Intertemporal tradeoffs: perceiving the risk in the benefits of marijuana in a prospective study of adolescents and young adults.

PURPOSE: Intertemporal tradeoffs characterize the decision to use drugs: pleasure now traded off against the possibility of pain later. Traditional approaches have examined whether individuals use drugs because they either seek immediate benefit or fail to appreciate long-term risk. We asked whether risk taking might also result from failing to appreciate benefits. We refer to this as risk in the benefits (RIBs), an understanding that one's first drug experience can be so good, that a person may not want (or be able) to stop, putting him/her on a path that leads directly to addiction. METHODS: In total, 304 participants, 160 adolescents and 144 young adults, participated in a longitudinal study on marijuana use and other risky health behaviors. RESULTS: The failure to perceive the RIBs of marijuana use led to increased risk taking 1 year later within 3 different health behaviors: alcohol, tobacco, and sexual risk-taking. Greater appreciation of RIBs predicted significantly less future risk taking over-and-above all the traditional cognitive and behavioral predictors, and RIBs were the only significant cognitive predictor when all were included in 1 model. RIBs also partially mediated the relationship between past and future risk taking, over and above the strongest predictors of risk taking. CONCLUSIONS: Failing to appreciate the impact of short-term benefits within the context of long-term risk increased future risk taking. Interventions that enhance the salience of RIBs may represent a new approach to reducing the likelihood that individuals will take risks with their health.

Forecasting changes in preference over the life span: a qualitative study of African-American men's prostate cancer decision making.

GOALS OF WORK: The goal of this study was to explore the processes by which African-American men, at greatest risk, might forecast and manage health changes as they age if they were diagnosed with prostate cancer. PATIENTS AND METHODS: Twenty-nine African-American men, 40-70 years old, with no history of prostate cancer, participated in four focus groups and four follow-up individual interviews. Transcripts were analyzed using Grounded Theory, with thematic analysis and constant comparison of data. MAIN RESULTS: There was a curvilinear relationship between age and participants' preference for quality versus quantity of life in deciding to treat prostate cancer. Two mechanisms accounted for this: a change with age in the (1) reference point for judging value and (2) decision-making goal. CONCLUSIONS: With increasing long-term survivorship, it is vital to understand the multiple decisions cancer patients will face as they continue to age. The current study is an initial step in studying how patients might anticipate and manage such changes.

Being there is important, but getting there matters too: the role of path in the valuation process.

PURPOSE: Traditional decision-analytic models presume that utilities are invariant to context. The influence of 2 types of context on patients' utility assessments was examined here the path by which one reaches a health state and personal experience with a health state. METHODS: Three groups of patients were interviewed: men older than age 49 years with prostate cancer but no diabetes (CaP), diabetes but no prostate cancer (DM), and neither disease (ND). The utility of erectile dysfunction (ED) was assessed using a standard gamble (SG). Each subject completed 2 SGs: 1) a no-context version that gave no explanation for the cause of ED and 2) a contextualized version in which prostate cancer treatment, the failure to manage diabetes, or the natural course of aging was said to be the cause. RESULTS: Patients with disease assigned higher utilities to ED in a matching context than in discrepant contexts. Regression models found that the valuation process was also sensitive to the match between disease path in the utility assessment and patients' personal experiences. CONCLUSIONS: These findings lend insight into why acontextual utility assessments typically used in decision analyses have not been able to predict patient behavior as well as expected. The valuation process appears to change systematically when context is specified, suggesting that unspecified contexts rather than random error may lead to fluctuations in the values assigned to identical health states.

How perceived risk and personal and clinical experience affect medical students' decisions to seek treatment for major depression.

PURPOSE: To examine the role of perceived risk, and personal and clinical experience in medical students' treatment seeking behavior for major depression. METHOD: In 2003, a questionnaire was administered to 173 first-year and 164 fourth-year medical students at Northwestern University's Feinberg School of Medicine to assess students' perception of risk for major depression in the general population and personal and clinical experience with major depression. Treatment-seeking behavior was examined using a hypothetical scenario. Data analysis used analysis of variance and regression models. RESULTS: A total of 157 (91%) first-year and 108 (66%) fourth-year students completed the questionnaire. The majority overestimated the risk for major depression in the general population (p <.001), although respondents were more accurate for risk in the medical student population. The significant predictors for willingness to diagnose depression in the scenario were: risk perception (beta =.176, p <.01), clinical experience (beta =.173, p <.01) and personal treatment for major depression (beta =.188, p <.01). Significant predictors for willingness to refer to a professional were personal treatment (beta =.136, p <.05) and having a close friend treated for major depression (beta =.176, p <.01). CONCLUSIONS: Students' hesitation to seek treatment may be explained by the overestimation of risk, which has been shown to cause increased anxiety and avoidance of health seeking behavior. Interestingly, personal experience was found to be a significant predictor of treatment seeking behavior. This information can be used in preparing health risk communication messages for medical students.

Beyond invulnerability: the importance of benefits in adolescents' decision to drink alcohol.

Some investigators propose that adolescents engage in risky behaviors mainly because they perceive themselves to be invulnerable to risk. However, studies have typically not included perceived benefits. In the current study, 5th, 7th, and 9th graders were surveyed about their perceptions of and experience with alcohol and tobacco. Results indicated that perceptions of the benefits were significantly related to drinking and smoking 6 months later, over and above perceptions of the risks, age of the respondent, and experience level. Further, the importance of benefits was replicated across 3 separate analyses. Experience with alcohol alone, especially positive experience, was also related to perception and behavior. These findings are discussed in terms of how to improve messages and influence adolescents' decisions regarding risk-taking behaviors.