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

Abstract

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.

Higher Behavioral Profile of Mindfulness and Psychological Flexibility is Related to Reduced Impulsivity in Smokers, and Reduced Risk Aversion Regardless of Smoking Status

“…Previous studies have established a robust relevance of discounting measures in addiction research (Amlung, Vedelago, Acker, Balodis, & MacKillop, 2017;Barlow, McKee, Reeves, Galea, & Stuckler, 2016). In a metaanalysis by MacKillop and colleagues (2011) it was found that individuals with an addiction discounted delayed rewards more steeply.…”

“…This is prominently evidenced in smoking addiction. An increasing body of evidence points to increased discounting in smokers (for a review, see Barlow et al, 2016). Moreover, increased delay discounting predicts poorer outcomes of addiction treatment, particularly for smoking addiction (Krishnan-Sarin et al, 2007;MacKillop & Kahler, 2009) and increases the risk of a relapse after smoking cessation (López-Torrecillas et al, 2014;Sheffer et al, 2014;Yoon et al, 2007).…”

Transforming brain signals related to value evaluation and self‐control into behavioral choices

“…Steep delay discounting, as a correlate of high impulsivity, has been implicated in addictive behaviors (Amlung, Vedelago, Acker, Balodis, & MacKillop, ). Specifically, smokers show higher impulsivity than healthy controls (Barlow, McKee, Reeves, Galea, & Stuckler, ). Although Luo, Ainslie, Giragosian, and Monterosso () and Kobiella et al () have shown that different brain activity in smokers as compared to healthy controls when choosing long‐term reward versus early reward, these two studies did not well control 2 hr of smoking cessation (Hukkanen, Jacob, & Benowitz, ).…”

A loyalty scheme to encourage physical activity in office workers: a cluster RCT

“…smoking and obesity). 100,101 Two other key concepts possibly related to behaviour change are risk preference and loss aversion. The former refers to the participants' willingness to take risks whereas the latter refers to the tendency of participants to prefer avoidance of losses to winning equivalent gains.…”