***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Rationale Higher rates of delay discounting , or impulsive choice , may be related to relapse during abstinence reinforcement interventions for cigarette smoking , and a transdermal nicotine patch may attenuate delay discounting . Objective The objectives of this study are to assess the relation between delay discounting and smoking after nicotine deprivation in a laboratory model of abstinence reinforcement and the effects of a transdermal nicotine patch on discounting and smoking . Material s and methods Smokers with no self-reported intention to quit were r and omly assigned to an active ( 14 mg ) or placebo patch group ( n = 15 per group ) . In each of three sessions , after a 3-h deprivation period , participants completed a  delay discounting task  ,  mood  , and craving measures and finally engaged in a laboratory model of abstinence reinforcement . Three abstinence reinforcement conditions were presented in counterbalanced order across the three sessions . During the control session , monetary consequences were delivered every 30 s regardless of smoking . During the low ( $ 5.00 available ) and high ( $ 20.00 available ) sessions , participants could earn a progressively increasing amount of money for each 30 s period of abstinence . Results The low and high conditions significantly increased the latency to smoke relative to control and significantly decreased the amount of smoking . The nicotine patch decreased negative affect , but it did not significantly affect delay discounting or smoking . Individuals who smoked during the low and high conditions showed higher rates of discounting . Conclusion The patch did not attenuate delay discounting or smoking after a period of deprivation , but contingencies for abstinence significantly decreased smoking . Higher rates of delay discounting were related to smoking in a model of abstinence reinforcement treatment Delay discounting was investigated in opioid-dependent and non-drug-using control participants . The latter participants were matched to the former on age , gender , education , and IQ . Participants in both groups chose between hypothetical monetary rewards available either immediately or after a delay . Delayed rewards were $ 1,000 , and the immediate-reward amount was adjusted until choices reflected indifference . This procedure was repeated at each of 7 delays ( 1 week to 25 years ) . Opioid-dependent participants were given a second series of choices between immediate and delayed heroin , using the same procedures ( i.e. , the amount of delayed heroin was that which could be purchased with $ 1,000 ) . Opioid-dependent participants  discounted delayed monetary rewards significantly more than did non-drug-using participants . Furthermore opioid-dependent participants discounted delayed heroin significantly more than delayed money BACKGROUND Excessive discounting of future rewards has been observed in a variety of disorders and has been linked both to valuation of the past and to memory of past events . METHODS To explore the functionality of discounting and memory , we examined whether training of working memory would result in less discounting of future rewards . In this study , 27 adults in treatment for stimulant use were r and omly assigned to receive either  working memory training or control training according to a yoked experimental design . Measures of delay discounting and several other cognitive behaviors were assessed pre- and posttraining . RESULTS Rates of discounting of delayed rewards were significantly reduced among those who received memory training but were unchanged among those who received control training ; other cognitive assessment s were not affected by memory training .  Discount rates were positively correlated with memory training performance measures . CONCLUSIONS To our knowledge , this is the first study demonstrating that neurocognitive training on working memory decreases delay discounting . These results offer further evidence of a functional relationship between delay discounting and working memory Context . Time preference ( how preference for an outcome changes depending on when the outcome occurs ) affects clinical decisions , but little is known about determinants of time preferences in clinical setting s. Objectives . To determine whether information about mean population time preferences for specific health states can be easily assessed , whether mean time preferences are constant across different diseases , and whether under certain circumstances substantial fractions of the patient population make choices that are consistent with a negative time preference . Design . Self-administered survey . Setting . Family physician waiting rooms in four states . Patients . A convenience sample of 169 adults . Intervention . Subjects were presented five clinical vignettes . For each vignette the subject chose between interventions maximizing a present and a future health outcome . The options for individual vignettes varied among the patients so that a distribution of responses was obtained across the population of patients . Main outcome measure . Logistic regression was used to estimate the mean preference for each vignette , which was translated into an implicit discount rate for this group of patients . Results . There were marked differences in time preferences for future health outcomes based on the five vignettes , ranging from a negative to a high positive ( 116 % ) discount rate . Conclusions . The study provides empirical evidence that time preferences for future health outcomes may vary substantially among disease conditions . This is likely because the vignettes evoked different rationale s for time preferences . Time preference is a critical element in patient decision making and cost-effectiveness research , and more work is necessary to improve our underst and ing of patient preferences for future health outcomes . Key words : time factors ; models , psychological ; attitude to health ; outcome assessment ( health care ) . ( Med Decis Making 2000;20:263 - 270 OBJECTIVES To determine if limited ability to delay gratification ( ATDG ) at age 4 years is independently associated with an increased risk of being overweight at age 11 years and to assess confounding or moderation by child body mass index z score at 4 years , self-reported maternal expectation of child ATDG for food , and maternal weight status . DESIGN Longitudinal prospect i ve study . SETTING Ten US sites . PARTICIPANTS Participants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development . Main Exposure Ability to delay gratification at 4 years , measured as pass or fail on a vali date d task . OUTCOME MEASURES Overweight at 11 years , defined as a body mass index greater than or equal to the 85th percentile based on measured weight and height . RESULTS Of 805 children , 47 % failed the ATDG task . Using multiple logistic regression , children who failed the ATDG task were more likely to be overweight at 11 years ( relative risk , 1.29 ; 95 % confidence interval , 1.06 - 1.58 ) , independent of income to needs ratio . Body mass index z score at 4 years and maternal expectation of child ATDG for food did not alter the association , but maternal weight status reduced the association significantly . CONCLUSIONS Children with limited ATDG at age 4 years were more likely to be overweight at age 11 years , but the association was at least partially explained by maternal weight status . Further underst and ing of the association between the child 's ATDG and maternal and child weight status may lead to more effective obesity intervention and prevention programs Obese ( n = 20 ) and normal weight ( n = 20 ) children ( 8 - 11 years ) were compared using the delay of gratification paradigm . All children were asked to choose between an immediate reward or a larger delayed ( one day ) reward . Half the children were offered an edible incentive and half a non-edible incentive . Results showed that the obese choose immediate rewards more often than normals only when the incentive was edible . This suggests that deficits in delay of gratification shown by obese children are not generalized dispositions but are specific to food . A second aspect of the study examined preference for food vs non-food items and activities . Normals showed a much stronger preference for non-food items , nutritious foods and non-food related activities than the obese . This suggests that the deficits in delay of gratification shown by the obese children for food related items may be due to the stronger incentive value of these items for them Objective : To evaluate the efficacy of a simple weight loss intervention , based on principles of habit formation . Design : An exploratory trial in which overweight and obese adults were r and omized either to a habit-based intervention condition ( with two subgroups given weekly vs monthly weighing ; n=33 , n=36 ) or to a waiting-list control condition ( n=35 ) over 8 weeks . Intervention participants were followed up for 8 months . Participants : A total of 104 adults ( 35 men , 69 women ) with an average BMI of 30.9 kg m−2.Intervention : Intervention participants were given a leaflet containing advice on habit formation and simple recommendations for eating and activity behaviours promoting negative energy balance , together with a self-monitoring checklist . Main outcome measures : Weight change over 8 weeks in the intervention condition compared with the control condition and weight loss maintenance over 32 weeks in the intervention condition . Results : At 8 weeks , people in the intervention condition had lost significantly more weight ( mean=2.0 kg ) than those in the control condition ( 0.4 kg ) , with no difference between weekly and monthly weighing subgroups . At 32 weeks , those who remained in the study had lost an average of 3.8 kg , with 54 % losing 5 % or more of their body weight . An intention-to-treat analysis ( based on last-observation-carried-forward ) reduced this to 2.6 kg , with 26 % achieving a 5 % weight loss . Conclusions : This easily disseminable , low-cost , simple intervention produced clinical ly significant weight loss . In limited re source setting s it has potential as a tool for obesity management OBJECTIVE Alcohol misuse in college students represents a significant public health problem . Toward improving the underst and ing of determinants of collegiate alcohol misuse , the current study examined several dimensions of impulsivity in relation to hazardous drinking in college students . METHOD A one-way , two-group , cross-sectional design was used to compare hazardous drinkers ( HZD ) with social drinkers ( SOC ) . HZD drinkers were required to score 6 or more on the  Alcohol Use Disorders Identification Test ( AUDIT ) ;  SOC drinkers were required to score 1 - 5 on the AUDIT . The sample comprised 93 participants ( 56 % HZD ; 76 % male ) who were recruited from a medium-sized public university . Participants were assessed under neutral conditions using the Eysenck Impulsivity Question naire ( EIQ ) , Delay Discounting Task ( DDT ) , and Stanford Time Perspective Inventory ( STPI ) .  RESULTS Consistent with predictions , HZD participants exhibited significantly greater impulsivity on the EIQ-Impulsivity subscale ( p < .001 ) , the STPI-Present Hedonism subscale ( p < .01 ) , and the STPIFuture subscale ( p < .01 ) ; however , no differences were evident on the DDT ( p > .40 ) . The HZD group also scored marginally higher than the SOC group on the EIQ-Venturesomeness subscale ( p < .10 ) . CONCLUSIONS These findings suggest that greater impulsivity is associated with alcohol misuse in college students , most prominently in the area of propensity toward risk-taking and nonplanning ( EIQ-Impulsivity subscale ) . The correspondence between these findings and previous studies , method ological considerations , and the need for prospect i ve studies on impulsivity and alcohol misuse in college students are discussed Summary Decision making is often considered to arise out of contributions from a model-free habitual system and a model-based goal -directed system . Here , we investigated the effect of a dopamine manipulation on the degree to which either system contributes to instrumental behavior in a two-stage Markov decision task , which has been shown to discriminate model-free from model-based control . We found increased dopamine levels promote model-based over model-free choice St and ard theories of decision-making involving delayed outcomes predict that people should defer a punishment , whilst advancing a reward . In some cases , such as pain , people seem to prefer to expedite punishment , implying that its anticipation carries a cost , often conceptualized as ‘ dread ’ . Despite empirical support for the existence of dread , whether and how it depends on prospect i ve delay is unknown . Furthermore , it is unclear whether dread represents a stable component of value , or is modulated by biases such as framing effects . Here , we examine choices made between  different numbers of painful shocks to be delivered faithfully at different time points up to 15 minutes in the future , as well as choices between  hypothetical painful dental appointments at time points of up to approximately eight months in the future , to test alternative models for how future pain is disvalued . We show that future pain initially becomes increasingly aversive with increasing delay , but does so at a decreasing rate . This is consistent with a value model in which moment-by-moment dread increases up to the time of expected pain , such that dread becomes equivalent to the discounted expectation of pain . For a minority of individuals pain has maximum negative value at intermediate delay , suggesting that the dread function may itself be prospect ively discounted in time . Framing an outcome as relief reduces the overall preference to expedite pain , which can be parameterized by reducing the rate of the dread-discounting function . Our data support an account of disvaluation for primary punishments such as pain , which differs fundamentally from existing models applied to financial punishments , in which dread exerts a powerful but time-dependent influence over choice AIMS  Delay reward discounting ( DRD ) measures the degree to which a person prefers smaller rewards soon or larger rewards later . People who smoke have been shown to have higher DRD . There are several ways of measuring DRD , and the method used might influence the association between smoking and DRD . The key differences are the order in which the items are presented , the delays used and the magnitude of the delayed amount . SETTING An international online study running from September 2010 to June 2011 . PARTICIPANTS A total of 9454 individuals ; 38 % male , mean age = 23.1 years . DESIGN AND MEASUREMENTS Users completed a multi-item DRD task . They were r and omly presented the immediate rewards in an ascending , descending or r and omized order . The delays were between 1 week and 5 years . The delayed 
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We conclude that intention-incongruent actions are often triggered by environmental cues or changes in motivational state , whose effects are not parameterized by hyperbolic discounting .
Under this framework , while discounting of delayed health may contribute to the initiation of unhealthy behavior , with repetition , many unhealthy behaviors become habitual ; if health goals then change , habitual behavior can still arise in response to environmental cues .