A Competing Neurobehavioral Decision Systems model of SES-related health and behavioral disparities

Abstract

We propose that executive dysfunction is an important component relating the socioeconomic status gradient of select health behaviors. We review and find evidence supporting an SES gradient associated with (1) negative health behaviors (e.g., obesity, excessive use of alcohol, tobacco and other substances), and (2) executive dysfunction. Moreover, the evidence supports that stress and insufficient cognitive resources contribute to executive dysfunction and that executive dysfunction is evident among individuals who smoke cigarettes, are obese, abuse alcohol, and use illicit drugs. Collectively these data supports the dual system model of cognitive control, referred to here as the Competing Neurobehavioral Decision Systems hypothesis. The implications of these relationships for intervention and social justice considerations are discussed.

Time discounting and tobacco smoking: a systematic review and network analysis

“…Poor cognitive function is linked to higher discounting and is hampered by stress, leading Bickel and colleagues, in a recent review, to highlight the potential role of stress-related socio-economic factors such as poverty in influencing unhealthy behaviour via increased discounting. 8 Research into the life-course determinants of cognitive function highlights the additional roles of language development, home learning environments, parenting style and beliefs, and health (maternal health, birth weight and breastfeeding). [81][82][83] The social patterning of these environmental factors corresponds to social gradients in smoking, suggesting that all could contribute to smoking behaviour via their knock-on effects on timediscounting.…”

“…For example, discount rates are found to be lower in older and more educated individuals with higher socio-economic status, whilst those who save less for retirement, who gamble and who are overweight have higher discount rates. [6][7][8][9][10] The health costs of cigarette smoking come at a delay whilst benefits are immediate. Thus, time-discounting may act as one important mediating, and potentially modifiable, factor linking environmental, social and life-course factors to risky unhealthy behaviours, including smoking.…”

“…Thus, time-discounting may act as one important mediating, and potentially modifiable, factor linking environmental, social and life-course factors to risky unhealthy behaviours, including smoking. 8 Over the past two decades, a growing body of scholarship has therefore begun testing whether time-discounting correlates with a range of smoking-related behaviours. Studies in this field analyse a range of temporal patterns, including the relationship of time-discounting with smoking initiation, smoking status and dependence at a fixed point in time and sustained cessation.…”

Developing Repetitive Transcranial Magnetic Stimulation (rTMS) as a Treatment Tool for Cocaine Use Disorder: a Series of Six Translational Studies

“…These are interdependent systems which compete for relative control during decision-making. Normal functioning results when the systems are in regulatory balance; however, pathologic behavior may result when the two systems are not in regulatory balance [28]. …”

Reward Processing in Motivational and Affective Disorders

“…Notably, there may be an interdependent relationship between low socioeconomic status, discounting, and mental ill health, whereby impatience for rewards leads to maladaptive choices such as substance misuse, which in turn are associated with worsening finances, further increases in discounting and increased risk of psychiatric disorder (e.g., Fields et al, 2009b;Leitão et al, 2013). A similar idea has been championed by Bickel et al (2014b), who propose that the environment associated with low socioeconomic status promotes steeper discounting, which in turn engenders unhealthy choices, thus contributing to known socioeconomic gradients in health status (Adler and Rehkopf, 2008). This is supported by evidence that cigarette smoking, obesity, alcohol use and illicit drug use all exhibit negative relationships with socioeconomic status (Conner and Norman, 2005), that these behaviors are associated with poor executive functioning (e.g., Bickel et al, 2012a), and that economic poverty is prospectively associated with poor executive functioning (Lupien et al, 2007;Noble et al, 2007;Evans and Schamberg, 2009).…”