The phenotype of recovery XI: associations of sleep quality and perceived stress with discounting and quality of life in substance use recovery.

PURPOSE: Sleep and stress show an interdependent relationship in physiology, and both are known risk factors for relapse in substance use disorder (SUD) recovery. However, sleep and stress are often investigated independently in addiction research. In this exploratory study, the associations of sleep quality and perceived stress with delay discounting (DD), effort discounting (ED), and quality of life (QOL) were examined concomitantly to determine their role in addiction recovery. DD has been proposed as a prognostic indicator of SUD treatment response, ED is hypothesized to be relevant to the effort to overcome addiction, and QOL is an important component in addiction recovery. METHOD: An online sample of 118 individuals recovering from SUDs was collected through the International Quit and Recovery Registry. Exhaustive model selection, using the Bayesian Information Criterion to determine the optimal multiple linear model, was conducted to identify variables (i.e., sleep quality, perceived stress, and demographics) contributing to the total variance in DD, ED, and QOL. RESULTS: After model selection, sleep was found to be significantly associated with DD. Stress was found to be significantly associated with psychological health, social relationships, and environment QOL. Both sleep and stress were found to be significantly associated with physical health QOL. Neither sleep nor stress was supported as an explanatory variable of ED. CONCLUSION: Together, these findings suggest sleep and stress contribute uniquely to the process of addiction recovery. Considering both factors when designing interventions and planning for future research is recommended.

Illegal product purchasing in the experimental tobacco marketplace: Effects of menthol cigarette and cigarette ventilation ban.

BACKGROUND: Tobacco regulations may increase demand for illegal cigarettes. We use the Experimental Tobacco Marketplace to estimate the impact of banning menthol cigarettes (Experiment 1) and decreasing allowable cigarette filter ventilation levels (Experiment 2). METHODS: Crowdsourced participants were randomized into one of four groups (2×2 factorial design). Experiment 1 included menthol availability (yes/no) by purchasing option (legal only vs illegal available). Experiment 2 included filter-vented cigarettes availability (yes/no) by purchasing option (legal only vs illegal available). Participants were given an individualized budget to purchase tobacco. Percent budget spent was the outcome measure. RESULTS: Experiment 1, with a legal marketplace only, non-menthol cigarette purchasing was lower (p=0.010) and electronic-cigarette purchasing was higher (p=0.016), when cigarettes were banned compared to when they were available. With an illegal marketplace, switching to legal non-menthol cigarettes was less likely (p<0.001) and purchasing illegal menthol cigarettes was higher (p<0.001), when cigarettes were banned compared to when they were available. Experiment 2, with a legal marketplace only, cigarette purchasing was lower (p=0.010), when the participant's filtered vented cigarettes were banned compared to when they were available. With an illegal marketplace, purchasing the legal low-ventilated cigarette option was lower (p<0.001) and significant differences in illegal filter-vented cigarette purchasing were not observed, when their filter-vented cigarettes were banned compared to when they were available legally. CONCLUSIONS: Without an illegal option, both restrictions decreased cigarette purchasing, but the menthol ban increased e-cigarette purchasing. With an illegal option, a menthol ban increased illegal cigarette purchasing, but decreasing filter ventilation did not.

Discounting of delayed rewards: Missing data imputation for the 21- and 27-item monetary choice questionnaires.

The Monetary Choice Questionnaire (MCQ) is a widely used behavioral task that measures the rate of delay discounting (i.e., k), the degree to which a delayed reward loses its present value as a function of the time to its receipt. Both 21- and 27-item MCQs have been extensively validated and proven valuable in research. Different methods have been developed to streamline MCQ scoring. However, existing scoring methods have yet to tackle the issue of missing responses or provide clear guidance on imputing such data. Due to this lack of knowledge, the present study developed and compared three imputation approaches that leverage the MCQ's structure and prioritize ease of implementation. Additionally, their performance was compared with mode imputation. A Monte Carlo simulation was conducted to evaluate the performance of these approaches in handling various missing responses in each observation across two datasets from prior studies that employed the 21- and 27-item MCQs. One of the three approaches consistently outperformed mode imputation across all performance measures. This approach involves imputing missing values using congruent non-missing responses to the items corresponding to the same k value or introducing random responses when congruent answers are unavailable. This investigation unveils a straightforward method for imputing missing data in the MCQ while ensuring unbiased estimates. Along with the investigation, an R tool was developed for researchers to implement this strategy while streamlining the MCQ scoring process.

Can delay discounting predict vaccine hesitancy 4-years later? A study among US young adults.

Despite being a major threat to health, vaccine hesitancy (i.e., refusal or reluctance to vaccinate despite vaccine availability) is on the rise. Using a longitudinal cohort of young adults (N = 1260) from Los Angeles County, California we investigated the neurobehavioral mechanisms underlying COVID-19 vaccine hesitancy. Data were collected at two time points: during adolescence (12th grade; fall 2016; average age = 16.96 (±0.42)) and during young adulthood (spring 2021; average age = 21.33 (±0.49)). Main outcomes and measures were delay discounting (DD; fall 2016) and tendency to act rashly when experiencing positive and negative emotions (UPPS-P; fall 2016); self-reported vaccine hesitancy and vaccine beliefs/knowledge (spring 2021). A principal components analysis determined four COVID-19 vaccine beliefs/knowledge themes: Collective Responsibility, Confidence and Risk Calculation, Complacency, and Convenience. Significant relationships were found between themes, COVID-19 vaccine hesitancy, and DD. Collective Responsibility (ß = -1.158[-1.213,-1.102]) and Convenience (ß = -0.132[-0.185,-0.078]) scores were negatively associated, while Confidence and Risk Calculation (ß = 0.283[0.230,0.337]) and Complacency (ß = 0.412[0.358,0.466]) scores were positively associated with COVID-19 vaccine hesitancy. Additionally, Collective Responsibility (ß = -0.060[-0.101,-0.018]) was negatively associated, and Complacency (ß = -0.063[0.021,0.105]) was positively associated with DD from fall 2016. Mediation analysis revealed immediacy bias during adolescence, measured by DD, predicted vaccine hesitancy 4 years later while being mediated by two types of vaccine beliefs/knowledge: Collective Responsibility (ß = 0.069[0.022,0.116]) and Complacency (ß = 0.026[0.008,0.044]). These findings provide a further understanding of individual vaccine-related decision-making among young adults and inform public health messaging to increase vaccination acceptance.

Predictors of smoking cessation outcomes identified by machine learning: A systematic review.

This systematic review aims to characterize the utility of machine learning to identify the predictors of smoking cessation outcomes and identify the machine learning methods applied in this area. In the current study, multiple searches occurred through December 9, 2022 in MEDLINE, Science Citation Index, Social Science Citation Index, EMBASE, CINAHL Plus, APA PsycINFO, PubMed, Cochrane Central Register of Controlled Trials, and the IEEE Xplore were performed. Inclusion criteria included various machine learning techniques, studies reporting cigarette smoking cessation outcomes (smoking status and the number of cigarettes), and various experimental designs (e.g., cross-sectional and longitudinal). Predictors of smoking cessation outcomes were assessed, including behavioral markers, biomarkers, and other predictors. Our systematic review identified 12 papers fitting our inclusion criteria. In this review, we identified gaps in knowledge and innovation opportunities for machine learning research in the field of smoking cessation.

Presentation matters: Effects of cigarette purchase task design on systematic data and purchasing behavior.

Hypothetical purchase tasks (HPTs) are effective tools for evaluating participants' demand for substances. The present study evaluated the effect of task presentation on producing unsystematic data and purchasing behavior in a sample of individuals who smoke cigarettes. Participants (n = 365) were recruited from Amazon Mechanical Turk and randomly assigned to complete two of three HPT presentations: List (prices on one page in an increasing order), Ascending (one price per page in an increasing order), or Random (one price per page in a random order). We evaluated outcomes using a mixed model regression with a random effect for participants. We observed a significant effect of task presentation on passing the criterion assessing consistency in effects of contiguous prices (i.e., Bounce; X²(2) = 13.31, p = .001). A significant effect of task presentation on Trend or Reversals from Zero was not observed. For purchasing behavior, we observed a significant effect of task presentation on R², X²(2) = 17.89, p < .001; BP1, X²(2) = 13.64, p = .001; ln(α), X²(2) = 332.94, p < .001; and ln(Omax), X²(2) = 20.26, p < .001; we did not observe a significant effect of task presentation on ln(Q0) or ln(Pmax). We recommend against using the Random HPT presentation to avoid unsystematic data. While the List and Ascending presentations do not differ across unsystematic criteria or purchasing behavior, the List presentation may be preferred due to participant experience. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Rate-dependent effects of narrative interventions in a longitudinal study of individuals who use alcohol.

BACKGROUND: Delay discounting (DD), the decrease in reward valuation as a function of delay to receipt, is a key process undergirding alcohol use. Narrative interventions, including episodic future thinking (EFT), have decreased delay discounting and demand for alcohol. Rate dependence, the relationship between a baseline rate and change in that rate after an intervention, has been evidenced as a marker of efficacious substance use treatment, but whether narrative interventions have rate-dependent effects needs to be better understood. We investigated the effects of narrative interventions on delay discounting and hypothetical demand for alcohol in this longitudinal, online study. METHODS: Individuals (n = 696) reporting high- or low-risk alcohol use were recruited for a longitudinal 3-week survey via Amazon Mechanical Turk. Delay discounting and alcohol demand breakpoint were assessed at baseline. Individuals returned at weeks 2 and 3 and were randomized into the EFT or scarcity narrative interventions and again completed the delay discounting tasks and alcohol breakpoint task. Oldham's correlation was used to explore the rate-dependent effects of narrative interventions. Study attrition as a function of delay discounting was assessed. RESULTS: Episodic future thinking significantly decreased, while scarcity significantly increased delay discounting relative to baseline. No effects of EFT or scarcity on the alcohol demand breakpoint were observed. Significant rate-dependent effects were observed for both narrative intervention types. Higher delay discounting rates were associated with a greater likelihood of attrition from the study. CONCLUSION: The evidence of a rate-dependent effect of EFT on delay discounting rates offers a more nuanced, mechanistic understanding of this novel therapeutic intervention and can allow more precise treatment targeting by demonstrating who is likely to receive the most benefit from it.

Is perception reality? Associations among "light" cigarettes and number of cigarettes smoked per day.

INTRODUCTION: Cigarette filter ventilation and light descriptors are associated with lowered perceptions of risk and smoking more cigarettes per day (CPD). This study examined the relationship between usual cigarette ventilation, perception, and CPD. METHODS: A crowdsourced sample (N = 995) of individuals who smoke higher-ventilated (=>20% ventilation) or lower-ventilated (=<10% ventilation) cigarettes identified their usual cigarette as "light" or "full flavor", and reported their average CPD. RESULTS: We found: 1) no association between ventilation status and perception of light versus full flavor (AUC=0.58), with the inaccurate perception being more prevalent in younger individuals (p = 0.041) and those who smoke L&M (73%, p < 0.001) and Camel (61%, p = 0.006) brands; and 2) perception, but not ventilation of usual cigarette, was significantly associated with CPD (p = 0.006), with individuals who perceived their cigarettes as light reporting an average of 13% more cigarettes per day (2.6 CPD), compared to those who perceived their cigarette as full flavor. CONCLUSIONS: Perceptions of light versus full-flavor, but not ventilation status, predicted CPD. These findings may inform anti-smoking health communication strategies and smoking cessation interventions. IMPLICATIONS: Tobacco control policies should eradicate the perception of cigarettes as light or full-flavored. Future research investigating the associations between cigarette filter ventilation and smoking behavior should consider the confounding effects that may lie in an individual's perceptions of their cigarettes.

The Associations between Remission Status, Discounting Rates, and Recovery from Substance Use Disorders.

Background: Recovery from substance use disorders (SUDs) requires sustained and purposeful support to maintain long-term remission. Methods: This study investigated the association between assessment of recovery capital, household chaos, delay discounting (DD) and probability discounting (PD), and remission status among individuals in recovery from SUD. Data from 281 participants from the International Quit & Recovery Registry (IQRR), an ongoing online registry that aims to study the recovery process, were included in the analysis. Results: Lower DD rates and higher recovery capital were found among those in remission compared to those not in remission after controlling for demographics. In contrast, the association of household chaos and PD with remission status were insignificant. Overall, DD accounted for 20% of the total effect between the recovery capital and the remission status. Conclusion: This study contributes to the understanding of recovery as a multidimensional process, supports DD as a behavioral marker of addiction, and suggests areas for future research.

Utility of the 5-trial adjusting delay task in screening for high delay discounting rates: A cohort study of individuals reporting harmful alcohol and tobacco use.

High delay discounting (DD) rates are associated with several health conditions, including addiction. Investigators interested in the modulation of DD rates may be interested in screening for individuals with high DD rates within substance-using samples. The adjusting delay discounting task (ADT) is a brief DD rate measure suitable for screening purposes, but how performance on this task is related to more granular DD measures (e.g., adjusting amount task; AAT) in individuals who use substances is unknown. This study investigated the relationship between DD rates measured by the ADT and AAT to assess the utility of the ADT in screening for high discounting rates in individuals who use tobacco and alcohol. Participants (N = 488) were screened for high discounting rates, ln(k) ≥ -4.3118, using the ADT. Subsequently, participants completed the AAT. Linear regressions were conducted to understand the relationship between the ADT and AAT DD rates. Separate analyses between the total, high-quality and low-quality samples were conducted. Significant relationships between the ADT and AAT were found for the total (p < .001), high-quality (p < .001), and low-quality samples (p < .001). Although the ADT overestimated DD rates on the AAT by 2.49, 2.29, and 2.97 units in the total, high-quality, and low-quality samples, the ADT accurately identified individuals with high discounting rates. Specifically, 71% of the total sample, 80% of the high-quality sample, and 66% of the low-quality sample maintained a high DD rate on the AAT. These results demonstrate that ADT can be used as a quick, accurate screening tool to identify high discounting rates in individuals who use substances. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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

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

The relationship between nonsystematic delay discounting and low-quality survey responses in a sample of smokers: ROC curve analysis.

Delay discounting (DD), the decrease of the subjective value of a reward as the delay to its receipt increases, is a crucial aspect of decision-making processes. As evidence continues to mount, additional attention needs to be given to nonsystematic DD, a response pattern that has been reported in the literature but rarely investigated. We noticed in our recent online research an increase in the proportion of nonsystematic DD responses across samples, consistent with the so-called Amazon Mechanical Turk (MTurk) data quality crisis. The significant proportion of nonsystematic responses created an opportunity to investigate its association with data quality in the present study. In a sample of smokers recruited from MTurk (n = 210), three independent quality check indexes evaluated participants' response quality. The degree of nonsystematic DD was quantified by the algorithms developed by Johnson and Bickel (2008). The area under the receiver operating characteristic curve (AUC) predicting response quality by nonsystematic DD was obtained. The observed AUC values were at the extreme of the null distributions (ps < .001) in a permutation test. Furthermore, the nonsystematic DD cutoffs provided in Johnson and Bickel (2008) showed good sensitivity (0.77-0.93), albeit low-moderate specificity (0.42-0.74), in detecting low-quality responses. The findings showed that nonsystematic DD was associated with low-quality responses, although other factors contributing to the nonsystematic responses remain to be identified. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Delay discounting, cognitive ability, and personality: What matters?

Steep delay discounting is associated with problems such as addiction, obesity, and risky sexual behavior that are frequently described as reflecting impulsiveness and lack of self-control, but it may simply indicate poor cognitive functioning. The present investigation took advantage of the unique opportunity provided by the Human Connectome Project (N=1,206) to examine the relation between delay discounting and 11 cognitive tasks as well as the Big Five fundamental personality traits. With income level and education statistically controlled, discounting was correlated with only four of the 11 cognitive abilities evaluated, although the rs were all small (<.20). Importantly, the two discounting measures loaded on their own factor. Discounting was not correlated with Neuroticism or Conscientiousness, traits related to psychometric impulsiveness and self-control. These findings suggest that steep delay discounting is not simply an indicator of poor cognitive functioning or psychometric impulsiveness but an important individual difference characteristic in its own right.

Choice patterns reveal qualitative individual differences among discounting of delayed gains, delayed losses, and probabilistic losses.

A new probabilistic losses questionnaire as well as Kirby's delayed gains questionnaire and a previously developed delayed losses questionnaire were administered to a large online sample. Almost all participants showed the positive discounting choice pattern expected on the Kirby questionnaire, decreasing their choice of a delayed gain as time to its receipt increased. In contrast, approximately 15% of the participants showed negative discounting on the delayed losses questionnaire and/or the probabilistic losses questionnaire, decreasing their choice of an immediate loss as time to a delayed loss decreased and/or decreasing their choice of a certain loss as likelihood of the probabilistic loss increased. Mixture model analysis confirmed the existence of these negative discounting subgroups. The inconsistent findings observed in previous research involving delayed/probabilistic losses may be due to differences in the proportion of negative discounters who participated in previous studies. Further research is needed to determine how negative discounting of delayed and probabilistic losses manifests itself in everyday decisions. It should be noted that the presence of individuals who show atypical choice patterns when losses are involved may pose challenges for efforts to modify discounting in order to ameliorate behavioral problems, especially because many such problems concern choices that have negative consequences, often delayed and/or probabilistic.

Excess mortality reduction given a "reduce patient mortality at all costs" scenario for mass burn casualties.

OBJECTIVE: The aim of this study was to estimate the effect on medical resource use and mortality of full financial support from the government for treatment costs after a mass burn casualty event in Taiwan. METHODS: All patients with burn injuries from the event were included (n = 483). Each burn patient from this incident was matched to a separate burn patient identified from the National Health Insurance database. Medical care usage and mortality were compared between groups at 1-, 3-, 6-, 9-, and 12-month intervals. RESULTS: Regarding outpatient expenditure, burn patients from the mass casualty event had significantly higher levels of medical expenditure compared with their control counterparts at all intervals and levels of medical institution. For inpatient expenditure, patients from the mass casualty event only had higher expenditure for the first month, and excess procedures used by these patients mainly consisted of nonvital procedures such as rehabilitation training. The mortality rate was only slightly lower for this group of burn patients compared with their control counterparts. CONCLUSIONS: Full financial support by the government in terms of medical treatment may engender only marginal additional benefits in terms of mortality if burn treatment procedures are already well established in the country.

Experience of distributing 499 burn casualties of the June 28, 2015 Formosa Color Dust Explosion in Taiwan.

OBJECTIVE: To describe the experience of distributing 499 burn casualties of an unexpected event and determine whether patient transfer is associated with patient outcomes measured 2 weeks after the incident. METHODS: All 499 patients injured in the event were included. For the 138 patients transferred to other hospitals after primary distribution, we evaluated whether the transfers were associated with patient severity. Furthermore, we used multinomial logistic regression to investigate the association of patient transfer with patient outcomes after controlling for age, gender, total burn surface area (TBSA), final hospital level, wound infection, and patient pneumonia. RESULTS: We determined that on-site triage differed significantly from hospital triage (p<0.001). Furthermore, the secondary distribution enabled the transfer of a high number of patients to medical centers based on the availability of beds; however, such transfers were not associated with patient outcomes (p>0.05). Factors associated with patient outcomes were wound infection and TBSA (p<0.001). CONCLUSIONS: In case of inadequate burn centers, satisfactory patient outcomes can be achieved by the immediate treatment of patients, despite the treating hospitals being lower-level hospitals. Regardless of the hospital level, immediate treatment of burn patients is crucial to reducing mortality.