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Gaalema DE, Khadanga S, Savage PD, Yant B, Katz BR, DeSarno M, Ades PA. Improving Cardiac Rehabilitation Adherence in Patients With Lower Socioeconomic Status: A Randomized Clinical Trial. JAMA Intern Med 2024:2821357. [PMID: 39037811 PMCID: PMC11264079 DOI: 10.1001/jamainternmed.2024.3338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/27/2024] [Indexed: 07/24/2024]
Abstract
Importance Participation in cardiac rehabilitation is associated with significant decreases in morbidity and mortality. Despite the proven benefits, cardiac rehabilitation is severely underutilized in certain populations, specifically those with lower socioeconomic status (SES). Objective To assess the efficacy of early case management and/or financial incentives for increasing cardiac rehabilitation adherence among patients with lower SES. Design, Setting, and Participants This randomized clinical trial enrolled patients from December 2018 to December 2022. Participants were followed up for 1 year with assessors and cardiac rehabilitation staff blinded to study condition. Patients with lower SES with a cardiac rehabilitation-qualifying diagnosis (myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention, heart valve replacement/repair, or stable systolic heart failure) were recruited. Then patients attended one of 3 cardiac rehabilitation programs at 1 university or 2 community-based hospitals. A consecutively recruited sample was randomized and stratified by age (<57 vs ≥57 years) and smoking status (current smoker vs nonsmoker or former smoker). Intervention Participants were randomized 2:3:3:3 to either a usual care control, case management starting in-hospital, financial incentives for completing cardiac rehabilitation sessions, or both interventions (case management plus financial incentives). Interventions were in place for 4 months following informed consent. Main Outcomes and Measures The main outcome was cardiac rehabilitation adherence (proportion of patients completing ≥30 sessions). The a priori hypothesis was that interventions would improve adherence, with the combined intervention performing best. Results Of 314 individuals approached, 11 were ineligible, and 94 declined participation. Of the 209 individuals who were randomized, 17 were withdrawn. A total of 192 individuals (67 [35%] female; mean [SD] age, 58 [11] years) were included in the analysis. Interventions significantly improved cardiac rehabilitation adherence with 4 of 36 (11%), 13 of 51 (25%), 22 of 53 (42%), and 32 of 52 (62%) participants completing at least 30 sessions in the usual care, case management, financial incentives, and case management plus financial incentives conditions, respectively. The financial incentives and case management plus financial incentives conditions significantly improved cardiac rehabilitation adherence vs usual care (adjusted odds ratio [AOR], 5.1 [95% CI, 1.5-16.7]; P = .01; AOR, 13.2 [95% CI, 4.0-43.5]; P < .001, respectively), and the case management plus financial incentives condition was superior to both case management or financial incentives alone (AOR, 5.0 [95% CI, 2.1-11.9]; P < .001; AOR, 2.6 [95% CI, 1.2-5.9]; P = .02, respectively). Interventions were received well by participants: 86 of 105 (82%) in the financial incentives conditions earned at least some incentives, and 96 of 103 participants (93%) assigned to a case manager completed the initial needs assessment. Conclusion and Relevance In this randomized clinical trial, financial incentives improved cardiac rehabilitation adherence in a population with higher risk and lower SES with additional benefit from adding case management. Trial Registration ClinicalTrials.gov Identifier: NCT03759873.
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Affiliation(s)
- Diann E. Gaalema
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston
| | - Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington
| | - Patrick D. Savage
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington
| | - Blair Yant
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Brian R. Katz
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Michael DeSarno
- Biomedical Statistics Research Core, University of Vermont, Burlington
| | - Philip A. Ades
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington
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Browning L, Cannoy CN, Moses TEH, Lundahl LH, Ledgerwood DM, Greenwald MK. Attention-deficit/hyperactivity disorder combined subtype exacerbates opioid use disorder consequences: Mediation by impulsive phenotypes. Drug Alcohol Depend 2024; 259:111292. [PMID: 38640865 PMCID: PMC11111336 DOI: 10.1016/j.drugalcdep.2024.111292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/28/2024] [Accepted: 04/06/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent and associated with opioid use disorder (OUD). Yet, little is known about the mechanisms by which ADHD (which is a heterogeneous construct/diagnosis) might alter the trajectory of OUD outcomes in persons who use heroin. AIM We examined whether ADHD subtypes are related to heroin-use consequences and the extent to which the effects of ADHD on lifetime heroin-use consequences are mediated by two impulsivity factors that may be partly independent of ADHD: foreshortened time perspective and drug-use impulsivity. METHODS Individuals who reported regular heroin use (N=250) were screened using the Assessment of Hyperactivity and Attention (AHA), Impulsive Relapse Questionnaire (IRQ), Stanford Time Perception Inventory (STPI), and a comprehensive assessment of lifetime and current substance use and substance-related consequences. This secondary analysis examined whether ADHD or intermediate phenotypes predicted heroin-use consequences. RESULTS Relative to participants whose AHA scores indicated lifetime absence of ADHD (n=88), those with scores indicating persistent ADHD (childhood and adult, n=62) endorsed significantly more total lifetime heroin-use consequences despite comparable heroin-use severity. Likewise, there was a significant indirect effect of the combined ADHD subtype in childhood on lifetime heroin-use consequences. This effect was mediated by STPI scores indicating less future (and more hedonism in the present) temporal orientation and by IRQ scores indicating less capacity for delaying drug use. CONCLUSION The combined ADHD subtype is significantly associated with lifetime heroin-use consequences, and this effect is mediated through higher drug-use impulsivity (less capacity for delay) and lower future temporal orientation.
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Affiliation(s)
- Liam Browning
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ciara N Cannoy
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tabitha E H Moses
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Leslie H Lundahl
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - David M Ledgerwood
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mark K Greenwald
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
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3
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Basso JC, Satyal MK, McKee KL, Lynn S, Gyamfi D, Bickel WK. Dissociation and other trauma symptomatology are linked to imbalance in the competing neurobehavioral decision systems. Front Psychol 2024; 14:1317088. [PMID: 38356995 PMCID: PMC10864435 DOI: 10.3389/fpsyg.2023.1317088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024] Open
Abstract
Objective Dissociation is a conscious state characterized by alterations in sensation and perception and is thought to arise from traumatic life experiences. Previous research has demonstrated that individuals with high levels of dissociation show impairments in cognitive-emotional processes. Therefore, using the Competing Neurobehavioral Decisions System (CNDS) theory, we used statistical modeling to examine whether dissociative experience and trauma symptoms are independently predicted by impulsivity, risk-seeking, affective state (i.e., anxiety, depression, stress, and negative affect), and trauma history. Method In this cross-sectional study design, data were collected via Amazon Mechanical Turk from a total of n = 557 English-speaking participants in the United States. Using Qualtrics, participants answered a series of self-reported questionnaires and completed several neurocognitive tasks. Three independent multiple linear regression models were conducted to assess whether impulsivity, risk seeking, affective state, and trauma history predict depersonalization, trauma symptoms, and PTSD symptoms. Results As hypothesized, we found that depersonalization and other trauma symptoms are associated with heightened impulsivity, increased risk-seeking, impaired affective states, and a history of traumatic experiences. Conclusion We demonstrate that an imbalanced CNDS (i.e., hyperimpulsive/hypoexecutive), as evidenced by decreased future valuation, increased risk seeking, and impaired affective states, predicts heightened depersonalization and other trauma and PTSD symptomatology. This is the first time that dissociation has been connected to delay discounting (i.e., the tendency to place more value on rewards received immediately compared to farther in the future). Interventions that positively impact areas of the CNDS, such as episodic future thinking or mindfulness meditation, may be a target to help decrease dissociative symptoms.
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Affiliation(s)
- Julia C. Basso
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - Medha K. Satyal
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Kevin L. McKee
- Center for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, United States
| | - Sarah Lynn
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Daphne Gyamfi
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Warren K. Bickel
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA, United States
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4
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Bolton D. A revitalized biopsychosocial model: core theory, research paradigms, and clinical implications. Psychol Med 2023; 53:7504-7511. [PMID: 37681273 PMCID: PMC10755226 DOI: 10.1017/s0033291723002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/31/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
The biopsychosocial model (BPSM) was proposed by George Engel in 1977 as an improvement to the biomedical model (BMM), to take account of psychological and social as well as biological factors relevant to health and disease. Since then the BPSM has had a mixed reputation, as the overarching framework for psychiatry, perhaps for medicine generally, while also being criticized for being theoretically and empirically vacuous. Over the past few decades, substantial evidence has accumulated supporting the BPSM but its theory remains less clear. The first part of this paper reviews recent well-known, general theories in the relevant sciences that can provide a theoretical framework of the model, constituting a revitalized BPSM capable of theorizing causal interactions within and between biological, psychological, and social domains. Fundamental concepts in this new framework include causation as regulation and dysfunction as dysregulation. Associated research paradigms are outlined in Part 2. Research in psychological therapies and social epidemiology are major examples of programs that have produced results anomalous for the BMM and consistent with the BPSM. Theorized models of causal mechanisms enrich empirical data and two biopsychosocial examples are models of chronic stress and pain perception. Clinical implications are reviewed in Part 3. The BPSM accommodates psychological and social as well as biological treatment effects evident in the clinical trials literature. Personal, interpersonal, and institutional aspects of clinical care are out of the scope of the BMM, assigned to the art of healthcare rather than the science, but can be accommodated and theorized in the BPSM.
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Affiliation(s)
- Derek Bolton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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5
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Epstein LH, Rizwan A, Paluch RA, Temple JL. Delay Discounting and the Income-Food Insecurity-Obesity Paradox in Mothers. J Obes 2023; 2023:8898498. [PMID: 37766882 PMCID: PMC10522429 DOI: 10.1155/2023/8898498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Food insecurity, defined as unpredictable access to food that may not meet a person's nutritional needs, is paradoxically associated with higher BMI (kg/m2) and obesity. Research has shown delay discounting, a behavioral economic measure of the preference for immediate rather than delayed rewards, is related to higher BMI, and moderates the relationship between income and food insecurity. Based on this research, we used regression models to test whether delay discounting, consideration of future consequences, and perceived stress were atemporal mediators of the food insecurity-BMI relation in 313 mothers, controlling for demographic variables. A secondary aim was to replicate the finding that delay discounting moderates the relationship between low income and high food insecurity. Results showed that low income was associated with higher food insecurity, and higher food insecurity was associated with higher BMI. Delay discounting was the only variable that was indirectly related to both paths of the food-insecurity-BMI relation. Delay discounting accounted for 22.2% of the variance in the low-income-food insecurity-obesity relation, and the total model accounted for 38.0% of the variance. The relation between low income and food insecurity was moderated by delay discounting. These data suggest that delay discounting is a potential mediator of the relationship between food insecurity and high BMI, which suggests reducing discounting in the future could be a novel target to reduce food insecurity and help people with food insecurity to reduce their excess body weight. Trial Registration. This trial is registered with NCT02873715.
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Affiliation(s)
- Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Ashfique Rizwan
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rocco A. Paluch
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jennifer L. Temple
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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Chichetto NE, Gebru NM, Plankey MW, Tindle HA, Koethe JR, Hanna DB, Shoptaw S, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Adimora AA, Lahiri CD, Wise JM, Freiberg MS. Syndemic trajectories of heavy drinking, smoking, and depressive symptoms are associated with mortality in women living with HIV in the United States from 1994 to 2017. Drug Alcohol Depend 2023; 249:110838. [PMID: 37352734 PMCID: PMC10726291 DOI: 10.1016/j.drugalcdep.2023.110838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Heavy drinking, smoking, and depression are common among people with HIV. Little is known about the co-occurring, synergistic effect of having two or more of these conditions long-term -a sustained syndemic - on mortality among women with HIV (WWH). METHODS Data from 3282 WWH of the Women's Interagency HIV Study from 1994 to 2017 were utilized. National Death Index review identified cause of death (n=616). Sustained syndemic phenotypes were based on membership in high-risk groups defined by group-based trajectory models of repeated self-reported alcohol use, smoking, and depressive symptoms and their co-occurrence. Cox proportional hazard models estimated associations of sustained syndemic phenotypes with all-cause, non-AIDS, and non-overdose mortality, adjusting for age, race/ethnicity, education, enrollment wave, illicit drug use, and time-varying HIV viral load and CD4+ T-cell count. RESULTS WWH were 58% Black and 26% Hispanic, with a mean baseline age of 36.7 years. Syndemic phenotypes included zero (45%, n=1463), heavy drinking only (1%, n=35), smoking only (28%, n=928), depressive symptoms only (9%, n=282), and 2+ trajectories (17%, n=574). Compared to zero trajectories, having 2+ trajectories was associated with 3.93 times greater all-cause mortality risk (95% CI 3.07, 5.04) after controlling for confounders and each high-risk trajectory alone. These findings persisted in sensitivity analyses, removing AIDS- and overdose-related mortalities. CONCLUSIONS Clustering of 2+ conditions of heavy drinking, smoking, and depression affected nearly one in five WWH and was associated with higher mortality than zero or one condition. Our findings underscore the need for coordinated screening and parsimonious treatment strategies for these co-occurring conditions.
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Affiliation(s)
| | | | | | - Hilary A Tindle
- Vanderbilt University Medical CenterNashville, TN37232, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare SystemNashville, TN37212USA
| | - John R Koethe
- Vanderbilt University Medical CenterNashville, TN37232, USA
| | - David B Hanna
- Albert Einstein College of MedicineBronx, NY10461, USA
| | - Steven Shoptaw
- David Geffen School of Medicine at UCLA, Los Angeles, CA90095USA
| | - Deborah L Jones
- University of Miami Miller School of MedicineMiami, FL33136, USA
| | | | - Jorge R Kizer
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA94121USA
| | - Mardge H Cohen
- Stroger Hospital/Cook County Health and Hospitals SystemChicago, IL60612, USA
| | - Sabina A Haberlen
- Johns Hopkins Bloomberg School of Public HealthBaltimore, MD21205, USA
| | | | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory UniversityAtlanta, GA30322, USA
| | - Jenni M Wise
- University of Alabama at BirminghamBirmingham, AL35294, USA
| | - Matthew S Freiberg
- Vanderbilt University Medical CenterNashville, TN37232, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare SystemNashville, TN37212USA
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7
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Appelhans BM. The Cognitive Burden of Poverty: A Mechanism of Socioeconomic Health Disparities. Am J Prev Med 2023; 64:293-297. [PMID: 36180316 PMCID: PMC10176429 DOI: 10.1016/j.amepre.2022.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Bradley M Appelhans
- From the Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, Illinois; and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.
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Mattheiss SR, Levinson H, Rosenberg-Lee M, Graves WW. Exposure to violence is associated with decreased neural connectivity in emotion regulation and cognitive control, but not working memory, networks after accounting for socioeconomic status: a preliminary study. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2022; 18:15. [PMID: 36503615 PMCID: PMC9743673 DOI: 10.1186/s12993-022-00201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/18/2022] [Indexed: 12/14/2022]
Abstract
Previous research has demonstrated behavioral and neural differences associated with experiencing adversity. However, adversity is unlikely to be a monolithic construct, and we expect that examining effects of more specific components such as exposure to violence in the home community will yield more concretely interpretable results. Here we account for effects of low socioeconomic status (SES) to examine the specific effects of exposure to violence on functional connectivity between brain areas known to be related to emotion regulation and working memory. Decreased resting state functional connectivity for individuals exposed to high compared to low levels of violence during childhood was predicted for two sets of areas: (1) bilateral amygdala with anterior medial regions involved in cognitive control of emotion, and (2) the right dorsolateral prefrontal cortex (dlPFC) with frontal and parietal regions implicated in working memory. Consistent with our predictions, increasing exposure to violence was related to decreased resting state functional connectivity between the right amygdala and anterior cingulate cortex, even after accounting for SES. Also after accounting for SES, exposure to violence was related to reductions in connectivity between the right dlPFC and frontal regions, but not with parietal regions typically associated with working memory. Overall, this pattern suggests increased exposure to violence in childhood is associated with reduced connectivity among key areas of the circuitry involved in emotion regulation and cognitive control, but not working memory. These results offer insight into the neural underpinnings of behavioral outcomes associated with exposure to violence, laying the foundation for ultimately designing interventions to address the effects of such exposure.
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Affiliation(s)
- Samantha R. Mattheiss
- grid.454556.30000 0000 9565 5747Psychology Department, Felician University, Lodi, NJ USA
| | - Hillary Levinson
- grid.430387.b0000 0004 1936 8796Psychology Department, Rutgers University - Newark, Newark, NJ USA
| | - Miriam Rosenberg-Lee
- grid.430387.b0000 0004 1936 8796Psychology Department, Rutgers University - Newark, Newark, NJ USA
| | - William W. Graves
- grid.430387.b0000 0004 1936 8796Psychology Department, Rutgers University - Newark, Newark, NJ USA
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Houston E, Mindry D, Alvarado E, Kim JJ, Evans J, Tarn DM. Hidden cues for approach and avoidance motivation: implicit cognitive associations among patients with Nonadherence to HIV treatment. AIDS Care 2022; 34:1257-1263. [PMID: 34851780 DOI: 10.1080/09540121.2021.2008296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although patient motivation related to HIV treatment is widely acknowledged as a key factor related to consistent adherence and engagement with medical care, research has predominantly focused on explicit rather than implicit cognitive processes that underlie motivation. This study identified and examined implicit cognitive processes that influence approach and avoidance treatment motivation in a sample of 30 HIV patients with suboptimal adherence and poor engagement with medical care. Study participants were predominantly African American (87%) and gay/bisexual (63%). We examined 173 thought statements about treatment collected from patients during two previous studies. Thematic analysis described how implicit cognitive associations influenced patients to approach or avoid treatment and medical care. Findings revealed three major contextual categories of treatment-related thoughts: links with routines and habits, connections to physical changes and reactions, and interpersonal associations. Within each category, implicit cognitive associations about treatment in terms of these daily life events and experiences cued approach and avoidance motivational tendencies without the patient's awareness. Findings from this study support the need for interventions that use implicit, less effortful approaches aimed at promoting adherence and improving the retention of patients with poor engagement.
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Affiliation(s)
- Eric Houston
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Deborah Mindry
- University of California Global Health Institute, Women's Health, Gender, and Empowerment Center of Expertise, Los Angeles, CA, USA
| | - Eric Alvarado
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Joshua J Kim
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Justine Evans
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Derjung M Tarn
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
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Crandall AK, Epstein LH, Fillo J, Carfley K, Fumerelle E, Temple JL. The Effect of Financial Scarcity on Reinforcer Pathology: A Dyadic Developmental Examination. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091338. [PMID: 36138648 PMCID: PMC9498192 DOI: 10.3390/children9091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022]
Abstract
This study investigated the effects of experimentally manipulated scarcity on the reinforcing value of food (RRVfood) and delay discounting (DD), which, together, create reinforcer pathology (RP) among parents and offspring. A stratified sample of 106 families (53 parent/child aged 7−10 dyads & 53 parent/adolescent aged 15−17 dyads) from high- and low-income households visited our laboratory for three appointments. Each appointment included an experimental manipulation of financial gains and losses and DD and RRV tasks. The results showed that, regardless of food insecurity or condition, children had greater RP (β = 1.63, p < 0.001) than adolescents and parents. DD was largely unaffected by acute scarcity in any group, but families with food insecurity had greater DD (β = −0.09, p = 0.002) than food-secure families. Food-insecure parents with children responded to financial losses with an increase in their RRVfood (β = −0.03, p = 0.011), while food-secure parents and food-insecure parents of adolescents did not significantly change their responding based on conditions. This study replicates findings that financial losses increase the RRVfood among adults with food insecurity and extends this literature by suggesting that this is strongest for parents of children.
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Affiliation(s)
- Amanda K. Crandall
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
- Correspondence:
| | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, 915 Greene St Discovery I, Suite 551, Columbia, SC 29208, USA
| | - Kevin Carfley
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Eleanor Fumerelle
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Jennifer L. Temple
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
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11
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Thrailkill EA, DeSarno M, Higgins ST. Loss aversion and risk for cigarette smoking and other substance use. Drug Alcohol Depend 2022; 232:109307. [PMID: 35093680 PMCID: PMC8887823 DOI: 10.1016/j.drugalcdep.2022.109307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cigarette smoking is among the leading preventable causes of global morbidity and mortality. We aimed to determine whether individual differences in loss aversion, a bias in decision-making wherein losses are valued greater than gains, predicts smoking and other addiction risk. METHODS We recruited current daily cigarette smokers (n = 181; > 10 cigarettes per day) and never-smokers (n = 237; < 100 cigarettes lifetime) from the United States using Amazon Mechanical Turk. Groups were matched on gender, educational attainment, and age. All completed items related to current cigarette smoking, alcohol use, other drug use, sleep problems, and depressed mood, and task-based measures of loss aversion and delay discounting, a decision-making bias associated with cigarette smoking. RESULTS Smokers were less loss averse than never-smokers (F(1, 411) = 24.19, η2 = 0.02, p < .0001) even after accounting for delay discounting (F(1, 410) = 20.53, η2 = 0.02, p < .0001). Loss aversion was also a significant independent risk factor for alcohol (F(1, 410) = 21.47, η2 = 0.02, p < .0001) and other drug use (F(1, 410) = 54.12, η2 = 0.04, p < .0001), although not other behavioral-health conditions (i.e., sleep disturbance, depressed mood). Further analyses revealed that co-occurring low loss aversion and high delay discounting were independently associated with greater risk for all patterns of substance use. CONCLUSIONS Loss aversion was associated with current cigarette smoking and other substance use patterns independent of delay discounting. Loss aversion may warrant attention as a protective factor and potential target for preventive intervention for substance use and addiction.
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Affiliation(s)
- Eric A. Thrailkill
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA,Department of Psychological Science, University of Vermont, Burlington, VT, USA,Department of Psychiatry, University of Vermont, Burlington, VT, USA,Corresponding author. Eric A. Thrailkill, Departments of Psychological Science and Psychiatry, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405;
| | - Michael DeSarno
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA,Department of Biomedical Statistics, University of Vermont, Burlington, VT, USA
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA,Department of Psychological Science, University of Vermont, Burlington, VT, USA,Department of Psychiatry, University of Vermont, Burlington, VT, USA
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12
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Downey H, Haynes JM, Johnson HM, Odum AL. Deprivation Has Inconsistent Effects on Delay Discounting: A Review. Front Behav Neurosci 2022; 16:787322. [PMID: 35221945 PMCID: PMC8867822 DOI: 10.3389/fnbeh.2022.787322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
Delay discounting, the tendency for outcomes to be devalued as they are more temporally remote, has implications as a target for behavioral interventions. Because of these implications, it is important to understand how different states individuals may face, such as deprivation, influence the degree of delay discounting. Both dual systems models and state-trait views of delay discounting assume that deprivation may result in steeper delay discounting. Despite early inconsistencies and mixed results, researchers have sometimes asserted that deprivation increases delay discounting, with few qualifications. The aim of this review was to determine what empirical effect, if any, deprivation has on delay discounting. We considered many kinds of deprivation, such as deprivation from sleep, drugs, and food in humans and non-human animals. For 23 studies, we analyzed the effect of deprivation on delay discounting by computing effect sizes for the difference between delay discounting in a control, or baseline, condition and delay discounting in a deprived state. We discuss these 23 studies and other relevant studies found in our search in a narrative review. Overall, we found mixed effects of deprivation on delay discounting. The effect may depend on what type of deprivation participants faced. Effect sizes for deprivation types ranged from small for sleep deprivation (Hedge's gs between −0.21 and 0.07) to large for opiate deprivation (Hedge's gs between 0.42 and 1.72). We discuss possible reasons why the effect of deprivation on delay discounting may depend on deprivation type, including the use of imagined manipulations and deprivation intensity. The inconsistency in results across studies, even when comparing within the same type of deprivation, indicates that more experiments are needed to reach a consensus on the effects of deprivation on delay discounting. A basic understanding of how states affect delay discounting may inform translational efforts.
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Affiliation(s)
- Haylee Downey
- Odum Laboratory, Department of Psychology, Utah State University, Logan, UT, United States
- Translational Biology Medicine and Health Graduate Program, Virginia Tech, Blacksburg, VA, United States
| | - Jeremy M. Haynes
- Odum Laboratory, Department of Psychology, Utah State University, Logan, UT, United States
| | - Hannah M. Johnson
- Odum Laboratory, Department of Psychology, Utah State University, Logan, UT, United States
| | - Amy L. Odum
- Odum Laboratory, Department of Psychology, Utah State University, Logan, UT, United States
- *Correspondence: Amy L. Odum
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13
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Basso JC, Satyal MK, Athamneh L, Bickel WK. Changes in temporal discounting, hedonic hunger, and food addiction during recovery from substance misuse. Appetite 2022; 169:105834. [PMID: 34871591 PMCID: PMC8790806 DOI: 10.1016/j.appet.2021.105834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/26/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023]
Abstract
Substance use disorders (SUDs) and obesity are both chronic, relapsing, remitting disorders that arise from a heightened preference for immediate-focused rewards (i.e., steep temporal discounting). During recovery from SUDs, overweight and obese outcomes are common as individuals may replace drug rewards for food rewards. However, little has been done to investigate the neuropsychological processes underlying food reward and addiction in individuals recovering from SUDs. Using data collected from the International Quit and Recovery Registry and Amazon Mechanical Turk, we aimed to elucidate the factors that influence the attraction to palatable foods in a population in recovery from substance misuse (n = 114) as well as a population with no history of substance misuse (n = 97). We hypothesized that individuals in recovery from substance misuse would have steeper temporal discounting, an increased drive for palatable foods (i.e., hedonic hunger), and greater food addiction symptoms than non-substance users. Contrary to our hypotheses, we found that individuals in recovery from SUDs show improved outcomes in temporal discounting, hedonic hunger, and food addiction symptoms. Moreover, recovery status and temporal discounting significantly predicted these outcomes. Our findings suggest that the enhanced executive control processes needed for successful SUD recovery may transfer to other reward-related processes such as food reward and consumption. Interventions targeted at improving executive function including episodic future thinking, meditation, or exercise, may be excellent ways to support a successful recovery and improve other reward-related processes, including food consumption, to decrease the risk of overweight or obese outcomes during recovery.
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Affiliation(s)
- Julia C Basso
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, 2 Riverside Circle, Roanoke, VA, USA; Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, USA; Department of Human Nutrition, Foods and Exercise, Virginia Tech, 1981, Kraft Dr., Blacksburg, VA, USA
| | - Medha K Satyal
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, 1981, Kraft Dr., Blacksburg, VA, USA
| | - Liqa Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, 2 Riverside Circle, Roanoke, VA, USA
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, 2 Riverside Circle, Roanoke, VA, USA; Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, USA.
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14
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Kraft P, Kraft B, Hagen T, Espeseth T. Subjective Socioeconomic Status, Cognitive Abilities, and Personal Control: Associations With Health Behaviours. Front Psychol 2022; 12:784758. [PMID: 35153907 PMCID: PMC8831894 DOI: 10.3389/fpsyg.2021.784758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo examine subjective and objective socioeconomic status (SSES and OSES, respectively) as predictors, cognitive abilities as confounders, and personal control perceptions as mediators of health behaviours.DesignA cross-sectional study including 197 participants aged 30–50 years, recruited from the crowd-working platform, Prolific.Main Outcome MeasureThe Good Health Practices Scale, a 16-item inventory of health behaviours.ResultsSSES was the most important predictor of health behaviours (beta = 0.19, p < 0.01). Among the OSES indicators, education (beta = 0.16, p < 0.05), but not income, predicted health behaviours. Intelligence (r = −0.16, p < 0.05) and memory (r = −0.22, p < 0.01) were negatively correlated with health-promoting behaviours, and the effect of memory was upheld in the multivariate model (beta = −0.17, p < 0.05). Personal control perceptions (mastery and constraints) did not act as mediators.ConclusionSSES predicted health behaviours beyond OSES. The effect of socioeconomic indicators was not confounded by cognitive abilities. Surprisingly, cognitive abilities were negatively associated with health-promoting behaviours. Future research should emphasise SSES as a predictor of health behaviours. Delineating the psychological mechanisms linking SSES with health behaviours would be a valuable contribution toward improved understanding of socioeconomic disparities in health behaviours.
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Affiliation(s)
- Pål Kraft
- Department of Psychology, University of Oslo, Oslo, Norway
- Oslo New University College, Oslo, Norway
- *Correspondence: Pål Kraft,
| | - Brage Kraft
- Division of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Thomas Hagen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Thomas Espeseth
- Department of Psychology, University of Oslo, Oslo, Norway
- Oslo New University College, Oslo, Norway
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15
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Nuijten R, Van Gorp P, Hietbrink J, Le Blanc P, Kemperman A, van den Berg P, Simons M. Pilot Evaluation of the Impact of Lottery-Based Incentives on Engagement Levels of Male Low SES Vocational Students With an mHealth App. Front Digit Health 2022; 3:748588. [PMID: 35072150 PMCID: PMC8782146 DOI: 10.3389/fdgth.2021.748588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022] Open
Abstract
In general, individuals with lower socioeconomic status (SES) are less physically active and adhere to poorer diets than higher SES individuals. To promote healthier lifestyles in lower SES populations, we hosted a digital health promotion program among male vocational students at a school in The Netherlands. In a pilot study, we evaluated whether this target audience could be engaged with an mHealth app using lottery-based incentives that trigger feelings of anticipated regret. Especially, we studied the social and interpersonal aspects of regret lotteries in a within-subject experimental design. In this design, subjects either participated in a social variant (i.e., with students competing against their peers for a chance at a regret lottery), or an individual variant (i.e., with subjects solely individually engaged in a lottery). Additionally, we studied the impact of different payout schedules in a between-subject experimental design. In this design, participants were assigned to either a short-term, low-value payout schedule, or a long-term, high-value payout schedule. From a population of 72 male students, only half voluntarily participated in our 10-week program. From interviews, we learned that the main reason for neglecting the program was not related to the lottery-based incentives, nor to the prizes that were awarded. Instead, non-enrolled subjects did not join the program, because their peers were not joining. Paradoxically, it was suggested that students withheld their active participation until a larger portion of the sample was actively participating. From the subjects that enrolled in the program (N = 36, males, between 15 and 25 years of age), we found that a large proportion stopped interacting with the program over time (e.g., after roughly 4 weeks). Our results also indicated that students performed significantly more health-related activities when assigned to the social regret lottery, as opposed to the individual variant. This result was supported by interview responses from active participants: They mainly participated to compete against their peers, and not so much for the prizes. Hence, from this study, we obtained initial evidence on the impact of social and competitive aspects in lottery-based incentives to stimulate engagement levels in lower SES students with an mHealth app.
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Affiliation(s)
- Raoul Nuijten
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- *Correspondence: Raoul Nuijten
| | - Pieter Van Gorp
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Juup Hietbrink
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pascale Le Blanc
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Astrid Kemperman
- Department of the Built Environment, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pauline van den Berg
- Department of the Built Environment, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Monique Simons
- Consumption and Healthy Lifestyles Group, Wageningen University & Research, Wageningen, Netherlands
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16
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Mazachowsky TR, McKenzie K, Busseri MA, Mahy CEV. "These pretzels are making me thirsty" so I'll have water tomorrow: A partial replication and extension of adults' induced-state episodic foresight. PLoS One 2021; 16:e0259424. [PMID: 34788318 PMCID: PMC8598010 DOI: 10.1371/journal.pone.0259424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
The ability to consider the future under the influence of an induced current state is known as induced-state episodic foresight. One study to date has examined adults' induced episodic foresight and found that adults' (like children's) preferences for the future are related to their current state such that they predicted wanting water (vs. pretzels) in the future when experiencing a current state of thirst [1]. We attempted to replicate these findings in adults. In Study 1, adults (N = 198) in a laboratory selected pretzels for tomorrow at the same rate (around 20%) in an experimental condition (thirst induced) and a control condition (thirst not induced). In a lecture, 32% of adults preferred pretzels for tomorrow without thirst induction (Study 2, N = 63). Partially replicating Kramer et al. [1], we found that a minority of adults preferred pretzels (vs. water) when experiencing a current state of thirst. However, in contrast to their findings, our results showed that when thirst was not induced, a minority of adults also preferred pretzels for tomorrow. Thus, adults' future preference was similar regardless of thirst induction. We also tested thirst as a mechanism for adults' preference for the future and found that across conditions adults' thirst predicted their choice of water (vs. pretzels) for the future. In sum, our results partially replicated Kramer et al. [1] by showing the current state, regardless of thirst induction, predicts adults' choices for the future.
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17
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van den Berk-Clark C, Pickard J, Davis D, Scherrer JF. The Role of Impulsive Decision Making on Health Behavior Related to Cardiovascular Disease Risk Among Older Adults With Hypertension. J Gerontol Nurs 2021; 47:22-30. [PMID: 34704864 DOI: 10.3928/00989134-20211013-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to investigate whether older adults who are more impulsive also tend to engage in more health behaviors associated with increased risk for cardiovascular disease (CVD). We analyzed data from the Health and Retirement Study. Logistic regression analysis was performed to determine the likelihood of medication adherence, alcohol consumption, and exercise among older adults with hypertension. Adjusted regression results revealed higher impulsive decision making was associated with greater likelihood of obesity (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.00, 8.92]), lower likelihood of medication adherence (OR = 0.37, 95% CI [0.15, 0.92]), and regular drinking (OR = 0.36, 95% CI [0.15, 0.87]). Higher impulsive decision making was associated with lower likelihood of regular exercise only in unadjusted models. Older adults with hypertension who had higher impulsive decision making engaged in health behaviors associated with increased risk for CVD. Health care providers should consider the range of strategies offered through behavioral economics to improve health in these at-risk populations. [Journal of Gerontological Nursing, 47(11), 22-30.].
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18
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Blondé J, Easterbrook MJ, Kulich C, Chipeaux M, Lorenzi‐Cioldi F. Social disparities in health behaviours: The role of
class‐related
behavioural norms and social class identification. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jérôme Blondé
- Faculty of Psychology and Educational Sciences University of Geneva Geneva Switzerland
| | | | - Clara Kulich
- Faculty of Psychology and Educational Sciences University of Geneva Geneva Switzerland
| | - Marion Chipeaux
- Faculty of Psychology and Educational Sciences University of Geneva Geneva Switzerland
| | - Fabio Lorenzi‐Cioldi
- Faculty of Psychology and Educational Sciences University of Geneva Geneva Switzerland
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19
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Increasing Physical Activity among Breast Cancer Survivors by Modulating Temporal Orientation with rTMS: Feasibility and Potential Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910052. [PMID: 34639353 PMCID: PMC8508508 DOI: 10.3390/ijerph181910052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/03/2022]
Abstract
Maintaining adequate amounts of physical activity is a critical component of survivorship care for women with breast cancer. Increased physical activity is associated with increases in well-being, quality of life, and longevity, but women with cancer face unique, cancer-related factors that might affect physical activity. Consistent with the Competing Neurobehavioral Decision Systems model of decision making, we proposed to decrease delay discounting and increase physical activity by stimulating the executive function system via high-frequency repetitive transcranial magnetic stimulation (HF rTMS) of the left dorsolateral prefrontal cortex (LDLPFC). This randomized, sham-controlled, double-blinded trial examined the feasibility and potential efficacy of this approach to increase physical activity in breast cancer survivors. We hypothesized that active rTMS would significantly increase the mean number of steps per day and decrease delay discounting. Participants (n = 30) were primarily middle-aged (M = 53.7, SD = 7.9) and white with a mean BMI and body mass indices below 40. Indicators of feasibility and limited efficacy testing were positive. Although repeated-measures ANOVA revealed no significant changes in delay discounting, generalized estimating equations (GEE) found that participants in the active condition increased their mean daily steps by 400 steps per day, while those in the sham condition decreased this by nearly 600 steps per day. These findings indicate that the continued investigation of HF rTMS for increasing physical activity among women with breast cancer is justified.
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20
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Chichetto NE, Kundu S, Freiberg MS, Koethe JR, Butt AA, Crystal S, So-Armah KA, Cook RL, Braithwaite RS, Justice AC, Fiellin DA, Khan M, Bryant KJ, Gaither JR, Barve SS, Crothers K, Bedimo RJ, Warner A, Tindle HA. Association of Syndemic Unhealthy Alcohol Use, Smoking, and Depressive Symptoms on Incident Cardiovascular Disease among Veterans With and Without HIV-Infection. AIDS Behav 2021; 25:2852-2862. [PMID: 34101074 PMCID: PMC8376776 DOI: 10.1007/s10461-021-03327-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence - termed a syndemic, defined as the synergistic effect of two or more conditions-on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veteran's Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47-2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35-2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p = .38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts.
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Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA.
| | - Suman Kundu
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, Weill-Cornell Medical College, Doha, USA
- Hamad Medical Corporation, Doha, Qatar
| | - Stephen Crystal
- Health Care Policy, and Aging Research and School of Social Work, Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Amy C Justice
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, New Haven, CT, USA
| | - David A Fiellin
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Maria Khan
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Julie R Gaither
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Shirish S Barve
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Roger J Bedimo
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alberta Warner
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CT, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
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21
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Schüz B, Conner M, Wilding S, Alhawtan R, Prestwich A, Norman P. Do socio-structural factors moderate the effects of health cognitions on COVID-19 protection behaviours? Soc Sci Med 2021; 285:114261. [PMID: 34332252 PMCID: PMC8299154 DOI: 10.1016/j.socscimed.2021.114261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/11/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Adherence to protection behaviours remains key to curbing the spread of the SARS-CoV-2 virus that causes COVID-19, but there are substantial differences in individual adherence to recommendations according to socio-structural factors. To better understand such differences, the current research examines whether relationships between health cognitions based on the Reasoned Action Approach (RAA) and eight COVID-19 protection behaviours vary as a function of participant-level socio-structural factors. METHODS Within-person design with behaviours nested within participants in a two-wave online survey (one week delay) conducted during the UK national lockdown in April 2020. A UK representative sample of 477 adults completed baseline measures from the RAA plus perceived susceptibility and past behaviour for eight protection behaviours, and self-reported behaviour one week later. Moderated hierarchical linear models with cross-level interactions were used to test moderation of health cognitions by socio-structural factors (sex, age, ethnicity, deprivation). RESULTS Sex, ethnicity and deprivation moderated the effects of health cognitions on protection intentions and behaviour. For example, the effects of injunctive norms on intentions were stronger in men compared to women. Importantly, intention was a weaker predictor of behaviour in more compared to less deprived groups. In addition, there was evidence that perceived autonomy was a stronger predictor of behaviour in more deprived groups. CONCLUSION Socio-structural variables affect how health cognitions relate to recommended COVID-19 protection behaviours. As a result, behavioural interventions based on social-cognitive theories might be less effective in participants from disadvantaged backgrounds.
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Affiliation(s)
| | | | | | - Rana Alhawtan
- University of Leeds, UK; Princess Nourah bint Abdulrahman University, Saudi Arabia
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22
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Oberle A, Postman W, van den Berk-Clark C. Novel, Neuroscience-Informed Approaches to Trauma Care in Community Clinical Settings. MISSOURI MEDICINE 2021; 118:358-362. [PMID: 34373672 PMCID: PMC8343633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Trauma exposure, a highly prevalent condition in the United States, results in the development of chronic physical and mental health disabilities, such as diabetes, cardiovascular disease and posttraumatic stress disorder. Bench science advances in neurobiology and neuroscience have been translated into exciting clinical interventions, which have been shown to improve mental functioning and stress response. This article highlights three such interventions in hospital, primary care and community settings.
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Affiliation(s)
- Andrew Oberle
- Executive Director of the Oberle Institute in the School of Medicine, Department of Surgery, Saint Louis University, St. Louis, Missouri
| | - Whitney Postman
- Director of the Neuro-Rehabilitation of Language Laboratory and Assistant Professor in the Department of Speech, Language, and Hearing Sciences - Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri
| | - Carissa van den Berk-Clark
- Associate Professor in the School of Medicine - Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri
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23
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Satyal MK, Basso JC, Tegge AN, Metpally AR, Bickel WK. A novel model of obesity prediction: Neurobehaviors as targets for treatment. Behav Neurosci 2021; 135:426-442. [PMID: 34264693 PMCID: PMC9955328 DOI: 10.1037/bne0000385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obesity is a worldwide epidemic that is on the rise, with approximately 30% of the world population classified as either overweight or obese. The United States has some of the highest rates of obesity, and in most countries in the world, obesity now poses more of a serious health concern than malnutrition. Obesity is a chronic, relapsing disorder that is both preventable and treatable; however, traditional interventions that target eating less and exercising more have low success rates, especially in the long term. Therefore, identifying the neurobehaviors that predict obesity is important to help identify targets to decrease BMI and improve obesity outcomes. Using the Competing Neurobehavioral Decisions System (CNDS) Theory, we hypothesized that individuals with obesity compared to individuals without obesity would display neurobehaviors marked by a hyperactive impulsive system and a hypoactive executive system. To test this hypothesis, we collected data from a battery of self-reported measures and neurocognitive assessments through Amazon Mechanical Turk from n = 178 obese (BMI ≥ 30) and n = 198 nonobese controls who were weight stable for the past 3 months. We found that compared to the nonobese control group, individuals with obesity showed heightened delay discounting (a marker of CNDS imbalance), impaired motivation, poor self-image, decreased affective state, and impaired executive function. Using a Bayesian network approach, we established a neurobehavioral model that predicts obesity with 64.4% accuracy and indicates an imbalance between impulsive and executive neural systems. Results from our study suggest that interventions targeting neurobehaviors may be integral to help improve obesity outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Medha K. Satyal
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, Virginia, United States
| | - Julia C. Basso
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia, United States,Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, United States,School of Neuroscience, Virginia Tech, Blacksburg, Virginia, United States
| | - Allison N. Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia, United States,Department of Statistics, Virginia Tech, Blacksburg, Virginia, United States
| | - Anvitha R. Metpally
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, United States
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia, United States
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24
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Kraft P, Kraft B. Explaining socioeconomic disparities in health behaviours: A review of biopsychological pathways involving stress and inflammation. Neurosci Biobehav Rev 2021; 127:689-708. [PMID: 34048858 DOI: 10.1016/j.neubiorev.2021.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/12/2021] [Accepted: 05/20/2021] [Indexed: 01/29/2023]
Abstract
The purpose of this article was to explore how individuals' position in a socioeconomic hierarchy is related to health behaviours that are related to socioeconomic disparities in health. We identified research which shows that: (a) low socioeconomic status (SES) is associated with living in harsh environments, (b) harsh environments are related to increased levels of stress and inflammation, (c) stress and inflammation impact neural systems involved in self-control by sensitising the impulsive system and desensitising the reflective system, (d) the effects are inflated valuations of small immediate rewards and deflated valuations of larger delayed rewards, (e) these effects are observed as increased delay discounting, and (f) delay discounting is positively associated with practicing more unhealthy behaviours. The results are discussed within an adaptive evolutionary framework which lays out how the stress response system, and its interaction with the immune system and brain systems for decision-making and behaviours, provides the biopsychological mechanisms and regulatory shifts that make widespread conditional adaptability possible. Consequences for policy work, interventions, and future research are discussed.
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Affiliation(s)
- Pål Kraft
- Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317, Oslo, Norway; Department of Psychology, Bjørknes University College, Lovisenberggata 13, 0456, Oslo, Norway.
| | - Brage Kraft
- Division of Psychiatry, Diakonhjemmet Hospital, P. O. Box 23 Vinderen, 0319, Oslo, Norway.
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Rodgers J, Cuevas AG, Williams DR, Kawachi I, Subramanian SV. The relative contributions of behavioral, biological, and psychological risk factors in the association between psychosocial stress and all-cause mortality among middle- and older-aged adults in the USA. GeroScience 2021; 43:655-672. [PMID: 33511488 PMCID: PMC8110664 DOI: 10.1007/s11357-020-00319-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022] Open
Abstract
Evidence of an association between psychosocial stress and mortality continues to accumulate. However, despite repeated calls in the literature for further examination into the physiological and behavioral pathways though which stress affects health and mortality, research on this topic remains limited. This study addresses this gap by employing a counterfactual-based mediation analysis of eight behavioral, biological, and psychological pathways often hypothesized to play a role in the association between stress and health. First, we calculated the survival rate of all-cause mortality associated with cumulative psychosocial stress (high vs. low/moderate) using random effects accelerated failure time models among a sample of 7108 adults from the Midlife in the United States panel study. Then, we conducted a multiple mediator mediation analysis utilizing a counterfactual regression framework to determine the relative contributions of each mediator and all mediators combined in the association between stress and mortality. Exposure to high psychosocial stress was associated with a 0.76 times reduced survival rate over the follow-up period 1995-2015, while adjusting for age, sex, race, income, education, baseline health, and study design effects. The mediators accounted for 49% of this association. In particular, smoking, sedentary behavior, obesity/BMI, and cardiovascular disease displayed significant indirect effects and accounted for the largest reductions in the total effect of stress on mortality, with natural indirect effects of 14%, 12%, 11%, and 4%, respectively. In conclusion, traditional behavioral and biological risk factors play a significant role in the association between psychosocial stress and mortality among middle and older adults in the US context. While eliminating stress and the socioeconomic disparities that so often deliver people into high-stress scenarios should be the ultimate goal, public health interventions addressing smoking cessation, physical activity promotion, and cardiovascular disease treatment may pay dividends for preventing premature mortality in the near-term.
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Affiliation(s)
- Justin Rodgers
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA
| | - Adolfo G Cuevas
- Department of Community Health, Tufts University, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S V Subramanian
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Promoting Intersectoral Action to Address Chronic Poverty and Social Exclusion. BEHAVIOR AND SOCIAL ISSUES 2020. [DOI: 10.1007/s42822-020-00029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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McHugh Power J, Tang J, Kenny RA, Lawlor BA, Kee F. Mediating the relationship between loneliness and cognitive function: the role of depressive and anxiety symptoms. Aging Ment Health 2020; 24:1071-1078. [PMID: 30955348 DOI: 10.1080/13607863.2019.1599816] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the relationship between loneliness and cognitive functioning, and whether depressive and anxiety symptoms have intermediate roles therein.Methods: Information about 7,433 participants of the Irish Longitudinal Study on Ageing (a prospective, representative cohort study), aged over 50, was collected at three time-points two years apart, and analysed using Structural Equation Modelling to assess whether depressive and anxiety symptoms mediate the relationship between loneliness and cognitive functioning. Cognitive functioning was measured as a latent factor, with four indicators: measures of immediate and delayed word recall, verbal fluency, and a global measure (the MMSE). Loneliness was measured using the UCLA Loneliness scale, depressive symptoms using the CES-D-ML scale, and anxiety symptoms using the HADS-A scale.Results: Loneliness at time-point 1 predicted cognitive functioning at time-point 3, β = -0.103, p < 0.001, and depressive (β = 0.426, p < 0.001) and anxiety (β = 0.410, p < 0.001) symptoms at time-point 2. Depressive (β = -0.020, p = 0.001) but not anxiety (β = -0.000, p = 0.658) symptoms mediated the relationship between loneliness and cognitive functioning, total effect: β = -0.123, p < 0.001.Conclusion: The relationship between loneliness and cognitive functioning is in part explained by its relationship with depressive symptoms. Statistically, the mediation model helps us understand possible mechanisms through which loneliness impacts cognitive functioning. Results have implications for cognitive functioning interventions for older adults, and imply that loneliness is also a worthwhile target for intervention.
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Affiliation(s)
- Joanna McHugh Power
- School of Business National College of Ireland, Dublin 1, Ireland.,UK CRC Centre of Excellence for Public Health Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland.,Institute of Neuroscience & School of Medicine, Trinity College, Dublin 2, Ireland
| | - Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Rose Ann Kenny
- Institute of Neuroscience & School of Medicine, Trinity College, Dublin 2, Ireland
| | - Brian A Lawlor
- Institute of Neuroscience & School of Medicine, Trinity College, Dublin 2, Ireland
| | - Frank Kee
- UK CRC Centre of Excellence for Public Health Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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Targeting cognitive and emotional regulatory skills for smoking prevention in low-SES youth: A randomized trial of mindfulness and working memory interventions. Addict Behav 2020; 104:106262. [PMID: 31918169 DOI: 10.1016/j.addbeh.2019.106262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
Research to date provides striking evidence that youth from low socio-economic status (SES) households are at an increased risk for smoking. Converging evidence from developmental studies, psychopathology studies, intervention studies, and basic research on self-control abilities have identified working memory and distress tolerance as potential crucial modifiable risk factors to prevent smoking onset in this cohort. To confirm the value of these mechanistic targets, this randomized trial was designed to evaluate the influence of working memory and distress tolerance interventions on risk of smoking initiation. Recruiting primarily from low-income community afternoon programs, we randomized 93 adolescents to one of three intervention conditions, all of which were a prelude to a smoking-prevention informational intervention: (1) a working memory intervention, (2) a mindfulness training intervention to target distress tolerance, and (3) a wellness-focused control condition. Despite a number of adherence efforts, engagement in treatment was limited, and under these conditions no significant evidence was found either for differential efficacy for smoking prevention or for intervention effects on mechanistic targets. However, working memory capacity and distress tolerance were found to be negatively related to smoking propensity. As such, our mechanistic targets-working memory and distress tolerance--may well be processes undergirding smoking, despite the fact that our interventions did not adequately engage these targets.
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Parnia A, Siddiqi A. Socioeconomic disparities in smoking are partially explained by chronic financial stress: marginal structural model of older US adults. J Epidemiol Community Health 2019; 74:248-254. [PMID: 31871017 DOI: 10.1136/jech-2019-213357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/18/2019] [Accepted: 12/05/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND A persistent socioeconomic gradient in smoking has been observed in a variety of populations. While stress is hypothesised to play a mediating role, the extent of this mediation is unclear. We used marginal structural models (MSMs) to estimate the proportion of the effect of socioeconomic status (SES) on smoking, which can be explained by an indicator of stress related to SES, experiences of chronic financial stress. METHODS Using the Health and Retirement Study (waves 7-12, 2004-2014), a survey of older adults in the USA, we analysed a total sample of 15 260 people. A latent variable corresponding to adult SES was created using several indicators of socioeconomic position (wealth, income, education, occupation and labour force status). The main analysis was adjusted for other factors that influence the pathway from adult SES to stress and smoking, including personal coping resources, health-related factors, early-life SES indicators and other demographic variables to estimate the proportion of the effect explained by these pathways. RESULTS Compared with those in the top SES quartile, those in the bottom quartile were more than four times as likely to be current smokers (rate ratio 4.37, 95% CI 3.35 to 5.68). The estimate for the MSM attenuated the effect size to 3.34 (95% CI 2.47 to 4.52). Chronic financial stress explained 30.4% of the association between adult SES and current smoking (95% CI 13 to 48). CONCLUSION While chronic financial stress accounts for part of the socioeconomic gradient in smoking, much remains unexplained.
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Affiliation(s)
- Abtin Parnia
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Madsen KP, Kjaer T, Skinner T, Willaing I. Time preferences, diabetes self-management behaviours and outcomes: a systematic review. Diabet Med 2019; 36:1336-1348. [PMID: 31392757 DOI: 10.1111/dme.14102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
AIM Time preferences, i.e. individuals' degree of patience/impatience in intertemporal choice, have been found to be associated with suboptimal health behaviours and health outcomes such as smoking, physical inactivity, unhealthy food intake and obesity. In this systematic review, we aimed to synthesise reported associations between time preferences, diabetes self-management behaviours, including use of diabetes technology, and outcomes. METHODS We searched MEDLINE, EMBASE, PsycINFO, CINAHL, EconLit and all databases in the Web of Science Core Collection. Peer-reviewed studies of people with diabetes that included at least one diabetes-related behaviour or outcome and a measure of time preferences were included. Non-English language studies were excluded. RESULTS A total of 961 records were identified, of which 12 articles were included. Three studies analysed both time-consistent and time-inconsistent preferences, three studies solely analysed time-inconsistent preferences and six studies did not explicitly define a time preference model. Measured outcomes across studies included self-care activities, such as medication-taking, exercising and eating a healthy diet, and biomedical outcomes, such as HbA1c and diabetes-related complications. There were 10 cross-sectional studies and two panel-data studies. No studies explicitly analysed the relationship between time preferences and diabetes technology use. CONCLUSIONS Associations between measures of time preferences, diabetes self-management behaviours and clinical outcomes exist. Higher discount rates determined by both time-consistent and time-inconsistent models predict less diabetes-related self-care and worse outcomes. These findings may add to explanations of the observed variation in diabetes-related health and provide new insights for tailoring interventions and policies aimed at improving diabetes self-management.
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Affiliation(s)
- K P Madsen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - T Kjaer
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - T Skinner
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - I Willaing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Gaalema DE, Dube S, Potter A, Elliott RJ, Mahoney K, Sigmon SC, Higgins ST, Ades PA. The effect of executive function on adherence with a cardiac secondary prevention program and its interaction with an incentive-based intervention. Prev Med 2019; 128:105865. [PMID: 31662210 PMCID: PMC6939881 DOI: 10.1016/j.ypmed.2019.105865] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/20/2019] [Accepted: 10/11/2019] [Indexed: 12/29/2022]
Abstract
Participation in secondary prevention programs such as cardiac rehabilitation (CR) reduces morbidity, mortality, and hospitalizations while improving quality of life. Executive function (EF) is a complex set of cognitive abilities that control and regulate behavior. EF predicts many health-related behaviors, but how EF interacts with interventions to improve treatment adherence is not well understood. The objective of this study is to examine if EF predicts CR treatment adherence and how EF interacts with an intervention to improve adherence. Data were collected from 2013 to 2018 in Vermont, USA. 130 Medicaid-enrolled individuals who had experienced a qualifying cardiac event were enrolled in a controlled clinical trial and randomized 1:1 to receive financial incentives for completing secondary prevention sessions or to usual care. In this secondary analysis, effects of EF on CR adherence (defined as completing ≥30/36 sessions) were examined in 112 participants (57 usual care, 55 intervention) who completed an EF battery. Delay-discounting, a measure of impulsivity, predicted CR adherence (p = 0.01) and interacted with the incentive intervention, such that those who exhibited greater discounting of future rewards benefitted more from the intervention than those who discounted less (F(1, 104) = 5.23, p = 0.02). Better cognitive flexibility, measured with the trail-making-task, also predicted CR adherence (p = 0.02). While EF has been associated with adherence to a variety of treatment regimens, this interaction between an incentive-based intervention to promote treatment adherence and EF is novel. This work illustrates the value of considering individual differences in EF when designing and implementing interventions to promote health-related behavior change.
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Affiliation(s)
- Diann E Gaalema
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America.
| | - Sarahjane Dube
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
| | - Alexandra Potter
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
| | | | | | - Stacey C Sigmon
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
| | - Stephen T Higgins
- University of Vermont, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
| | - Philip A Ades
- University of Vermont, United States of America; University of Vermont Medical Center, United States of America; Vermont Center on Behavior and Health, Burlington, VT, United States of America
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Antonio RDL, Pompeia S. A fractionated analysis of hot and cool self-regulation in cigarette smokers from different socioeconomic backgrounds. PLoS One 2019; 14:e0220222. [PMID: 31430293 PMCID: PMC6701789 DOI: 10.1371/journal.pone.0220222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/11/2019] [Indexed: 11/25/2022] Open
Abstract
Smoking cigarettes and low socioeconomic status (SES) are both related to impaired cognition. However, it is unknown whether people of lower SES, who comprise most tobacco smokers worldwide, are more susceptible to cognitive impairment associated with smoking. In this non-randomized, cross-sectional study we investigated the effects of cigarette smoking, SES and their interaction on dissociable executive or “cool” and “hot” measures of behavioural self-regulation. Participants (n = 80) were selected among young physically and mentally healthy smokers and non-smokers who had graduated high school and were from different SES backgrounds. Cool self-regulation was measured by executive function tasks that tap inhibition, updating, shifting, dual tasking, planning, access to long-term memory (semantic fluency), and working memory capacity. Hot measures assessed self-reported impulsivity, delay discounting and risk taking. Exposure to tobacco (cotinine, exhaled carbon monoxide, tobacco dependence, cigarette consumption) was assessed to determine to what extent it mediated the cognitive effects of smoking. Nicotine abstinence and its acute effects were controlled, as were sex, age, schooling, and psychiatric symptoms despite the fact that smokers and non-smokers were selected as being as similar as possible in these demographic characteristics. Lower SES (less years of parental schooling) was associated with worse performance on tasks that measured all cool domains except dual tasking and fluency, while smoking status was related to impaired delayed discounting and impulsivity (hot domains), effects that were not mediated by tobacco exposure. Smoking and SES, however, did not interact. In short, impaired performance in measures of most cool skills was associated with SES irrespective of smoking status; in contrast, regardless of SES, smokers showed specific impairment in hot self-regulation domains (more difficulty resisting immediate temptations and weighing future consequences of actions). Possible explanations for the lack of mediation of tobacco exposure on hot skills of smokers are discussed.
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Affiliation(s)
- Raquel de Luna Antonio
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Curso de Naturologia, Universidade Anhembi Morumbi, São Paulo, São Paulo, Brazil
- * E-mail:
| | - Sabine Pompeia
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Wiss DA. A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health. Front Public Health 2019; 7:193. [PMID: 31338359 PMCID: PMC6629782 DOI: 10.3389/fpubh.2019.00193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
The opioid crisis has reached epidemic proportions in the United States with rising overdose death rates. Identifying the underlying factors that contribute to addiction vulnerability may lead to more effective prevention strategies. Supply side environmental factors are a major contributing component. Psychosocial factors such as stress, trauma, and adverse childhood experiences have been linked to emotional pain leading to self-medication. Genetic and epigenetic factors associated with brain reward pathways and impulsivity are known predictors of addiction vulnerability. This review attempts to present a biopsychosocial approach that connects various social and biological theories related to the addiction crisis. The emerging role of nutrition therapy with an emphasis on gastrointestinal health in the treatment of opioid use disorder is presented. The biopsychosocial model integrates concepts from several disciplines, emphasizing multicausality rather than a reductionist approach. Potential solutions at multiple levels are presented, considering individual as well as population health. This single cohesive framework is based on the interdependency of the entire system, identifying risk and protective factors that may influence substance-seeking behavior. Nutrition should be included as one facet of a multidisciplinary approach toward improved recovery outcomes. Cross-disciplinary collaborative efforts, new ideas, and fiscal resources will be critical to address the epidemic.
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Affiliation(s)
- David A. Wiss
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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Shevorykin A, Pittman JC, Bickel WK, O'Connor RJ, Malhotra R, Prashad N, Sheffer CE. Primed for Health: Future Thinking Priming Decreases Delay Discounting. HEALTH BEHAVIOR AND POLICY REVIEW 2019; 6:363-377. [PMID: 32671129 PMCID: PMC7363048 DOI: 10.14485/hbpr.6.4.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Delay discounting, the propensity to devalue delayed rewards, has robust predictive validity for multiple health behaviors and is a new therapeutic target for health behavior change. Priming can influence behaviors in a predictable manner. We aimed to use the Future Thinking Priming task, administered remotely, to reliably decrease delay discounting rates. METHODS In this pre-post randomized control group design, participants completed multiple delay discounting measures at baseline; then, 2 weeks later, they were randomized to Future Thinking Priming or Neutral Priming conditions. We hypothesized that Future Thinking Priming would significantly decrease delay discounting rates accounting for baseline delay discounting rates and time in repeated measures analyses. RESULTS Participants randomized to Future Thinking Priming (N = 783) demonstrated significantly lower delay discounting rates post-intervention than those randomized to Neutral Priming (N = 747) on multiple delay discounting measures and magnitudes. CONCLUSIONS A single administration of Future Thinking Priming produces statistically reliable reductions in delay discounting rates. The task is brief, can be administered remotely, and is highly scalable. If found to support behavior change, the task might be disseminated broadly to enhance evidence-based behavior change interventions. Future research must determine optimal exposure patterns to support durable health behavior change.
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Affiliation(s)
| | | | - Warren K Bickel
- Advanced Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA
| | | | - Ria Malhotra
- City University of New York Medical School, New York, NY
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Abstract
This paper places the Abecedarian Approach in theoretical and historical context and reviews the results from three randomized controlled trials that have tested an experimental protocol designed to prevent cognitive disabilities and their social consequences. Results affirm that cognitive disabilities can be prevented in early childhood and subsequent academic achievement enhanced via a multipronged comprehensive approach that contains individualized and responsive early childhood education starting in early infancy, coupled with pediatric health care, good nutrition, and family-oriented social services. Additional important findings reveal that the most vulnerable children benefited the most and that cognitive gains were not at the expense of children's socioemotional development or relationship to family. In general, mothers derived benefits in education and employment and teenage mothers especially benefited from their children participating in the early education treatment group. On the whole, the overall pattern of results supports a multidisciplinary, individualized, and long-term longitudinal perspective on human development and prevention science. Recent structural and functional brain imaging in the fifth decade of life shows persistent effects of intensive early educational treatment. Independent recent cost-benefit analysis in adulthood reveals a 7.3:1 return on investment with a 13.7% average annual rate of return. The paper concludes with a discussion of implications of the Abecedarian Approach to today's high-risk population in the USA.
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Kim-Spoon J, Lauharatarahirun N, Peviani K, Brieant A, Deater-Deckard K, Bickel WK, King-Casas B. Longitudinal pathways linking family risk, neural risk processing, delay discounting, and adolescent substance use. J Child Psychol Psychiatry 2019; 60:655-664. [PMID: 30809804 PMCID: PMC6791121 DOI: 10.1111/jcpp.13015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Current theories in neuroscience emphasize the crucial role of individual differences in the brain contributing to the development of risk taking during adolescence. Yet, little is known about developmental pathways through which family risk factors are related to neural processing of risk during decision making, ultimately contributing to health risk behaviors. Using a longitudinal design, we tested whether neural risk processing, as affected by family multi-risk index, predicted delay discounting and substance use. METHOD One hundred and fifty-seven adolescents (aged 13-14 years at Time 1, 52% male) were assessed annually three times. Family multi-risk index was measured by socioeconomic adversity, household chaos, and family risk-taking behaviors. Delay discounting was assessed by a computerized task, substance use by questionnaire data, and risk-related neural processing by blood-oxygen-level-dependent (BOLD) responses in the amygdala during a lottery choice task. RESULTS Family multi-risk index at Time 1 was related to adolescent substance use at Time 3 (after controlling for baseline substance use) indirectly through heightened amygdala sensitivity to risks and greater delay discounting. CONCLUSIONS Our results elucidate the crucial role of neural risk processing in the processes linking family multi-risk index and the development of substance use. Furthermore, risk-related amygdala activation and delay discounting are important targets in the prevention and treatment of substance use among adolescents growing up in high-risk family environments.
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Affiliation(s)
| | - Nina Lauharatarahirun
- Department of Psychology, Virginia Tech
- Virginia Tech Carilion Research Institute
- U.S. Army Research Laboratory, Aberdeen Proving Ground
- Annenberg School for Communication, University of Pennsylvania
| | | | | | - Kirby Deater-Deckard
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst
| | - Warren K. Bickel
- Department of Psychology, Virginia Tech
- Virginia Tech Carilion Research Institute
| | - Brooks King-Casas
- Department of Psychology, Virginia Tech
- Virginia Tech Carilion Research Institute
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Chichetto NE, Kundu S, Freiberg MS, Butt AA, Crystal S, So-Armah KA, Cook RL, Braithwaite RS, Fiellin DA, Khan MR, Bryant KJ, Gaither JR, Barve SS, Crothers K, Bedimo RJ, Warner AL, Tindle HA. Association of Syndemic Unhealthy Alcohol Use, Cigarette Use, and Depression With All-Cause Mortality Among Adults Living With and Without HIV Infection: Veterans Aging Cohort Study. Open Forum Infect Dis 2019; 6:ofz188. [PMID: 31211153 PMCID: PMC6559272 DOI: 10.1093/ofid/ofz188] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/15/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The prevalence and risk of concurrent unhealthy drinking, cigarette use, and depression on mortality among persons living with HIV (PLWH) is unclear. This study applied a syndemic framework to assess whether these co-occurring conditions increase mortality and whether such risk is differential by HIV status. METHODS We evaluated 6721 participants (49.8% PLWH) without baseline cancer from the Veterans Aging Cohort Study, a prospective, observational cohort of PLWH and matched uninfected veterans enrolled in 2002 and followed through 2015. Multivariable Cox proportional hazards regressions estimated risk of a syndemic score (number of conditions: that is, unhealthy drinking, cigarette use, and depressive symptoms) on all-cause mortality by HIV status, adjusting for demographic, health status, and HIV-related factors. RESULTS Fewer than 10% of participants had no conditions; 25.6% had 1, 51.0% had 2, and 15.0% had all 3. There were 1747 deaths (61.9% PLWH) during the median follow-up (11.4 years). Overall, age-adjusted mortality rates/1000 person-years increased with a greater number of conditions: (0: 12.0; 1: 21.2; 2: 30.4; 3: 36.3). For 3 conditions, the adjusted hazard ratio of mortality was 36% higher among PLWH compared with uninfected participants with 3 conditions (95% confidence interval, 1.07-1.72; P = .013), after adjusting for health status and HIV disease progression. Among PLWH and uninfected participants, mortality risk persisted after adjustment for time-updated health status. CONCLUSIONS Syndemic unhealthy drinking, cigarette use, and depression are common and are associated with higher mortality risk among PLWH, underscoring the need to screen for and treat these conditions.
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Affiliation(s)
| | - Suman Kundu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matt S Freiberg
- Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Weill-Cornell Medical College, Doha, Qatar, and New York City, New York
- Hamad Medical Corporation, Doha, Qatar
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, Florida
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, New York
| | - David A Fiellin
- Yale University Schools of Medicine and Public Health, New Haven, Connecticut
| | - Maria R Khan
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Julie R Gaither
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Shirish S Barve
- Departments of Medicine and Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kristina Crothers
- Department of Medicine, University of Washington, Seattle, Washington
| | - Roger J Bedimo
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alberta L Warner
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Hilary A Tindle
- Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
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Leventhal AM, Bello MS, Galstyan E, Higgins ST, Barrington-Trimis JL. Association of Cumulative Socioeconomic and Health-Related Disadvantage With Disparities in Smoking Prevalence in the United States, 2008 to 2017. JAMA Intern Med 2019; 179:777-785. [PMID: 31009023 PMCID: PMC6547249 DOI: 10.1001/jamainternmed.2019.0192] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Understanding emerging patterns of smoking disparities among disadvantaged populations can guide tobacco control policy. OBJECTIVE To estimate disparities in smoking prevalence associated with the number of socioeconomic and health-related disadvantages faced by a population among US adults from 2008 to 2017. DESIGN, SETTING, AND PARTICIPANTS Nationally representative cross-sectional annual household-based probability sample of US noninstitutionalized residents. Polytomous regression estimated associations of disadvantage variables, survey year, and their interaction with the following 3 pairwise contrasts: current vs never smoking (estimate of overall disparities), current vs former smoking (unique contribution of disparities in smoking cessation), and former vs never smoking (unique contribution of disparities in smoking initiation). The setting was in-home face-to-face interviews. Participants were respondents in 2008 to 2017 survey years who were aged 25 years or older (N = 279 559). EXPOSURES Self-reported past-year unemployment, income below the federal poverty line, absence of high school diploma, disability/limitation interfering with daily functions, serious psychological distress on the Kessler 6-item screen, and at least 60 past-year heavy drinking days, each coded yes or no. These indicators were summed in a cumulative disadvantage index (0, 1, 2, 3, 4, or 5 or 6). MAIN OUTCOMES AND MEASURES Self-reported current, former (ever smoked ≥100 cigarettes, had since quit, and not currently smoking), and never (<100 cigarettes) smoking. RESULTS Among 278 048 respondents (mean [SD] age, 51.9 [16.8] years; 55.7% female) with data on smoking history (99.5% of the sample), the mean current smoking prevalence across 2008 to 2017 compared with populations without disadvantages was successively higher among populations with 1 disadvantage (21.4% vs 13.8%; current vs never smoking adjusted odds ratio [OR], 2.34; 95% CI, 2.27-2.43), 2 disadvantages (26.6% vs 13.8%; OR, 3.55; 95% CI, 3.39-3.72), 3 disadvantages (35.1% vs 13.8%; OR, 5.35; 95% CI, 5.05-5.66), 4 disadvantages (45.7% vs 13.8%; OR, 8.59; 95% CI, 7.91-9.34), or 5 or 6 disadvantages (58.2% vs 13.8%; OR, 14.70; 95% CI, 12.30-17.50). In current vs former and former vs never smoking status contrasts, ORs were lower but also showed successively greater associations with increasing cumulative disadvantage. Current (vs never) smoking odds significantly declined each year among populations with 0 (OR, 0.95; 95% CI, 0.94-0.96), 1 (OR, 0.96; 95% CI, 0.95-0.97), or 2 (OR, 0.98; 95% CI, 0.97-0.99) disadvantages but did not change across 2008 to 2017 among those with 3 or more disadvantages. CONCLUSIONS AND RELEVANCE Results of this study demonstrate that US disparities in smoking prevalence from 2008 to 2017 were successively larger with each additional disadvantage faced, were expressed in higher smoking initiation odds and lower smoking cessation odds, and widened over time.
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Affiliation(s)
- Adam M Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles.,Department of Psychology, University of Southern California, Los Angeles.,USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
| | - Mariel S Bello
- Department of Psychology, University of Southern California, Los Angeles
| | - Ellen Galstyan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Stephen T Higgins
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington.,Department of Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington
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Oshri A, Hallowell E, Liu S, MacKillop J, Galvan A, Kogan SM, Sweet LH. Socioeconomic hardship and delayed reward discounting: Associations with working memory and emotional reactivity. Dev Cogn Neurosci 2019; 37:100642. [PMID: 31004982 PMCID: PMC6546101 DOI: 10.1016/j.dcn.2019.100642] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022] Open
Abstract
Prolonged exposure to socioeconomic hardship (SH) is associated with greater delayed reward discounting (DRD), a form of impulsive decision-making that reflects a reduced capacity to delay gratification and a significant correlate of diverse risk behaviors, but the neurobehavioral mechanisms linking SH and DRD are unknown. An emerging hypothesis suggests that cognitive and affective stress associated with poverty may tax neurocognitive functions, such as working memory (WM), and lead to impulsive DRD. Furthermore, research suggests that emotional reactivity (ER) is an important dispositional factor to consider in the link between executive functions and DRD. Thus, we longitudinally examined the indirect effect of SH on impulsive DRD via a network of brain regions associated with WM function in a sample of young adults, and whether that link was moderated by ER. Participants were 119 rural African Americans (aged 19–24 years) assessed behaviorally on four occasions, with fMRI at the last time point. Results showed that, among emerging adults with higher ER, SH severity was predictive of increased DRD via reduced response in brain regions activated during an n-back WM task. These findings reveal both the cognitive and affective mechanisms that underlie the relationship between SH and DRD.
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Affiliation(s)
- Assaf Oshri
- Department of Human Development and Family Science, The Youth Development Institute, University of Georgia, 123 Dawson Hall, 305 Sanford Dr., Athens, GA, 30602, Greece.
| | - Emily Hallowell
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, Greece
| | - Sihong Liu
- Department of Human Development and Family Science, The Youth Development Institute, University of Georgia, 123 Dawson Hall, 305 Sanford Dr., Athens, GA, 30602, Greece
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L8N 3K7, Canada
| | - Adriana Galvan
- Department of Psychology, University of California in Los Angeles Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095, United States
| | - Steven M Kogan
- Department of Human Development and Family Science, The Youth Development Institute, University of Georgia, 123 Dawson Hall, 305 Sanford Dr., Athens, GA, 30602, Greece
| | - Lawrence H Sweet
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, Greece
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Peviani KM, Kahn RE, Maciejewski D, Bickel WK, Deater-Deckard K, King-Casas B, Kim-Spoon J. Intergenerational transmission of delay discounting: The mediating role of household chaos. J Adolesc 2019; 72:83-90. [PMID: 30875564 PMCID: PMC6450567 DOI: 10.1016/j.adolescence.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Adolescence is a period when impulsive decision making may be especially vulnerable to environmental influences. Impulsive decision making is often assessed using a delay discounting paradigm, which measures the preference for smaller rewards sooner over larger rewards with a delay. Research is needed to clarify the relationship between parents' and adolescents' delay discounting and to identify related environmental processes that might facilitate the intergenerational transmission of delay discounting. The current prospective longitudinal study examined the competing mediating processes of household chaos and harsh parenting in the intergenerational transmission of delay discounting between parents and adolescents. METHODS Participants included 167 adolescents (mean age = 14.07 years at Time 1; 53% male) and their parents (mean age = 41.98 years at Time 1; 87% female) recruited from the southeast United States. Parents' delay discounting was collected at Time 1, and adolescents' delay discounting was collected both at Time 1 and at Time 3 via a computerized delay discounting task. Parents and adolescents reported household chaos and harsh parenting at Time 2. RESULTS A parallel mediation model indicated that parents' delay discounting at Time 1 indirectly predicted adolescents' delay discounting Time 3 residualized change scores (regressing Time 3 delay discounting onto baseline delay discounting) through household chaos but not through harsh parenting at Time 2. CONCLUSIONS These results underline the importance of household chaos in facilitating the intergenerational transmission of delay discounting between parents and adolescents. Furthermore, our findings point to household chaos as a potential environmental target for interrupting intergenerational impulsivity.
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Affiliation(s)
- Kristin M Peviani
- Department of Psychology, Virginia Tech. 109 Williams Hall, Blacksburg, VA, 24061, United States.
| | - Rachel E Kahn
- Department of Psychology, Virginia Tech. 109 Williams Hall, Blacksburg, VA, 24061, United States
| | - Dominique Maciejewski
- Department of Psychology, Virginia Tech. 109 Williams Hall, Blacksburg, VA, 24061, United States
| | - Warren K Bickel
- Department of Psychology, Virginia Tech. 109 Williams Hall, Blacksburg, VA, 24061, United States; Fralin Biomedical Research Institute at VTC, 2 Riverside Circle, Roanoke, VA, 24016, United States
| | - Kirby Deater-Deckard
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst. 135 Hicks Way/Tobin Hall, Amherst, MA, 01003, United States
| | - Brooks King-Casas
- Department of Psychology, Virginia Tech. 109 Williams Hall, Blacksburg, VA, 24061, United States; Fralin Biomedical Research Institute at VTC, 2 Riverside Circle, Roanoke, VA, 24016, United States
| | - Jungmeen Kim-Spoon
- Department of Psychology, Virginia Tech. 109 Williams Hall, Blacksburg, VA, 24061, United States
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Cook PF, Schmiege SJ, Reeder B, Horton-Deutsch S, Lowe NK, Meek P. Temporal Immediacy: A Two-System Theory of Mind for Understanding and Changing Health Behaviors. Nurs Res 2019; 67:108-121. [PMID: 29489632 PMCID: PMC8592031 DOI: 10.1097/nnr.0000000000000265] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Health promotion and chronic disease management both require behavior change, but people find it hard to change behavior despite having good intentions. The problem arises because patients' narratives about experiences and intentions are filtered through memory and language. These narratives inaccurately reflect intuitive decision-making or actual behaviors. OBJECTIVES We propose a principle-temporal immediacy-as a moderator variable that explains which of two mental systems (narrative or intuitive) will be activated in any given situation. We reviewed multiple scientific areas to test temporal immediacy as an explanation for findings. METHODS In an iterative process, we used evidence from philosophy, cognitive neuroscience, behavioral economics, symptom science, and ecological momentary assessment to develop our theoretical perspective. These perspectives each suggest two cognitive systems that differ in their level of temporal immediacy: an intuitive system that produces behavior in response to everyday states and a narrative system that interprets and explains these experiences after the fact. FINDINGS Writers from Plato onward describe two competing influences on behavior-often with moral overtones. People tend to identify with the language-based narrative system and blame unhelpful results on the less accessible intuitive system, but neither is completely rational, and the intuitive system has strengths based on speed and serial processing. The systems differ based on temporal immediacy-the description of an experience as either "now" or "usually"-with the intuitive system generating behaviors automatically in real time and the narrative system producing beliefs about the past or future. DISCUSSION The principle of temporal immediacy is a tool to integrate nursing science with other disciplinary traditions and to improve research and practice. Interventions should build on each system's strengths, rather than treating the intuitive system as a barrier for the narrative system to overcome. Nursing researchers need to study the roles and effects of both systems.
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Affiliation(s)
- Paul F Cook
- Paul F. Cook, PhD, is Associate Professor; Sarah J. Schmiege, PhD, is Associate Professor; Blaine Reeder, PhD, is Assistant Professor; Sara Horton-Deutsch, PhD, RN, PMHCNS, FAAN, ANEF, is Professor; Nancy K. Lowe, PhD, CNM, FACNM, FAAN, is Professor; and Paula Meek, PhD, RN, FAAN, is Professor, College of Nursing, University of Colorado, Aurora
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Acuff SF, MacKillop J, Murphy JG. Applying behavioral economic theory to problematic Internet use: An initial investigation. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 32:846-857. [PMID: 30451521 DOI: 10.1037/adb0000404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The widespread availability of the Internet has had profound social, educational, and economic benefits. Yet, for some, Internet use can become compulsive and problematic. The current study seeks to apply a behavioral economic framework to Internet use, testing the hypothesis that, similar to other addictive behaviors, problematic Internet use is a reinforcer pathology, reflecting an overvaluation of an immediately acquirable reward relative to prosocial and delayed rewards. Data were collected through Amazon's Mechanical Turk data collection platform. A total of 256 adults (Mage = 27.87, SD = 4.79; 58.2% White, 23% Asian; 65.2% had an associate degree or greater) completed the survey. Measures of delay discounting, consideration of future consequences, Internet demand, and alternative reinforcement all contributed unique variance in predicting both problematic Internet use and Internet craving. In aggregate models controlling for all significant predictors, alternative reinforcement and future valuation variables contributed unique variance. Individuals with elevated demand and discounting were at greatest risk for problematic Internet use. Consistent with behavioral economic research among substance abusing samples, individuals engaging in heavy Internet use report elevated motivation for the target behavior coupled with diminished motivation for other potentially rewarding activities, especially those associated with delayed reward. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - James MacKillop
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University/St Joseph's Healthcare Hamilton
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43
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Snider SE, DeHart WB, Epstein LH, Bickel WK. Does delay discounting predict maladaptive health and financial behaviors in smokers? Health Psychol 2018; 38:21-28. [PMID: 30474996 DOI: 10.1037/hea0000695] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Excessive delay discounting, the rapid devaluation of future rewards, is often demonstrated by individuals suffering from substance use disorders, including chronic cigarette smokers. This constricted temporal window not only produces increased valuation of immediate unhealthy rewards (e.g., cigarettes) but also a decreased valuation of both future healthy rewards (e.g., increased energy) and future consequences (e.g., lung cancer). Moreover, in addition to cigarettes, smokers tend to engage in other behaviors that elicit immediate rewards and negative future consequences such as overconsuming alcohol, unhealthy eating, physical inactivity, and/or irresponsible spending. The present study sought to determine whether smokers' discounting rate would predict the frequency of engagement in other poor health and financial behaviors, independent of cigarette smoking. METHOD A total of 303 daily smokers were asked to complete a delay discounting task and then answer how frequently they typically engaged in health and finance related behaviors. RESULTS A structural equation model was used to group the questions into highly significantly latent factors of "Drug Use," "Finances," "Fitness," "Food," "Health," "Household Savings," "Personal Development," and "Safe Driving." When regressed on the model, delay discounting significantly predicted engagement all of the factors, except "Safe Driving," independent of smoking status. CONCLUSION In sum, these findings highlight delay discounting as a useful metric for predicting whether individuals' engagement in variety of healthy physical and financial behaviors, as a function of their temporal window. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Sarah E Snider
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute
| | | | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Warren K Bickel
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute
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O'Donnell S, Daniel TO, Koroschetz J, Kilanowski C, Otminski A, Bickel WK, Epstein LH. Do process simulations during episodic future thinking enhance the reduction of delay discounting for middle income participants and those living in poverty? JOURNAL OF BEHAVIORAL DECISION MAKING 2018; 32:231-240. [PMID: 34334945 DOI: 10.1002/bdm.2108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Two studies examined whether episodic future thinking (EFT; pre-experiencing future events) reduces discounting of future rewards (DD). No studies have investigated whether process simulations (i.e., simulating the process of executing a future event) amplify EFT's reduction of DD. Study 1 examined the effect of incorporating process simulations into EFT (N = 42, M age = 43.27; 91% female, family income = $75,976) using a 2 × 2 factorial design with type of episodic thinking (process, nonprocess/general) and temporal perspective (EFT, episodic recent thinking) as between-subjects factors. Study 2 replicated Study 1 in a sample of adults living in poverty (N = 36; M age = 38.44, 88% female; family income = $25,625). The results of both studies showed EFT reduced DD, but process-oriented EFT did not amplify the effect of EFT. Our findings suggest the key ingredient in EFT's effect on DD is self-projection into the future. This was also the first study to show EFT improves DD in a sample living in poverty.
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Affiliation(s)
- Sara O'Donnell
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Tinuke Oluyomi Daniel
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Jordynn Koroschetz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Aris Otminski
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Warren K Bickel
- Department of Psychiatry, Virginia Tech Carilion Research Institute, Roanoke, Virginia, United States
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
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Duffy KA, McLaughlin KA, Green PA. Early life adversity and health-risk behaviors: proposed psychological and neural mechanisms. Ann N Y Acad Sci 2018; 1428:151-169. [PMID: 30011075 PMCID: PMC6158062 DOI: 10.1111/nyas.13928] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022]
Abstract
Early life adversity (ELA) is associated with poorer health in adulthood, an association explained, at least in part, by increased engagement in health-risk behaviors (HRBs). In this review, we make the case that ELA influences brain development in ways that increase the likelihood of engaging in HRBs. We argue that ELA alters neural circuitry underpinning cognitive control as well as emotional processing, including networks involved in processing threat and reward. These neural changes are associated psychologically and behaviorally with heightened emotional reactivity, blunted reward responsivity, poorer emotion regulation, and greater delay discounting. We then demonstrate that these adaptations to ELA are associated with an increased risk of smoking cigarettes, drinking alcohol, and eating high-fat, high-sugar foods. Furthermore, we explore how HRBs affect the brain in ways that reinforce addiction and further explain clustering of HRBs.
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Affiliation(s)
- Korrina A. Duffy
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Paige A. Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Mellis AM, Athamneh LN, Stein JS, Sze YY, Epstein LH, Bickel WK. Less is more: Negative income shock increases immediate preference in cross commodity discounting and food demand. Appetite 2018; 129:155-161. [PMID: 29959952 DOI: 10.1016/j.appet.2018.06.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/25/2018] [Accepted: 06/26/2018] [Indexed: 02/03/2023]
Abstract
Negative income shock, or the rapid reduction in financial stability, has previously been shown to increase impulsive choice for money and demand for fast food. The interplay of these conditions for obesity is called reinforcer pathology. The present work examines the impact of negative income shock on monetary and fast food discounting using a cross-commodity delay discounting task and on purchasing of fast food and an alternative commodity. An obese sample (n = 120) was recruited from Amazon Mechanical Turk and assigned to read one of two narratives: negative income shock (n = 60) or control (n = 60). Participants then completed both within- and cross-commodity discounting tasks of money and food, and purchase tasks for fast food and bottled water. The negative income shock group demonstrated greater impulsive choice across discounting tasks, as well as higher intensity of demand for fast food but not for a non-caloric control commodity (bottled water). These results suggest that negative income shock increases preference for immediate reinforcement regardless of commodity type (money or fast food), but has specific effects increasing demand for particular commodities (fast food but not an alternative). In a reinforcer pathology framework, negative income shock increasing discounting of the future while increasing demand for fast food specifically represents a high-risk state for negative health behavior in obesity.
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Affiliation(s)
- Alexandra M Mellis
- Center for Transformative Research on Health Behavior, Virginia Tech Carilion Research Institute, United States; Graduate Program of Translational Biology, Medicine & Health, Virginia Tech, United States
| | - Liqa N Athamneh
- Center for Transformative Research on Health Behavior, Virginia Tech Carilion Research Institute, United States; Graduate Program of Translational Biology, Medicine & Health, Virginia Tech, United States
| | - Jeffrey S Stein
- Center for Transformative Research on Health Behavior, Virginia Tech Carilion Research Institute, United States
| | - Yan Yan Sze
- Department of Pediatrics, University at Buffalo, United States
| | | | - Warren K Bickel
- Center for Transformative Research on Health Behavior, Virginia Tech Carilion Research Institute, United States; Department of Psychology, Virginia Tech, United States; Department of Pediatrics, University at Buffalo, United States.
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Barlow P, McKee M, Reeves A, Galea G, Stuckler D. Time-discounting and tobacco smoking: a systematic review and network analysis. Int J Epidemiol 2018; 46:860-869. [PMID: 27818375 PMCID: PMC5637946 DOI: 10.1093/ije/dyw233] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Tobacco smoking harms health, so why do people smoke and fail to quit? An explanation originating in behavioural economics suggests a role for time-discounting, which describes how the value of a reward, such as better health, decreases with delay to its receipt. A large number of studies test the relationship of time-discounting with tobacco outcomes but the temporal pattern of this relationship and its variation according to measurement methods remain unclear. We review the association between time-discounting and smoking across (i) the life course, from initiation to cessation, and (ii) diverse discount measures. Methods: We identified 69 relevant studies in Web of Science and PubMed. We synthesized findings across methodologies and evaluated discount measures, study quality and cross-disciplinary fertilization. Results: In 44 out of 54 studies, smokers more greatly discounted the future than non-smokers and, in longitudinal studies, higher discounting predicted future smoking. Smokers with lower time-discount rates achieved higher quit rates. Findings were consistent across studies measuring discount rates using hypothetical monetary or cigarette reward scenarios. The methodological quality of the majority of studies was rated as ‘moderate’ and co-citation analysis revealed an isolation of economics journals and a dearth of studies in public health. Conclusion: There is moderate yet consistent evidence that high time-discounting is a risk factor for smoking and unsuccessful cessation. Policy scenarios assuming a flat rate of population discounting may inadequately capture smokers’ perceptions of costs and benefits.
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Affiliation(s)
- Pepita Barlow
- Department of Sociology, University of Oxford, Oxford, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Aaron Reeves
- International Inequalities Institute, London School of Economics, London, UK
| | - Gauden Galea
- Division of Noncommunicable Diseases and Life-course, Regional Office for Europe, World Health OrganizationCopenhagen, Denmark
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
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Epstein LH, Paluch RA, Carr KA, Temple JL, Bickel WK, MacKillop J. Reinforcing value and hypothetical behavioral economic demand for food and their relation to BMI. Eat Behav 2018; 29:120-127. [PMID: 29656049 PMCID: PMC9664377 DOI: 10.1016/j.eatbeh.2018.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 12/16/2022]
Abstract
Food is a primary reinforcer, and food reinforcement is related to obesity. The reinforcing value of food can be measured by establishing how hard someone will work to get food on progressive-ratio schedules. An alternative way to measure food reinforcement is a hypothetical purchase task which creates behavioral economic demand curves. This paper studies whether reinforcing value and hypothetical behavioral demand approaches are assessing the same or unique aspects of food reinforcement for low (LED) and high (HED) energy density foods using a combination of analytic approaches in females of varying BMI. Results showed absolute reinforcing value for LED and HED foods and relative reinforcing value were related to demand intensity (r's = 0.20-0.30, p's < 0.01), and demand elasticity (r's = 0.17-0.22, p's < 0.05). Correlations between demographic, BMI and restraint, disinhibition and hunger variables with the two measures of food reinforcement were different. Finally, the two measures provided unique contributions to predicting BMI. Potential reasons for differences between the reinforcing value and hypothetical purchase tasks were actual responding versus hypothetical purchasing, choice of reinforcers versus purchasing of individual foods in the demand task, and the differential role of effort in the two tasks. Examples of how a better understanding of food reinforcement may be useful to prevent or treat obesity are discussed, including engaging in alternative non-food reinforcers as substitutes for food, such as crafts or socializing in a non-food environment, and reducing the value of immediate food reinforcers by episodic future thinking.
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Affiliation(s)
- Leonard H. Epstein
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, United States,Corresponding author at: Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Farber Hall, Room G56, 3435 Main Street, Building #26, Buffalo, NY 14214-3000, United States. (L. H. Epstein)
| | - Rocco A. Paluch
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, United States
| | - Katelyn A. Carr
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, United States
| | - Jennifer L. Temple
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, United States
| | | | - James MacKillop
- Michael G. DeGroote School of Medicine, McMaster University, Canada
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Appelhans BM, French SA, Olinger T, Bogucki M, Janssen I, Avery-Mamer EF, Powell LM. Leveraging delay discounting for health: Can time delays influence food choice? Appetite 2018; 126:16-25. [PMID: 29551401 DOI: 10.1016/j.appet.2018.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/05/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
Delay discounting, the tendency to choose smaller immediate rewards over larger delayed rewards, is theorized to promote consumption of immediately rewarding but unhealthy foods at the expense of long-term weight maintenance and nutritional health. An untested implication of delay discounting models of decision-making is that selectively delaying access to less healthy foods may promote selection of healthier (immediately available) alternatives, even if they may be less desirable. The current study tested this hypothesis by measuring healthy versus regular vending machine snack purchasing before and during the implementation of a 25-s time delay on the delivery of regular snacks. Purchasing was also examined under a $0.25 discount on healthy snacks, a $0.25 tax on regular snacks, and the combination of both pricing interventions with the 25-s time delay. Across 32,019 vending sales from three separate vending locations, the 25-s time delay increased healthy snack purchasing from 40.1% to 42.5%, which was comparable to the impact of a $0.25 discount (43.0%). Combining the delay and the discount had a roughly additive effect (46.0%). However, the strongest effects were seen under the $0.25 tax on regular snacks (53.7%) and the combination of the delay and the tax (50.2%). Intervention effects varied substantially between vending locations. Importantly, time delays did not harm overall vending sales or revenue, which is relevant to the real-world feasibility of this intervention. More investigation is needed to better understand how the impact of time delays on food choice varies across populations, evaluate the effects of time delays on beverage vending choices, and extend this approach to food choices in contexts other than vending machines. TRIAL REGISTRATION ClinicalTrials.gov, NCT02359916.
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Affiliation(s)
- Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA; Department of Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 400, Chicago, IL, 60612, USA.
| | - Simone A French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN, 55454, USA
| | - Tamara Olinger
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | | | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | - Elizabeth F Avery-Mamer
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | - Lisa M Powell
- Health Policy and Administration, School of Public Health, University of Illinois at Chicago, MC 923, 1603 W Taylor St, Chicago, IL, 60612, USA
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Sheffer CE, Bickel WK, Franck CT, Panissidi L, Pittman JC, Stayna H, Evans S. Improving tobacco dependence treatment outcomes for smokers of lower socioeconomic status: A randomized clinical trial. Drug Alcohol Depend 2017; 181:177-185. [PMID: 29065390 PMCID: PMC7780926 DOI: 10.1016/j.drugalcdep.2017.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/08/2017] [Accepted: 09/03/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Evidence-based treatments for tobacco dependence are significantly less effective for smokers of lower socioeconomic status which contributes to socioeconomic disparities in smoking prevalence rates and health. We aimed to reduce the socioeconomic gradient in treatment outcomes by systematically adapting evidence-based, cognitive-behavioral treatment for tobacco dependence for diverse lower socioeconomic smokers. METHODS Participants were randomized to adapted or standard treatment, received six 1-h group treatment sessions, and were followed for six months. We examined the effectiveness of the adapted treatment to improve treatment outcomes for lower socioeconomic groups. RESULTS Participants (n=227) were ethnically, racially, and socioeconomically diverse. The adapted treatment significantly reduced the days to relapse for the two lowest socioeconomic groups: SES1: M=76.6 (SD 72.9) vs. 38.3 (SD 60.1) days to relapse (RR=0.63 95% CI, 0.45, 0.88, p=0.0013); SES2: M=88.2 (SD 67.3) vs. 40.1 (SD 62.6 days to relapse (RR=0.57 95% CI, 0.18, 0.70, p=0.0024). Interactions between socioeconomic status and condition were significant for initial abstinence (OR=1.26, 95% CI 1.09, 1.46, p=0.002), approached significance for 3-month abstinence (OR=0.90, 95% CI 0.80, 1.01, p<0.071), and were not significant for 6-month abstinence (OR=0.99 95% CI 0.88, 1.10, p=0.795). No significant differences in long-term abstinence were observed. CONCLUSION Systematic adaption of evidence-based treatment for tobacco dependence can significantly improve initial and short-term treatment outcomes for diverse lower socioeconomic smokers and reduce inequities in days to relapse. Novel methods of providing targeted extended support are needed to improve long-term outcomes.
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Affiliation(s)
- Christine E Sheffer
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States.
| | - Warren K Bickel
- Advanced Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States
| | | | - Luana Panissidi
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States
| | - Jami C Pittman
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States
| | - Helen Stayna
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States
| | - Shenell Evans
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States
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