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Delay Discounting, Locus of Control, and Cognitive Impulsiveness Independently Predict Tobacco Dependence Treatment Outcomes in a Highly Dependent, Lower Socioeconomic Group of Smokers


  • Dr. Sheffer is now at the City College of New York. Address correspondence to Dr. Sheffer, Community Health and Social Medicine Department, Sophie Davis School of Biomedical Education, Harris Hall Suite 400, City College of New York, 160 Convent Avenue, New York, NY 10031. E-mail:


Tobacco use disproportionately affects lower socioeconomic status (SES) groups. Current explanations as to why lower SES groups respond less robustly to tobacco control efforts and tobacco dependence treatment do not fully account for this disparity. The identification of factors that predict relapse in this population might help to clarify these differences. Good candidates for novel prognostic factors include the constellation of behaviors associated with executive function including self-control/impulsiveness, the propensity to delay reward, and consideration and planning of future events. This study examined the ability of several measures of executive function and other key clinical, psychological, and cognitive factors to predict abstinence for highly dependent lower SES participants enrolled in intensive cognitive-behavioral treatment for tobacco dependence. Consistent with predictions, increased discounting and impulsiveness, an external locus of control as well as greater levels of nicotine dependence, stress, and smoking for negative affect reduction predicted relapse. These findings suggest that these novel factors are clinically relevant in predicting treatment outcomes and suggest new targets for therapeutic assessment and treatment approaches. (Am J Addict 2012;21:221–232)