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Cross-sectional research suggests that smokers are more impulsive than are nonsmokers, but few studies have examined relations between impulsiveness and later success in quitting smoking. The purpose of this study was to investigate the reliability and predictive validity of facets of impulsiveness in adult smokers trying to quit. Baseline behavioral measures of impulsive choice (assessed with a delay discounting task) and impulsive action (assessed with a measure of behavioral disinhibition) were used as predictors of smoking cessation success over 12 weeks. The sample included 116 adult (18 years old or older) daily smokers from central New Jersey. Impulsive choice, impulsive action, and self-reported impulsiveness were not significantly related to one another at baseline. Impulsive choice had high test-retest reliability from pre- to postquit, whereas impulsive action was less stable. Test-retest reliability from prequit to 3 weeks' postquit was moderated by achievement of 7-day abstinence. Baseline impulsive action was significantly negatively related to quitting for at least 1 day in the first 2 weeks of a quit attempt and of prolonged abstinence (no relapse over the next 10 weeks). Baseline impulsive choice was robustly associated with biochemically verified 7-day point-prevalence abstinence 12 weeks' postquit, such that those with lower delay discounting were more likely to achieve abstinence. Facets of impulsiveness appear to function largely independently in adult smokers, as indicated by their lack of intercorrelation, differential stability, and differential relations with abstinence. Impulsive action may impede initial quitting, whereas impulsive choice may be an obstacle to maintaining lasting abstinence., ((c) 2016 APA, all rights reserved).)

Individual decision-making regarding vaccination may be affected by the vaccination choices of others. As vaccination produces externalities reducing transmission of a disease, it can provide an incentive for individuals to be free-riders who benefit from the vaccination of others while avoiding the cost of vaccination. This study examined an individual's decision about vaccination in a group setting for a hypothetical disease that is called "influenza" using a computerized experimental game. In the game, interactions with others are allowed. We found that higher observed vaccination rate within the group during the previous round of the game decreased the likelihood of an individual's vaccination acceptance, indicating the existence of free-riding behavior. The free-riding behavior was observed regardless of parameter conditions on the characteristics of the influenza and vaccine. We also found that other predictors of vaccination uptake included an individual's own influenza exposure in previous rounds increasing the likelihood of vaccination acceptance, consistent with existing empirical studies. Influenza prevalence among other group members during the previous round did not have a statistically significant effect on vaccination acceptance in the current round once vaccination rate in the previous round was controlled for.

This study aimed to expand the current understanding of smoking maintenance mechanisms by examining how putative relapse risk factors relate to a single behavioral smoking choice using a novel laboratory smoking-choice task. After 12 hr of nicotine deprivation, participants were exposed to smoking cues and given the choice between smoking up to two cigarettes in a 15-min window or waiting and receiving four cigarettes after a delay of 45 min. Greater nicotine dependence, higher impulsivity, and lower distress tolerance were hypothesized to predict earlier and more intensive smoking. Out of 35 participants (n = 9 women), 26 chose to smoke with a median time to a first puff of 1.22 min (SD = 2.62 min, range = 0.03-10.62 min). Survival analyses examined latency to first puff, and results indicated that greater pretask craving and smoking more cigarettes per day were significantly related to smoking sooner in the task. Greater behavioral disinhibition predicted shorter smoking latency in the first 2 min of the task, but not at a delay of more than 2 min. Lower distress tolerance (reporting greater regulation efforts to alleviate distress) was related to more puffs smoked and greater nicotine dependence was related to more time spent smoking in the task. This novel laboratory smoking-choice paradigm may be a useful laboratory analog for the choices smokers make during cessation attempts and may help identify factors that influence smoking lapses.

Background: Living wills are intended to preserve patient autonomy, but recent studies suggest that they do not always have their desired effect. One possible explanation is that living wills do not capture the authentic preferences of the patients who write them but instead reflect transient contextual effects on preferences., Purpose: Two experiments examined whether end-of-life treatment preferences expressed in a living will were influenced by the presence of default options., Method: College students participated in 2 Web-based questionnaire experiments (Ns = 182 and 51). Participants were randomly assigned to 1 of 2 or 3 default conditions., Results: In experiment 1, participants expressed significantly different treatment preferences in 3 normatively equivalent, check box-formatted living wills that were either positively worded ("indicate medical treatments you would want administered"), negatively worded ("indicate treatments you would want withheld"), or of forced-choice format (P = 0.01). Participants expressed a stronger preference to receive treatment in the negatively worded document than in the positively worded document as a consequence of preferring the default option in both cases. Participants in experiment 2 were also influenced by the presence of a default option, but this time, while writing narrative living wills after viewing 1 of 2 sample living wills. In this experiment, the sample living will represented the default preference. The participants' own living wills tended to express preferences similar to those in the sample (P = 0.0005)., Conclusion: The default manipulations in both experiments had potent but transient effects and influenced what participants wrote in their living wills but not their responses to later medical scenarios. Expression of end-of-life treatment preferences appears to be temporarily constructed from the decision-making context. These results have implications for surrogate decision making and the use of the living will as a tool to preserve patient autonomy.

Background: Little research has examined how anchor numbers affect choice, despite several decades of research showing that judgments typically and robustly assimilate toward irrelevant anchors., Methods: In one experiment, HIV-positive patients (N = 99) judged the chances that sexual partners would become infected with HIV after sex using a defective condom and then indicated their choices of remedial action. In a second experiment, Iowa physicians (N =191) rated the chances that hypothetical patients had a pulmonary embolism and then formulated a treatment plan., Results: Irrelevant anchor numbers dramatically affected judgments by HIV-infected patients of the chances of HIV infection after a condom broke during sex (43% v. 64% in the low- and high-anchor conditions, respectively) and judgments by doctors of the chances of pulmonary embolism (23% v. 53%, respectively). Despite large anchoring effects in judgement, treatment choices did not differ between low-and high-anchor conditions. Accountability did not reduce the anchoring bias in the doctors' judgments., Discussion: The practical implications of anchoring for risk judgments are potentially large, but the bias may be less relevant to treatment choices. The findings suggest that the theoretical underpinnings of the anchoring bias may be more complex than previously thought.

Two experiments were performed to test a psychophysical account of parallels between biases in risky choice and intertemporal choice. Experiment 1 demonstrated the common difference effect in intertemporal choice and the common ratio effect in risky choice. As was predicted, these two biases were uncorrelated with each other, although each was correlated across monetary/health domains. This result is consistent with the supposition that these two biases result from psychophysical properties of two different dimensions (time and probability, respectively). Experiment 2 examined the magnitude effect in intertemporal choice and the peanuts effect in risky choice. These two biases were correlated with each other but were uncorrelated across monetary/health domains. This result is consistent with the supposition that these two biases result from psychophysical properties of the same dimension (utility of money or health).

Background: Time preferences reflect how future outcomes are valued relative to present ones. Previous research has found that time preferences for one domain (say, money) are inconsistent (uncorrelated) with those from another (say, health). The present studies evaluated whether this domain independence was due to decision makers' sensitivity to a normatively appropriate principle about the tradability of health and money., Method: Participants read a scenario in which health and money were described as tradable or not tradable and then responded to hypothetical intertemporal trade-off questions. RESULTS. In experiment 1, participants showed higher agreement between health and money time preferences in the tradable condition, as predicted. In experiment 2, participants responded from either an individual decision maker or policy maker perspective. Perspective had little effect on agreement between health and money discount rates, but there was again higher agreement in the tradable as compared to the not-tradable condition., Conclusion: Previous demonstrations of domain independence may have been due in part to decision makers' assumption that health and money are not tradable.

Many important decisions concern outcomes delayed by decades or centuries. Whereas some economists have argued that inter-generational discount rates should be lower than intra-generational rates, three experiments found that inter- and intra-generational discount rates were quite similar. Experiment 1 found that discount rates for long delays (30-900 years) were lower than those for shorter delays (1-30 years) but that, holding delay constant, discount rates for outcomes occurring to future generations were similar to those for outcomes occurring to the present generation. Experiment 2 compared inter-generational discount rates for three different types of outcomes and found similar discount rates for saving lives, improving health, and financial benefits. Experiment 3 found similar inter-generational discounting of life-saving programs that benefit people close to or distant from the decision maker. These studies indicate that the discount rate applied to outcomes occurring to future generations depends on the length of the time delay but not on other factors.

Aim: To explore framing or editing effects and a method to debias framing in a clinical context., Method: Clinical scenarios using multioutcome life-expectancy lotteries of equal value required choices between two supplementary drugs that either prolonged or shortened life from the 20-year beneficial effect of a baseline drug. The effects of these supplementary drugs were presented in two conditions, using a between-subjects design. In segregated editing (n = 116) the effects were presented separately from the effects of the baseline drug. In integrated editing (n = 100), effects of supplementary and baseline drugs were combined in the lottery presentation. Each subject responded to 30 problems. To explore one method of debiasing, another 100 subjects made choices after viewing both segregated and integrated editings of 20 problems (dual framing)., Results: Statistically significant preference reversals between segregated and integrated editing of pure lotteries occurred only when one framing placed outcomes in the gain domain, and the other framing placed them in the loss domain. When both editings resulted in gain-domain outcomes only, there was no framing effect. There was a related relationship of framing-effect shifts from losses to gains in mixed-lottery-choice problems. Responses to the dual framing condition did not consistently coincide with responses to either single framing. In some situations, dual framing eliminated or lessened framing effects., Conclusion: The results support two components of prospect theory, coding outcomes as gains or losses from a reference point, and an s-shaped utility function (concave in gain, convex in loss domains). Presenting both alternative editings of a complex situation prior to choice more fully informs the decision maker and may help to reduce framing effects. Given the extent to which preferences shift in response to alternative presentations, it is unclear which choice represents the subject's "true preferences."

Two versions of the time-tradeoff (TTO) method were compared. In the personal TTO version, 31 prostate cancer patients decided whether they personally would give up some longevity to have perfect health rather than a longer life in a state of poor health associated with prostate cancer. In the impersonal version, 28 patients compared two hypothetical friends, one of whom has perfect health but will live less time than the other who is in poor health, and decided which person they would rather be. All patients evaluated three hypothetical health states. The two TTO methods were assessed by examining 1) how well they distinguished three health states of varying degrees of dysfunction and 2) patients' willingness to trade time for quality of life. Patients using the impersonal TTO version were more likely than those using the personal version to order the three health states appropriately (68% vs 16%, p < 0.0001) and were more willing to trade off length of life for quality of life (p < 0.05).