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Improvement of Working Memory is a Mechanism for Reductions in Delay Discounting Among Mid-Age Individuals in an Urban Medically Underserved Area.

ABSTRACT: BACKGROUND:Delay discounting, or the tendency to devalue rewards as a function of their delayed receipt, is associated with myriad negative health behaviors. Individuals from medically underserved areas are disproportionately at risk for chronic health problems. The higher rates of delay discounting and consequent adverse outcomes evidenced among low-resource and unstable environments suggest this may be an important pathway to explain health disparities among this population. PURPOSE:The current study examined the effectiveness of a computerized working memory training program to decrease rates of delay discounting among residents of a traditionally underserved region. METHODS:Participants (N = 123) were recruited from a community center serving low income and homeless individuals. Subjects completed measures of delay discounting and working memory and then took part in either an active or control working memory training. RESULTS:Analyses indicated that participants in the active condition demonstrated significant improvement in working memory and that this improvement mediated the relation between treatment condition and reductions in delay discounting. CONCLUSIONS:Results suggest that a computerized intervention targeting working memory may be effective in decreasing rates of delay discounting in adults from medically underserved areas (ClinicalTrials.gov number NCT03501706).

SUBMITTER: Felton JW

PROVIDER: S-EPMC6779071 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Improvement of Working Memory is a Mechanism for Reductions in Delay Discounting Among Mid-Age Individuals in an Urban Medically Underserved Area.

Felton Julia W JW Collado Anahi A Ingram Katherine M KM Doran Kelly K Yi Richard R

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 20191001 11

<h4>Background</h4>Delay discounting, or the tendency to devalue rewards as a function of their delayed receipt, is associated with myriad negative health behaviors. Individuals from medically underserved areas are disproportionately at risk for chronic health problems. The higher rates of delay discounting and consequent adverse outcomes evidenced among low-resource and unstable environments suggest this may be an important pathway to explain health disparities among this population.<h4>Purpose ...[more]

PMID: 30955043

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Project description:IntroductionThe competing neurobehavioral decision systems theory conceptualizes addictive behavior, such as cigarette smoking, as arising from the imbalance between stronger impulsive relative to weaker executive decision processes. Working memory trainings may enhance executive decision processes, yet few studies have evaluated its efficacy on substance misuse, with mixed evidence. The current study is the first to evaluate the efficacy of a working memory training on cigarette smoking. We consider the moderating role of delay discounting (DD), or the preference for smaller, immediately available rewards relative to larger, delayed rewards, which has been associated with smoking onset, progression, and resumption. The investigation focuses on individuals living in high-poverty, low-resource environments due high burden of tobacco-related disease they experience.Aims and methodsThe study utilized a subset of data (N = 177 individuals who smoke) generated from a randomized clinical trial that is evaluating the efficacy of working memory training for improving health-related outcomes. Participants were randomized to complete up to 15 sessions of the active, working memory training or a control training.ResultsFindings showed that among participants who were randomized to the working memory condition, those with higher rates of baseline DD demonstrated decreases in cigarette smoking (p = .05). Conversely, individuals randomized to the control condition, who had higher rates of baseline DD exhibited increases in cigarette smoking (p = .025).ConclusionsResults suggest that DD may be an important indicator of working memory training outcomes and a possible approach for effectively targeting treatments in the future.ImplicationsDD is important indicator of working memory training outcomes on cigarette smoking. The findings suggest the possibility to effectively target treatments considering the impact of DD. Given that rates of DD tend to be higher among individuals from low-resource communities, and that computer-based working memory training programs are relatively low-cost and scalable, these findings suggest this approach may have specific utility for adults at heightened risk for cigarette use.This study was registered with ClinicalTrials.gov (Identifier NCT03501706).

Project description:Medical students engage with medically underserved communities (MUC) and vulnerable populations but often lack preparation to advocate appropriately for these communities. While preclinical programs with an experiential community component effectively increase knowledge about serving MUC, the pandemic limited clinical opportunities in community settings for learners. We examined the impact of a streamlined, hybrid service learning curriculum on first-year medical student attitudes towards MUC and their readiness and interest in addressing health barriers faced by this population. The redesigned curriculum for the student-led program required participants to attend nine virtual seminars led by faculty and community members with expertise serving MUC. Students partnered with one of three community agencies to organize service projects and gain exposure to the life experiences of MUC using virtual and in-person approaches. Of the fifteen first year medical students who participated in the program, positive attitudes were sustained across all scales using the Medical Student Attitudes Toward the Underserved (MSATU) questionnaire after one year. A majority (≥50%) of students reported a large increase in their knowledge of the health challenges faced by underserved populations after each didactic session. Despite the mostly virtual nature of community partnerships, students reported increased confidence in their ability to direct MUC patients to local resources (p < 0.01). The program also had a positive impact on student interest in working with medically underserved patients in the future, with 71% of participants indicating a significant impact on their interest in working in a medically underserved area. Our redesigned elective curriculum provided participants with foundational knowledge to advocate appropriately for underserved populations and demonstrated the efficacy of virtual approaches for community service and service learning. Our findings suggest hybrid and virtual experiential learning opportunities are a viable and non-inferior curricular approach to teaching health equity and community health.

Dataset Information

Improvement of Working Memory is a Mechanism for Reductions in Delay Discounting Among Mid-Age Individuals in an Urban Medically Underserved Area.

Publications

Improvement of Working Memory is a Mechanism for Reductions in Delay Discounting Among Mid-Age Individuals in an Urban Medically Underserved Area.

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