The temporal window of valuation is constricted among adolescent smokers

Application of behavioral economics for understanding health behaviors among adolescents and young adults

PURPOSE OF REVIEW

Behavioral economics (BE) concepts have become well studied tools in addressing patient issues, such as weight loss, smoking cessation, and medication adherence. Although predominantly studied in adult populations, emerging literature has shown BE's utility for adolescent/young adult (AYA) populations, offering a practical framework to safeguard AYA health and influence healthy decision making.

RECENT FINDINGS

We identified substantive areas in which BE concepts have been applied in AYA populations (e.g., substance use) and outline how these concepts have been used as a tool to identify individuals at risk for poor outcomes and to leverage behavioral insights to improve health behaviors.

SUMMARY

BE research holds significant promise as a tool for clinicians and researchers to encourage healthy decision making in AYA populations. Yet, there are opportunities for BE research to expand further into current trends impacting adolescent health, such as electronic nicotine delivery systems, social media apps, and coronavirus disease 2019 vaccinations. Furthermore, the full degree of BE utility remains to be explored, as few studies demonstrate the translation of associative findings into direct interventions. Additional work is needed to formalize BE techniques into best practices that clinicians can implement in their daily practice.

Discounting, Cognitive Inflexibility, and Antisocial Traits as Predictors of Adolescent Drug Involvement

Cognitive impairments, such as steep delay discounting, have been correlated with substance-related disorders. However, antisocial traits, cognitive inflexibility, and loss discounting have been barely considered despite having a high relationship with problematic consumption. This study aims to identify the predictive power of these variables in four types of drug use. Fifty-two adolescents (age range of 13 to 19 years) were assessed with a substance involvement test, four discounting tasks using $3,000, a card sorting test, and antisocial screening. Discriminant analysis with simultaneous estimation and varimax rotation was carried out. Function one included discounting of both losses, function two AT and CI, and function three probabilistic gains. The three functions explained 60.1% of the variance. The results show that preference for small and soon punishments and larger and unlikely punishments distinguished non-use and experimental use of moderate consumption and problematic consumption. High antisocial traits and low cognitive inflexibility distinguished experimental use groups of non-use. Risk-taking did not discriminate effectively between moderate consumption and problematic consumption. A replication of this study with a larger sample size is recommended to verify the results.

Behavioral economic demand and delay discounting are differentially associated with cigarette dependence and use in adolescents

INTRODUCTION

The Reinforcer Pathology Model describes how two behavioral economic processes, increased sensitivity to immediate rewards (delay discounting) and excessive reward derived from a substance (demand), both contribute to problematic patterns of substance use. In a novel application of this model, the current cross-sectional study examined how these distinct processes relate to different facets of cigarette use in adolescents.

METHODS

Adolescent daily cigarette smokers ages 15 to 19 (Mean age 17.7, N = 50) completed a laboratory assessment of demand using a Cigarette Purchase Task for their usual brand cigarettes and an adjusting-amount delay discounting task. Demand was conceptualized as two factors (Amplitude and Persistence) and delay discounting was calculated as Area Under the Curve (log AUC). The two factors of demand and discounting AUC were included as statistical predictors of level of cigarette dependence and average number of cigarettes smoked per day in linear regression models.

RESULTS

Amplitude of demand was marginally significant predictor (p = .06) of cigarettes smoked per day whereas neither Persistence of demand nor delay discounting significantly predicted this outcome. Both Amplitude of demand and delay discounting, but not Persistence, were associated with level of cigarette dependence. The effects of amplitude of demand and delay discounting on cigarette dependence or use did not significantly interact.

CONCLUSIONS

Results of this study suggest that amplitude of cigarette demand may be a risk factor for both cigarette consumption and dependence, while discounting - a known risk factor for cigarette initiation - may relate specifically to level of dependence.

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).