, the Adjusting-Amount procedure and the Monetary Choice Questionnaire (MCQ). Of interest was whether the two procedures measure the same construct. Results obtained from two online samples recruited using the Prolific (N = 150) and MTurk (N = 243) platforms revealed generally similar results for both procedures. Regardless of the procedure, the sample, the reward amount, and whether the discounting measure used was theoretically based (i.e., log k) or was atheoretical (i.e., area under the curve, proportion of choices of the delayed reward option), the degree of discounting on the Adjusting-Amount procedure was highly correlated with the degree of discounting on the MCQ, consistent with the hypothesis that both procedures assess the same construct.

Consumer choices with variations in item price, delay, and opportunity cost

Tversky and Kahneman (1981) told participants to imagine they were at a store about to purchase an item. They were asked if they would be willing to drive 20 min to another store to receive a $5 discount on the item's price. Most participants were willing, but only when the original price of the item was small ($15); when the original price was relatively large ($125), most said they would not drive 20 min for a $5 discount. We examined this framing effect in 296 participants, but instead used a psychophysical-adjustment procedure to obtain quantitative estimates of the discount required with different (a) item prices, (b) delays until the item's receipt, and (c) opportunity costs (in "driving" vs. "delivery" tasks). We systematically replicated Tversky and Kahneman's results, but also extended them by showing a substantial influence of opportunity costs on the consumer discounts required. A behavioral model of delay discounting-additive-utility theory-accounted for 97% of the variance in these consumer discounts.

Choices about whether to wait: Changes in delay discounting without changes in time perception

Delay discounting occurs when the present, subjective value of a reward decreases as a function of delay. Delay discounting is steeper when individuals must wait during the delay, and delay discounting rates for decisions about waiting are not strongly correlated with those for decisions about postponing without waiting. We examined whether changes in delay discounting in choices about waiting are linked to changes in subjective time perception. In Experiment 1, participants completed an experiential waiting task twice. We established that delay discounting was steeper later in the session. In Experiment 2 participants again completed the delay discounting task twice, and we also tracked time perception across the session using the temporal bisection task. Once again, participants demonstrated steeper discounting during the second discounting task, but time perception did not differ significantly. Additionally, discounting rates were not correlated with subjective time perception. Changes in delay discounting across the session might be understood in terms of context or reference effects.

Beyond Systematic and Unsystematic Responding: Latent Class Mixture Models to Characterize Response Patterns in Discounting Research

Operant behavioral economic methods are increasingly used in basic research on the efficacy of reinforcers as well as in large-scale applied research (e.g., evaluation of empirical public policy). Various methods and strategies have been put forward to assist discounting researchers in conducting large-scale research and detecting irregular response patterns. Although rule-based approaches are based on well-established behavioral patterns, these methods for screening discounting data make assumptions about decision-making patterns that may not hold in all cases and across different types of choices. Without methods well-suited to the observed data, valid data could be omitted or invalid data could be included in study analyses, which subsequently affects study power, the precision of estimates, and the generality of effects. This review and demonstration explore existing approaches for characterizing discounting and presents a novel, data-driven approach based on Latent Class Analysis. This approach (Latent Class Mixed Modeling) characterizes longitudinal patterns of choice into classes, the goal of which is to classify groups of responders that differ characteristically from the overall sample of discounters. In the absence of responders whose behavior is characteristically distinct from the greater sample, modern approaches such as mixed-effects models are robust to less-systematic data series. This approach is discussed, demonstrated with a publicly available dataset, and reviewed as a potential supplement to existing methods for inspecting and screening discounting data.

Methamphetamine administration dose effects on sexual desire, sexual decision making, and delay discounting

Correlational evidence has linked methamphetamine use and HIV sexual risk behavior, but the direct effects of methamphetamine on sexual desire and sexual decision making in humans have not been tested. This study was designed to test the effect of methamphetamine administration on sexual desire and hypothetical condom-use decisions as measured by the Sexual Delay Discounting Task. Recreational stimulant users (n = 19) participated in this within-subject, placebo-controlled study comparing the effects of 0 mg, 20 mg, and 40 mg of oral methamphetamine. Compared to placebo, methamphetamine caused dose-related and time-related increases in a single-item sexual desire rating and some standard stimulant abuse liability ratings, as well as dose-related increases in the Sexual Arousal and Desire Inventory (SADI; a multidimensional scale capturing positive and negative aspects of desire/arousal). However, methamphetamine caused no significant mean differences in likelihood of condom use within the Sexual Delay Discounting Task or the Monetary Discounting Task. SADI scores were negatively correlated with change from placebo in condom use likelihood in the Sexual Delay Discounting Task for some partner conditions (i.e., decreased reported likelihood of condom use in participants who experienced increased desire/arousal and vice versa). These mixed results may be consistent with methamphetamine's role as both a treatment for attention-deficit/hyperactivity disorder and as a drug of abuse associated with increased delay discounting, and they suggest that methamphetamine's effects on discounting may be modulated by the reinforcing properties of what is being discounted. Delay discounting may be an understudied element of risky sexual decision making, particularly among individuals who use methamphetamine. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The phenotype of recovery II: The association between delay discounting, self-reported quality of life, and remission status among individuals in recovery from substance use disorders

Quality of life (QOL) and delay discounting (preference for smaller, immediate rewards) are significantly associated with substance use status, severity, and treatment outcomes. Associations between delay discounting and QOL among individuals in recovery from substance use have not been investigated. In this 2-study investigation, using data collected from The International Quit & Recovery Registry, we examined the association between QOL, discounting rates, and remission status among individuals in recovery from SUD. Study 1 (N = 166) investigated the relationship between delay discounting and QOL among individuals in recovery from SUD. Study 2 (N = 282) aimed to validate and extend the results of Study 1 by assessing the association between the remission status, delay discounting, and QOL among individuals in recovery from alcohol use disorder (AUD). In both studies, delay discounting was a significant predictor of QOL domains of physical health, psychological, and environment even after controlling for age, gender, race, ethnicity, education, and days since last use. In Study 2, a mediation analysis using Hayes's methods revealed that the association between the remission status and QOL domains of physical health, psychological and environment were partially mediated by the discounting rates. The current study expands the generality of delay discounting and indicates that discounting rates predict QOL and remission status among individuals in recovery from substance use disorders. This finding corroborates the recent characterizations of delay discounting as a candidate behavioral marker of addiction and may help identify subgroups that require special treatment or unique interventions to overcome their addiction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Temporal discounting across adulthood: A systematic review and meta-analysis

A number of developmental theories have been proposed that make differential predictions about the links between age and temporal discounting, or the devaluation of future rewards. Most empirical studies examining adult age differences in temporal discounting have relied on economic intertemporal choice tasks, which pit choosing a smaller, sooner monetary reward against choosing a larger, later one. Although initial studies using these tasks suggested older adults discount less than younger adults, follow-up studies provided heterogeneous, and thus inconclusive, results. Using an open science approach, we test the replicability of adult age differences in temporal discounting by conducting a preregistered systematic literature search and meta-analysis of adult age differences in intertemporal choice tasks. Across 37 cross-sectional studies (Total N = 104,737), a planned meta-analysis found no sizeable relation between age and temporal discounting, r = -0.068, 95% CI [-0.170, 0.035]. We also found little evidence of publication bias or p-hacking. Exploratory analyses of moderators found no effect of research design (e.g., extreme-group vs. continuous age), incentives (hypothetical vs. real rewards), duration of delay (e.g., days, weeks, months, or years), or quantification of discounting behavior (e.g., proportion of immediate choices vs. parameters from computational modeling). Additional analyses of 12 participant-level data sets found little support for a nonlinear relation between age and temporal discounting across adulthood. Overall, the results suggest that younger, middle-aged, and older adults show similar preferences for smaller, sooner over larger, later rewards. We provide recommendations for future empirical work on temporal discounting across the adult life span. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A systematic review and meta-analysis of delay discounting and cannabis use

Delay discounting reflects the systematic reduction in the value of a consequence by delay to delivery. Theoretical and empirical work suggests that delay discounting is a key behavioral mechanism underlying substance use disorder. Existing work on cannabis use, however, is mixed with many studies reporting null results. The purpose of this review was to provide an in-depth assessment of the association between delay discounting and cannabis use. We conducted metaregression analyses to determine the omnibus correlation between delay discounting and cannabis use, and to evaluate task-based and sample-based moderators. Studies included evaluated an association between delay discounting and cannabis quantity-frequency or severity measures in human participants (27 studies, 61 effect sizes, 24,782 participants). A robust variance estimation method was used to account for dependence among effect sizes. A significant, but small, omnibus effect was observed (r = .082) in which greater cannabis use frequency or severity was associated with greater discounting. Incentive structure and outcome type were each significant moderators in a multiple moderator model such that incentivized tasks correlated with severity measures showed stronger associations (r = .234) than hypothetical tasks correlated with quantity-frequency measures (r = .029). Comparisons to historic effect size data supported the hypothesis that, at present, the relationship between cannabis use and delay discounting appears empirically smaller than for other substances. Future work should explore theoretical rationales explaining this modest relationship involving cannabis use and delay discounting, such as reflecting the smaller magnitude of perceived long-term clinical outcomes associated with cannabis compared to other substances. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Influence of Episodic Future Thinking and Graphic Warning Labels on Delay Discounting and Cigarette Demand

Delay discounting and operant demand are two behavioral economic constructs that tend to covary, by degree, with cigarette smoking status. Given historically robust associations between adverse health outcomes of smoking, a strong preference for immediate reinforcement (measured with delay discounting), and excessive motivation to smoke cigarettes (measured with operant demand), researchers have made numerous attempts to attenuate the extent to which behaviors corresponding to these constructs acutely appear in smokers. One approach is episodic future thinking, which can reportedly increase the impact of future events on present decision making as well as reduce the reinforcing value of cigarettes. Graphic cigarette pack warning labels may also reduce smoking by increased future orientation. Experiment 1 evaluated the combined effects of episodic future thinking and graphic warning labels on delay discounting; Experiment 2 evaluated solely the effects of episodic future thinking on delay discounting and operant demand. We observed no statistically significant effects of episodic future thinking when combined with graphic warning labels or when assessed on its own. These results serve as a call for further research on the boundary conditions of experimental techniques reported to alter behaviors associated with cigarette smoking.

Sexual Arousal Discounting: Devaluing Condom-Protected Sex as a Function of Reduced Arousal

Sexual discounting is a growing area of research aimed at identifying factors that reduce people's reported willingness to have safe sex. One commonly reported reason for condom non-use is that a condom reduces sexual arousal. However, researchers have yet to isolate the specific role of sexual arousal using a sexual discounting framework. We extended past research by measuring how sexual arousal reduced people's willingness to have condom-protected sex ("sexual arousal discounting": SAD). College students (n = 379; 67.5% females) selected partners they most wanted and least wanted to have sex with and were randomized to one of two groups. In one group, participants rated their willingness to have sex with a condom if their own arousal decreased (from 100 to 10%) from condom use. The other group completed the same task except their partner's arousal decreased from condom use instead of their own. We observed a three-way interaction between arousal levels, most versus least desirable partners, and self versus partner groups. Participants' willingness to have condom-protected sex systematically reduced as a function of sexual arousal. This was observed more with the most (vs. least) desirable partner and in the self-arousal (vs. partner-arousal) group but only when the partner was their least desirable. Men (vs. women) displayed more arousal discounting but only with the most desirable partner. Finally, higher arousal discounting was associated with lower safe-sex self-efficacy and higher reported frequency of unprotected sex in the past 3 months. This study demonstrates how reduced sexual arousal from condom use can be measured as a factor influencing sexual risk-taking.

The discounting of death: Probability discounting of heroin use by fatal overdose likelihood and drug purity

As fatal overdoses from synthetic opioids continue to rise, we need to understand decision-making processes underlying heroin and synthetic opioid use. This study evaluated the influence of sample impurity and fatal overdose risk on hypothetical heroin use. Individuals who currently use heroin (n = 69) were recruited online. Participants completed two probability-discounting tasks evaluating the likelihood of using a sample of heroin based on the likelihood of sample impurity and likelihood of fatal overdose, where greater discounting represented reduced use likelihood. Prior to completing the probability-discounting tasks, participants were randomized to read one of four prompts varying by the presence of information on heroin effects and active (e.g., fentanyl) or inert impurities. Influence of prompts on discounting processes and associations among probability-discounting measures, opioid use behaviors, and dependence severity were evaluated. Heroin use likelihood decreased with increased impurity or overdose risk and in a generally orderly fashion. Discounting was greater (i.e., reduced heroin use likelihood) when overdose risk, compared to sample impurity, was manipulated. Less discounting was associated with more severe opioid dependence. Discounting did not differ among prompts for either task. Individuals might adjust their heroin-use behavior to reduce harm with risk-related information. Greater discounting elicited by overdose relative to impurity risk suggests that equating adulteration and overdose risk is essential for harm reduction. Expanded access to drug checking services, which inform impurity and overdose risk, can reduce fatal overdoses. Due to fear of legal sanctions for these services, legislation and judicial decisions should explicitly protect these services. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Setting a goal could help you control: Comparing the effect of health goal versus general episodic future thinking on health behaviors among cigarette smokers and obese individuals

Episodic Future Thinking (EFT) reduces delay discounting (DD; preference for smaller, immediate rewards) and various maladaptive behaviors. Exploring potential personalization of EFT to optimize its ability to alter DD and demand for unhealthy reinforcers is important for the development of interventions targeting long-term improvement and maintenance of health. In this investigation, using 2 separate studies, we examined the effects of EFT with and without a health goal on rates of discounting, demand, and craving for cigarettes and fast food among cigarette smokers and obese individuals, respectively. Using data collected from Amazon Mechanical Turk (mTurk), Study 1 (N = 189) examined the effect of EFT on DD and measures of cigarette demand and craving in cigarette smokers who were randomly assigned to 1 of 3 conditions: EFT-health goal, EFT-general, or Episodic Recent Thinking (ERT)-general. Study 2 (N = 255), using a 2x2 factorial design, examined the effects of health goals and general EFT on DD and measures of fast food demand and craving in obese individuals who were randomly assigned to 1 of 4 conditions: EFT-health goal, EFT-general, ERT-health goal or ERT-general. Health goal EFT was not more effective than general EFT in reducing monetary discounting. However, the addition of a health goal to general EFT was significantly associated with higher effect on intensity and elasticity of demand for cigarettes and fast food compared to EFT without a health goal. These findings suggest that the amplification of future thinking through the inclusion of a health goal may promote healthy decisions and result in positive behavior changes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effects of Time Framing on Compliance to Hypothetical Social-Distancing Policies Related to COVID-19

The current study analyzed the effects of two frames for durations of time-calendar unit and calendar date-on measures of compliance to hypothetical social-distancing policies related to the COVID-19 pandemic. Participants reported the extent to which they would comply with hypothetical social-distancing policies lasting different durations of time. Durations of time were framed as calendar units (e.g., days, weeks, months, years) and calendar dates (i.e., specific dates the policies would extent to). Levels of compliance across durations of time were used to calculate the area under the curve (AuC) for each condition. Social-distancing policies framed in calendar dates yielded significantly greater AuC values compared to social-distancing policies framed in calendar units. Participants' self-reported political affiliation yielded a significant main effect: Conservative participants' AuC values were significantly lower than liberal participants' AuC values. The framing of the duration of time was a significant variable in controlling rates of compliance to hypothetical social-distancing policies.

Delay and probability discounting in cocaine use disorder: Comprehensive examination of money, cocaine, and health outcomes using gains and losses at multiple magnitudes

Understanding factors associated with cocaine use disorder is important given its public health impact. One factor is delay discounting (devaluation of future consequences). Cocaine users have shown greater delay discounting of money rewards than non-cocaine users. But underexamined are factors known to affect discounting, such as the sign (reward vs. loss), magnitude (e.g., $10 vs. $1,000), and commodity (e.g., money vs. health) of the consequence. Also underexamined is probability discounting (devaluation of uncertain consequences). We conducted a comprehensive group-comparison study of discounting processes by comparing sign, magnitude, and commodity effects between demographically matched cocaine users (n = 23) and never users (n = 24) for delay discounting and sign and magnitude effects for probability discounting. Participants completed delay and probability discounting tasks spanning rewards and losses; money, cocaine, and health outcomes; and magnitudes of $10, $100, and $1,000. Four primary findings emerged when controlling for other drug use. First, cocaine users pervasively discounted delayed consequences more than never users regardless of sign, magnitude, or commodity, with the possible exception of delay discounting of $1,000 health equivalences. Second, both groups discounted delayed rewards more than losses, with a similar trend for probability discounting. Third, magnitude effects in cocaine users for delayed and probabilistic outcomes were similar to those previously observed in never users and other-drug users. Fourth, cocaine users discounted cocaine-related outcomes more than money and health, with variable results comparing money and health. These data suggest that the behavioral processes of delay and probability discounting are qualitatively similar for cocaine users and never users. However, quantitatively, cocaine users generally showed greater delay discounting and similar probability discounting compared with never users. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Analyzing the magnitude effect in spontaneously hypertensive (SHR) and wistar Kyoto (WKY) rats

We analyzed the magnitude effect in Spontaneously Hypertensive (SHR) and Wistar Kyoto (WKY) rats choosing between a smaller-sooner (SSF) and a larger-later food (LLF) in the initial link of a concurrent-chains procedure. The SSF was delivered immediately in one terminal link and the LLF delayed 0.01, 5, 10, 20, 40, or 80 s in the other terminal link. An ABABA design varied food amount, 1 vs. 4 and 3 vs. 8 food-pellets in conditions A and B, respectively. The SHRs made more impulsive choices than the WKYs. The hyperbolic-decay model and the Generalized Matching Law fitted the data well. Discounting rate (k) and the area under the discounting curve (AUC) for the choices made by the SHRs in conditions A, were like those in conditions B. For the choices that the individual WKYs made, k was slightly higher and AUC smaller in conditions B than in conditions A. For both strains sensitivity to the immediacy of the LLF (s) was slightly higher in conditions A than in conditions B. Thus, we found no conclusive, compelling evidence either supporting or discarding the magnitude effect in the SHRs and scarce evidence supporting an effect opposite to the magnitude effect in the WKYs.

Mechanical Turk data collection in addiction research: utility, concerns and best practices

AIMS

Amazon Mechanical Turk (MTurk) provides a crowdsourcing platform for the engagement of potential research participants with data collection instruments. This review (1) provides an introduction to the mechanics and validity of MTurk research; (2) gives examples of MTurk research; and (3) discusses current limitations and best practices in MTurk research.

METHODS

We review four use cases of MTurk for research relevant to addictions: (1) the development of novel measures, (2) testing interventions, (3) the collection of longitudinal use data to determine the feasibility of longer-term studies of substance use and (4) the completion of large batteries of assessments to characterize the relationships between measured constructs. We review concerns with the platform, ways of mitigating these and important information to include when presenting findings.

RESULTS

MTurk has proved to be a useful source of data for behavioral science more broadly, with specific applications to addiction science. However, it is still not appropriate for all use cases, such as population-level inference. To live up to the potential of highly transparent, reproducible science from MTurk, researchers should clearly report inclusion/exclusion criteria, data quality checks and reasons for excluding collected data, how and when data were collected and both targeted and actual participant compensation.

CONCLUSIONS

Although on-line survey research is not a substitute for random sampling or clinical recruitment, the Mechanical Turk community of both participants and researchers has developed multiple tools to promote data quality, fairness and rigor. Overall, Mechanical Turk has provided a useful source of convenience samples despite its limitations and has demonstrated utility in the engagement of relevant groups for addiction science.

Contribution of alcohol- and cigarette-related cues to concurrent reinforcer choice in humans

Drug-related cues have been extensively studied for their contributions to decision-making processes involving drug consumption. Less studied is how drug-related stimuli may impact decisions involving outcomes not directly related to substance use. Studies using concurrent choice tasks have demonstrated that cocaine and cannabis cues result in robust and selective biases for monetary reinforcers contiguous with those cues. The purpose of this study was to provide a conceptual replication of these findings with alcohol and cigarettes. Participants recruited using crowdsourcing completed a cued concurrent choice task involving presentation of two cues (one drug and one neutral) followed by concurrent monetary offers below each image. Alcohol (Experiment 1; N = 103) and cigarette (Experiment 2; N = 256) visual cues were evaluated. Participants with hazardous alcohol use and current cigarette use showed greater-than-indifference selection for the alcohol- (p = .004) and cigarette-cued (p = .02) monetary choices, respectively. Qualitative responses indicated that the most popular rationale for responding was "image quality" despite images having no explicit impact on the reinforcer received. Low alcohol use (p = .03) and non-cigarette using controls (p < .001) showed an avoidance bias with lower-than-indifference selection for drug-cued choices. These findings replicate and extend observations that spatially contiguous drug-related cues can bias decisions involving concurrently presented non-drug reinforcers.

Narrative theory III: Evolutionary narratives addressing mating motives change discounting and tobacco valuation

Relationships between discounting and addictive behaviors have both state- and trait-based components. Evolutionarily driven motives may trigger risk-taking behaviors, and narratives might be used to alter the temporal window of reward valuation. The current investigation-in 2 separate studies-sought to understand the basic effects of narratives on smoking behavior by examining the effect of mating narratives on the discounting rates of cigarette smokers. Using data collected online, Study 1 (N = 132) assessed the within-individual effect of a mating narrative describing a long-term romantic relationship on rates of discounting after being randomly assigned to 1 of 2 narratives (romance or control) and Study 2 (N = 273) assessed the between-individual effect of 2 mating narratives (1 describing a long-term romantic relationship and 1 describing a short-term sexual encounter) on rates of discounting, craving, and cigarette valuation after being randomly assigned to 1 of 3 motivational narratives (romance, sex, or control). Reading the romance narrative decreased rates of discounting (i.e., increased preference for larger delayed rewards), compared to a control narrative (Studies 1 and 2). In contrast, reading the sexual narrative increased discounting (i.e., decreased preference for larger delayed rewards). Moreover, the romance narrative significantly decreased craving of cigarettes while the sexual narrative increased cigarette valuation (Study 2). These findings suggest that mating narratives may be useful in manipulating the temporal window of reward valuation, relevant for altering demand and craving, and may show potential as a component of future behavioral addiction interventions. Given the small effect sizes, replicating the study in future research will be beneficial. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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.

Demographic and sexual risk predictors of delay discounting of condom-protected sex

Objective: Sexual delay discounting describes the decreased likelihood of condom-protected sex if a condom is not immediately available, which can be quantitatively summarised using the Sexual Delay Discounting Task (SDDT). The present studies determined the extent to which condom use likelihood as assessed by the SDDT is associated with self-reported sexual risk behaviours and demographics in two online samples of adults. Design: Study 1 (n = 767) assessed demographics, sexual risk behaviour, and delay discounting, and examined relations between these variables using correlation and regression. Study 2 (n = 267) examined whether real-world instances of unprotected sex because a condom was not immediately available predicted greater sexual discounting. Main outcome measures: Sexual delay discounting, condom use. Results: Both studies observed significant positive relations between sexual delay discounting and self-reported sexual risk behaviours, and found that males tended to show greater sexual discounting. In Study 2, 46% of the sample self-reported having unprotected sex because a condom was not immediately available, and these individuals showed significantly greater sexual delay discounting. Conclusion: These results extend prior findings by demonstrating that delay is a critical variable underlying real-life sexual risk behaviour among non-clinical samples. The SDDT is an ecologically valid measure of these processes.

The drug purity discounting task: Ecstasy use likelihood is reduced by probabilistic impurity according to harmfulness of adulterants

BACKGROUND

Ecstasy typically contains adulterants in addition to, or in lieu of, MDMA which may pose a greater risk to users than MDMA itself. The current study aimed to evaluate the effectiveness of adulterant-related informational prompts in reducing Ecstasy use using a novel probability discounting task.

METHODS

An online sample of past-month Ecstasy users (N = 278) were randomized to one of four different framing prompt conditions: no prompt; a prompt describing MDMA's effects; a prompt describing adulterants as inert "filler"; or a prompt describing adulterants as pharmacologically-active, potentially-harmful compounds. Each prompt contained general, potential public-health information that was not specifically related to subsequent behavioral tasks. All participants then completed an identical Drug Purity Discounting Task, in which they indicated the likelihood of using a sample of Ecstasy across different probabilities of the sample being impure, and then completed a hypothetical Ecstasy purchasing task.

RESULTS

Likelihood of Ecstasy use decreased as impurity probability increased across conditions. Ecstasy use likelihood was highest in the "inert" prompt condition, whereas pharmacologically-active adulterant or adulterant-nonspecific prompts resulted in comparably low likelihood of use. Ecstasy-use likelihood did not differ among conditions when the likelihood of sample impurity was 0. Ecstasy purchasing did not differ among groups. Inelastic purchasing was associated with greater likelihood of using potentially-impure Ecstasy.

CONCLUSIONS

Altogether, these data highlight the necessity of education regarding pharmacologically-active, rather than inert, adulterants in Ecstasy, and suggest that increased access to drug checking kits and services may mitigate some of the harms associated with Ecstasy use.

Leveraging crowdsourcing methods to collect qualitative data in addiction science: Narratives of non-medical prescription opioid, heroin, and fentanyl use

BACKGROUND

Online crowdsourcing methods have proved useful for studies of diverse designs in the behavioral and addiction sciences. The remote and online setting of crowdsourcing research may provide easier access to unique participant populations and improved comfort for these participants in sharing sensitive health or behavioral information. To date, few studies have evaluated the use of qualitative research methods on crowdsourcing platforms and even fewer have evaluated the quality of data gathered. The purpose of the present analysis was to document the feasibility and validity of using crowdsourcing techniques for collecting qualitative data among people who use drugs.

METHODS

Participants (N = 60) with a history of non-medical prescription opioid use with transition to heroin or fentanyl use were recruited using Amazon Mechanical Turk (mTurk). A battery of qualitative questions was included indexing beliefs and behaviors surrounding opioid use, transition pathways to heroin and/or fentanyl use, and drug-related contacts with structural institutions (e.g., health care, criminal justice).

RESULTS

Qualitative data recruitment was feasible as evidenced by the rapid sampling of a relatively large number of participants from diverse geographic regions. Computerized text analysis indicated high ratings of authenticity for the provided narratives. These authenticity percentiles were higher than the average of general normative writing samples as well as than those collected in experimental settings.

CONCLUSIONS

These findings support the feasibility and quality of qualitative data collected in online settings, broadly, and crowdsourced settings, specifically. Future work among people who use drugs may leverage crowdsourcing methods and the access to hard-to-sample populations to complement existing studies in the human laboratory and clinic as well as those using other digital technology methods.

Evaluating the effect of delay spacing on delay discounting: carry-over effects on steepness and the form of the discounting function

Most delay discounting studies use tasks that arrange delay progressions in which the spacing between consecutive delays becomes progressively larger. To date, little research has examined delay discounting using other progressions. The present study assessed whether the form or steepness of discounting varied across different delay progressions. Human participants completed three discounting tasks with delay progressions that varied in the time between consecutive delays: a standard (increasing duration between delays), linear (equal duration between delays), and an inverse progression (decreasing duration between delays). Steepness of discounting was generally reduced, and remained so, following experience with the inverse progression. Effects of the delay progression on the best fitting equation were order-dependent. Overall the hyperbola model provided better fits, but the exponential model performed better with data from the inverse progression. Regardless, differences in which model fit best were often small. The finding that the best fitting model was dependent, in some cases, on the delay progression suggests that a single quantitative model of discounting may not be applicable to describe discounting across all procedural contexts. Ultimately, changes in steepness of discounting following experience with the inverse progression appeared similar to anchoring effects, whose mechanism will require further study to delineate.

Demand characteristics in episodic future thinking II: The role of cues and cue content in changing delay discounting

Episodic future thinking (EFT), or imagining experiencing one's future, reduces discounting of future rewards, but the mechanisms of this effect are unclear. We examined the role of cues to engage in EFT, possible demand characteristics inherent to those cues (prompting awareness of the hypothesized effects of EFT), and changes in temporal horizon (how far one thinks into the future) in these reductions in delay discounting. In Experiment 1, cues prompting participants to engage in EFT during the discounting task were presented or withheld: EFT decreased discounting only when cues were present. In a time-perspective task in which cues were not presented, EFT did not broaden temporal horizon; however, episodic recent thinking (the putative control activity) shortened temporal horizons. In Experiment 2, cues were manipulated in a way designed to make them either more theoretically relevant (prompting episodic thought) or more prone to demand characteristics (prompting attention to the correspondence in delays between EFT and discounting tasks). Only theoretically relevant cues reduced delay discounting. These results do not support the hypothesis that EFT reduces delay discounting because of demand characteristics. Instead, they suggest limitations on the generalizability of EFT effects in uncued contexts and suggest that mechanisms other than temporal horizon may be responsible for its effects. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Using behavioral economic variables to predict future alcohol use in a crowdsourced sample

BACKGROUND

Theoretical perspectives at the intersection of behavioral economics and operant theory have resulted in numerous advances for addiction science. Three mechanisms (i.e. behavioral economic demand [consumption-price relationships], delay discounting [reinforcer devaluation with delay], and proportionate alcohol-related reinforcement [relative reinforcement attributable to alcohol]) are proposed to contribute to problematic alcohol use. Limited research has evaluated the unique contribution of these mechanisms for predicting future alcohol consumption.

AIM

The purpose of this study was to evaluate the predictive relationship between these mechanisms and self-reported alcohol use frequency, quantity, and severity.

METHODS

Participants (n=223) sampled from the crowdsourcing website Amazon Mechanical Turk completed a survey containing behavioral economic measures. Weekly reports of daily alcohol use were then collected for 18 weeks. Unadjusted and adjusted models determined the association between behavioral economic variables and alcohol use.

RESULTS/OUTCOMES

Behavioral economic measures were associated with alcohol and soda use at baseline in a stimulus-selective manner (e.g. alcohol demand associated with alcohol, but not soda, variables). Predictive models adjusted for Alcohol Use Disorder Identification Test scores indicated that increased proportionate alcohol-related reinforcement and behavioral economic demand were uniquely and incrementally associated with frequency (e.g. adjusted odds ratio (AOR)=5.54 for proportionate alcohol-related reinforcement, p<0.05) and quantity-severity measures (e.g. AOR=7.58 for alcohol demand intensity, p<0.001), respectively. Test-retest reliability was generally acceptable (r_xx=0.42-0.76) with the exception of proportionate alcohol-related reinforcement (r_xx=0.29).

CONCLUSION/INTERPRETATION

These findings indicate the unique, predictive, and incremental validity of behavioral economic measures for evaluating future alcohol consumption, supporting their continued use in addiction science research.

Contribution of cannabis-related cues to concurrent reinforcer choice in humans

BACKGROUND

Drug-related cues play a critical role in the development and persistence of substance use disorder. Few human laboratory studies have evaluated how these cues contribute to decisions between concurrently presented reinforcers, and none have examined the specific role of cannabis cues. This study evaluated the contribution of cannabis-related cues to concurrent monetary reinforcer choice in humans.

METHODS

Participants with a cannabis use history (i.e., use in the past two weeks and 50 or more lifetime uses; n = 71) and controls without this history (i.e., 5 or less lifetime uses; n = 79) were recruited using Amazon Mechanical Turk. A cued concurrent choice task was used in which cannabis trials presented two cues (one cannabis and one neutral) side-by-side followed by concurrent monetary offers below each image. The primary dependent measure was choice for cannabis-cued monetary reinforcers on equal value trials. Secondary analyses evaluated individual difference variables related to choice bias.

RESULTS

Participants in the cannabis group showed a significant bias for cannabis-cued choices (mean 76.0%) whereas participants in the control group showed a significant bias against cannabis-cued choices (mean 30.3%). Reaction times on cannabis trials were faster than neutral filler trials and did not differ by group. Cannabis-cued choice was significantly associated with more frequent cannabis use (r = .44), higher cannabis demand intensity (r = .28), and lower cannabis elasticity (r = -.30).

CONCLUSIONS

These findings suggest that cannabis-related cues can influence reinforcer choice and potentially promote disadvantageous decision-making related to non-drug reinforcers.

Influence of Electronic Cigarette Characteristics on Susceptibility, Perceptions, and Abuse Liability Indices among Combustible Tobacco Cigarette Smokers and Non-Smokers

This study assessed how electronic cigarette (ECIG) characteristics amenable to regulation-namely nicotine content, flavor, and modified risk messages-impact ECIG use susceptibility, harm/addiction perceptions, and abuse liability indices among combustible tobacco cigarette (CTC) smokers and non-smokers. CTC smokers and non-smokers varying in ECIG use recruited via Amazon Mechanical Turk (MTurk) completed an online survey in 2016 (analytic n = 706). Participants were randomly assigned to one of eight conditions differing in ECIG characteristics: nicotine content (no, low, high), flavor (menthol, tobacco, fruit), or modified risk message (reduced harm, reduced carcinogen exposure). Regressions assessed ECIG susceptibility, harm/addiction perceptions, and abuse liability indices (purchase task measures of breakpoint/intensity) within each regulatory domain (nicotine content, flavor, message) and their interactions with CTC/ECIG status. Differential effects on ECIG susceptibility, harm/addiction perceptions, and abuse liability indices were observed by regulatory domain with many effects moderated by CTC/ECIG status. ECIG nicotine content and flavor conditions were the most influential across outcomes. Greater nicotine content, tobacco-flavored and reduced carcinogen exposure ECIGs were more highly preferred by CTC smokers with some differing preferences for non-users. Findings reinforce consideration of discrete ECIG preferences across tobacco use status to improve regulatory efficacy.

Reliability and validity of the Brief DSM-5 Alcohol Use Disorder Diagnostic Assessment: A systematic replication in a crowdsourced sample

Effectively and efficiently identifying alcohol use disorder (AUD) is an essential goal for researchers and clinicians alike. To date, there are a limited number of self-reported tools specifically designed for evaluating DSM-5 criteria for AUD. The Brief DSM-5 AUD Diagnostic Assessment is a recently created participant self-reported measure with demonstrated reliability and validity in college student populations. The purpose of this study was to replicate and extend these findings by evaluating the psychometric properties of the Brief DSM-5 AUD Diagnostic Assessment in a geographically diverse adult sample with varying alcohol use history. Participants (N = 1986) were sampled from the crowdsourcing website Amazon Mechanical Turk (mTurk). The Brief DSM-5 AUD Diagnostic Assessment was completed to evaluate scale reliability and validity. A subset of individuals with answers indicative of AUD (N = 448) also completed a battery of standardized alcohol use questionnaires for additional validity assessments. High internal consistency reliability was observed (α = 0.92) along with strong item-total correlations. Convergent validity was supported by significant positive relationships between diagnostic category and measures of alcohol use consumption and severity. Modest relationships that were generally not statistically significant were observed with soda use measures supporting discriminant validity. AUD severity remained a significant predictor of alcohol use measures after accounting for AUDIT scores, thereby establishing incremental validity. These findings collectively support the Brief DSM-5 AUD Diagnostic Assessment as a reliable, valid, and rapid self-report tool for evaluating DSM-5 AUD in diverse research and clinical settings.

Feasibility, Acceptability, and Initial Efficacy of Delivering Alcohol Use Cognitive Interventions via Crowdsourcing

BACKGROUND

Inhibitory control training and working memory training are 2 cognitive interventions that have been considered for alcohol use disorder (AUD). Existing studies have typically relied on small samples that preclude the evaluation of small effects. Crowdsourcing is a sampling method that can address these limitations by effectively and efficiently recruiting large samples with varying health histories. This study tested the feasibility and acceptability of delivering cognitive training interventions via crowdsourcing.

METHODS

Participants with AUD were recruited from the crowdsourcing website Amazon Mechanical Turk (mTurk) (ClinicalTrials.gov; NCT03438539). Following completion of a baseline survey, participants were randomized to an inhibitory control, working memory, or control training condition. Participants were asked to complete training tasks daily over a 2-week period. Follow-up assessments evaluating acceptability measures and alcohol and soda consumption were completed immediately following and 2 weeks after training.

RESULTS

Response rates were satisfactory over the 2-week intervention period (65% of training tasks completed), and performance on training tasks was consistent with expected effects. A majority of participants indicated that they were satisfied with the study procedures (94.6%), would participate again (97.4%), and would consider incorporating the training task in their daily life (81.1%). Modest reductions in alcohol consumption were observed (e.g., 0.5 drinking day/wk), primarily in the inhibitory control group, and these effects were selective to alcohol use and did not extend to soda consumption.

CONCLUSIONS

These findings demonstrate the feasibility and acceptability of utilizing crowdsourcing methods for interventions development. Such a demonstration helps establish the crowdsourcing setting for future large sample studies testing novel interventions for AUD and other substance use disorders.

Effects of Acceptance and Commitment Therapy on Impulsive Decision-Making

This study examined the transdiagnostic effect of acceptance and commitment therapy (ACT) on impulsive decision-making in a community sample. A total of 40 adults were randomized to eight individual sessions of ACT or an inactive control. Participants completed pre-, mid-, and post-assessments for psychological symptoms; overall behavior change; valued living; delay discounting; psychological flexibility; and distress tolerance. Data were analyzed with multilevel modeling of growth curves. Significant interaction effects of time and condition were observed for psychological flexibility, distress tolerance, psychological symptoms, and the obstruction subscale of valued living. No significant interaction effect was found for two delay discounting tasks nor the progress subscale of valued living. The ACT condition had a significantly larger reduction of problem behavior at post-assessment. The results support use of ACT as a transdiagnostic treatment for impulsive behaviors. The lack of change in delay discounting contrasts previous research.

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).

Past and future preference reversals are predicted by delay discounting in smokers and non-smokers

Delay discounting, the devaluation of delayed reinforcers, is one defining behavioral economic characteristic of cigarette smokers. Attempts at abstinence by smokers that result in relapse are conceptualized in this framework as preference reversals. Despite preference reversals being predicted by delay discounting models, little research has investigated the association between discount rate and preference reversals. The present study extended this research by examining the relation between discounting and preference reversals. Because previous research indicates that cigarette smokers discount at higher rates than controls and that past and future discounting are symmetrical, the present study assessed the relation between these two processes when hypothetical money was distanced in the past and future, respectively. These assessments of delay discounting and preference reversals were adapted from Yi, Matusiewicz, and Tyson (2016) and examined in 68 smokers and 68 nonsmokers using the crowdsourcing program Amazon Mechanical Turk. Smokers discounted both past and future hypothetical money more steeply than demographically matched controls. Smokers switched preference from the smaller-sooner (SS) to the larger-later (LL) outcome more slowly than nonsmokers, consistent with smokers' steeper delay discounting. For each group, significant positive correlations between past and future discount rates and past and future preference reversals was obtained. The overall pattern of results illustrate symmetry between past and future discounting and preference reversals, respectively and that discount rate is positively associated with the timing of preference reversals. Importantly, the results confirm that cigarette smokers discount more and reverse preference from a SS to a LL reward later than controls. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sexual Probability Discounting: A Mechanism for Sexually Transmitted Infection Among Undergraduate Students

Lack of condom use among youth is a major contributor to the spread of sexually transmitted infections (STIs) including HIV/AIDS, which has lifelong deleterious health consequences. College students (N = 262) completed the Sexual Probability Discounting Task in which participants reported their likelihood of condom use under various probabilities of contracting an STI. Each participant completed the task in regard to different STIs including HIV/AIDS and different partners. Results showed that the likelihood of condom-protected sex generally decreased as HIV/AIDS and other STI contraction became less probable. Moreover, condom-protected sex likelihood was related to STI type (e.g., decreased condom-protected sex in chlamydia relative to HIV/AIDS condition) and partner desirability (decreased condom-protected sex with more desirable partners). Results are the first to show that compared to other STIs, HIV/AIDS had the most influence on condom-protected sex. Results showed probability discounting contributed to lack of condom-protected sex and offers a novel framework for examining determinants of within-subject variability in condom use.

Young adult dual combusted cigarette and e-cigarette users' anticipated responses to hypothetical e-cigarette market restrictions

Introduction: The aim of this exploratory study was to assess young adult dual e-cigarette (EC) and combusted cigarette (CC) users' anticipated responses to hypothetical market restrictions regarding key EC characteristics. Methods: Data came from 240 young adult dual EC and CC users recruited via Amazon Mechanical Turk in June 2017. Descriptive statistics were used to report sociodemographic, CC smoking, and EC use characteristics. McNemar's chi-square tests and chi-square tests were used to assess differences between groups in terms of anticipated responses to hypothetical EC market restrictions. Results: Hypothetical regulations resulted in reported intentions to reduce EC use and increase CC use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor and ability to modify EC devices. Moreover, individuals reporting use of flavored e-liquid, high nicotine content e-liquid, and customizable EC were most likely to report intentions to reduce EC use and increase CC use. Conclusions: This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.

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.

Adverse Childhood Experiences, Tobacco Use, and Obesity: A Crowdsourcing Study

Background: Exposure to adverse childhood experiences (ACEs) increases health risk behavior in adulthood and is a risk for premature mortality. For example, ACEs are associated with both tobacco smoking and obesity, which remain significant health challenges for many adults, despite widespread knowledge about the risks. Objective: The present investigation used a novel online crowdsourcing platform (Amazon.com mechanical turk) to study the relationship between ACEs and later tobacco smoking and obesity. Methods: Participants were recruited based on smoking (n = 74 smokers; n = 75 nonsmokers) and stratified based on obesity (n = 52 BMI ≥ 30; n = 97 BMI < 30). Participants had no recent history of other substance use, except alcohol. The relationship between ACE score and smoking and obesity categories was analyzed using logistic regression. Results: The average age of the sample was 38.6-years old and was mostly female (66.4%), employed (82.6%) and college educated (63.1%). Those with 4+ ACEs had a significantly greater odds of cigarette use. Any ACEs exposure was associated with a significantly greater odds of obesity. Conclusions/Importance: Findings are concordant with previous studies and suggest crowdsourcing is a viable platform for studying ACEs and health behavior. Access to large samples and specific populations provided by crowdsourcing could help examine theoretical models about how exposure to ACEs could be connected to later adoption of high-risk behaviors such as tobacco cigarette smoking and obesity.

Young adult dual combusted cigarette and e-cigarette users' anticipated responses to a nicotine reduction policy and menthol ban in combusted cigarettes

BACKGROUND

The aim of the study was to assess young adult dual e-cigarette (EC) and combusted cigarette (CC) users' anticipated responses to a hypothetical very low nicotine content product standard and menthol ban in CC.

METHODS

Data came from 240 young adult (18-29 years) dual CC and EC users recruited via Amazon Mechanical Turk between June 20-22, 2017. Descriptive statistics were used to report sample characteristics. McNemar's tests were used to assess differences between product categories in terms of anticipated responses to hypothetical regulations.

RESULTS

A hypothetical very low nicotine content product standard in CC resulted in reported intentions to quit or reduce CC use and increase use of EC (p's<0.001). Hypothetical restrictions regarding the availability of menthol CC resulted in marginally significant reported intentions to increase EC use (p = 0.080). Anticipated responses to regulation were associated with baseline EC and CC use characteristics.

CONCLUSIONS

This work provides preliminary evidence of the impact that regulations regarding nicotine content and menthol in CC may have on the use of EC among young adult dual users.

The treasure of now and an uncertain future: Delay discounting and health behaviors among cancer survivors

BACKGROUND

The identification of new therapeutic targets to improve health behaviors among cancer survivors (CS) is likely to improve cancer treatment outcomes. Delay discounting (DD) rate is the degree to which one devalues rewards as a function of time to receipt. Lower DD rates (ie, prioritizing long-term over immediate rewards) are associated with healthier behaviors. CS often experience distress and thoughts of early mortality that can potentially shift priorities to the present and negatively impact DD rates, especially when newly diagnosed. Understanding relations between DD and health behaviors among CS will contribute to the examination of DD as a therapeutic target for improving health behaviors for CS.

METHOD

CS (n = 1001) were recruited from a web panel and administered a web-based questionnaire. Multivariate models examined relations among DD rate, years since diagnosis, and 10 health behavior indicators. We hypothesized that 1) higher DD rates would be associated with fewer years since diagnosis, and 2) lower DD rates would be associated with healthier behaviors, moderated by years since diagnosis.

RESULTS

In general, higher DD rates were associated with fewer years since diagnosis. Higher DD rates were associated with more alcohol consumption, cigarette smoking, other tobacco use, tanning booth use, and conversely, greater adherence to annual primary care visits. A significant interaction between DD rate and years since diagnosis was not found.

CONCLUSION

Lower DD rates are associated with several important healthy lifestyle behaviors. DD rate is a promising therapeutic target for new interventions to improve multiple health behaviors among CS.

Perceived risk of developing smoking-related disease among persons living with HIV

Perceived risk of smoking is associated with smoking status, interest in quitting, cessation attempts, and quit success. Research is needed to explore risk perceptions of developing smoking-related disease among persons living with HIV (PLWH). Data came from 267 HIV-positive smokers who completed an online survey assessing perceived health risks associated with (a) generic smoking status; (b) generic non-smoking status; (c) their own personal current smoking; and (d) a hypothetical situation in which they were a non-smoker. PLWH perceived greater risk associated with their current smoking versus hypothetical personal non-smoking (p's < 0.001), and greater risks associated with generic smoking status compared with their current smoking (p's < 0.001). Being on HIV medication (β = 0.65, 95% CI = 0.17, 1.12), interest in quitting smoking (β = 0.89, 95% CI = 0.45, 1.32), and having an HIV healthcare provider who has recommended cessation (β = 1.04, 95% CI = 0.42, 1.67) were positively associated with perceived risk of developing smoking-related diseases. Findings have implications for developing targeted interventions to correct misperceptions regarding the health risks of smoking among PLWH, a population at particular risk for smoking and smoking-related morbidity and mortality.

Choosing the right delay-discounting task: Completion times and rates of nonsystematic data

A variety of delay discounting tasks are widely used in human studies designed to quantify the degree to which individuals discount the value of delayed rewards. It is currently unknown which task(s) yields the largest proportion of valid and systematic data using standard criteria (Johnson & Bickel, 2008). The goal of this study was to compare three delay-discounting tasks on task duration and amount of valid and systematic data produced. In Experiment 1, 180 college students completed one of three tasks online (fixed alternatives, titrating, or visual analogue scale [VAS]). Invalid and nonsystematic data, identified using standard criteria, were most prevalent with the VAS (47.3% of participants). The other tasks produced more (and similar amounts of) valid and systematic data, but required more time to complete than the VAS. Viewing systematic data as more important than completion times, Experiment 2 (n = 153 college students) sought to reduce the amount of invalid datasets in the fixed-alternatives task, and compare amounts of nonsystematic data with the titrating task. Completion times were superior in the titrating task, which produced modestly more systematic data than the fixed-alternatives task. Causes of invalid and nonsystematic data are discussed, as are methods for reducing data exclusion.