Dimensions of impulsive behavior: Predicting contingency management treatment outcomes for adolescent smokers

Abstract

Background: Behavioral measures of impulsive behavior include the dimensions of behavioral disinhibition, decision-making, and lapses of attention. These behaviors are associated with a range of risky activities during adolescence, including cigarette smoking; however, few studies have evaluated their associations with tobacco treatment outcomes. The current study examined the relationship between impulsive behavior and contingency management treatment outcomes for adolescent smokers.

Methods: Data from two contingency management smoking cessation trials were combined (N = 189 adolescents). Participants provided breath carbon monoxide (CO) samples with incentives delivered contingent (i.e., active treatment [AT] condition) or non-contingent (i.e., control treatment [CT] condition) on CO level. Dimensions of impulsive behavior were assessed pre- and post-treatment using the Go/Stop Task, a measure of delay discounting, a continuous performance task, while self-reported impulsivity was assessed with the Barratt Impulsiveness Scale-Adolescent. Relationships between impulsive behavior and treatment outcomes (efficacy and adherence) were assessed using linear mixed effects models.

Results: Participants in the AT condition had significantly lower program CO levels at each treatment phase. Delay discounting in the AT condition predicted CO levels, with those discounting the most lowering their breath CO levels the least. Delay discounting also predicted program adherence across both conditions.

Conclusions: Delay discounting may be the most relevant dimension of impulsive behavior to predict outcomes for adolescent smokers completing CM programs, both in terms of successful reductions in smoking and program adherence. Suggestions are made to reduce the effects of delay discounting for adolescent smokers using this treatment approach.

Keywords: Adolescent; Contingency Management; Impulsive Behavior; Outcomes; Smoking.

Figure 1.. Overall Study Timeline.

Figure 2.. Change in carbon monoxide from Baseline to Return-to-Baseline phases

Reduction in CO from Baseline to Return-to-Baseline phases. AT = Active Treatment; CT = Control Treatment. Values are mean change in CO (95% CI denoted by error bars) based on parameter estimates derived from a multiple regression model using average values for covariates of age, Fagerstrom Test for Nicotine Dependence, Stage-of-Change Ladder score, and averaged across sexes and studies. Reduction was calculated for −1 SD (High Impulsive behavior; right bars) and +1 SD (Low Impulsive behavior; left bars) pre-treatment delay discounting score.