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This study addressed the question of whether poor decision making would be associated with adolescent past 7-day smoking. We conducted a cross-sectional study of 208 10th-grade adolescents in Chengdu City, China. We used the Iowa Gambling Task (IGT) to assess decision-making, and the Self-ordered Pointing Task (SOPT) to assess working memory capacity. Paper and pencil questionnaires assessed the school academic performance (SAP) and smoking variables. The results showed that a significantly higher proportion of past 7-day smokers (91.7%) were susceptible to future smoking and cigarette offers from best friends compared to other levels of smokers (never, ever and past 30-day smokers). Consistent with these behavioral data, the neuropsychological assessments revealed that relative to never smokers, past 7-day adolescent smokers (but not ever smokers or past 30-day smokers) demonstrated significantly lower scores on the IGT. Moreover, a higher proportion of past 7-day smokers (91.7%) performed poorly (no more than an overall net score of 10) on the IGT than nonsmokers and irregular (ever or past 30-day) smokers (about 65.3%). There were no differences on working memory performance for smokers (at any level) compared to never smokers after adjusting for school-type. In addition, logistic regression showed that the IGT significantly predicted past 7-day smoking after controlling for the working memory, school academic performance and demographic variables. These results suggest that poor affective decision making might predispose some adolescents to smoking in the future or in the social situations where their peers are smoking. Intervention targeting affective decision making might hold promise for reducing adolescents' risks for substance use.

Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th-grade Chinese adolescent smokers