Takagi Daisuke, Kondo Naoki, Takada Misato, Hashimoto Hideki
Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Soc Sci Med. 2016 Mar;153:116-22. doi: 10.1016/j.socscimed.2016.01.054. Epub 2016 Feb 18.
Evidence consistently shows that low education is associated with unhealthy behaviors. A recent study in behavioral economics argued that high time preferences - the tendency to prefer immediate gain to later reward - explain the limited self-control of individuals in making preventive health-related choices. The aim of this study was to examine the mediating effect of time preference on the associations between education and smoking, binge drinking and overweight in young and middle-aged adults living in a Japanese metropolitan area, using a quantitatively measured time discount rate. A population-based probabilistic sample of residents of 25-50 years of age living in four municipalities within Japanese metropolitan areas where economic disparity is relatively large was obtained from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE). Respondents answered the questionnaire items using a computer-aided personal instrument (CAPI). Data from 3457 respondents were used in this study. Time preferences measured as categorical responses were converted into a continuous number of time discount rates by using the maximum likelihood method. Smoking habit, binge drinking, and body mass index were regressed on educational attainment with demographics and other confounders. The mediating effects of the time discount rate were examined with the bootstrapping method. Results showed that the time discount rate did not mediate the association between education and binge drinking and BMI. Even for smoking, the mediating effect of time discount rate was quite limited, indicating that the proportion of total effect of education mediated was only 4.3% for men and 3.0% for women. The results suggest that modifying time preferences through educational intervention has only limited efficacy in closing disparities in health-related behaviors, and that other mediators fostered by schooling, such as knowledge/skills, group norms and supportive peers/networks, may be more important as modifiable mediators in the link between education and smoking.
证据始终表明，低教育水平与不健康行为有关。行为经济学最近的一项研究认为，高时间偏好——即倾向于即时收益而非延迟奖励——解释了个体在做出与预防性健康相关选择时自我控制能力有限的原因。本研究的目的是使用定量测量的时间贴现率，检验时间偏好在日本大都市地区的年轻和中年成年人中，教育与吸烟、暴饮和超重之间关联的中介作用。从日本分层、健康、收入和邻里关系研究（J-SHINE）中获得了居住在日本大都市地区四个经济差距相对较大的市的25至50岁居民的基于人群的概率样本。受访者使用计算机辅助个人工具（CAPI）回答问卷项目。本研究使用了3457名受访者的数据。通过最大似然法将以分类回答测量的时间偏好转换为连续的时间贴现率数量。将吸烟习惯、暴饮和体重指数对受教育程度进行回归分析，并纳入人口统计学和其他混杂因素。使用自抽样法检验时间贴现率的中介作用。结果表明，时间贴现率并未介导教育与暴饮和体重指数之间的关联。即使对于吸烟，时间贴现率的中介作用也非常有限，表明教育介导的总效应比例，男性仅为4.3%，女性为3.0%。研究结果表明，通过教育干预来改变时间偏好，在缩小与健康相关行为的差距方面效果有限，而学校教育培养的其他中介因素，如知识/技能、群体规范和支持性的同龄人/网络，可能作为教育与吸烟之间联系中更重要的可改变中介因素。
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