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Keywords:

  • Rational addiction;
  • smoking;
  • time perspective;
  • time preference

The proposal that people who place more value on future events, specifically their future health, are more likely to engage in behaviours that safeguard that future health is intuitively appealing. However, the research evidence that attitudes to the future are associated with health behaviour change is only just beginning to accrue.

Time and risk preference are economic concepts that describe how individuals' preference for outcomes vary as the time to, or probability of, that outcome changes. In general, it has been found that the perceived value of positive outcomes decreases as the time to the outcome increases, or the probability of the outcome occurring decreases. Time perspective is a related psychological concept that describes the influence that considerations of past, present and future events can have on present day behavioural decisions. Related psychological concepts include future orientation, consideration of future consequences, delay of gratification and impulsivity.

A number of authors have argued that time preference, and related concepts, may play a role both in uptake of health-promoting behaviours and cessation of health-damaging behaviours [1–3]. In the smoking field, there is consistent evidence that time preference-like concepts are related cross-sectionally to current smoking, with smokers tending to place less value on future events than both never and ex-smokers (e.g. [4–8]). The paper by Goto and colleagues contributes to the growing literature that time preference and perspective may also be related to successful smoking cessation [9]. They found that time and risk preference were significantly associated with successful smoking cessation over 5 months in a cohort of individuals who had quit smoking within the last month. Others have found that time perspective, or related concepts, are associated significantly with continued cessation among a group of women who quit spontaneously during pregnancy [10], relapse to smoking in the context of a cessation-promotion intervention [11,12] and successful spontaneous cessation in a group of older smokers [8]—in all cases those who value future events being more likely to quit or less likely to relapse.

Despite this growing evidence that time perspective, and related concepts, play a role in smoking behaviour—and in smoking cessation behaviour in particular—a number of important questions remain. First, and crucially from a research perspective, our conceptualization of the phenomenon under study remains hazy, as exemplified by the need to refer to it as ‘time preference, and related concepts’. Numerous different terms have been used, each accompanied by a different definition and different measurement instrument [13]. While there is clearly conceptual overlap, it remains unclear exactly to what we are referring, what we are measuring and how appropriate it is to lump together research using different measures and conceptualizations. Even within the concept of time preference, different domains exist such that time preference for money, health or any other commodity can be measured. Within individuals, time preference in different domains tends to correlate to some degree, but not entirely [4,14]. This is rarely acknowledged or discussed and needs further consideration. As the domain considered most often when measuring time preference is money, there is a high risk of confounding by socio-economic position [15]—which is associated strongly with many health-related behaviours, including smoking and smoking cessation success [16].

Further, the behavioural journey that a current smoker takes to become an ex-smoker is complex. To date, research has tended to focus upon whether or not time preference, and related concepts, play a role in the success of quit attempts once initiated. However, it is also possible that time preference is related to the likelihood of initiating a quit attempt, or indeed the type of smoker that one is—in terms of, for instance, level of addiction. Fine-tuning our understanding of exactly what role time perspective, and related concepts, are playing in smoking and smoking cessation is the obvious next step now that broad associations are beginning to be confirmed.

Finally, and most importantly from a public health perspective, the implications of this research for policy and practice remain to be established. The finding that those who place higher value on future outcomes are more likely to be successful quitters suggests, perhaps controversially, that efficiencies could be achieved by focusing on cessation support according to time preference. Alternatively, incorporating time preference manipulation into smoking cessation interventions may increase their success. This has been attempted in the physical activity field [17], but substantial further work is required to determine how easy and effective it is to manipulate time preference. One other possibility for intervention is to tailor cessation messages to individuals' time preference. Preliminary analyses in the context of disease screening have found that messages related to the costs and benefits of screening that are tailored to recipients' time perspective lead to greater reported intention to attend for screening than generic messages [18,19]. Further work is required to determine how useful this approach could be in the smoking cessation field.

There is a risk that the intuitive appeal of the time perspective–health behaviour change association leads to a lack of research rigour in this area. While the general association may be ‘obvious’, the specifics of conceptualization, measurement and in-depth understanding and, in particular, the practical implications of this association, deserve rigorous attention.

Acknowledgements

  1. Top of page
  2. Acknowledgements
  3. References

Jean Adams is supported by a UK Medical Research Council Special Training Fellowship in Health Services and Health of the Public Research.

References

  1. Top of page
  2. Acknowledgements
  3. References
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