A quasi-hyperbolic discounting approach to smoking behavior

Delay discounting in children exposed to disaster

Delay discounting is an important predictor of future health and academic success in children but can change in environmental uncertainty situations. Here we show that the experience of loss of housing in the Great East Japan Earthquake 2011-but not other psychological trauma such as loss of loved ones-was correlated delay discounting of children. In 2014, we assessed delay discounting in children (N = 167; mean age = 8.3 years-old), who were preschool age at the time of the earthquake (mean age at the time of disaster = 4.8 years-old) in a time-investment exercise where children allocated five tokens between rewards "now" (one candy per token on the same day) versus "one month later" (two candies per token one month later). The number of tokens allocated for "now" was higher by 0.535 (95% confidence interval: -0.012, 1.081) in children who had their housing destroyed or flooded than those with no housing damage. Other types of traumatic experiences were not associated with delay discounting.

The Effect of Individual Time Preferences on Smoking Behavior: Insights from Behavioral Economics

BACKGROUND

We aimed to explore the correlation between the time and risk preferences and the smoking behavior of adult population in western Iran.

METHODS

Overall, 792 individuals with the age of 35 to 65 yr participating in an ongoing national cohort study (Persian Cohort) were approached to complete a pre-structured questionnaire in 2017. Time preferences were measured using a standard choice-based method. The individuals' discount rates were identified by questions that offered binary monetary choices on immediate future and distant future, by making trade-offs between them. Probit regression model was used to investigate the relationship between time preferences and smoking when controlling for demographic and socioeconomic variables.

RESULTS

Time and risk preferences had statistically significant direct correlations with smoking. A unit increase in discount rate was associated with a 4.4% percentage point increase in the likelihood of being smoker. A present-biased individual had 5.7% percentage points lower likelihood of being smoker. Moreover, a unit increase in willingness to take the risk increased the likelihood of being a smoker by 1.5% percentage points.

CONCLUSION

Time and risk preferences are important determinants of smoking behavior. These factors should be considered in designing effective prevention and control programs. Policies that increase the immediate costs of cigarette smoking or the immediate benefits of smoking cessation are likely to have a greater impact on reducing the prevalence of cigarette smoking.

Time preference and personal value: a population-based cross-sectional study in Japan

Objective

This study aimed to investigate the association between time preference (i.e., time discounting and hyperbolic time discounting) and personal values (the areas of priority values and commitment to value) in a sample of adult community residents in Japan.

Methods

Data from respondents (N = 2787) who completed the wave 1 and 3 surveys of a three-wave panel study of adult community residents in municipalities in Tokyo and suburban areas spanning 2010–2017 were analysed. Time discount rate and hyperbolic discount were measured using a three-item choice-based scale at the wave 1. Areas of priority value at present and at age 15 were measured by 11 questions for different value areas at the wave 3; the commitment to value at present and age 15 was measured by the Personal Value Questionnaire-II (PVQ-II) at the wave 3. Linear regression analyses were conducted of priority areas of values and commitment to value on time preference indicators, adjusting for sociodemographic variables and childhood socioeconomic status.

Results

After excluding those with missing responses, data from 1880 and 1958 respondents were subject to analyses on time discounting and hyperbolic time discounting, respectively. Time discount rate was significantly and negatively associated with the value area of maintaining a stable life at present. Hyperbolic time discounting was significantly and negatively associated with the commitment to value at age 15.

Conclusion

There may be an association between time preference and personal values. Time discounting and hyperbolic time discounting may be associated with different aspects of personal values, i.e., area of priority values and commitment to value, respectively.

Association of cognitive biases with human papillomavirus vaccine hesitancy: a cross-sectional study

Given the link between vaccine hesitancy and vaccine-preventable disease outbreaks, it is critical to examine the cognitive processes that contribute to the development of vaccine hesitancy, especially among parents of adolescents. We conducted a secondary analysis of baseline data from a two-phase randomized trial on human papillomavirus to investigate how vaccine hesitancy and intent to vaccinate are associated with six decision-making factors: base rate neglect, conjunction fallacy, sunk cost bias, present bias, risk aversion, and information avoidance. We recruited 1,413 adults residing in the United States with at least one daughter aged 9-17 years old through an online survey on Amazon Mechanical Turk. Vaccine hesitancy, intent to vaccinate, and susceptibility to cognitive biases was measured through a series of brief questionnaires. 1,400 participants were in the final analyzed sample. Most participants were white (74.1%), female (71.6%), married (75.3%), and had a college or graduate/professional education (88.8%). Conjunction fallacy, sunk cost bias, information avoidance, and present bias may be associated with vaccine hesitancy. Intent to vaccinate may be associated with information avoidance. These results suggest that cognitive biases play a role in developing parental vaccine hesitancy and vaccine-related behavior.

Time preferences, diabetes self-management behaviours and outcomes: a systematic review

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 HbA_1c 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.

Association between time preference, present-bias and physical activity: implications for designing behavior change interventions

BACKGROUND

The decision to initiate or maintain a healthy habit, such as physical activity involves a trade-off between a short-term cost, such as time and effort, which are commonly identified as barriers to physical activity, and a long-term health benefit. Research suggests that individual time preference may be associated with unhealthy behaviors. However, empirical evidence of this for physical activity is scant. This study investigated the relationship between time preference and physical activity, and how this might influence behavior change.

METHODS

Employees (n = 176; mean age 42.2 years) who participated in a physical activity intervention were invited to take part in a behavioral economic field experiment. Two economic experiments, using multiple price lists and monetary trade-off tables involving real money choices, were conducted face-to-face with participants to measure the two components of time preference, namely present-bias and discount rate. Together with individual risk preferences, these three variables were jointly estimated by maximum likelihood. These three parameters were expressed as a linear function of the levels of physical activity while controlling for socio-demographic variables within the same maximum likelihood framework.

RESULTS

Those who were present-biased and who had higher discount rates did significantly less physical activity than their patient and non present-biased counterparts. A 3% lower discount rate and 1.14 unit decrement in the present-bias parameter was associated with a 30 min increase of physical activity per week. This negative association was more significant for certain sub-groups, such as younger and married adults and those with higher staff grade and those who have children. Participants who dropped out of the study earlier were more present-biased.

CONCLUSIONS

Results demonstrated that discount rate and present-biasedness have a significant impact on physical activity levels. Such concepts have been largely overlooked and underutilized in physical activity interventions. Promising implications include 1) utilizing individuals' time preferences to better target interventions; 2) taking account of time preferences in the intervention design; 3) interventions attempting to correct for present-biasedness.

Time-discounting and tobacco smoking: a systematic review and network analysis

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.

Pathways to Retention in HIV Care Among U.S. Veterans

Retaining HIV patients in clinical care is a critical component of the HIV care continuum, impacting not only patients' virologic suppression, but their overall health and wellbeing. Understanding reasons for patient drop-out is therefore important to improve HIV outcomes and reduce transmission. This study used qualitative in-depth interviews with patients who dropped out of HIV care (n = 16) from the Atlanta Veterans Affairs Medical Center, to explore their reasons for drop-out and how they negotiate barriers to return to care. Results show three interlinked "pathways" leading to patient drop-out -wellness, illness, and medication pathways. These pathways encompass both barriers to retention and triggers to resume clinic visits, with patients following different pathways at different times in their lives. Perhaps the strongest deterrent to continuing clinic visits was participants' self-perception of wellness, which often outweighed clinical indicators of wellness. These pathways suggest that multiple approaches are needed to improve treatment retention, including reducing clinic-based barriers, addressing basic needs that are barriers to clinic visits, and empowering patients to view clinic visits as a facilitator to maintaining their overall health rather than only a reaction to illness.

Application of Discrete-Choice Experiment Methods in Tobacco Control: A Systematic Review

BACKGROUND

Economic evidence relating to tobacco control is generally derived from the cost effectiveness of smoking-cessation programs or the economic impact of tobacco-induced disease, based on revealed-preference data. However, empirical estimates from stated-preference data on tobacco users' preferences, smoking behaviour and smoking cessation aids using analytical techniques such as discrete-choice experiments (DCEs) could be important for policy decision making in tobacco control.

OBJECTIVES

Our objective was to review the practice and utility of DCE methodology across nicotine- and tobacco-related issues, particularly smoking and smoking-cessation behaviour, anti-smoking policies and preferences for smoking-cessation aids.

METHODS

We searched the PubMed, MEDLINE and ECONLIT databases for full-text original research articles on tobacco-related issues published between January 2000 and April 2016 that used a DCE method. We summarised the evidence and methodological characteristics of DCEs according to Lancsar and Louviere, 2008.

RESULTS

Our review of the 12 eligible studies showed that DCE methodology was used to elicit smoker preferences and to evaluate tobacco-control policies. The majority of the studies were published in the last 5 years. The areas of application were smoking cessation, smoking behaviour, electronic cigarette use, water-pipe smoking and tobacco packaging. Monetary attributes were the most influential attributes in all studies. The design of the DCEs varied.

CONCLUSION

DCE studies of tobacco-related issues were methodologically consistent with guidelines proposed for conducting health-related DCEs.