Remediation of elevated delay discounting in mid-life individuals: A phase-II trial

摘要 早期生活中的不利因素阻碍了正常的发育轨迹，并增加了健康状况不佳的风险， 个人和经济后果，尤其是在中年人。这是一 在不成比例地遭受与老龄化有关疾病的贫困社区， 消极的结果。不幸的是，目前的干预措施针对单一的主要临床结果，而不是一个 针对各种与衰老有关后果的机制，因此是有限的。这种竞争性的更新 申请旨在利用（1）在初始供资期间完成的工作和（2）新的关系 在马里兰州巴尔的摩服务不足的社区与社区合作伙伴建立，以继续和扩大 一个针对提高延迟折扣（DD）的项目，这是中年负面后果的核心机制。 表明夸大的偏好立即奖励，DD升高与广泛的 在早期生活的人的中年生活中观察到的损害健康的行为和负面结果， 劣势在第二阶段背景下使用计算机化执行功能（EF）培训干预 随机对照试验设计，该建议旨在通过实验检查中年样本中EF和DD的变化 经历过早期生活劣势的人。主要目的是检查初始和 EF训练对EF和DD的持续（3个月和6个月）影响，与匹配的 控制训练条件和不训练条件。我们预计EF改善和DD减少 立即和3个月和6个月后，积极的训练条件，但不是在控制或没有 训练条件。我们将研究EF的改善是否干预效果的机制 在DD。我们预计DD的降低将通过EF的改善来介导。一个探索性的目标是 检查主动训练条件是否改善健康行为和结果。的 拟议的研究可能会阐明一种创新的方法，可能特别适用于贫困 社区，并广泛影响中年人的健康和福祉，增加穷人的风险 由于早期生活的不利影响。

Abstract Early-life disadvantage impedes normal developmental trajectories and confers elevated risk for poor health, personal, and financial consequences that are particularly pronounced for individuals in mid-life. This is a significant public health issue in impoverished communities that disproportionately suffer aging-related negative outcomes. Unfortunately, current interventions target single primary clinical outcomes rather than a target mechanism of various aging-related consequences, and are thus limited. This competing renewal application seeks to leverage (1) the work completed during the initial funding period and (2) new relationships established with community partners in the underserved communities of Baltimore, MD to continue and expand a project targeting elevated delay discounting (DD), a core mechanism for negative consequences in mid-life. Indicative of exaggerated preference for immediate rewards, elevated DD is associated with a wide spectrum of health-compromising behaviors and negative outcomes observed in mid-life of individuals with early-life disadvantage. Using a computerized executive function (EF) training intervention in a context of a Phase-II RCT design, this proposal seeks to experimentally examine changes in EF and DD in a sample of mid-life individuals who have experienced early-life disadvantage. Primary Aims are to examine initial and maintained (3-month and 6-month) effects of EF training on both EF and DD, in comparison to a matched control training condition and a no training condition. We expect EF improvement and reductions in DD immediately and at 3-months and 6-months following the active training condition but not in the control or no training conditions. We will examine whether improvement in EF is a mechanism of intervention effects on DD. We expect that reductions in DD will be mediated by improvement in EF. An exploratory aim is examination of whether the active training condition improves health behaviors and outcomes. The proposed research may illuminate an innovative approach that may be particularly applicable to impoverished communities and broadly impact the health and wellness of mid-life individuals with increased risk for poor consequences due to early-life disadvantage.