Understanding Everyday Decisions: An Examination Of Biases In Decision-Making, Educational Attainment, And Use Of Tobacco And Nicotine Delivery Products Among Women Of Reproductive Age

The aim of this study was to examine associations between biases in decision-making (delay discounting [DD], opportunity cost neglect [OCN], status quo bias [SQB]), educational attainment, and use of cigarettes and other tobacco and nicotine delivery products among women of reproductive age. Women of reproductive age are of special interest because of the additional risks that cigarette smoking or use of these other products represents should they become pregnant. Data were collected anonymously online in survey format using Amazon Mechanical Turk [AMT]. Participants were 800 women of reproductive age (24-44 years) from across the US. Half (n = 400) were smokers who reported current, daily smoking and half (n = 400) were never smokers who reported smoking less than 100 cigarettes in their lifetime. Participants reported smoking characteristics, plans to quit smoking, use of nicotine replacement therapies, use of other tobacco and nicotine delivery products, alcohol and drug use histories, and the Fagerström Test for Nicotine Dependence. Participants completed two measures for each of the three biases in decision-making, the Barratt Impulsiveness Scale [BIS-11], and two scales measuring short- and long-term propensity to plan for money expenditures [PPMS and PPML]. Educational attainment analyses compared three education groups: high school or less vs. some college (e.g. some college/A.A.) vs. B.A. or higher. DD was steeper among current vs. never smokers and for women with lower vs. higher levels of education, with no significant interaction between smoking and education. Modifying the instructions of the DD measure to make the zero option explicit reduced DD similarly across levels of smoking status and education. OCN was worse at lower vs. higher educational attainment on one OCN measure, with no significant effect of smoking status or interaction between opportunity cost neglect and educational attainment on either measure. No evidence was found for stronger SQB by smoking status or education. Smoking status was related to BIS Total, BIS Motor and Nonplanning subscales and to PPML in initial models but remained significant after adjusting for baseline differences in participant characteristics only for BIS Motor subscale and educational attainment was related only to BIS Nonplanning subscale. Preliminary comparisons of e-cigarette users to non-users suggest smokers using e-cigarettes only differ from smokers not using e-cigarettes on measures related to quitting smoking whereas within never smokers e-cigarette users demonstrated a pattern of riskier decision-making compared to non-users. Results confirm that DD and education are important to understanding the use of tobacco and nicotine products in women of reproductive age, and suggest that smoking and educational attainment are independently related to discounting rates. The observed explicit-zero framing effect suggests making alternatives more explicit when presenting choices may help reduce DD and lead to better decision-making, which has possible treatment implications. Results identify OCN as an additional decision-making bias to consider in understanding how low educational attainment might relate to smoking vulnerabilities. The preliminary examination of e-cigarette use suggests for women of reproductive age above age 24 years, e-cigarette use among current smokers may reflect desire or attempts to quit or cut back on smoking whereas e-cigarette use among non-smokers may be a marker of a more impulsive, riskier repertoire, although additional study of this question is needed

E-cigarette use among women of reproductive age: Impulsivity, cigarette smoking status, and other risk factors.

INTRODUCTION: The study aim was to examine impulsivity and other risk factors for e-cigarette use among women of reproductive age comparing current daily cigarette smokers to never cigarette smokers. Women of reproductive age are of special interest because of the additional risk that tobacco and nicotine use represents should they become pregnant. METHOD: Survey data were collected anonymously online using Amazon Mechanical Turk in 2014. Participants were 800 women ages 24-44years from the US. Half (n=400) reported current, daily smoking and half (n=400) reported smokingsociodemographics, tobacco/nicotine use, and impulsivity (i.e., delay discounting & Barratt Impulsiveness Scale). Predictors of smoking and e-cigarette use were examined using logistic regression. RESULTS: Daily cigarette smoking was associated with greater impulsivity, lower education, past illegal drug use, and White race/ethnicity. E-cigarette use in the overall sample was associated with being a cigarette smoker and greater education. E-cigarette use among current smokers was associated with increased nicotine dependence and quitting smoking; among never smokers it was associated with greater impulsivity and illegal drug use. E-cigarette use was associated with hookah use, and for never smokers only with use of cigars and other nicotine products. CONCLUSIONS: E-cigarette use among women of reproductive age varies by smoking status, with use among current smokers reflecting attempts to quit smoking whereas among non-smokers use may be a marker of a more impulsive repertoire that includes greater use of alternative tobacco products and illegal drugs

Effects of Initial Abstinence and Programmed Lapses on The Relative Reinforcing Effects of Cigarette Smoking

Fifty-eight smokers received abstinence-contingent monetary payments for 1 (n  =  15) or 14 (n  =  43) days. Those who received contingent payments for 14 days also received 0, 1, or 8 experimenter-delivered cigarette puffs on 5 evenings. The relative reinforcing effects of smoking were assessed in a 3-hr session on the final study day, when participants made 20 choices between smoking or money. The reinforcement contingencies exerted robust control over smoking, and programmed smoking lapses produced few discernible effects. These results further illustrate the robust control that reinforcement contingencies can exert over cigarette smoking and suggest that any effects of lapses on the relative reinforcing effects of smoking are modest under conditions involving abstinence-contingent reinforcement contingencies

Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine

Abstract: Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine. A systematic review of evidence, across the key pillars of prevention, diagnosis, treatment and prognosis, outlines milestones that need to be met to enable the broad clinical implementation of precision medicine in diabetes care

Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine

Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.</p