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

摘要 早年的不利条件阻碍了正常的发育轨迹，增加了健康状况不佳的风险， 对中年的人来说，个人的和经济上的后果尤其明显。这是一个 与老龄化相关的贫困社区的重大公共卫生问题 消极的结果。不幸的是，目前的干预措施针对的是单一的初级临床结果，而不是 靶机制的各种衰老相关后果，因此是有限的。这种相互竞争的更新 申请寻求利用(1)在初始供资期间完成的工作和(2)新的关系 与马里兰州巴尔的摩服务不足社区的社区合作伙伴建立，以继续和扩大 一个旨在提高延迟折扣(DD)的项目，这是中年负面后果的核心机制。 DD升高表明人们对直接奖励的偏好被夸大了，这与广泛的光谱有关 早产儿在中年观察到的危害健康的行为和负面后果 劣势。在第二阶段的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，这项建议试图从实验上检验中年样本中EF和DD的变化 经历过早年劣势的个体。主要目标是检查初始和 EF训练对EF和DD的持续(3个月和6个月)效果，与匹配的 控制训练条件和不训练条件。我们预计DD的EF会有所改善和减少 在积极训练条件后的即刻、3个月和6个月，但不在对照组或不 训练条件。我们将研究EF的改善是否是干预效果的一种机制 在DD上。我们预计DD的减少将通过EF的改善来实现。探索性的目标是 检查积极的训练条件是否改善了健康行为和结果。这个 拟议的研究可能会照亮一种可能特别适用于贫困人口的创新方法 并广泛影响贫困风险增加的中年个人的健康和健康 由于早年的劣势造成的后果。

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.