Delay discounting predicts postpartum relapse to cigarette smoking among pregnant women.

Delay discounting (DD), a measure of impulsivity, describes the rate at which rewards lose value as the delay to their receipt increases. Greater discounting has been associated with cigarette smoking and various other types of drug abuse in recent research. The present study examined whether DD predicts treatment outcome among cigarette smokers. More specifically, the authors examined whether baseline discounting for hypothetical monetary rewards predicted smoking status at 24 weeks postpartum among women who discontinued smoking during pregnancy. Participants were 48 pregnant women (10.5 = 4.1 weeks gestational age at study entry) who participated in a clinical trial examining the use of incentives to prevent postpartum relapse. Several sociodemographic characteristics (being younger, being less educated, and reporting a history of depression) assessed at study entry were associated with increased baseline DD, but in multivariate analyses only DD predicted smoking status at 24 weeks postpartum. Greater baseline DD was a significant predictor of smoking status at 24 weeks postpartum. DD was reassessed periodically throughout the study and did not significantly change over time among those who eventually resumed smoking or those who sustained abstinence. The results extend the association of DD with risk for substance abuse to pregnant and recently postpartum cigarette smokers and demonstrate a significant relationship between DD and treatment outcome.

[1]  A. Odum,et al.  Needle sharing in opioid-dependent outpatients: psychological processes underlying risk. , 2000, Drug and alcohol dependence.

[2]  B. Rounsaville Treatment of cocaine dependence and depression , 2004, Biological Psychiatry.

[3]  V. Quinn,et al.  Spontaneous quitting: self-initiated smoking cessation in early pregnancy. , 2004, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[4]  P. Mullen,et al.  Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery. , 1991, Addictive behaviors.

[5]  Kris N Kirby,et al.  Heroin and cocaine abusers have higher discount rates for delayed rewards than alcoholics or non-drug-using controls. , 2004, Addiction.

[6]  A. Logue Self-Control: Waiting Until Tomorrow for What You Want Today , 1994 .

[7]  G. Madden,et al.  Delay discounting of real and hypothetical rewards. , 2003, Experimental and clinical psychopharmacology.

[8]  N. Kerse,et al.  Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues , 2006, BMC family practice.

[9]  C. Taylor,et al.  Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention. , 1990, Annals of internal medicine.

[10]  G. Madden,et al.  Discounting of delayed rewards in opioid-dependent outpatients: exponential or hyperbolic discounting functions? , 1999, Experimental and clinical psychopharmacology.

[11]  D. Farnill,et al.  Sex and age differences in sensation seeking: Some national comparisons , 1984 .

[12]  C. X. Poulos,et al.  Impulsivity predicts individual susceptibility to high levels of alcohol self‐administration , 1995, Behavioural pharmacology.

[13]  Francisco J. Silva,et al.  The rich get richer: Students’ discounting of hypothetical delayed rewards and real effortful extra credit , 2004, Psychonomic bulletin & review.

[14]  H Rachlin,et al.  Commitment, choice and self-control. , 1972, Journal of the experimental analysis of behavior.

[15]  G. Badger,et al.  A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum. , 2004, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[16]  Andrew Goudie,et al.  Delay discounting and the behavioural economics of cigarette purchases in smokers: the effects of nicotine deprivation , 2006, Psychopharmacology.

[17]  P. Mullen,et al.  Postpartum Return to Smoking: Who is at Risk and When , 1997, American journal of health promotion : AJHP.

[18]  C. McBride,et al.  Prevention of relapse in women who quit smoking during pregnancy. , 1999, American journal of public health.

[19]  Warren K Bickel,et al.  Within-subject comparison of real and hypothetical money rewards in delay discounting. , 2002, Journal of the experimental analysis of behavior.

[20]  J. Skelly,et al.  Smoking relapse prevention during pregnancy. A trial of coordinated advice from physicians and individual counseling. , 1998, American journal of preventive medicine.

[21]  L. Epstein,et al.  Relationship between education and delay discounting in smokers. , 2004, Addictive behaviors.

[22]  S. Mitchell,et al.  Effects of short-term nicotine deprivation on decision-making: delay, uncertainty and effort discounting. , 2004, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[23]  B. Reynolds Do high rates of cigarette consumption increase delay discounting? A cross-sectional comparison of adolescent smokers and young-adult smokers and nonsmokers , 2004, Behavioural Processes.

[24]  P. Mullen,et al.  Relapse prevention among women who stop smoking early in pregnancy: a randomized clinical trial of a self-help intervention. , 1995, American journal of preventive medicine.

[25]  J. Astbury,et al.  Women Who Spontaneously Quit Smoking in Early Pregnancy , 1997, The Australian & New Zealand journal of obstetrics & gynaecology.

[26]  B. K. Hartman,et al.  Pathological gambling and mood disorders: clinical associations and treatment implications. , 2006, Journal of affective disorders.

[27]  J. E. Mazur An adjusting procedure for studying delayed reinforcement. , 1987 .

[28]  K. Cummings,et al.  Debunking myths about self-quitting. Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves. , 1989, The American psychologist.

[29]  L. Green,et al.  Discounting of Delayed Rewards: A Life-Span Comparison , 1994 .

[30]  K. Balanda,et al.  Smoking Relapse Prevention Methods for Pregnant Women: A Formative Evaluation , 1997, American journal of health promotion : AJHP.

[31]  L. Klerman Protecting children: reducing their environmental tobacco smoke exposure. , 2004 .

[32]  Joel Myerson,et al.  Temporal discounting in choice between delayed rewards: the role of age and income. , 1996 .

[33]  W K Bickel,et al.  Impulsive and self-control choices in opioid-dependent patients and non-drug-using control participants: drug and monetary rewards. , 1997, Experimental and clinical psychopharmacology.

[34]  S. Kasper,et al.  A longitudinal view of triggers and thresholds of suicidal behavior in depression. , 2002, The Journal of clinical psychiatry.

[35]  Matthew W. Johnson,et al.  Delay discounting in currently using and currently abstinent cocaine-dependent outpatients and non-drug-using matched controls. , 2006, Addictive behaviors.

[36]  W. Bickel,et al.  Toward a behavioral economic understanding of drug dependence: delay discounting processes. , 2001, Addiction.

[37]  M. Weissman,et al.  Heterogeneity of psychiatric diagnosis in treated opiate addicts. , 1982, Archives of general psychiatry.

[38]  N. Petry,et al.  Delay discounting of money and alcohol in actively using alcoholics, currently abstinent alcoholics, and controls , 2001, Psychopharmacology.

[39]  J. Skelly,et al.  Smoking relapse prevention counseling during prenatal and early postnatal care. , 1995, American journal of preventive medicine.

[40]  Taiki Takahashi,et al.  Discounting delayed and probabilistic monetary gains and losses by smokers of cigarettes , 2005, Psychopharmacology.

[41]  J. Adès,et al.  Study of compulsive buying in depressed patients. , 1997, The Journal of clinical psychiatry.

[42]  J. Guelfi,et al.  Impulsivity: a relevant dimension in depression regarding suicide attempts? , 1999, Journal of affective disorders.

[43]  R. West,et al.  Randomized controlled trial of a midwife-delivered brief smoking cessation intervention in pregnancy. , 2001, Addiction.

[44]  N. Petry,et al.  Health and psychosocial correlates of disordered gambling in older adults. , 2005, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[45]  P. Thompson,et al.  A randomized controlled trial of smoking cessation counseling after myocardial infarction. , 2000, Preventive medicine.

[46]  B. Grant,et al.  Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. , 2005, The Journal of clinical psychiatry.

[47]  R. Vuchinich,et al.  Hyperbolic temporal discounting in social drinkers and problem drinkers. , 1998, Experimental and clinical psychopharmacology.

[48]  B. Spring,et al.  Impulsivity and smoking relapse. , 2004, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[49]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[50]  N. Petry,et al.  Severity of Gambling Problems and Psychosocial Functioning in Older Adults , 2006, Journal of geriatric psychiatry and neurology.

[51]  George Loewenstein,et al.  Mild opioid deprivation increases the degree that opioid-dependent outpatients discount delayed heroin and money , 2002, Psychopharmacology.

[52]  T S Critchfield,et al.  Temporal discounting: basic research and the analysis of socially important behavior. , 2001, Journal of applied behavior analysis.

[53]  J R Hughes,et al.  Smoking cessation among self-quitters. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[54]  G. Koob,et al.  Depression and stimulant dependence: neurobiology and pharmacotherapy. , 1998, The Journal of nervous and mental disease.

[55]  Gregory J. Madden,et al.  Impulsivity (delay discounting) as a predictor of acquisition of IV cocaine self-administration in female rats , 2005, Psychopharmacology.

[56]  J. Patton,et al.  Factor structure of the Barratt impulsiveness scale. , 1995, Journal of clinical psychology.

[57]  A. Odum,et al.  Impulsivity and cigarette smoking: delay discounting in current, never, and ex-smokers , 1999, Psychopharmacology.

[58]  H J Eysenck,et al.  Sensation seeking in England and America: cross-cultural, age, and sex comparisons. , 1978, Journal of consulting and clinical psychology.

[59]  Lee N. Robins,et al.  Psychiatric Disorders in America: The Epidemiologic Catchment Area Study , 1990 .

[60]  Matthew W. Johnson,et al.  Delay discounting in current and never-before cigarette smokers: similarities and differences across commodity, sign, and magnitude. , 2003, Journal of abnormal psychology.

[61]  J. Pierce,et al.  Smoking cessation with and without assistance: a population-based analysis. , 2000, American journal of preventive medicine.

[62]  B. Rounsaville,et al.  Psychopathology as a predictor of treatment outcome in alcoholics. , 1987, Archives of general psychiatry.

[63]  M. Alda,et al.  Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men. , 2005, The American journal of psychiatry.

[64]  B. Prusoff,et al.  Psychiatric diagnoses of treatment-seeking cocaine abusers. , 1991, Archives of general psychiatry.