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Suicide is a leading cause of death for young people globally. Professional organizations such as the American Academy of Pediatrics (AAP) recommend suicide screening for every young person at every healthcare contact and these guidelines are now being implemented across the US. To optimize deployment of these guidelines, we draw on insights from two parallel fields, implementation science - or the study of how to support clinicians in providing evidence-based care within organizational constraints - and behavioral economics, which centers human decision-making. In this brief review, we offer potential barriers to suicide screening and strategies to address barriers drawing on these two literatures, illustrating how best to integrate insights from these fields for maximal impact., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Social norms and financial incentives are both known to shape the decisions people make about prosocial actions. This paper reviews the financial incentives in normative systems (FINS) model, which integrates theories of social norms from communication, social psychology, and behavioral economics to predict relationships among incentives, norms, and behaviors. It addresses how incentives can affect norms and how they change the effects of norms on behaviors. The model shows how strategic communication (framing) of social norms and incentives can shape the way people respond to incentives, minimizing unwanted outcomes and even enhancing the effectiveness of behavioral incentive payments. These insights can guide hypothesis testing and application to real-world use of incentives for behavior change., Competing Interests: Declaration of competing interest The authors declare no conflict of interest exists in relation to the content of this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The adulteration of illicit fentanyl with the alpha-2 agonist xylazine has been designated an emerging public health threat. The clinical rationale for combining fentanyl with xylazine is currently unclear, and the inability to study fentanyl/xylazine interactions in humans warrants the need for preclinical research. We studied fentanyl and xylazine pharmacodynamic and pharmacokinetic interactions in male and female rats using drug self-administration behavioral economic methods. Fentanyl, but not xylazine, functioned as a reinforcer under both fixed-ratio and progressive-ratio drug self-administration procedures. Xylazine combined with fentanyl at three fixed dose-proportion mixtures did not significantly alter fentanyl reinforcement as measured using behavioral economic analyses. Xylazine produced a proportion-dependent decrease in the behavioral economic Q 0 endpoint compared to fentanyl alone. However, xylazine did not significantly alter fentanyl self-administration at FR1. Fentanyl and xylazine co-administration did not result in changes to pharmacokinetic endpoints. The present results demonstrate that xylazine does not enhance the addictive effects of fentanyl or alter fentanyl plasma concentrations. The premise for why illicitly manufacture fentanyl has been adulterated with xylazine remains to be determined., Competing Interests: Declaration of Competing Interest The author has no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Despite considerable evidence suggesting that sweet foods are a substitute for nicotine in humans, no formal behavioral economic analysis of this interrelationship has been conducted in nonhumans. The purpose of the present study was to examine this phenomenon in rats using concurrent schedules of sucrose pellet, chow pellet, and nicotine reinforcer delivery. Rats responded on separate levers that delivered sucrose pellets, chow pellets, or nicotine infusions under concurrent fixed-ratio (FR) 1 schedules for each commodity within a closed economy. Following stable food and nicotine intake, the unit price of either sucrose or nicotine (the primary commodity) was increased while the two alternative commodities remained unchanged. Substitution was quantified using a behavioral economic cross-price model, as well as a novel commodity relation index that normalizes consumption of dissimilar commodities. Asymmetrical partial substitution was observed, wherein sucrose served as a partial substitute for nicotine, but nicotine failed to substitute for sucrose. Moreover, sucrose was a stronger partial substitute for nicotine than chow in most rats. These findings indicate that substitution of food for nicotine depends on the type of food. These findings mirror the selective increase in carbohydrate intake that can occur during smoking cessation and demonstrate a behavioral economic mechanism that may mediate it., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Behavioral economics studies how external influences subconsciously affect decision making. Everyone is subject to a range of cognitive biases, which can affect the radiology training environment and can impact resident selection, resident education, feedback, workflow, and report composition. Understanding the cognitive sources of error and patterns of deviation can help faculty and trainees better engage in an optimal learning environment. This review focuses on the role of cognitive biases as they impact multiple facets of radiology education and training environments., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background: Social Security Disability Insurance (SSDI) beneficiaries who work are often overpaid, with a median overpayment amount of over $9000. These overpayments occur when the Social Security Administration (SSA) pays benefits to beneficiaries not entitled to them because of work; beneficiaries are required to repay the debt to SSA. Work-related overpayments most often occur because beneficiaries work but do not follow SSDI program rules to report earnings and evidence suggests that SSDI beneficiaries are often unaware of reporting requirements., Objective: To assess written earnings reporting reminders that SSA makes available to SSDI beneficiaries as a way of diagnosing a potential barrier to earnings reporting that contributes to overpayments., Methods: Using insights from the behavioral economics literature, this article provides a comprehensive diagnosis of SSA's written communications that include earnings reporting reminders., Results: Beneficiaries are infrequently notified or reminded of requirements, especially at points in time when that information is actionable; the content is not always clear, salient, and urgent; relevant text can be hard to find; and communications rarely emphasize how easy it is to report, what needs to be reported, deadlines for reporting, and the consequences of failing to report., Conclusions: Potential shortcomings in written communications may contribute to limited awareness about earning reporting. Policymakers should consider the benefits of improving communications about earnings reporting., Competing Interests: Disclosures A working paper version of this research was previously available online: https://crr.bc.edu/working-papers/a-behavioral-economics-assessment-of-ssdi-earnings-reporting-documents/. The working paper has been removed, per DHJO guidelines. The research reported herein was derived in whole or in part from research activities performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium. The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA, any agency of the federal government, Mathematica, or Boston College. Neither the United States Government nor any agency thereof, nor any of their employees, make any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Behavioral economics strategies implemented within social marketing campaigns improve eating behavior., Objective: To identify which behavioral economics strategies in social marketing messages particularly messengers, norms, and commitments will promote low-income Louisiana residents to add more vegetables to meals., Design: Full profile traditional conjoint analysis survey with single concept ratings., Participants: Purposive sample of low-resource Louisiana residents (N = 213) SETTING: Online survey., Intervention: Participants rated randomized concepts that featured a messenger and a message., Main Outcome Measure: Ratings (one to nine) of likelihood to add vegetables to meals., Statistical Analysis: A model of ratings was generated using mixed-effects multiple regression, which accounted for repeated measurement of participants. Interactions of variables and covariates were modeled., Results: There was a significant main effect of the messenger variable (P = 0.02) and main effect of the message variable (P = 0.008). Pairwise comparisons demonstrated differences between friend (μ (predicted mean) = 6.80) and mother (μ = 7.06; P = 0.03) as well as friend and normal-weight doctor (μ = 7.03; P = 0.04). Pairwise comparisons demonstrated differences between descriptive norm (μ = 6.79) and grocery list precommitment (μ = 7.02; P = 0.05) along with descriptive norm and injunctive norm (μ = 6.98; P = 0.04). Covariate models demonstrated main effects of race (P = 0.006) and sex (P = 0.0001). There was significant variation in the message variable and frequency of vegetable intake interaction (P = 0.01)., Conclusions: Both message and messenger variables predicted the likelihood to add vegetables to meals. Race and sex influenced ratings to add vegetables. As reported vegetable consumption increased, behavioral economics messages improved the likelihood to add vegetables to meals. Behavioral economic approaches are well suited to social marketing messages that aim to promote healthy eating behavior in low-income LA residents., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Public health officials in the U.S. and New Zealand are considering a reduced nicotine standard for cigarettes to reduce their addictive potential. This study's aim was to evaluate the effects of nicotine reduction on the reinforcing efficacy of cigarettes in adolescents who smoke, which has implications for this policy's potential for success., Methods: Adolescents who smoked cigarettes daily (n = 66; mean age: 18.6) participated in a randomized clinical trial assessing effects of assignment to very low nicotine content (VLNC; 0.4 mg/g nicotine) or normal nicotine content (NNC; 15.8 mg/g nicotine) cigarettes. Hypothetical cigarette purchase tasks were completed at baseline and the end of Week 3 and demand curves fit to the data. Linear regressions estimated effects of nicotine content on demand for study cigarettes at baseline and Week 3 and associations between baseline demand for cigarette consumption at Week 3., Results: An extra sum of squares F-test of fitted demand curves indicated that demand (α) was more elastic among VLNC participants at baseline and Week 3 (F(2, 1016)= 35.72, p < 0.001). Adjusted linear regressions indicated demand was more elastic (ß= 1.45, p < 0.01) and maximum expenditure (O max ) lower (ß= -1.42, p-0.03) among VLNC participants at Week 3. More elastic demand for study cigarettes at baseline predicted lower consumption of cigarettes at Week 3 (p's < 0.01)., Conclusions: A nicotine reduction policy may reduce the reinforcing value of combustible cigarettes among adolescents. Future work should investigate likely responses to such a policy among youth with other vulnerabilities and evaluate the potential for substitution to other nicotine containing products., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: In the United States (U.S), cannabis policies have been increasingly liberalized whereas tobacco policies have been increasingly stringent. Given the high prevalence of cannabis and tobacco dual use, there are concerns that a policy regulating one substance may unintendedly influence the other. This study examined the responsiveness of the demand for cannabis joints and cigarettes when price varied., Methods: The study included 338 adult participants (21+) who used both cannabis and tobacco and lived in one of the U.S. states with recreational cannabis legalized by the time of interview in 2019. They completed hypothetical purchase tasks to indicate the quantity desired of cannabis joints and cigarette packs 1) when only one substance was available with escalating prices and 2) when both substances were concurrently available with escalating prices of cannabis joints and a fixed price of cigarette packs. We estimated 1) the own-price elasticity of demand for each substance using nonlinear exponential demand model, and 2) the cross-price elasticity of demand at aggregate level using nonlinear exponential demand model and at individual level using log-linear demand model., Results: The estimates for the rate of change of own-price elasticity (α) were 0.0011 (SE = 0.000039, p < 0.001) for cannabis joints and 0.00095 (SE = 0.000037, p < 0.001) for cigarette packs. The aggregate-level estimates of cross-price elasticity (I = 13.032, SE = 0.34, p < 0.001; β = 0.0029, SE = 0.0021, p > 0.05) suggest an independent relationship between the two substances. At individual level, 78.70% of the participants treated the two substances as independent, 17.46% as complements, and 3.85% as substitutes., Conclusions: For most adults who used both cannabis and tobacco in the U.S., cannabis joints and cigarettes had an independent relationship. Policies regulating the price of cannabis may not have large unintended consequences on cigarette use., Competing Interests: Declarations of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Background: The Diabetes Prevention Program (DPP) and metformin can prevent or delay the onset of type 2 diabetes mellitus (T2DM) among patients with prediabetes. Yet, even when these evidence-based strategies are accessible and affordable, uptake is low. Thus, there is a critical need for effective, scalable, and sustainable approaches to increase uptake and engagement in these interventions., Methods: In this randomized controlled trial, we will test whether financial incentives and automated messaging to promote autonomous motivation for preventing T2DM can increase DPP participation, metformin use, or both among adults with prediabetes. Participants (n = 380) will be randomized to one of four study arms. Control Arm participants will receive usual care and educational text messages about preventing T2DM. Incentives Arm participants will receive the Control Arm intervention plus financial incentives for DPP participation or metformin use. Tailored Messages Arm participants will receive the Control Arm intervention plus tailored messages promoting autonomous motivation for preventing T2DM. Combined Arm participants will receive the Incentives Arm and Tailored Messages Arm interventions plus messages to increase the personal salience of financial incentives. The primary outcome is change in hemoglobin A1c from baseline to 12 months. Secondary outcomes are change in body weight, DPP participation, and metformin use., Discussion: If effective, these scalable and sustainable approaches to increase patient motivation to prevent T2DM can be deployed by health systems, health plans, and employers to help individuals with prediabetes lower their risk for developing T2DM., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Kevin Volpp is the co-owner of the consulting firm VALHealth. Dr. Jeff Kullgren has received consulting fees from SeeChange Health, HealthMine, and the Kaiser Permanente Washington Health Research Institute; and honoraria from the Robert Wood Johnson Foundation, AbilTo, Inc., the Kansas City Area Life Sciences Institute, the American Diabetes Association, the Donaghue Foundation, and the Luxembourg National Research Fund. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Adolescence is a period of psychological and neural development in which harms associated with cannabis use may be heightened. We hypothesised that adolescent who use cannabis (adolescentsWUC) would have steeper delay discounting (preference for immediate over future rewards) and greater demand (relative valuation) for cannabis than adults who use cannabis (adultsWUC)., Methods: This cross-sectional study, part of the 'CannTeen' project, compared adultsWUC (n = 71, 26-29 years old) and adolescentsWUC (n = 76, 16-17 years old), and gender- and age-matched adolescent (n = 63) and adult (n = 64) controls. AdolescentsWUC and adultsWUC used cannabis 1-7 days/week and were matched on cannabis use frequency (4 days/week). The Monetary Choice Questionnaire assessed delay discounting. A modified Marijuana Purchase Task (MPT) assessed cannabis demand in adolescentsWUC and adultsWUC. The MPT yielded five indices: intensity (amount of cannabis used at zero cost), O max (total peak expenditure), P max (price at peak expenditure), breakpoint (cost at which cannabis demand is suppressed to zero) and elasticity (degree to which cannabis use decreases with increasing price). Analyses were adjusted for covariates of gender, socioeconomic status, other illicit drug use., Results: Both adolescentsWUC and adultsWUC had steeper delay discounting than controls (F, (1,254)= 9.13, p = 0.003, η p 2 = 0.04), with no significant age effect or interaction. AdolescentsWUC showed higher intensity (F, (1,138)= 9.76, p = 0.002, η p 2 = 0.07) and lower elasticity (F, (1,138)= 15.25, p < 0.001, η p 2 = 0.10) than adultsWUC. There were no significant differences in P max , O max or breakpoint., Conclusion: Individuals who use cannabis prefer immediate rewards more than controls. AdolescentsWUC, compared to adultsWUC, may be in a high-risk category with diminished sensitivity to cannabis price increases and a greater consumption of cannabis when it is free., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

People frequently engage in dishonest behavior. Yet, they do so only to a limited extent, often forgoing potential profits. In the past few decades, the dominant psychological account explaining people's "limited dishonesty" characterized this behavior as driven by a desire to preserve a positive image of the self. Recently, a new account has been put forward, based on social considerations. This social image account claims that limited dishonesty is driven by a desire to be viewed positively by others. Here we review empirical findings from psychology and behavioral economics on the role of social image in dishonest behavior. We conclude by suggesting that both self-image and social image are at play., Competing Interests: Conflict of interest statement Nothing declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Currently, there are no FDA-approved medications for the treatment of psychostimulant (e.g., cocaine) use disorders. Because the GluN2B subunit of the glutamate N-methyl-D-aspartate (NMDA) receptor is an important mediator of addiction-like behaviors, the goal of the current study was to determine if the GluN2B-selective antagonist Ro 63-1908 is efficacious in attenuating cocaine self-administration., Methods: Adult Sprague Dawley rats (24 males and 11 females) were implanted with indwelling catheters and were trained to self-administer cocaine (0.75 mg/kg/inf). Rats were then trained in a threshold procedure, in which the dose of cocaine decreased across six 6-min blocks (0.75, 0.27, 0.08, 0.03, 0.01, 0.003 mg/kg/inf). This procedure allowed for the quantification of behavioral economic indices of drug self-administration. Following training in the threshold procedure, rats were treated with the GluN2B-selective antagonist Ro 63-1908 (0, 0.1, 0.3, 1.0 mg/kg; s.c.). Rats also received treatments of the NMDA receptor channel blocker MK-801 (0, 0.01, 0.03, 0.06 mg/kg; s.c.)., Results: Blocking NMDA receptors decreased initial intake (i.e., consumption during the first block), although Ro 63-1908 and MK-801 increased area under the curve (global measure of demand) and decreased demand elasticity, an effect observed primarily in males. Neither drug affected demand intensity (i.e., consumption of cocaine at a minimally constrained price)., Conclusions: While blocking the NMDA receptor decreases initial intake of cocaine, NMDA receptor antagonists make cocaine more inelastic with increasing price. These results suggest that NMDA receptor antagonists can exacerbate addiction-like behaviors during self-administration during extinction-like conditions that are observed in later blocks of the threshold procedure., (Copyright © 2022 Elsevier B.V. All rights reserved.)

In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose 5 general considerations in designing and applying incentive interventions to children. These include: 1) the potential impact of incentives on intrinsic motivation, 2) ethical concerns about incentives promoting undue influence, 3) the importance of child neurodevelopmental stage, 4) how incentive interventions may influence health disparities, and 5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation., (Copyright © 2021 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: Overtesting and treatment of older patients is common and may lead to harms. The Choosing Wisely campaign has provided recommendations to reduce overtesting and overtreatment of older adults. Behavioral economics-informed interventions embedded within the electronic health record (EHR) have been shown to reduce overuse in several areas. Our objective is to conduct a parallel arm, pragmatic cluster-randomized trial to evaluate the effectiveness of behavioral-economics-informed clinical decision support (CDS) interventions previously piloted in primary care clinics and designed to reduce overtesting and overtreatment in older adults., Methods/design: This trial has two parallel arms: clinician education alone vs. clinician education plus behavioral-economics-informed CDS. There are three co-primary outcomes for this trial: (1) prostate-specific antigen (PSA) screening in older men, (2) urine testing for non-specific reasons in older women, and (3) overtreatment of diabetes in older adults. All eligible primary care clinics from a large regional health system were randomized using a modified constrained randomization process and their attributed clinicians were included. Clinicians were recruited to complete a survey and educational module. We randomized 60 primary care clinics with 374 primary care clinicians and achieved adequate balance between the study arms for prespecified constrained variables. Baseline annual overuse rates for the three co-primary outcomes were 25%, 23%, and 17% for the PSA, urine, and diabetes measures, respectively., Discussion: This trial is evaluating behavioral-economics-informed EHR-embedded interventions to reduce overuse of specific tests and treatments for older adults. The study will evaluate the effectiveness and safety of these interventions., (Copyright © 2021. Published by Elsevier Inc.)

Background: The marijuana purchase task (MPT) is a commonly used behavioral economic measure of relative cannabis value (i.e. demand) that presents specific methodological concerns due to non-standardized measurement, variability in modality of use, and evolving legalization policies. Refinement of the task is critical to improve task ecological validity and accurate measurement of cannabis demand. The present study examined the construct validity of an adaptive MPT that allowed for participant selection of their preferred cannabis-based product and unit of measurement and the effect of next-day responsibilities on demand., Methods: Participants reporting at least monthly cannabis use (N = 186, 40.3 % women, M age = 33.59) were recruited via Amazon Mechanical Turk and completed the original MPT and our adaptive form with 2 next-day responsibilities scenarios (no responsibilities vs. morning job interview) for each MPT. Cannabis use motives, problems, and risk for cannabis use disorder were also assessed., Results: Cannabis demand was sensitive to next-day responsibility, with higher hypothetical consumption observed in the no responsibilities condition. Responsibility-related decreases in Omax (F(1,185) = 4.83, p = .029, η 2 p = .03) were significantly greater on the adaptive MPT than the original MPT. Demand indices derived from the adaptive MPT were significantly correlated with cannabis problems (r breakpoint = .19, r Pmax = 0.18, r elasticity =-0.18) and motives (r range =-.32-.25), and demand metrics from the original MPT., Conclusions: Results provide preliminary support for the construct validity of an adaptive MPT and suggest that early-morning work responsibilities may reduce cannabis demand. Continued research is needed to further refine this task and determine implications for cannabis use disorder intervention and prevention approaches., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Physical inactivity post-stroke can negatively impact long-term health outcomes and contribute to cardiovascular deconditioning, muscle loss, and increased risk for recurrent stroke. The limited number of interventions designed to improve daily physical activity post-stroke have lacked precision in step goals, are resource intensive, and difficult to scale. The purpose of the Leveraging Insights from Behavioral Economics to Improve Mobility for Adults with Stroke (BE Mobile) trial is to examine the preliminary effectiveness of a novel gamification with social incentives intervention for improving physical activity post-stroke. This trial includes adults who have experienced an ischemic or hemorrhagic stroke ≥3 months prior to the time of recruitment who are randomized to a control or gamification arm. All participants receive a Fitbit Inspire 2 wearable device to quantify daily steps and complete a 2-week baseline run-in period followed by an 8-week intervention period. All participants select a daily step goal and the gamification arm is enrolled in a game with loss-framed points and levels to help participants achieve their daily step goal. Participants in the gamification arm also select a support partner who receives weekly updates on their progress in the game. The primary outcome is change in daily steps from baseline during the intervention period. The secondary outcome is difference in the proportion of days participants achieved their daily step goal. Results from this trial will inform future, larger studies that leverage insights from behavioral economics to help improve daily physical activity post-stroke. Trial registration: NCT #04607811., (Copyright © 2021. Published by Elsevier Inc.)

Background: A majority of children's restaurant meals are nutritionally deficient; use of behavioral economics may improve healthful menu selections. Parents play a role in children's restaurant meal selection, thus understanding parent preferences for potential behavioral economic strategies is warranted., Objective: To examine parent-derived and -stated preferences for selected attributes of children's restaurant menus, which included behavioral economic strategies (eg, optimal defaults and vice-virtue bundles)., Design: A descriptive, cross-sectional, within-subjects survey integrating a conjoint design was developed along with 8 children's menus. Menus were manipulated by varying levels of attributes (meal price, healthful side dishes, number of side dish items, healthful entrées, and cost for sugar-sweetened beverages [SSB]). Parents rated menus and attributes using Likert scales., Participants/setting: A national sample of US parents with children 4 to 10 years (n = 463) were recruited in August of 2019 via Amazon's Mechanical Turk., Analysis: A conjoint (regression) analysis was conducted to derive parent preference for each attribute and overall menu preference. Descriptive statistics (means) described overall stated parent menu preferences and ratings. Cluster analysis segmented parents into groups with similar preferences., Results: Derived preferences showed parents had the strongest preference for choice of side dishes (β = .73) and low-priced menus (β = .51), and weak preferences for inclusion of healthful entrées (β = .04) and added cost for SSB (β = .18). Parents stated preference was for a menu that included healthful entrées, was low priced, and featured choices for side dishes. Cluster analysis revealed half of parents preferred the low-cost children's menu with the other half of parents split evenly across preferences related to health, choice, and traditional menus., Conclusion: Parents stated preference was for a socially desirable menu featuring healthful entrée options and added cost for SSB, which was contrary to the conjoint derived menu preferences. Understanding parent preferences may help guide nutrition professionals working to build a more healthful food environment through the use of behavioral economic strategies., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Each day, adolescents and young adults (AYAs) choose to engage in behaviors that impact their current and future health. Behavioral economics represents an innovative lens through which to explore decision-making among AYAs. Behavioral economics outlines a diverse set of phenomena that influence decision-making and can be leveraged to develop interventions that may support behavior change. Up to this point, behavioral economic interventions have predominantly been studied in adults. This article provides an integrative review of how behavioral economic phenomena can be leveraged to motivate health-related behavior change among AYAs. We contextualize these phenomena in the physical and social environments unique to AYAs and the neurodevelopmental changes they undergo, highlighting opportunities to intervene in AYA-specific contexts. Our review of the literature suggests behavioral economic phenomena leveraging social choice are particularly promising for AYA health. Behavioral economic interventions that take advantage of AYA learning and development have the potential to positively impact youth health and well-being over the lifespan., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Nutrition interventions promoting healthy food choices aim to address health challenges of residents in low-income environments. Research about the effectiveness of nutrition interventions in low-income populations is limited, particularly for those in rural areas. Behavioral economics (BE) strategies demonstrate effectiveness for improving eating behaviors in some settings. However, the efficacy of BE interventions in retail food stores serving low-income populations residing in rural and urban geographies is nascent., Objective: This systematic literature review aims to identify and compare nutrition interventions implemented in rural and urban low-income retail food stores, including BE strategies when applied., Methods: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviewers searched five databases for peer-reviewed publications from October 2010 to October 2019. Included studies implemented a nutrition intervention in low-income retail food stores and provided a quantitative outcome evaluation with results separated by rural and urban geography. BE interventions were analyzed based on the MINDSPACE framework for behavior change., Results: Forty-six separate publications (n = 20 rural, n = 26 urban) in the United States, Canada, Europe, New Zealand, and Australia were included. Researchers independently rated publications as low risk of bias (n = 4), moderate (n = 18), or high risk of bias (n = 24) using the Quality Assessment Tool for Quantitative Studies. Studies (n = 18) demonstrated positive outcomes for customer purchases, store sales, or participant intake of targeted healthy foods. Overall, most effective interventions included point-of-purchase signage (n = 16) and product placement strategies (n = 4 urban). Rural studies included financial incentives combined with participant education (n = 2) and incorporated culturally appropriate messengers and/or symbols (n = 5) to improve healthy food purchases and intake., Conclusions: Improved research quality and tailored evidence-based interventions, including BE strategies, are necessary in retail food environments to promote healthy eating behaviors in low-income populations., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Introduction: Cigarette demand, or relative value, can be assessed via analysis of performance on a hypothetical behavioral economic cigarette purchase task (CPT). Substance purchase tasks are highly amenable to manipulation, namely, external stimuli, instructional changes, or acute stressors. In this regard, the current secondary analysis evaluates the role a novel, computerized stress induction paradigm, the Contextual-Frustration Intolerance Typing Task (C-FiTT), plays in eliciting varying levels of stress and resulting demand., Method: Daily smokers (n = 484) completed the C-FiTT wherein they were randomly assigned to one of five distress conditions: combination of task difficulty (low or high difficulty) with neutral or withdrawal cues, and a neutral control group. Tobacco demand was assessed immediately following the distress task using the hypothetical CPT., Results: The C-FiTT distress-induction task significantly increased key cigarette demand indices, including price at maximum expenditure (P max ) and first price where consumption was suppressed to zero (breakpoint). Moreover, demand increased with severity of C-FiTT condition, with the high-difficulty condition resulting in significantly higher breakpoint and P max , compared to other conditions. C-FiTT condition was not related to a significant increase in O max , intensity, or elasticity., Discussion: The novel C-FiTT paradigm produced comparable effects on tobacco demand relative to in vivo withdrawal induction, indicating that the C-FiTT is a viable procedure by which to influence demand. Reduction of internal and external stressors may be effective in lowering motivation for tobacco. These results highlight the importance of state distress in tobacco demand, and offer a potential avenue for intervention., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Behavioral economics provides a framework in which to understand choice and motivation in the field of substance use disorders. Hypothetical purchase tasks (HPT), which indicate the amount or probability of purchasing substances at different prices, have been suggested as a clinical tool that can help predict future substance use and identify targets for intervention., Methods: Hypothetical demand for heroin, cocaine, and benzodiazepines was assessed at baseline and after six-months in 52 opioid-agonist treatment patients. The results were analyzed using a novel exponential demand equation (normalized zero-bounded exponential model [ZBEn]) that uses a log-like transform that accommodates zero consumption values., Results: Demand for these drugs was well described by the ZBEn model. After six months, demand intensity for heroin was decreased and demand metrics for cocaine and benzodiazepines increased. Multiple demand curve indices at baseline predicted the percentage of drug-positive urinalysis results at follow-up, even after controlling for covariates. Additionally, participants were divided into High and Low baseline demand groups for each drug based on demand indices. Participants with High demand at baseline for 8 out of 9 groups had significantly more drug-positive urine samples in the subsequent 6-month period., Conclusions: This report provides evidence that demand assessment is predictive of future substance use and could help guide treatment planning at intake. These results also demonstrated that the ZBEn model provides good fits to consumption data and allows for sensitive statistical analyses., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Behavioral economic theory predicts decisions to drink are cost benefit analyses, and heavy episodic drinking occurs when benefits outweigh costs. Social interaction is a known benefit associated with alcohol use. Although heavy drinking is typically considered more likely during more social drinking events, people who drink heavily in isolation tend to report greater severity of use. This study explicitly disaggregates between-person and within-person effects of sociality on heavy episodic drinking and examines behavioral economic moderators., Methods: We used day-level survey data over an 18-week period in a community adult sample recruited through crowdsourcing (mTurk; N = 223). Behavioral economic indices were examined to determine if macro person-level variables (alcohol demand, delay discounting, proportionate alcohol-related reinforcement [R-ratio]) interact with event-level social context to predict heavy drinking episodes., Results: Mixed effect models indicated significant between-person and within-person social context associations. Specifically, people with a higher proportion of total drinking occasions in social contexts had decreased odds of heavy drinking, whereas being in a social context for a specific drinking occasion was associated with increased odds of heavy drinking. Person-level R-Ratio, demand elasticity, and breakpoint variables interacted with social context to predict heavy episodic drinking, such that the event-level social context association was stronger when R-Ratios, alcohol price insensitivity, and demand breakpoints were high., Conclusions: These results demonstrate an ecological fallacy, in which the size and direction of effects were divergent at different levels of analysis, and highlight the potential for merging behavioral economic variables with proximal contextual effects to predict heavy drinking., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Menthol cigarette smokers may switch to other combusted products like menthol little cigars and cigarillos (LCCs) or switch to non-combusted products like menthol vapes if menthol cigarettes are banned or otherwise restricted. This pilot study used a behavioral economics task to understand (a) menthol cigarette demand across a range of increasing prices in the context of available alternative products and (b) how the availability of menthol LCCs affected cigarette demand and alternative product substitution., Methods: Menthol smokers completed the Experimental Tobacco Marketplace task during two sessions. Cigarettes, LCCs, smokeless tobacco, vapes, and medicinal nicotine were available from an online store. The price of menthol cigarettes increased across trials while the prices of the alternative products remained constant. Menthol LCCs were available in one session and excluded in the other. Cross-price elasticity beta estimates identified significant product substitutes., Results: When menthol LCCs were available, increasing the price of menthol cigarettes led to substitution with non-menthol cigarettes (β = 0.65, 95%CI = 0.34, 0.96), menthol little cigars (β = 0.39, 95%CI = 0.08, 0.70), and menthol vapes (β = 0.26, 95%CI = 0.16, 0.35). When menthol LCCs were not available, increasing the price of menthol cigarettes led to substitution with non-menthol cigarettes (β = 0.59, 95% CI = 0.08, 1.11), non-menthol cigarillos (β = 0.62, 95%CI = 0.19, 1.04), and menthol vapes (β = 0.13, 95%CI = 0.08, 0.18)., Conclusions: As the price of menthol cigarettes increased, demand for menthol cigarettes decreased and demand for combusted and non-combusted products increased, indicating significant substitution for menthol cigarettes. Policies targeting menthol combusted tobacco could result in some menthol smokers switching to non-combusted products like vaping devices., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Most psychologists assume a harmonious correspondence between attitudes, behavior, and cultural institutions. However, institutions often act as intermediating forces between collective attitudes and behavior, and institutions' value-expressive function may be at-odds with the actual behavioral outcomes they produce. We illustrate this with the paradox-of-debt: Protestant cultures have traditionally been relatively less sympathetic to debtors than Catholic cultures have been. Consequently, Protestant cultures set up more pro-creditor institutions. With lending being safer and more profitable in Protestant cultures, creditors increased the amount they were willing to lend. With more credit available, people now borrow more in Protestant (versus Catholic) cultures. Intermediating institutions may thus invert the usual attitude-behavior relationship, facilitating rather than inhibiting traditionally stigmatized behavior., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Intact decision-making skills in the social context are essential for optimal functioning in the community. Despite its significance, social decision making in schizophrenia (SCZ) has not been adequately examined. Hence, we examined social decision making in SCZ using the Ultimatum Game(UG), a neuroeconomic paradigm that involves financial transactions between a proposer and a responder to split a sum of money between them. Thirty male patients with a diagnosis of schizophrenia as per DSM-IV (age = 30 ± 7.08) and thirty age-matched healthy male volunteers (HV;age = 28.48 ± 3.74) participated in the study. All participants functioned as responders and had to either accept or reject offers made by an anonymous proposer. We also examined whether the gender or emotional expression of the proposer influenced acceptance rates. SCZ had significantly lower acceptance rates than HV for slightly unequal offers (t = 3.94, p = < 0.0001). However, there was no significant difference between SCZ and HV for other offers. Gender and emotional expression of the proposer did not significantly influence the outcome. These results suggest aberrant social decision making and increased inequity aversion in patients with SCZ. The difficulty in incorporating social components while engaging in financial interactions could have important implications for rehabilitation, functional recovery, and successful community living in SCZ., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Recurrent fluctuations in health states can occur as a result of long-term conditions with episodic symptoms or through side effects of cycles of treatment. Fluctuations and associated duration of symptoms can be predictable (eg, side effects of chemotherapy treatment) or unpredictable (eg, relapse in multiple sclerosis). Such recurrent fluctuations in health states can have an important impact on a person's health-related quality of life. When symptoms vary by time of day, day of the week, or during the month, it is challenging to obtain reliable health-related quality of life estimates for use in assessing cost-effectiveness of interventions. The adequacy of the quality of life estimate will be affected by (1) the standard recall period associated with the chosen measure (eg, "health today" EQ-5D, "past 4 weeks" for SF-36/SF-6D) and the way that respondents understand and make judgments about these recall periods, (2) the chosen time points for assessing health-related quality of life in relation to the fluctuations in health, and (3) the assumptions used to interpolate between measurement time points and thus calculate the quality-adjusted life-years. These issues have not received sufficient methodological attention and instead remain poorly accounted for in economic analyses. There is potential for these issues to considerably distort treatment decisions away from the optimal allocation. This article brings together evidence from health economics, psychology, and behavioral economics to explore these challenges in depth; presents the solutions that have been applied to date; and details a methodological research agenda for measuring quality-adjusted life-years in recurrent fluctuating health states., (Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

All financial bubbles eventually burst and cause financial crises. In 2008 the US housing bubble burst, causing the global economy to suffer for 4 years. While the 2008 crisis received considerable attention because of its global impact, in the 21st century alone, there have been more than 10 financial crises. While economic, political and legal analysis of the crises have dominated academia, this dissertation argues that an interdisciplinary approach to financial market analysis is required to better understand why they occur. This argument is based on the idea, that the choices of traders are at the core of this issue, and consequently an understanding of trader decision-making behavior was required. Economic models of decision-making are unable to explain this behavior, as they assume decision-making to be an entirely rational process. To address this limitation, findings in neuroscience, psychology and biology are considered. Using this approach, this chapter outlines the role of different neural mechanisms, gut-feelings and hormonal states, that facilitate irrational behavior and increase a trader's susceptibility to partake in bubble markets., (© 2020 Elsevier B.V. All rights reserved.)

Behavioral economics in the addictions is the application of both economics and psychology to study multifaceted components of substance use decision-making behavior. One such component is demand: the relative value of a substance for a user (i.e., the association between drug use and cost). The degree to which a user values a substance can be measured via performance on hypothetical purchase tasks which replicate drug purchase and consumption. Demand has been evaluated across substances, including alcohol, marijuana, tobacco, and alternative tobacco products. Recent advances in the study of demand have greatly improved the assessment of drug value, including application to novel products, selection of optimal task unit, assessment of demand in naïve or potential future users, and the importance of instructional set specificity., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Delay discounting, or the process by which reinforcers lose value with delay to their receipt, has been identified as a trans-disease process underlying addiction, other disorders, and maladaptive health behaviors. Delay discounting has been identified as an endophenotype for multiple psychiatric disorders including substance use disorder, ADHD, and major depressive disorder, with this endophenotype being linked to deficits in dopaminergic and serotonergic neurotransmission. In addition, neuroanatomical and neurophysiological deficits in areas of the executive and impulsive systems have been associated with both steeper discounting and substance use disorders. Delay discounting constitutes a novel target for interventions to change health behaviors. A new theory, termed reinforcer pathology, has been developed uniting these findings and setting the stage for future research., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Behavioral economics provides a framework for quantifying drug abuse potential that can inform public health risk, clinical treatment, and research. Hypothetical purchase task (HPT) questionnaires may provide a low-cost and sensitive method by which to measure and predict the appeal of pharmaceutical drugs that differ by formulation. However, the validity of this type of analysis must be empirically established by comparing the "essential value" (EV) of different drugs across subgroups., Procedures: This pilot study used HPT assessments and the Exponential Model of Demand to quantify the EV of opioid medications-specifically, easily tampered formulations versus (vs.) abuse-deterrent formulations-in patients with a history of opioid abuse., Main Findings: Participants had more inelastic demand for opioid pills than for cigarettes and alcohol. Participants with experience manipulating pills (M group) had more inelastic demand for standard pills vs. participants with no manipulation experience (NM group), and the M group had a more elastic demand for the abuse-deterrent opioid pill than for the standard pill. There was no effect of formulation in the NM group and there was no difference in demand elasticity for abuse-deterrent pills between the two groups. There was a positive correlation between the EVs of different drugs, and between some behavioral economic indices and treatment variables., Conclusions: Our results suggest that HPTs may provide a sensitive measure of abuse potential that can distinguish between different formulations in at-risk populations., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Identity fusion theory has become a popular psychological explanation of costly self-sacrifice. It posits that while maintaining one's own individual identity, a deep affinity with one's group can contribute to sacrifice for that group. We test this and related hypotheses using a behavioral economic experiment designed to detect biased, self-interested favoritism among eight different populations ranging from foragers and horticulturalists to the fully market-integrated. We find that while individuals favor themselves on average, those with higher ingroup fusion sacrifice more money to other members of their ingroup who are unable to reciprocate. We also find that positive outgroup relations has a similar effect. Additionally, we assess a recently-posited interaction between ingroup and outgroup relations and show no consistent effect at the individual or sub-sample levels., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Nicotine is the addictive component in cigarettes that maintain cigarette smoking that subsequently leads to morbidity and mortality. Methods for assessing the abuse liability of cigarettes are essential to inform new tobacco product standards. This secondary analysis evaluated the utility of one subjective effects measure, the modified Cigarette Evaluation Questionnaire (mCEQ), and one behavioral economic task, the Cigarette Purchase Task (CPT), for predicting acute relative reinforcing efficacy measured by concurrent choice Self-Administration (SA)., Methods: Smokers (N = 169) belonging to one of three vulnerable populations participated in a multi-site, double-blind study evaluating research cigarettes with varying levels of nicotine (0.4, 2.4, 5.2, 15.8 mg/g). Participants sampled cigarettes and completed the mCEQ and CPT. In subsequent sessions, cigarette preference was assessed using a concurrent choice SA procedure. Mixed-model repeated measures analysis of variance tests were used to evaluate the utility of the mCEQ subscales and CPT indices for predicting preference for the higher compared to lower nicotine content cigarettes. In addition, stepwise regressions were used to determine which subscales and indices independently predicted concurrent choice SA., Results: Greater increases on the Satisfaction and Enjoyment of Respiratory Tract Sensations mCEQ subscales independently predicted higher dose preference in concurrent choice testing. Elasticity was the only CPT index that predicted choice. However, its predictive utility differed by dose among opioid-maintained individuals., Conclusion: The mCEQ and CPT predict behavioral measures of relative reinforcing efficacy as assessed in concurrent choice SA, with the mCEQ Satisfaction and Enjoyment of Respiratory Tract Sensations subscales being the strongest independent predictors., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Identifying effective strategies for treating obesity is a clinical challenge and a public health priority. The present study is an innovative test of the relative effectiveness of lottery-based financial incentives and environmental strategies on weight loss and maintenance. The Healthy Weigh study is evaluating the comparative effectiveness of behavioral economic financial incentives and environmental strategies, separately and together, in achieving initial weight loss and maintenance of weight loss, in obese urban employee populations. Healthy Weigh is a multi-site, 4-arm randomized controlled trial (RCT) in which 344 employed participants were randomized to one of four arms. The study arms are: 1) standard employee wellness benefits and weigh-ins every 6 months (control arm/usual care); and the control/usual care plus either: 2) daily lottery incentives tied to achievement of weight loss goals (incentive arm); 3) individually tailored environmental strategies around food intake and physical activity (environmental arm); or 4) a combination of incentives and environmental strategies (combined arm). This trial used a web-based platform to enroll, communicate with, and track participant weight change. Wireless scales were used by participants in the three treatment group arms to digitally transmit daily/weekly weights. For females, the baseline median (interquartile range, IQR) for BMI and weight were 37.0 (33.5, 40.6) and 219.9 (198.1, 248.6), respectively; and for males, they were 36.0 (32.8, 39.8) and 247.9 (228.1, 279.5), respectively. The population was generally well-educated. This study demonstrated that multi-site employee-based recruitment for a weight-control intervention study is feasible but may need additional time for coordination between diverse environments., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Pediatric clinical practice often involves improving child health by changing parents' behavior. Strategies from behavioral economics-a field that leverages predictable patterns in human decision making to overcome barriers to behavior change-can improve health outcomes in adults. Although more research is needed, the application of these approaches to parent behavior change in pediatric settings has the potential to improve the clinical effectiveness of child health care. We review the foundational concepts of behavioral economics and identify the unique role of pediatricians in motivating parent behavior change. We then discuss how to apply 4 key strategies in practice-message framing, use of defaults, enhanced active choice, and harnessing social forces-to support parent decision making to improve child health. Leveraging behavioral economic principles around parental decision making has the potential to supercharge program effectiveness and improve patient and family health., (Copyright © 2019. Published by Elsevier Inc.)

Background: The Alcohol Purchase Task (APT) is a behavioral economic assessment of alcohol demand (i.e., motivation for consumption during escalating levels of response cost) using simulated marketplace survey techniques. While the APT is often used and widely cited, to date, there has yet to be a systematic review elucidating the variability in administering and analyzing the APT. The purpose of the current paper is to address this knowledge gap in the literature by cataloging the various purchase task methodologies and providing recommendations and future areas of inquiry., Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was utilized (Prospero: No. CRD42017072159). Searches through Google Scholar, PsychINFO, PubMed, and SpringerLink databases identified 47 empirical articles referencing the use of an APT and published through the year 2016. Articles were coded for demographic and procedural characteristics, structural characteristics of the APT itself, and characteristics of data analysis., Results: Results indicate substantial variation within categories and suggest that there is no standard approach to administering the APT or analyzing the responses generated from it. The results underscore the need for researchers to report as much information as possible related to administration, instructions, price structuring, and analytical approach, as we found that many articles did not provide these details., Conclusion: Enhancing the transparency of APT methods and analyses in published reports will aid in reproducibility as well as future meta-analytic studies of alcohol demand that could lead to the development of best-practice recommendations for this procedure., (Published by Elsevier B.V.)

Background: Varenicline is an FDA approved medication for the treatment of nicotine dependence. While the efficacy and safety of this medication have been demonstrated, success rates remain low, and efforts to understand mechanisms of efficacy are in progress. A behavioral economics framework is one unique way to examine how demand for a drug changes under different circumstances. Therefore, the current randomized placebo-controlled, cross-over study aimed to examine effects of varenicline on subjective cigarette craving and objective demand for cigarettes measured by a hypothetical behavioral economic task as well as associations between subjective craving and objective demand., Method: Non-treatment seeking (n = 37) daily smokers (>10 cigarettes per day) completed a measure of subjective craving for cigarettes and the Cigarette Purchase Task following overnight nicotine abstinence. Participants completed these measures after 10 days on varenicline (1 mg twice per day) and matched placebo., Results: Analyses revealed a significant reduction in subjective craving for cigarettes while on varenicline (p = 0.01), as compared to placebo, and a sex effect such that females exhibited greater craving than males (p = 0.03). However, there were no medication × sex effects (p = 0.84). Analyses of objective demand for cigarettes found varenicline reduced maximum expenditure (Omax) (p = 0.03). Subjective craving was also associated with various indices of demand., Conclusion: Results demonstrated varenicline's efficacy in attenuating subjective craving and objective demand for cigarettes and highlight the partial overlap between dimensions of acute drug motivation, namely subjective craving and behavioral economic indices of cigarette demand., (Copyright © 2018. Published by Elsevier B.V.)

Background: For the Food and Drug Administration to effectively regulate tobacco products, the contribution of non-nicotine tobacco constituents to the abuse liability of tobacco must be well understood. Our previous work compared the abuse liability of electronic cigarette refill liquids (EC liquids) and nicotine (Nic) alone when each was available in isolation and found no difference in abuse liability (i.e., demand elasticity). Another, and potentially more sensitive measure, would be to examine abuse liability in a choice context, which also provides a better model of the tobacco marketplace., Methods: Demand elasticity for Nic alone and an EC liquid were measured when only one formulation was available (alone-price demand) and when both formulations were concurrently available (own-price demand), allowing an assessment of the degree to which each formulation served as a substitute (cross-price demand) when available at a low fixed-price., Results: Own-price demand for both formulations were more elastic compared to alone-price demand, indicating that availability of a substitute increased demand elasticity. During concurrent access, consumption of the fixed-price formulation increased as the unit-price of the other formulation increased. The rate of increase was similar between formulations, indicating that they served as symmetrical substitutes., Conclusion: The cross-price model reliably quantified the substitutability of both nicotine formulations and indicated that the direct CNS effects of non-nicotine constituents in EC liquid did not alter its abuse liability compared to Nic. These data highlight the sensitivity of this model and its potential utility for examining the relative abuse liability and substitutability of tobacco products., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: The objectives of this study were to measure the impact of a behavioral economic intervention on human papillomavirus (HPV) vaccine initiation and series completion rates for adolescents and to measure the impact of the intervention on the receipt of a nonincentivized influenza vaccine., Methods: We conducted a quasi-randomized trial to compare the impact of an escalating delayed cash incentive (intervention), compared with usual care (control), on HPV vaccination initiation and series completion rates among adolescents (11-17 years) at an urban medical center. We measured HPV vaccine initiation and completion rates during the 12 months after enrollment and subsequent influenza vaccination rates for 24 months after enrollment., Results: A total of 85 participants were actively enrolled in the intervention arm and 103 were passively enrolled in the control arm. Participants were predominantly publically insured African-American and Hispanic adolescents. The majority (75%) of the intervention group received one or more doses of the HPV vaccine, with 36% completing the three-dose series, compared with 47% of the control group receiving one or more doses and only 13% completing the series. The odds of HPV p-value vaccine initiation (odds ratio 4.19 [95% confidence interval 1.84-10.10], p < .01) and HPV vaccine series completion (OR 4.16 [95% confidence interval 1.64-11.28], p < .01) were greater among the intervention group compared with the control group. There was no difference in influenza vaccination rates between the intervention group and the control group during the 2013-2014 season (p = .138) and during the 2014-2015 influenza season (p value .683)., Conclusions: An incentive-based approach to HPV vaccination was effective in increasing vaccine initiation and series dose completion., (Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Numerous studies in behavioral economics have demonstrated that individuals are more sensitive to the prospect of a loss than a gain (i.e., loss aversion). Although loss aversion has been well described in "healthy" populations, little research exists in individuals with substance use disorders. This gap is notable considering the prominent role that choice and decision-making play in drug use. The purpose of this pilot study was to evaluate loss aversion in active cocaine users., Methods: Current cocaine users (N=38; 42% female) participated in this within-subjects laboratory pilot study. Subjects completed a battery of tasks designed to assess loss aversion for drug and non-drug commodities under varying risk conditions. Standardized loss aversion coefficients (λ) were compared to theoretically and empirically relevant normative values (i.e., λ=2)., Results: Compared to normative loss aversion coefficient values, a precise and consistent decrease in loss aversion was observed in cocaine users (sample λ≈1). These values were observed across drug and non-drug commodities as well as under certain and risky conditions., Conclusions: These data represent the first systematic study of loss aversion in cocaine-using populations and provide evidence for equal sensitivity to losses and gains or loss equivalence. Futures studies should evaluate the specificity of these effects to a history of cocaine use as well as the impact of manipulations of loss aversion on drug use to determine how this phenomenon may contribute to intervention development efforts., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Introduction: Tobacco demand (i.e., relative value attributed to a given reinforcer) and delay discounting (i.e., relative preference for smaller immediate rewards over larger delayed rewards) are two behavioral economic processes that are linked to the progression of problematic substance use. These processes have not been studied among those with psychopathology, a vulnerable group of smokers. The current study examined differences in tobacco demand and delay discounting, and their association with smoking topography among smokers with (n=43) and without (n=64) past-year psychopathology., Method: Adult daily smokers (n=107,M age =43.5; SD=9.7) participated in a study on "smoking behavior." Past-year psychological disorders were assessed via a clinician-administered diagnostic assessment. All subjects participated in an ad libitum smoking trial and then completed an assessment of delay discounting (Monetary Choice Questionnaire) and tobacco demand (Cigarette Purchase Task) approximately 45-60min post-smoking., Results: Smokers with psychopathology, compared to those without, had significantly higher demand intensity and maximum expenditure on tobacco (O max ), but did not differ on other demand indices or delay discounting. Smokers with psychopathology had shorter average inter-puff intervals and shorter time to cigarette completion than smokers without psychopathology. Tobacco demand and delay discounting measures were significantly intercorrelated among smokers with psychopathology, but not those without. Both behavioral economic measures were associated with specific aspects of smoking topography in smokers with psychopathology., Discussion: The association between tobacco demand and delay discounting is evident among smokers with psychopathology and both measures were most consistently related to smoking behavior., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Nutrition education has a long history of being informed by economic thinking, with the earliest nutrition education guides incorporating household food budgeting into nutrition advice. Behavioral economics research goes beyond that traditional role to provide new insights into how consumers make choices. These insights have numerous potential applications for nutrition interventions to promote healthy food choices consistent with the US Dietary Guidelines for Americans. Research to test the value of such applications can contribute to the development of evidence-based nutrition education practice called for in federal nutrition education programs., (Published by Elsevier Inc.)

Payment reform has been at the forefront of the movement toward higher-value care in the U.S. health care system. A common belief is that volume-based incentives embedded in fee-for-service need to be replaced with value-based payments. While this belief is well-intended, value-based payment also contains perverse incentives. In particular, behavioral economists have identified several features of individual decision making that reverse some of the typical recommendations for inducing desirable behavior through financial incentives. This paper discusses the countervailing incentives associated with four behavioral economic concepts: loss aversion, relative social ranking, inertia or status quo bias, and extrinsic vs. intrinsic motivation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Aim: The aim of the current study was to evaluate tobacco product purchasing in the Experimental: Tobacco Marketplace (ETM) among male and female smokers who also use e-cigarettes. We hypothesized a high substitution profile for e-cigarettes and that males would purchase more Snus than females., Methods: The ETM is an online market used in clinical abuse liability research to mimic real-world purchasing patterns. Tobacco products, including each participant's usual choice of conventional and e-cigarettes, were presented along with a price and description of nicotine content. Participants were endowed with an account balance based on the number of cigarettes and e-cigarettes consumed per week. Each participant was exposed to four ETM sessions in random order during which the price of conventional cigarettes was manipulated., Results: Cigarette consumption decreased as price increased. A mixed factor three-way ANOVA revealed a significant main effect of price (i.e., more alternative products were purchased at higher cigarette prices), product (i.e., more e-cigarettes were purchased than gum, lozenges, and Snus), and sex (i.e., males purchased more than females). A significant three-way interaction indicated that males purchased more e-cigarettes, Snus, and dip than females at higher cigarette prices., Conclusion: This study suggests that the user profile of cigarette smokers is associated with behavioral economic measures of alternative product substitution and indicates that the evaluation of nicotine replacement products should be considered for both males and females separately., (Copyright © 2017 Elsevier B.V. All rights reserved.)