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Discounting is a description of the devaluing of an outcome based on increased delay or decreased probability of that outcome. This framework can be extended to virtually any choice situation, including preventive medical procedures. One third of Americans will be diagnosed with cancer in their lifetimes. Identifying how key factors affect decisions to engage in preventive care could inform interventions that are designed to promote equitable access to care. Therefore, the purpose of this study was to better understand how individuals would weigh key factors in the decision to have surgery to remove a premalignant tumor. Two experiments were conducted. In each experiment, participants (n = 50) were provided with hypothetical situations in which they were faced with the decision to undergo surgery to remove a premalignant tumor. Probability of cancer, delay to onset of cancer, frame, and cost of surgery were varied across questions. Surgical cost and probability of malignancy had the most effect on tumor removal. Delay of cancer onset and the question being framed as malignant or benign also had a small effect on tumor removal. Most participants also reported having delayed a real medical procedure due to cost, indicating that cost is a major factor in health-related decision making. Likelihood of cancer and cost of health care is a major determinant of decision making when removing a premalignant tumor. Changes in the U.S. health-care system that decrease direct costs to patients could encourage important preventative procedures, and lower potentially worse long-term cancer outcomes and increased costs due to treatment. Keywords Cancer * Discounting Decisionmaking * Surgical cost * Behavioral economics, Many choices involve a more immediate or more probable outcome pitted against a delayed or less probable outcome. Examples include immediate spending versus investing, eating a high-calorie, high-fat meal versus [...]

The present study was designed to extend research by Pattison et al. (2012) and compare performance on behavior-based and hypothetical scenario-based sunk cost procedures. Participants (n = 25) completed behavior-based and hypothetical scenario-based tasks to investigate the effects of manipulating percent of task completed on sunk cost behavior. For the behavior-based task, participants played a video game and chose between continuing to engage an initial monster or switching to attack a new monster that arrived. For the hypothetical scenario-based tasks, participants were given a scenario in which continuing on a present course of action entailed losses or was otherwise non-optimal. They were asked at various points of completion how likely they were to invest the remaining funds in the project. Overall, participants responded optimally on the behavior-based task and engaged in sunk cost behavior for the hypothetical scenario-based tasks. One explanation for the difference between these tasks is that the behavior-based task may have more discriminable consequences; the consequences for the hypothetical tasks were unknown. Results from the present study align with previous studies suggesting that stimulus discriminability is a major determinant of non-optimal persistence on a task. It is possible that many supposed instances of the sunk cost effect are better conceptualized as behavior produced by contingencies in contexts with uncertain or probabilistic outcomes. In sunk cost procedures with human participants, verbal behavior appears to play an important role. Keywords sunk cost * choice * fixed-ratio schedules * monetary reinforcers * adult humans, Behaving optimally entails maximizing the future benefits of a choice relative to its costs. Sunk costs are previous investments (e.g., time, effort, or money) that cannot be recovered. Optimality is [...]

Abstract Background Interdental cleaning is recommended by dentists but many people do not floss regularly. The health benefits of interdental cleaning are delayed, and sensitivity to delay is an important factor in many health behaviors. Thus, the present studies explore the relationship between frequency of flossing, and sensitivity to delayed and probabilistic outcomes. Method Crowd-sourced subjects were recruited in two studies (n = 584 and n = 321, respectively). In both studies, subjects reported their frequency of flossing and completed delay discounting and probability discounting tasks. Discounting was measured with area under the curve, and linear regression was used to analyze the results. Results Findings show that higher levels of delay discounting were associated with less frequent flossing (p

Background and Objectives: Opioid agonist pharmacotherapies are effective in the treatment of opioid use disorder (OUD) but concurrent stimulant use is common and can lead to relapse and treatment drop out. Contingency management in combination with opioid agonist pharmacotherapy has broad beneficial effects in polysubstance users, including promoting drug abstinence and treatment retention, but clinic-based implementation can be burdensome. The present study was conducted to evaluate a contingency management intervention delivered via a smartphone-smartcard platform in OUD patients who had concurrent stimulant use disorder.Methods: Retrospective comparison of (n = 124) patients; half received the contingency management intervention and half were matched controls. Drug use and clinic attendance outcomes over four consecutive 30-day periods were analyzed with regression.Results: The intervention group showed consistently higher rates of drug abstinence and clinic attendance which were significant at the latter two timepoints.Discussion: Smartphone-smartcard platforms can facilitate dissemination of contingency management by surmounting or obviating key barriers to adoption. They appear to be convenient for all stakeholders, are easy to use, and facilitate high-fidelity implementation. Delivering contingency management via a smartphone-smartcard platform produces effects consistent with those observed when the intervention is delivered with substantially costlier and more burdensome in-person procedures.

Keyboarding skill is an important target for adult education programs due to the ubiquity of computers in modern work environments. A previous study showed that novice typists learned key locations quickly but that fluency took a relatively long time to develop. In the present study, novice typists achieved fluent performance in nearly half the time when words rather than jumbled characters were used as stimuli. This suggests that using real words in the keyboarding program can enhance the efficiency of training. (Contains 1 figure.)

BackgroundDual dependence on opiate and cocaine occurs in about 60% of patients admitted to methadone maintenance and negatively impacts prognosis (Kosten et al. 2003. Drug Alcohol Depend. 70, 315). Topiramate (TOP) is an antiepileptic drug that may have utility in the treatment of cocaine dependence because it enhances the GABAergic system, antagonizes the glutamatergic system, and has been identified by NIDA as one of only a few medications providing a "positive signal" warranting further clinical investigation. (Vocci and Ling, 2005. Pharmacol. Ther. 108, 94).MethodIn this double-blind controlled clinical trial, cocaine dependent methadone maintenance patients (N=171) were randomly assigned to one of four groups. Under a factorial design, participants received either TOP or placebo, and monetary voucher incentives that were either contingent (CM) or non-contingent (Non-CM) on drug abstinence. TOP participants were inducted onto TOP over 7 weeks, stabilized for 8 weeks at 300 mg daily then tapered over 3 weeks. Voucher incentives were supplied for 12 weeks, starting during the fourth week of TOP induction. Primary outcome measures were cocaine abstinence (Y/N) as measured by thrice weekly urinalysis and analyzed using Generalized Estimating Equations (GEE) and treatment retention. All analyses were intent to treat and included the 12-week evaluation phase of combined TOP/P treatment and voucher intervention period.ResultsThere was no significant difference in cocaine abstinence between the TOP vs. P conditions nor between the CM vs. Non-CM conditions. There was no significant TOP/CM interaction. Retention was not significantly different between the groups.ConclusionTopiramate is not efficacious for increasing cocaine abstinence in methadone patients.

Antiretroviral therapy can improve the lives of people living with HIV and reduce the rate of transmission. However, high levels of adherence are required. Some people living with HIV, including people who use drugs, are at elevated risk for non-adherence. Contingency management is a promising intervention for promoting adherence to antiretroviral therapy. Barriers to adoption of contingency management include lack of provider expertise and implementation effort. To address these barriers, a smartphone-based adherence intervention was developed. HIV + people with a substance use disorder were required to submit video selfies of medication consumption that met validity criteria. Monetary incentives were delivered to participants via reloadable debit cards, contingent upon a valid video. The intervention was evaluated in a small (n = 50) randomized controlled trial. Intervention participants submitted 75% of possible videos, and 81% of videos met validity criteria, indicating a high level of usability. Participants also rated the intervention as highly acceptable. Adherence was measured as the percent of participants who achieved a 95% adherence threshold, and also as the overall percent of days in which participants were adherent to their antiretroviral therapy. The former showed a significant effect for group, (p = .034) but this was not maintained when adjusting for stratification variables as covariates (p = .094). The latter measure showed a significant group × time interaction. Smartphone-based contingency management is a promising method for promoting adherence to antiretroviral therapy. Assessing the cost-benefit of the intervention and development of strategies for long-term adherence are priorities for future research.

Drug addiction is a chronic, relapsing health problem that is associated with the degree to which individuals choose small, immediate monetary outcomes over larger, delayed outcomes. This study was a secondary analysis exploring the relation between financial choices and drug use in opioid-dependent adults in a therapeutic workplace intervention. Sixty-seven participants were randomly assigned to a condition in which access to paid job training was contingent upon naltrexone adherence (N = 35) or independent of naltrexone adherence (N = 32). Participants could earn approximately $10 per hour for 4 hours every weekday and could exchange earnings for gift cards or bill payments each weekday. Urine was collected and tested for opiates and cocaine thrice weekly. Participants' earning, spending, and drug use were not related to measures of delay discounting obtained prior to the intervention. When financial choices were categorized based on drug use during the intervention, however, those with less frequent drug use or frequent use of one drug spent a smaller proportion of their daily earnings and maintained a higher daily balance than those who frequently tested positive for both drugs (i.e., opiates and cocaine). Several patterns described the relation between cumulative earning and spending including no saving, periods of saving, and sustained saving. One destructive effect of drug use may be that it creates a perpetual zero-balance situation in the lives of users, which in turn prevents them from gaining materials that could help to break the cycle of addiction. Keywords Delay discounting * Impulsivity ? Money management * Drug dependence, Drug addiction is a chronic health condition characterized by persistent drug use in the face of undesirable physical, social, or economic consequences. This impaired decision making is reflected in other [...]

Advancing the education of low-income adults could increase employment and income, but adult education programs have not successfully engaged low-income adults. Monetary reinforcement may be effective in promoting progress in adult education. This experiment evaluated the benefits of providing incentives for performance in a job-skills training program for low-income, unemployed adults. Participants worked on typing and keypad programs for 7 months. Participants randomly assigned to Group A (n?=?23) earned hourly and productivity pay on the typing program (productivity pay), but earned only equalized hourly pay on the keypad program (hourly pay). Group B (n?=?19) participants had the opposite contingencies. Participants worked more on, advanced further on, and preferred their productivity pay program. These results show that monetary incentives can increase performance in a job-skills training program, and indicate that payment in adult education programs should be delivered contingent on performance in the training program instead of simply on attendance.

Adults in a therapeutic workplace working on a computerized keyboarding training program earned vouchers for typing correct characters. Typing technique was evaluated on review steps. Participants could pass the review and earn a bonus, or skip the review and proceed with no bonus. Alternatively, participants could continue practicing on the same step. Participants persistently repeated the same step, which halted progress through the program but allowed them to increase their rate of responding and, as a result, their earnings. Blocking the initiation of practice on review steps and removing payment for practice initiated after prompts (extinction) both produced rapid progress through the program. These results underscore the importance of careful arrangement of the contingencies in adult education programs. (Contains 4 figures and 2 tables.)

Pigeons pecked a response key on a variable-interval (VI) schedule, in which responses produced food every 40 s, on average. These VI periods, or components, alternated in irregular fashion with extinction components in which food was unavailable. Pecks on a second (observing) key briefly produced exteroceptive stimuli (houselight flashes) correlated with the component schedule currently in effect. Across conditions within a phase, the dependency between observing and presentation of the stimuli was decreased systematically while the density of stimulus presentation was held constant. Across phases, the proportion of session time spent in the VI component was adjusted from 0.5 to 0.25, and then to 0.75. Results indicate that rate of observing decreased as the dependency between responses and stimulus presentations was decreased. Further, discriminative control by the schedule-correlated stimuli was systematically weakened as dependency was decreased. Increasing the proportion of session time spent in VI decreased the rate of observing. This effect was additive with the manipulation of the dependency between observing and presentation of the stimuli. Overall, these results show that conditioned reinforcers function similarly to unconditioned reinforcers with respect to response-consequence dependencies, and that stimulus control is enhanced under conditions in which the relevant stimuli are produced by an organism's behavior. (Contains 3 figures and 2 tables.)

Two experiments examined pigeons' postponement of a signaled extinction period, or timeout (TO), from an ongoing schedule of response-dependent food delivery. A concurrent-operant procedure was used in which responses on one (food) key produced food according to a variable-interval schedule and responses on a second (postponement) key delayed the next scheduled TO according to a response-TO (R-TO) interval. A series of response-independent stimulus changes on the food key temporally partitioned the R-TO into three equal segments (S1, S2, and S3). Postponement responses, in addition to postponing TO, also reinstated S1, the stimulus correlated with the greatest temporal distance from TO. In Experiment 1, the R-TO interval was manipulated systematically across blocks of sessions (conditions) at a given ratio of R-TO:TO duration. This R-TO:TO ratio was manipulated across blocks of conditions (phases). Postponement response rates varied inversely with R-TO interval in each phase. Changes in the R-TO:TO ratio did not produce consistent differences except at the 1:10 ratio for some pigeons, where it disrupted postponement responding in some conditions. Most of the postponement responses occurred in the presence of S2 and S3, the stimuli most proximal to TO, whereas most of the food-key responses occurred in S1. In Experiment 2, the R-TO contingencies were systematically manipulated in the presence of the time-correlated stimuli. In one set of conditions, the R-TO contingencies were made either ineffective or less effective in the presence of one or more stimuli. Postponement responses typically shifted to stimuli in the presence of which responses were relatively more effective. Postponement responses decreased markedly when the added stimuli were removed, and then recovered when the stimuli were reinstated. Results from both experiments indicate that the added stimuli in a discriminated TO-avoidance procedure serve predominately discriminative functions, delineating periods during which behavior is maximally effective. The results parallel those obtained in shock-avoidance procedures, providing further evidence that TO functions as an aversive stimulus. (Contains 2 tables and 6 figures.)

In this study we asked whether measures of phonological awareness and rapid naming were correlated with single-word reading skills of 30 adults with mild mental retardation. We presented four tests of phonological awareness (for rime, first, middle, and end-sound categorization), two rapid-naming tests (pictures and letters), and the Woodcock Word-Identification and Word-Attack subtests. All four phonological-awareness measures and both rapid-naming measures were significantly correlated with both word-attack and word-identification skills. This outcome is consistent with findings from typically developing children, suggesting that instruction in phonological awareness would facilitate the acquisition of word-attack skills in individuals with mental retardation.