Disrupting future discounting: a commentary on an underutilised psychological approach for improving adherence to diet and physical activity interventions.

Non-communicable diseases (NCD) such as CVD and type 2 diabetes mellitus are major contributors to the burden of disease. NCD are largely driven by modifiable lifestyle factors including poor diet and insufficient physical activity, and consequently, prevention is a public health priority. Although diet and physical activity levels can be improved via lifestyle interventions, long-term adherence to such interventions remains low, which limits their effectiveness. Thus, it is critical to identify the underlying mechanisms that challenge uptake and adherence to such interventions. The current commentary discusses an important, but underexplored, psychological driver of poor adherence to lifestyle interventions, namely, future discounting, which describes the tendency to prefer smaller, short-term rewards over larger, long-term rewards. For example, in the nutrition domain, future discounting refers to valuing the immediate reward of excessive intake of energy-dense, nutrient-poor, discretionary foods high in salt, sugar, and saturated fat, and insufficient intake of low-energy, nutrient-dense, whole foods such as vegetables. Prominent theoretical models propose that excessive future discounting is a major contributor to the development of unhealthy lifestyle behaviours. Furthermore, a vast body of evidence suggests that future discounting plays a key role in risk of NCD. Thus, the evidence to date supports the idea that future discounting is an important multi-behaviour target for supporting lifestyle behaviour change; however, this approach has been largely neglected in preventive health efforts. Furthermore, this commentary discusses promising techniques (e.g. Episodic Future Thinking) for disrupting future discounting to promote improved adherence to lifestyle interventions aimed at reducing NCD risk.

Measuring delay discounting in a crowdsourced sample: An exploratory study.

Delay discounting is a measure of preferences for smaller immediate rewards over larger delayed rewards. Discounting has been assessed in many ways; these methods have variably and inconsistently involved measures of different lengths (single vs. multiple items), forced-choice methods, self-report methods, online and laboratory assessments, monetary and non-monetary compensation. The majority of these studies have been conducted in laboratory settings. However, over the past 20 years, behavioral data collection has increasingly shifted online. Usually, these experiments involve completing short tasks for small amounts of money, and are thus qualitatively different than experiments in the lab, which are typically more involved and in a strongly controlled environment. The present study aimed to determine how to best measure future discounting in a crowdsourced sample using three discounting measures (a single shot measure, the 27-item Kirby Monetary Choice Questionnaire, and a one-time Matching Task). We examined associations of these measures with theoretically related variables, and assessed influence of payment on responding. Results indicated that correlations between the discounting tasks and conceptually related measures were smaller than in prior laboratory experiments. Moreover, our results suggest providing monetary compensation may attenuate correlations between discounting measures and related variables. These findings suggest that incentivizing discounting measures changes the nature of measurement in these tasks.

Impact of Unmet Social Needs, Scarcity, and Future Discounting on Adherence to Treatment in Children With Asthma: Protocol for a Prospective Cohort Study.

BACKGROUND: Asthma is one of the most prevalent chronic diseases of childhood and disproportionately affects children with lower socioeconomic status. Controller medications such as inhaled corticosteroids significantly reduce asthma exacerbations and improve symptoms. However, a large proportion of children still have poor asthma control, in part owing to suboptimal adherence. Financial barriers contribute to hindering adherence, as do behavioral factors related to low income. For example, unmet social needs for food, lodging, and childcare may create stress and worry in parents, negatively influencing medication adherence. These needs are also cognitively taxing and force families to focus on immediate needs, leading to scarcity and heightening future discounting; thus, there is the tendency to attribute greater value to the present than to the future in making decisions. OBJECTIVE: In this project, we will investigate the relationship between unmet social needs, scarcity, and future discounting as well as their predictive power over time on medication adherence in children with asthma. METHODS: This 12-month prospective observational cohort study will recruit 200 families of children aged 2 to 17 years at the Asthma Clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary care pediatric hospital in Montreal, Canada. The primary outcome will be adherence to controller medication, measured using the proportion of prescribed days covered during follow-up. Exploratory outcomes will include health care use. The main independent variables will be unmet social needs, scarcity, and future discounting, measured using validated instruments. These variables will be measured at recruitment as well as at 6- and 12-month follow-ups. Covariates will include sociodemographics, disease and treatment characteristics, and parental stress. Primary analysis will compare adherence to controller medication, measured using the proportion of prescribed days covered, between families with versus those without unmet social needs during the study period using multivariate linear regression. RESULTS: The research activities of this study began in December 2021. Participant enrollment and data collection began in August 2022 and are expected to continue until September 2024. CONCLUSIONS: This project will allow the documentation of the impact of unmet social needs, scarcity, and future discounting on adherence in children with asthma using robust metrics of adherence and validated measures of scarcity and future discounting. If the relationship between unmet social needs, behavioral factors, and adherence is supported by our findings, this will suggest the potential for novel targets for integrated social care interventions to improve adherence to controller medication and reduce risk across the life course for vulnerable children with asthma. TRIAL REGISTRATION: ClinicalTrials.gov NCT05278000; https://clinicaltrials.gov/ct2/show/NCT05278000. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37318.

Vaccine Refusal: A Preliminary Interdisciplinary Investigation.

Many people who generally receive standard recommended inoculations refuse to partake of COVID-19 vaccines, preventatives that are effective, safe, and life-saving amidst the current pandemic. Our quest is to understand this puzzling and dangerous phenomenon, as it exists among US and UK citizens, whom in other respects would be regarded as quite regular. We will discuss Vaccine Refusal compared with two better understood phenomena: addiction, and akrasia, along with the related matters of human action, intention, agency, will, and identity. Vaccine Refusal, we will argue, appears to be rewarded by "informational reinforcement" leading to heightened arousal, along with increases in self-esteem resulting from "bucking the trend," asserting one's "superior" understanding, and "tribal identity" in acting against social norms. These factors provide an overall reward amounting to satisfaction that outweighs the well-known consequences of COVID-19 infections. Our investigations will also lead us to a pair of epistemological hypotheses about two subtypes of the Vaccine Refusers under consideration here.

The effect of direct and indirect exposure to violence on youth survival expectations.

PURPOSE: Research finds that adolescents gravely overestimate their risk of death and that these pessimistic attitudes correlate with risky behaviors undermining health and well-being; however, it remains unclear why adolescents have negative expectations about their survival. Because youth are most likely to be exposed to violence (as victims and/or witnesses), perhaps these experiences are key in undermining expectations about the future. We explored the effect of direct and indirect exposures to violence-across various contexts-on adolescents' survival expectations. METHODS: Using data from the National Longitudinal Study of Adolescent Health, we tested the effect of violent experiences: individual direct and vicarious violence, familial and relational violence, school violence, and community violence on adolescents' expectations of surviving to 35 years of age. RESULTS: Victims of childhood physical abuse were less likely to expect to survive to 35 years of age. Although not significant at the conventional p < .05 level, violent victimization (being jumped, cut/stabbed, shot, or threatened with a weapon) and intimate partner violence were marginally associated with decreased survival expectations (p < .10). School and community violence undermined expectations at the bivariate level, but became nonsignificant after adjustments for individual demographic characteristics. CONCLUSIONS: Violent victimization in childhood and adolescence is a public health issue with both immediate and long-term consequences. Violence exposure severely compromises individuals' optimism about the future and places them at risk for behaviors that can further undermine well-being. Practitioners should be mindful of diminished survival expectations as a less overt consequence of exposure to violence.

Do people adjust career choices according to socioeconomic conditions?: an evolutionary analysis of future discounting

The ability to process environmental cues and make advantageous choices has been fundamental during human evolution. Discounting future rewards is a capacity of our evolved mind and could be useful for understanding career decisions. This paper investigated the relationship between real-life plans, career choices, and income indicators based on an evolutionary approach of future discounting. Study 1 analyzed the plans of 200 senior high school students, and Study 2 analyzed a database of 46,649 applicants to a Brazilian public university. The results demonstrated that lower income subjects made career decisions with quicker returns and smaller investments. They included a job in immediate plans more frequently than higher income students who planned to go to a university. Analyzing the applicants' choices, higher income subjects sought courses with greater entrance difficulty. We suggest that individuals adjust career plans and choices according to their socioeconomic conditions and assume different discounting rates by considering risks of failure and future gains...

Achievement goals of youngsters in rio de janeiro in different contexts / Metas de realização de jovens do rio de janeiro em contextos distintos / Los objetivos futuros de jovenes en rio de janeiro en diferentes contextos

In this study, we compared the Future Goals of 160 youngsters (16-30 years-old; 71 female and 89 male). University students and slum-dwelling youth were compared. Participants completed a sociodemographic questionnaire, information about their families and two open questions: “What do you expect to do in your life that you consider very important?” and “Do you believe you’ll achieve that? Why?” Predicted differences in the participants’ answers between the two groups were observed. Favela youth showed higher levels of uncertainty while describing their goals and also presented lower scores of objectives. From an Evolutionary perspective of Psychology, through the Life Story Strategies Theory, we concluded that, for young people from different social contexts, the ways of planning the future tend to vary depending on the adaptability of achievement due to the present constraints in the youth’s realities.

Este estudo teve por objetivo comparar as metas de realização de jovens de dois contextos distintos: universitários e moradores de favela. Participaram 160 jovens do Rio de Janeiro: estudantes universitários ( n = 80) e jovens moradores de duas favelas cariocas (Rocinha, n = 40 e Vigário Geral, n = 40), de ambos os sexos, com idades entre 16 e 30 anos. Os participantes responderam ao questionário sociodemográfico, questões referentes à família e duas perguntas abertas: “O que você pretende realizar em sua vida que considera muito importante?” e “Você acredita que conseguirá realizar isso? Por quê?”. Por meio da análise de conteúdo temático-categorial observou-se uma diferença significativa entre os grupos no número de metas relatadas, esperança de realizá-las e justificativas referentes à esperança de realização. A partir da Teoria Evolucionista das Estratégias de História de Vida, conclui-se que para jovens de diferentes contextos os modos de planejar o futuro tendem a variar em função das limitações e possibilidades presentes.

La finalidad en este estudio fue comparar las metas de rendimiento de jóvenes de dos contextos distintos: estudiantes universitarios y jóvenes que viven en barrios pobres. Participaron 160 jóvenes de Rio de Janeiro: estudiantes universitarios ( n = 80) y jóvenes que viven en dos barrios pobres (Rocinha, n = 40 y Vigário Geral, n = 40), ambos sexos, entre 16 y 30 años de edad. Los participantes respondieron un cuestionario sociodemográfico, cuestiones relacionadas con la familia y dos preguntas abiertas: “¿Qué es lo que quiere lograr en su vida que considera muy importante?” y “¿Usted cree que puede lograr esto? ¿Por qué?”. Aplicando el análisis de contenido temático-categorial, se identificó una diferencia significativa entre los grupos en el número de objetivos reportados, en la esperanza de alcanzarlos y en las justificaciones relativas a esta esperanza. Con base en la Teoría de la Evolución de las Estrategias de Historia de Vida, se concluye que, para los jóvenes en contextos diferentes, las maneras de planificar el futuro varían de acuerdo a las posibilidades y limitaciones actuales.