Measuring and modifying delay discounting as a mechanism of smoking in pregnancy

PROJECT SUMMARY/ABSTRACT One in 10 pregnant women in the United States smokes at the beginning of pregnancy, increasing the risk of miscarriage, preterm birth, low birth weight, and neonatal death. Among these women who smoke, virtually all report a desire to quit, yet only 25% abstain throughout pregnancy. A known behavioral economic mechanism behind this “intention-action gap” is delay discounting (DD), the tendency to discount delayed outcomes when choosing present actions. Because the negative consequences of smoking are delayed, whereas its benefits are immediate, DD reinforces tobacco use even when one desires abstinence. In pregnancy, existing smoking cessation pharmacotherapies are generally considered unsafe and/or ineffective, and thus DD may provide a novel therapeutic target for smoking cessation treatment. However, three critical knowledge gaps currently limit this possibility: (1) the optimal approach to measuring DD in the context of addiction is unclear, (2) the longitudinal relationship between DD and smoking in pregnancy is poorly characterized, and (3) no pharmacologic agent for reducing DD that is safe in pregnancy is known. To address these gaps, I will pursue a set of training and research activities centered around “Measuring and Modifying Delay Discounting as a Mechanism of Smoking in Pregnancy (The MM-DD Study)”. Leveraging (1) the Effort Delay Discounting Task (EDDT), a novel mobile phone-based instrument that I have developed for measuring DD based on willingness to exert cognitive and physical effort, (2) a mentorship committee with expertise in nicotine dependence, behavioral economics, neuroscience, and structural equation modeling, and (3) an ongoing NIH-sponsored RCT of high-dose omega-3 polyunsaturated fatty acid supplementation for pregnant smokers, my SPECIFIC AIMS are to: (1) jointly measure and test the factor structure of cognitive effort DD, physical effort DD, and monetary DD, (2) characterize the longitudinal relationship between DD and smoking in pregnancy, and (3) safely test the modifiability of DD in pregnancy through a clinical trial. In parallel with these Aims, building on previous training in behavioral economics, I will pursue four integrated training objectives, in which I will gain: (1) advanced expertise in DD research, (2) foundational knowledge of the neurobiology of addiction, (3) competence in structural equation modeling, and (4) skills to build scholarly productivity in biomedical research. IMPACT: This career development award will (1) advance addiction science by systematically measuring and attempting to modify DD as a novel therapeutic target for smoking cessation in pregnancy and (2) advance my career by enabling me to secure R01 funding to further investigate novel approaches to measuring and modifying DD across addiction contexts. In so doing, this award will position me to become an independent investigator of interventions that prevent and treat addiction by targeting its behavioral economic mechanisms, including DD.