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The ability to delay gratification is crucial for a successful and healthy life. An effective way for young children to learn this ability is to observe the action of adult models. However, the underlying neurocomputational mechanism remains unknown. Here, we tested the hypotheses that children employed either the simple imitation strategy or the goal-inference strategy when learning from adult models in a high-uncertainty context. Results of computational modeling indicated that children used the goal-inference strategy regardless of whether the adult model was their mother or a stranger. At the neural level, results showed that successful learning of delayed gratification was associated with enhanced interpersonal neural synchronization (INS) between children and the adult models in the dorsal lateral prefrontal cortex but was not associated with children's own single-brain activity. Moreover, the discounting of future reward's value obtained from computational modeling of the goal-inference strategy was positively correlated with the strength of INS. These findings from our exploratory study suggest that, even for 3-year-olds, the goal-inference strategy is used to learn delayed gratification from adult models, and the learning strategy is associated with neural interaction between the brains of children and adult models.
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Desvalorização pelo Atraso , Adulto , Feminino , Humanos , Criança , Pré-Escolar , Recompensa , Córtex Pré-Frontal , Aprendizagem , MotivaçãoRESUMO
OBJECTIVE: The capacity of individuals with anorexia nervosa (AN) to forgo immediate food rewards in their long-term pursuit of thinness is thought to reflect elevated self-control and/or abnormal reward sensitivity. Prior research attempted to capture an increased tendency to delay gratification in AN using delay-discounting tasks that assess how rapidly the subjective value of rewards decreases as a function of time until receipt. However, significant effects were mostly subtle or absent. Here, we tested whether the process leading to such decisions might be altered in AN. METHOD: We recorded mouse-cursor movement trajectories leading to the final choice in a computerized delay-discounting task (238 trials) in 55 acutely underweight females with AN and pairwise age-matched female healthy controls (HC). We tested for group differences in deviations from a direct choice path, a measure of conflict strength in decision making, and whether group moderated the effect of several predictors of conflict strength (e.g., choice difficulty, consistency). We also explored reaction times and changes in trajectory directions (X-flips). RESULTS: No group differences in delay-discounting parameters or movement trajectories were detected. However, the effect of the aforementioned predictors on deviations (and to a lesser extent reaction times) was reduced in AN. DISCUSSION: These findings suggest that while delay discounting and conflict strength in decision making are generally unaltered in AN, conflict strength was more stable across different decisions in the disorder. This might enable individuals with AN to pursue (maladaptive) long-term body-weight goals, because particularly conflicting choices may not be experienced as such. PUBLIC SIGNIFICANCE: The deviations from a direct path of mouse-cursor movements during a computerized delay-discounting task varied less in people with anorexia nervosa. Assuming such deviations measure decision conflict, we speculate that this increased stability might help people with anorexia nervosa achieve their long-term weight goals, as for them the struggle with the decision to eat high-calorie meals when hungry will be milder, so they would be more likely to skip them.
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Cuing adults to imagine their personal futures enhances prudent choice in delay discounting tasks. However, it has not been established that such cueing also reduces discounting in children. We assessed the effect of episodic future thinking (EFT) on delay of gratification in children using EFT cues specifically related to the rewards on offer. One hundred and thirty-nine 8-12-year-olds were assigned to one of three conditions: (i) EFT (imagine spending money in the future), (ii) Imagine Place (imagine being in a certain place), or (iii) No Cue. They were cued on each trial of two tasks: a delay discounting task with hypothetical monetary rewards and a real delay choice task involving choices between real rewards over real delays (coins that could be swapped for treats). In the delay discounting task, the Imagine Place group showed significantly higher discounting than the other two groups. In the real delay choice task, the Imagine Place group made significantly fewer delayed choices than the EFT group. However, the EFT group did not differ from the No Cue group in either task. The lack of a difference between the EFT and No Cue conditions supports previous findings suggesting children struggle to benefit from EFT cues. Poorer performance of the Imagine Place group suggests that cued imagination is cognitively taxing for children, using up cognitive resources required to delay gratification.
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Desvalorização pelo Atraso , Adulto , Humanos , Criança , Pensamento , Recompensa , Previsões , Sinais (Psicologia)RESUMO
Forgoing immediate satisfaction for higher pay-offs in the future (delayed gratification) could be adaptive in situations that wild animals may encounter. To explain species-differences in self-control, hypotheses based on social complexity, feeding ecology, brain size and metabolic rate have been proposed. To explore these hypotheses in a comparative setting, we tested three macaw species (neotropical parrots)-great green macaws (N = 8), blue-throated macaws (N = 6), blue-headed macaws (N = 6)-and the distantly related African grey parrots (afrotropical parrots; N = 8) in a modified rotating tray task, in which subjects are required to inhibit consuming a constantly available low-quality reward in favour of a high-quality reward that becomes available only after an increasing delay (min. 5 s, max. 60 s). All four species successfully waited for a minimum of 8.3 s ± 11.7 s (group level mean ± SD) with African greys reaching a delay of 29.4 ± 15.2 s, and great green macaws-as best performing macaw species-tolerating delays of 20 s ± 8 s. The best performing African grey individual reached a maximum delay of 50 s, whereas, a great green and a blue-throated macaw tolerated a delay of 30 s max. Females tolerated higher maximum delays than males. Engaging in distraction behaviours enhanced waiting performance across species and all birds were able to anticipate the waiting duration. Our results suggest that both feeding and socio-ecological complexity may be a factor in self-control, but further systematically collected comparative data on self-control of different (parrot) species are required to test the evolutionary hypotheses rigorously.
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Papagaios , Recompensa , Autocontrole , Animais , Evolução Biológica , Feminino , Masculino , Papagaios/classificação , PrazerRESUMO
Brucks (Anim Cogn 25(2):473-491, 2021) have published an intriguing paper on the differing abilities of various species of parrots to succeed in a delay of gratification task. I find their interspecies comparisons of considerable interest but take exception to their misrepresentation of prior research on delayed gratification from our laboratory in Koepke (J Comp Psychol 129:339-346, 2015). Contrary to their claims, our subject was never trained on the task; rather, one might argue instead that all their subjects received considerable training or at least forms of pre-exposure that could affect their overall claims. I also briefly discuss other design features that may have affected their results.
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Desvalorização pelo Atraso , Papagaios , Autocontrole , Animais , Prazer , RecompensaRESUMO
Self-control underlies cognitive abilities such as decision making and future planning. Delay of gratification is a measure of self-control and involves obtaining a more valuable outcome in the future by tolerating a delay or investing a greater effort in the present. Contextual issues, such as reward visibility and type, may influence delayed gratification performance, although there has been limited comparative investigation between humans and other animals, particularly non-primate species. Here, we adapted an automated 'rotating tray' paradigm used previously with capuchin monkeys to test for delay of gratification ability that requires little pre-test training, where the subject must forgo an immediate, less preferred reward for a delayed, more preferred one. We tested New Caledonian crows and 3-5-year-old human children. We manipulated reward types to differ in quality or quantity (Experiments 1 and 2) as well as visibility (Experiment 2). In Experiments 1 and 2, both species performed better when the rewards varied in quality as opposed to quantity, though performed above chance in both conditions. In Experiment 1, both crows and children were able to delay gratification when both rewards were visible. In Experiment 2, 5-year-old children outperformed 3- and 4-year olds, though overall children still performed well, while the crows struggled when reward visibility was manipulated, a result which may relate to difficulties in tracking the experimenters' hands during baiting. We discuss these findings in relation to the role of contextual issues on self-control when making species comparisons and investigating the mechanisms of self-control.
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Corvos , Desvalorização pelo Atraso , Autocontrole , Animais , Cebus , Humanos , RecompensaRESUMO
Previous research suggests that the sleep-obesity association varies significantly across individuals. This study examined the associations between actigraphically measured sleep parameters and body mass index and hypothesized that the associations would be stronger in individuals with greater delay discounting, the devaluation of future rewards and response disinhibition and the difficulty in withholding previously rewarded responses. Seventy-eight college students carried a wrist-worn actigraph and completed diaries reporting bedtime, wake time and covariates including physical activity, alcohol and caffeine consumption, daytime nap duration and perceived stress for 7 days and completed the delay discounting and go/no-go response disinhibition tasks. Their height and weight were measured. Only bedtime variability was significantly associated with body mass index in the main effect model controlling for all covariates (B = 0.03, P = 0.001). Delay discounting moderated associations of bedtime (B = 0.03, P < 0.001), sleep duration variability (B = 0.05, P = 0.002), bedtime variability (B = 0.03, P = 0.002) and wake time variability (B = 0.02, P < 0.001) with body mass index; these associations were significant only when the delay discounting rate was high. Response disinhibition moderated the association between bedtime variability and body mass index in a similar pattern (B = 0.01, P = 0.004). The findings suggest that, using actigraphy measures of sleep, circadian desynchrony rather than sleep duration is a risk factor for higher body mass index. The findings support the hypothesis that delay discounting and response disinhibition moderate the associations between sleep and body mass index. Delay discounting and response disinhibition might characterize individuals who are vulnerable to the influence of circadian desynchrony on weight.
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Actigrafia/métodos , Índice de Massa Corporal , Desvalorização pelo Atraso/fisiologia , Obesidade/etiologia , Sono/fisiologia , Adulto , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Carrying food to water and either dunking or manipulating it before consumption has been observed in various taxa including birds, racoons and primates. Some animals seem to be simply moistening their food. However, true washing aims to remove unpleasant surface substrates such as grit and sand and requires a distinction between items that do and do not need cleaning as well as deliberate transportation of food to a water source. We provide the first evidence for food washing in suids, based on an incidental observation with follow-up experiments on European wild boar (Sus scrofa) kept at Basel Zoo, Switzerland. Here, all adult pigs and some juveniles of a newly formed group carried apple halves soiled with sand to the edge of a creek running through their enclosure where they put the fruits in the water and pushed them to and fro with their snouts before eating. Clean apple halves were never washed. This indicates that pigs can discriminate between soiled and unsoiled foods and that they are able to delay gratification for long enough to transport and wash the items. However, we were unable to ascertain to which degree individual and/or social learning brought this behaviour about.
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Comportamento Alimentar , Sus scrofa/fisiologia , Animais , Animais de Zoológico , Galinhas , Feminino , Masculino , Malus , VerdurasRESUMO
This research explores the origins of observed differences in time preference across countries and regions. Exploiting a natural experiment associated with the expansion of suitable crops for cultivation in the course of the Columbian Exchange, the research establishes that pre-industrial agro-climatic characteristics that were conducive to higher return to agricultural investment, triggered selection, adaptation and learning processes that generated a persistent positive effect on the prevalence of long-term orientation in the contemporary era. Furthermore, the research establishes that these agro-climatic characteristics have had a culturally embodied impact on economic behavior such as technological adoption, education, saving, and smoking.
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Agricultura , Desenvolvimento Econômico/estatística & dados numéricos , Tempo , Agricultura/história , Produtos Agrícolas , Emigração e Imigração , Europa (Continente) , História do Século XV , História do Século XVI , Humanos , Fumar , Estados UnidosRESUMO
Displacement activities are commonly recognized as behavioral patterns, mostly including self-directed actions (e.g., scratching, self-touching), that often occur in situations involving conflicting motivational tendencies. In ethology, several researchers have suggested that displacement activities could facilitate individuals in dealing with the stress experienced in a frustrating context. In child developmental research, some authors have assessed whether distraction strategies could help children to inhibit a dominant response during delay of gratification tasks. However, little is known about the displacement activities that young children may produce in such situations. This study was aimed at investigating whether displacement activities had an effect on preschool children's ability to postpone an immediate gratification (i.e., interacting with an attractive toy, a musical box), thereby functioning as regulators of their emotional state. To this end, we administered 143 2- to 4-year-olds with a delay maintenance task and related their performance with displacement activities they produced during the task and with actions with an external object. Children's latency to touch the musical box was positively related to their rate of displacement activities. However, the rate of displacement activities increased progressively as long as the children were able to inhibit the interaction with the musical box. In addition, the rate of displacement activities during the first 1 min of test did not predict the ability of children to inhibit the interaction with the box. These results suggest that displacement activities represented a functionless by-product of motivational conflict rather than a strategy that children used to inhibit their response to an attractive stimulus.
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Comportamento Infantil/psicologia , Deslocamento Psicológico , Inibição Psicológica , Pré-Escolar , Feminino , Humanos , Masculino , Psicologia da Criança , Fatores de TempoRESUMO
When given the choice between $100 today and $110 in 1 week, certain people are more likely to choose the immediate, yet smaller reward. The present study examined the relations between temporal discounting rate and body mass while accounting for important demographic variables, depressive symptoms, and behavioral inhibition and approach. After having their heights and weights measured, 100 healthy adults completed the Monetary Choice Questionnaire, the Beck Depression Inventory-II, and the Behavioral Inhibition Scale/Behavioral Approach Scale. Overweight and obese participants exhibited higher temporal discounting rates than underweight and healthy weight participants. Temporal discounting rates decreased as the magnitude of the delayed reward increased, even when other variables known to impact temporal discounting rate (i.e., age, education level, and annual household income) were used as covariates. A higher body mass was strongly related to choosing a more immediate monetary reward. Additional research is needed to determine whether consideration-of-future-consequences interventions, or perhaps cognitive control interventions, could be effective in obesity intervention or prevention programs.
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Peso Corporal , Comportamento de Escolha , Desvalorização pelo Atraso , Motivação , Obesidade/psicologia , Recompensa , Adulto , Depressão , Feminino , Humanos , Comportamento Impulsivo , Masculino , Sobrepeso , Inquéritos e Questionários , Magreza , Adulto JovemRESUMO
Previous studies have failed to show an effect of episodic future thinking (EFT) on children's delay of gratification (DoG), contrasting strikingly with adult findings. Recent findings from a sample of 8-11-year-old children by Canning et al. (J. Exp. Child Psychol., 228, 2023, 105618) indicate that EFT cueing is not effective compared to a no-cue control even when it is reward related. Canning et al. suggest children's DoG performance, unlike that of adults, may be negatively affected by the cognitive load of cueing, but this leaves unexplained why EFT reward-related cueing produced significantly better performance than cueing that did not involve EFT in their study. The current study attempted to further delineate the importance of linking future thinking cues to rewards. A reward-related EFT condition was compared to a reward-unrelated EFT condition and a no-cue control on a delay choice task. No significant differences were observed between the three conditions. This suggests that even reward-related future thinking is ineffective at improving children's delayed gratification. Further research is needed to determine why children struggle to benefit from EFT cues.
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Desvalorização pelo Atraso , Memória Episódica , Adulto , Criança , Humanos , Prazer , Pensamento , Recompensa , Sinais (Psicologia)RESUMO
Preserving a normal body mass index (BMI) is crucial for the healthy growth and development of children. As a core aspect of executive functions, inhibitory control plays a pivotal role in maintaining a normal BMI, which is key to preventing issues of childhood obesity. By studying individual variations in inhibitory control performance and its associated connectivity-based neuromarker in a sample of primary school students (N = 64; 9-12 yr), we aimed to unravel the pathway through which inhibitory control impacts children's BMI. Utilizing resting-state functional MRI scans and a connectivity-based psychometric prediction framework, we found that enhanced inhibitory control abilities were primarily associated with increased functional connectivity in brain structures vital to executive functions, such as the superior frontal lobule, superior parietal lobule, and posterior cingulate cortex. Conversely, inhibitory control abilities displayed a negative relationship with functional connectivity originating from reward-related brain structures, such as the orbital frontal and ventral medial prefrontal lobes. Furthermore, we revealed that both inhibitory control and its corresponding neuromarker can moderate the association between food-related delayed gratification and BMI in children. However, only the neuromarker of inhibitory control maintained its moderating effect on children's future BMI, as determined in the follow-up after one year. Overall, our findings shed light on the potential mechanisms of how inhibitory control in children impacts BMI, highlighting the utility of the connectivity-based neuromarker of inhibitory control in the context of childhood obesity.
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BACKGROUND: We analyzed data from a study to evaluate the effectiveness of the Relationships Under Construction (RUC) sexual risk avoidance education program promoting positive youth development and healthy relationships. METHODS: Twelve schools in the Midwestern region of the United States randomized to the intervention implemented RUC in health or science classes, while control schools collected study measures and implemented the standard curriculum. RESULTS: Post-randomization analyses revealed significant differences in grade, race/ethnicity, and prior relationship education at baseline between intervention and control students. Subsequent analyses controlled for these differences. We distributed parental notification letters to 641 students, and no parents requested that their adolescent opt out of data collection. We obtained assent and baseline computer-assisted survey interviews or paper-and-pencil instrument forms from 100% of these students. Findings suggest that RUC significantly reduced sexual activity (odds ratio = 0.56, p = .046) at 3-month follow-up, compared to those in the control group. RUC also reduced pornography viewing and improved attitudes about delayed gratification, beliefs, decision making, and negative outcome expectations. CONCLUSIONS: Our findings suggest that RUC improves sexual attitudes, beliefs, and behaviors among this population of adolescents. Additional research is needed to assess RUC impacts among diverse populations.
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Educação Sexual , Humanos , Adolescente , Feminino , Masculino , Educação Sexual/métodos , Comportamento Sexual , Comportamento do Adolescente/psicologia , Serviços de Saúde Escolar/organização & administração , Meio-Oeste dos Estados UnidosRESUMO
Objective: The concept of "compensatory belief" pertains to an individual's conviction that the negative consequences of a specific behavior can be counteracted by engaging in a subsequent positive behavior. This study sought to devise a scale tailored to gauge compensatory beliefs concerning internet instant gratification behaviors. Methods: Utilizing the Credamo online questionnaire platform, data were amassed from two distinctive cohorts: organizational employees and college students. A collective 1064 responses were amassed. Results: The newly created Compensatory Belief Scale for Internet Instant Gratification Behavior was bifurcated into two versions: one tailored for employees (CBS-IIGB-E) and the other for college students (CBS-IIGB-S). Through an exploratory factor analysis, two factors were discerned, namely "Compensatory Beliefs for Working/Studying " and "Compensatory Beliefs for Resting". A confirmatory factor analysis validated this two-factor model with the following metrics for the employee version: SBχ2 = 54.88, df = 32, CFI = 0.974, TLI = 0.964, RMSEA = 0.064, SRMR = 0.047, and for the student version: SBχ2 = 19.26ï¼df = 19ï¼CFI = 0.999ï¼TLI = 0.999ï¼RMSEA = 0.008ï¼SRMR = 0.033. The scores on the Internet Addiction Scale and the Smartphone Addiction Scale showed a positive correlation with the overall scores of the CBS-IIGB-E and the scores of its two factors. Conversely, the scores on the Self-control Scale exhibited a negative correlation with the total scores of the CBS-IIGB-E and the scores of its two factors. The correlation pattern with the criterion scales for the CBS-IIGB-S mirrored that of the CBS-IIGB-E, with the exception that the Self-control Scale only correlated with the two factors and not the overall score of the CBS-IIGB-S. The McDonald's Omega coefficients for the two factors of the CBS-IIGB-E were 0.84 and 0.86 respectively, and those for the CBS-IIGB-S were 0.82 and 0.87 respectively. Both scales demonstrated a test-retest reliability of 0.76. Significant differences in the scale scores across diverse target groups were observed in the simulation game of internet instant gratification behavior, thereby validating the predictive validity of the developed scales. Conclusion: The Compensatory Belief Scale for Internet Instant Gratification Behavior (CBS-IIGB) is a reliable and valid tool for measuring compensatory belief in situations where the allure of immediate internet gratification comes into conflict with long-term objectives, among both organizational employees (CBS-IIGB-E) and college students (CBS-IIGB-S).
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Impulsive behaviour is a key characteristic of mania in bipolar disorder (BD). However, there is mixed evidence as to whether impulsivity is a trait feature of the disorder, present in the euthymic state in the absence of mania. The aim of this systematic review and meta-analysis was to examine whether impulsivity is elevated in euthymic BD in comparison to controls. Electronic databases were searched for papers published until April 2022 reporting data on a self-report or behavioural measure of impulsivity in a euthymic BD group and a healthy control group. In total, 46 studies were identified. Euthymic BD showed significantly higher levels of self-reported impulsivity compared to controls (large effect size). Euthymic BD also showed significantly higher levels of impulsivity on response inhibition and inattention tasks, with moderate and large effect sizes, respectively. Only two studies measured delay of gratification, finding no significant differences between groups. Our results suggest impulsivity may be a trait feature of BD, however longitudinal cohort studies are required to confirm whether elevated impulsivity is present before illness onset. Future research should establish whether cognitive interventions are beneficial in improving impulsivity in BD.
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Objective: Eating behavior regulation emerges during early development and involves general self-regulation (emotional, behavioral), appetite regulation (homeostatic metabolic need) and appetite self-regulation (including both Bottom-Up Food Approach and Bottom-Up Food Avoidance and top-down purposeful self-control of eating). Limited research has investigated developmental trajectories of the regulation of eating behavior before the preschool years. The current study used a novel food delay task to assess infant distress as an early emerging marker of eating behavior regulation constructs across early infancy and examine associations with amount of milk consumed. Method: Mother-infant dyads (n = 179) completed the Ability to Delay Gratification for Food in Infants Task (ATDG-FIT) at 2 weeks, 8 weeks, and 16 weeks of age. The ATDG-FIT required infants to wait before being fed while their bottle was present, but not accessible (3-min Pre-Feeding Delay). After this, the infant was fed for 1 min, then the feeding was paused for 30 s (Mid-Feeding Delay). Infant distress was coded during each feeding delay period and the amount of milk consumed was measured. Results: The mean proportion of distress during the Pre-Feeding Delay period decreased from 8 to 16 weeks of age (F(2,230) = 15.02, p < 0.001), whereas the mean proportion of distress during the Mid-Feeding Delay increased from 2 to 8 weeks of age (F(2,230) = 27.04, p < 0.001). There was a positive interaction between distress during Mid-Feeding Delay and infant age predicting the amount consumed in the protocol (ß = 0.30, p = 0.022), suggesting that the association between distress during this part of the task and amount consumed strengthens as infants get older. Conclusion: The ATDG-FIT may be an effective method to assess emerging eating behavior regulation constructs during early infancy.
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Objective: To investigate the effect of different rearing arrangements on children's self-control and verify the promoting effect sports games might have on children's self-control in intergenerational rearing. Methods: A total of 72 intergenerational rearing children and 66 non-intergenerational rearing children were included in Experiment 1, in which the delay-of-gratification task was used to examine the differences in self-control among children with different rearing arrangements. In experiment 2, 70 intergenerational rearing children were included as subjects, and sports games were used to improve their self-control. Results: The results of experiment 1 showed that compared with non-intergenerational rearing children, the self-control ability of intergenerational rearing children was poor. In experiment 2, it was found that after the intervention with sports games, the self-control ability of the children in the intergenerational rearing group was effectively improved. Conclusion: Although intergenerational rearing arrangements have a certain negative impact on the self-control ability of children, the sports game intervention can be used to effectively develop the self-control ability of intergenerational rearing children.
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Leveraging exogenous variation in time preferences, we measure the causal effects of culturally embodied long-term orientation traits on voluntary social distancing behavior, COVID-19 cases, hospitalizations, and mortality outcomes in 2020 in the United States. We establish that long-term orientation traits with bio-geographical origins causally reduce measures of COVID-19 cases, deaths and hospitalization, inpatient bed utilization, and age-specific excess deaths. Mobility indicators measuring voluntary decisions to socially distance, comprising measures of visitors/visits to recreational locations, and mobility proxy measuring duration of hours away from home show that a lower prevalence of long-term orientation traits explains persistent resistance to social distancing. Supplementary Information: The online version contains supplementary material available at 10.1007/s10887-022-09218-0.
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BACKGROUND: In search of innovative approaches to the challenge of uncontrolled hypertension, we assessed the association between preference for immediate gratification (i.e., high discounting rate), low medication adherence, and uncontrolled blood pressure (BP) in adults with hypertension. METHODS: Using a probability discounting model and the Collier-Williams hypothetical discount rate framework, participants in this cross-sectional study reported their preference for a smaller amount of money available immediately (high discount rate; immediate gratification preference) vs. a larger amount available 1 year later (low discount rate; delayed gratification preference). Multivariable Poisson regression was used to test the association of high discounting rates with low antihypertensive medication adherence using the validated 4-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4 score ≥1). Mediation of the association between high discounting rate and uncontrolled BP (systolic/diastolic BP ≥ 130/80 mm Hg) by low adherence was tested using the counterfactual approach. RESULTS: Among 235 participants (mean age 63.7 ± 6.7 years; 51.1% women; 41.9% Black), 50.6% had a high 1-year discount rate, 51.9% had low K-Wood-MAS-4 adherence, and 59.6% had uncontrolled BP. High discounting rates were associated with low adherence (adjusted prevalence ratio 1.58, 95% confidence interval (CI) 1.18, 2.12). Forty-three percent (95% CI 40.9%, 45.8%) of the total effect of high discount rate on uncontrolled BP was mediated by low adherence. CONCLUSIONS: Adults with preference for immediate gratification had worse adherence; low adherence partially mediated the association of high discount rate with uncontrolled BP. These results support preference for immediate gratification as an innovative factor underlying low medication adherence and uncontrolled BP.