Assessing behavioral economic biases among young adults who have increased likelihood of acquiring HIV: a mixed methods study in Baltimore, Maryland.

BACKGROUND: Behavioral economic (BE) biases have been studied in the context of numerous health conditions, yet are understudied in the field of HIV prevention. This aim of this study was to quantify the prevalence of four common BE biases-present bias, information salience, overoptimism, and loss aversion-relating to condom use and HIV testing in economically-vulnerable young adults who had increased likelihood of acquiring HIV. We also qualitatively examined participants' perceptions of these biases. METHODS: 43 participants were enrolled in the study. Data were collected via interviews using a quantitative survey instrument embedded with qualitative questions to characterize responses. Interviews were transcribed and analyzed using descriptive statistics and deductive-inductive content analyses. RESULTS: 56% of participants were present-biased, disproportionately discounting future rewards for smaller immediate rewards. 51% stated they were more likely to spend than save given financial need. Present-bias relating to condom use was lower with 28% reporting they would engage in condomless sex rather than wait one day to access condoms. Most participants (72%) were willing to wait for condom-supported sex given the risk. Only 35% knew someone living with HIV, but 67% knew someone who had taken an HIV test, and 74% said they often think about preventing HIV (e.g., high salience). Yet, 47% reported optimistically planning for condom use, HIV discussions with partners, or testing but failing to stick to their decision. Most (98%) were also averse (b = 9.4, SD ±.9) to losing their HIV-negative status. Qualitative reasons for sub-optimal condom or testing choices were having already waited to find a sex partner, feeling awkward, having fear, or not remembering one's plan in the moment. Optimal decisions were attributed qualitatively to self-protective thoughts, establishing routine care, standing on one's own, and thinking of someone adversely impacted by HIV. 44% of participants preferred delayed monetary awards (e.g., future-biased), attributed qualitatively to fears of spending immediate money unwisely or needing time to plan. CONCLUSION: Mixed methods BE assessments may be a valuable tool in understanding factors contributing to optimal and sub-optimal HIV prevention decisions. Future HIV prevention interventions may benefit from integrating savings products, loss framing, commitment contracts, cues, or incentives.

Strengthening HIV and HIV co-morbidity care in low- and middle-income countries: insights from behavioural economics to improve healthcare worker behaviour.

INTRODUCTION: Despite advances in HIV and HIV co-morbidity service delivery, substantial challenges remain in translating evidence-based interventions into routine practice to bring optimal care and prevention to all populations. While barriers to successful implementation are often multifactorial, healthcare worker behaviour is critical for on-the-ground and in-clinic service delivery. Implementation science offers a systematic approach to understanding service delivery, including approaches to overcoming delivery gaps. Behavioural economics is a field that seeks to understand when and how behaviour deviates from traditional models of decision-making, deviations which are described as biases. Clinical policies and implementation strategies that incorporate an understanding of behavioural economics can add to implementation science approaches and play an important role in bridging the gap between healthcare worker knowledge and service delivery. DISCUSSION: In HIV care in low- and middle-income countries (LMICs), potential behavioural economic strategies that may be utilized alone or in conjunction with more traditional approaches include using choice architecture to exploit status quo bias and reduce the effects of cognitive load, overcoming the impact of anchoring and availability bias through tailored clinical training and clinical mentoring, reducing the effects of present bias by changing the cost-benefit calculus of interventions with few short-term benefits and leveraging social norms through peer comparison. As with any implementation strategy, understanding the local context and catalysts of behaviour is crucial for success. CONCLUSIONS: As the focus of HIV care shifts beyond the goal of initiating patients on antiretroviral therapy to a more general retention in high-quality care to support longevity and quality of life, there is an increasing need for innovation to achieve improved care delivery and management. Clinical policies and implementation strategies that incorporate elements of behavioural economic theory, alongside local testing and adaptation, may increase the delivery of evidence-based interventions and improve health outcomes for people living with HIV in LMIC settings.

Impact of reduced nicotine content on behavioral economic measures of cigarette reinforcement in adolescents who smoke cigarettes.

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 (Omax) 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.

Behavioural economic interventions to embed palliative care in community oncology (BE-EPIC): study protocol for the BE-EPIC randomised controlled trial.

INTRODUCTION: Palliative care (PC) is a medical specialty focusing on providing relief from the symptoms and stress of serious illnesses such as cancer. Early outpatient specialty PC concurrent with cancer-directed treatment improves quality of life and symptom burden, decreases aggressive end-of-life care and is an evidence-based practice endorsed by national guidelines. However, nearly half of patients with advanced cancer do not receive specialty PC prior to dying. The objective of this study is to test the impact of an oncologist-directed default PC referral orders on rates of PC utilisation and patient quality of life. METHODS AND ANALYSIS: This single-centre two-arm pragmatic randomised trial randomises four clinician-led pods, caring for approximately 250 patients who meet guideline-based criteria for PC referral, in a 1:1 fashion into a control or intervention arm. Intervention oncologists receive a nudge consisting of an electronic health record message indicating a patient has a default pended order for PC. Intervention oncologists are given an opportunity to opt out of referral to PC. Oncologists in pods randomised to the control arm will receive no intervention beyond usual practice. The primary outcome is completed PC visits within 12 weeks. Secondary outcomes are change in quality of life and absolute quality of life scores between the two arms. ETHICS AND DISSEMINATION: This study has been approved by the Institutional Review Board at the University of Pennsylvania. Study results will be disseminated in peer-reviewed journals and scientific conferences using methods that describe the results in ways that key stakeholders can best understand and implement. TRIAL REGISTRATION NUMBER: NCT05365997.

Use of a sequential multiple assignment randomized trial to test contingency management and an integrated behavioral economic and mindfulness intervention for buprenorphine-naloxone medication adherence for opioid use disorder.

BACKGROUND: Buprenorphine-naloxone is a medication shown to improve outcomes for individuals seeking treatment for opioid use disorder (OUD); however, outcomes are limited by low medication adherence rates. This is especially true during the early stages of treatment. METHODS: The present study proposes to utilize a sequential multiple assignment randomized trial design to compare two psychological interventions targeting buprenorphine-naloxone adherence: (1) contingency management (CM) and (2) brief motivational interviewing plus substance-free activities session plus mindfulness (BSM). Participants will be N = 280 adults who present to a university-based addictions clinic seeking treatment for OUD. Participants will be randomized to condition to receive 4 sessions of their assigned intervention (CM or BSM). Participants who are adherent, defined as attending physician appointments and having buprenorphine present in urine toxicology, will enter maintenance intervention for an additional 6 months. Those who are not adherent will be re-randomized to receive either the other intervention or both interventions. Follow-up will occur at 8 months post-randomization. CONCLUSIONS: This novel design will examine the benefit of sequential treatment decisions following non-adherence. The primary outcome of this study is buprenorphine-naloxone medication adherence, as assessed by physician visit attendance and presence of buprenorphine in urine. Results will elicit the relative efficacy of CM and BSM compared to one another and whether keeping the initial treatment approach when adding the alternative approach for initially non-adherent individuals is beneficial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04080180.

Interpretation(s) of essential value in operant demand.

The operant demand framework has achieved high levels of adoption as an approach to quantify how various ecological factors influence choice. A central goal of the framework proposed by Hursh and Silberburg (2008) was to isolate the "essential value" of reinforcers-namely, their effects on behavior given various contextual factors. The effect of reinforcers on behavior is a phenomenon that is expected to vary as a function of reinforcer magnitude/dosage (i.e., units of reinforcement), price (i.e., schedule requirements), the intensity of demand (i.e., consumption in free operant conditions), the availability of reinforcers (i.e., supply, presence of alternatives), and the individual's current and historical context. This technical report provides a historical summary of the concept, describes the quantitative basis for essential value in the framework of Hursh and Silberburg (2008), reviews prior attempts to extract a generalizable index of essential value, and presents a newer formulation using exact solution that provides a more succinct and durable index. Proofs and solutions are provided to clarify the bases for novel and existing representations of essential value. Recommendations are provided to improve the precision and accuracy of behavioral economic metrics as well as support consensus regarding their interpretation in the operant demand framework.

Evaluation of behavioral economic strategies to raise influenza vaccination rates across a health system: Results from a randomized clinical trial.

Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a nested factorial design within the treatment arm, randomizing patients to usual-care control (no portal interventions) or to one or more portal interventions. We included all patients within this health system during the 2020-2021 influenza vaccination season, which overlapped with the COVID-19 pandemic. Through the patient portal, we simultaneously tested: pre-commitment messages (sent September 2020, asking patients to commit to a vaccination); monthly portal reminders (October - December 2020), direct appointment scheduling (patients could self-schedule influenza vaccination at multiple sites); and pre-appointment reminder messages (sent before scheduled primary care appointments, reminding patients about influenza vaccination). The main outcome measure was receipt of influenza vaccine (10/01/2020-03/31/2021). We randomized 213,773 patients (196,070 adults ≥18 years, 17,703 children). Influenza vaccination rates overall were low (39.0%). Vaccination rates for study arms did not differ: Control (38.9%), pre-commitment vs no pre-commitment (39.2%/38.9%), direct appointment scheduling yes/no (39.1%/39.1%), pre-appointment reminders yes/no (39.1%/39.1%); p > 0.017 for all comparisons (p value cut-off adjusted for multiple comparisons). After adjusting for age, gender, insurance, race, ethnicity, and prior influenza vaccination, none of the interventions increased vaccination rates. We conclude that patient portal interventions to remind patients to receive influenza vaccine during the COVID-19 pandemic did not raise influenza immunization rates. More intensive or tailored interventions are needed beyond portal innovations to increase influenza vaccination.

The Blinded-Dose Purchase Task: assessing hypothetical demand based on cocaine, methamphetamine, and alcohol administration.

RATIONALE: Behavioral economic drug purchase tasks quantify the reinforcing value of a drug (i.e., demand). Although widely used to assess demand, drug expectancies are rarely accounted for and may introduce variability across participants given diverse drug experiences. OBJECTIVES: Three experiments validated and extended previous hypothetical purchase tasks by using blinded drug dose as a reinforcing stimulus, and determined hypothetical demand for experienced effects while controlling for drug expectancies. METHODS: Across three double-blind, placebo-controlled, within-subject experiments, cocaine (0, 125, 250 mg/70 kg; n=12), methamphetamine (0, 20, 40 mg; n=19), and alcohol (0, 1 g/kg alcohol; n=25) were administered and demand was assessed using the Blinded-Dose Purchase Task. Participants answered questions regarding simulated purchasing of the blinded drug dose across increasing prices. Demand metrics, subjective effects, and self-reported real-world monetary spending on drugs were evaluated. RESULTS: Data were well modeled by the demand curve function, with significantly higher intensity (purchasing at low prices) for active drug doses compared to placebo for all experiments. Unit-price analyses revealed more persistent consumption across prices (lower α) in the higher compared to lower active dose condition for methamphetamine (a similar non-significant finding emerged for cocaine). Significant associations between demand metrics, peak subjective effects, and real-world spending on drugs also emerged across all experiments. CONCLUSIONS: Orderly demand curve data revealed differences across drug and placebo conditions, and relations to real-world measures of drug spending, and subjective effects. Unit-price analyses enabled parsimonious comparisons across doses. Results lend credence to the validity of the Blinded-Dose Purchase Task, which allows for control of drug expectancies.

Modeling Behavioral Economics Strategies in Social Marketing Messages to Promote Vegetable Consumption to Low-Resource Louisiana Residents: A Conjoint Analysis.

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.

Extra-experimental scarcity impacts hypothetical operant demand: A natural SARS-CoV-2 eperiment.

Behavioral economic demand models quantify the extent to which an organism defends its consumption of a commodity. Commodity purchase tasks permit humans a quick yet psychometrically sound approach to assessing commodity demand for various retail products. Operant behavioral economic literature suggests economy type (open vs closed) can significantly alter demand, yet this effect is largely undocumented in the commodity purchase task literature. In this study, we leveraged the market pressures for retail goods (hand lotion and sanitizer; paper towels and toilet paper; soda and water) resulting from SARS-CoV-2 into a natural experiment comparing within-subject demand across two time-points during the pandemic using a crowdsourced approach. Results suggest that hypothetical commodity purchase tasks are sensitive to extra-experimental market pressures (e.g., scarcity due to the closing of economies), adding additional confidence to the self-report nature of purchase task responding and providing further construct validity to these approaches.

Pensamiento episódico futuro para la prevención y el tratamiento deconductas de riesgo para la salud / Episodic future thinking for the prevention and treatment of health risk behaviors

Las enfermedades no transmisibles (i.e., enfermedades cardiovasculares, oncológicas, respiratorias y endocrinas) representan la principal causa de muerte y morbilidad en el mundo, siendo el consumo de tabaco y alcohol, una dieta no saludable y un estilo de vida sedentario los principales factores de riesgo. Desde la teoría de la patología del refuerzo, sustentada en el modelo de la Economía Conductual (EC), estas conductas de riesgo para la salud se entienden como trastornos de elección, caracterizados por una valoración excesiva del reforzador (p.ej., droga) y una preferencia por los reforzadores inmediatos en detrimento de los demorados. El pensamiento episódico futuro (PEF) es una intervención psicológica que consiste en visualizar vívidamente eventos futuros y proyectarse en ellos, con el fin de incrementar la valoración de los reforzadores asociados a la ejecución de una conducta saludable. Esta técnica presenta resultados prometedores en la reducción de la toma de decisiones impulsiva y en el aumento de conductas relacionadas con la salud (p.ej., abstinencia, dieta, actividad física).(AU)

Non-communicable diseases (i.e., cardiovascular, oncological, respiratory, and endocrine diseases) represent the main cause of death and morbidity in the world, with tobacco and alcohol use, an unhealthy diet, and a sedentary lifestyle being the main risk factors. From reinforcer pathology theory, based on behavioral economics (BE), these health risk behaviors are understood as choice disorders, characterized by an excessive valuation of the reinforcer (e.g., the drug) and a preference for immediate reinforcers over delayed ones. Episodic future thinking (EFT) is a psychological intervention that consists of vividly visualizing future events and projecting oneself into them, in order to increase the valuation of the reinforcers associated with the execution of a healthy behavior. This technique shows promising results in reducing impulsive decision-making and increasing health-related behaviors (e.g., abstinence, diet, physical activity).(AU)

Extra-experimental scarcity impacts hypothetical operant demand: A natural SARS-CoV-2 eperiment.

Behavioral economic demand models quantify the extent to which an organism defends its consumption of a commodity. Commodity purchase tasks permit humans a quick yet psychometrically sound approach to assessing commodity demand for various retail products. Operant behavioral economic literature suggests economy type (open vs closed) can significantly alter demand, yet this effect is largely undocumented in the commodity purchase task literature. In this study, we leveraged the market pressures for retail goods (hand lotion and sanitizer; paper towels and toilet paper; soda and water) resulting from SARS-CoV-2 into a natural experiment comparing within-subject demand across two time-points during the pandemic using a crowdsourced approach. Results suggest that hypothetical commodity purchase tasks are sensitive to extra-experimental market pressures (e.g., scarcity due to the closing of economies), adding additional confidence to the self-report nature of purchase task responding and providing further construct validity to these approaches.

Behavioural Economics to Improve Antihypertensive Therapy Adherence (BETA): protocol for a pilot randomised controlled trial in Los Angeles.

INTRODUCTION: Non-adherence to antihypertensive therapy is one of the major barriers to reducing the risk of cardiovascular disease. Several interventions have targeted higher medication adherence, yet most do not result in sustained adherence. Routinisation has emerged as a potential method for mitigating this problem, but requires high motivation during the relatively long habit formation phase. This pilot randomised controlled trial aims to test the feasibility, acceptability, and preliminary efficacy of behavioural economics-based incentives and text messages to support the routinisation of the medication-taking behaviour for promoting long-term medication adherence. METHODS AND ANALYSIS: This study will recruit and randomly assign 60 adult patients seeking care for hypertension at the Cedars-Sinai Medical Center in Los Angeles to one of the three groups, Control (n=20), Messages (n=20) and Incentives (n=20) in a 1:1:1 ratio. All participants will receive information about the importance of routinisation and will select an existing behavioural routine ('anchor') to which they will tie their pill-taking to, and the corresponding time. Additionally, participants in the Messages group will receive daily text messages reminding them of the importance of routines, while those in the Incentives group will receive daily text messages and conditional prize drawings. The interventions will be delivered over three months. Participants will be followed for six months post-intervention to measure behavioural persistence. Surveys will be administered at baseline, month-3 and month-9 visits. Primary outcomes include: (1) electronically measured mean medication adherence during the intervention period and (2) post-intervention period; and (3) mean timely medication adherence based around the time of the participants' anchor during the intervention period, and (4) post-intervention period. ETHICS AND DISSEMINATION: The study was approved by the Cedars-Sinai Institutional Review Board (Study ID: Pro00057764). Findings will be published in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04029883.

A reinforcement learning approach to explore the role of social expectations in altruistic behavior.

While altruism has been studied from a variety of standpoints, none of them has proven sufficient to explain the richness of nuances detected in experimentally observed altruistic behavior. On the other hand, the recent success of behavioral economics in linking expectation formation to key behaviors in complex societies hints to social expectations having a key role in the emergence of altruism. This paper proposes an agent-based model based upon the Bush-Mosteller reinforcement learning algorithm in which agents, subject to stimuli derived from empirical and normative expectations, update their aspirations (and, consequently, their future cooperative behavior) after playing successive rounds of the Dictator Game. The results of the model are compared with experimental results. Such comparison suggests that a stimuli model based on empirical and normative expectations, such as the one presented in this work, has considerable potential for capturing the cognitive-behavioral processes that shape decision-making in contexts where cooperative behavior is relevant.

Behavioral economic relationship between cannabis and cigarettes: Evidence from hypothetical purchase tasks.

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; ß = 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.

Hyperbolic discounting and exponentiated demand: Modeling demand for cigarettes in three dimensions.

Behavioral economics has been a fruitful area of research in substance use. Mathematical descriptions of how individuals temporally discount the value of a commodity have been correlated with substance use and mathematical descriptions of drug consumption decreasing as a function of price (i.e., demand) predict maladaptive substance use. While there is a logical assumption that temporal factors affect demand for a drug, little has been done to merge these models. Thus, the purpose of this study was to combine models of discounting and demand, extending Howard Rachlin's work and contributions to novel areas of study. Data from 85 participants from Amazon Mechanical Turk (MTurk) who completed a hypothetical cigarette purchase task that included price of and delay to cigarettes were analyzed. Multilevel modeling was used to determine descriptive accuracy of combined additive and multiplicative models of discounting and demand. Of the discounting models used in conjunction with the exponentiated demand equation, the Rachlin hyperboloid best described the delay dimension of consumption. The multiplicative version of the Rachlin equation applied to both delay and price outperformed other models tested. Therefore, existing models of discounting and demand can be extended to modeling consumption data from complex multidimensional experimental arrangements.

The effects of social context and opportunity cost on the behavioral economic value of cannabis.

OBJECTIVE: Behavioral economics suggest that cannabis reinforcing value (cannabis demand) may be influenced by external, contextual factors such as the social reward that might accompany cannabis use and the presence of opportunity costs (e.g., a next-day responsibility that cannabis use might adversely impact). The present study examined the effect of social context and opportunity cost on cannabis demand and explored whether relations were moderated by cannabis use severity. METHOD: Adults with past-week cannabis use recruited from Amazon's Mechanical Turk (N = 310; 53.5% female, 79.4% White) completed four purchase tasks, in which participants reported how much cannabis they would purchase across escalating prices, to index cannabis demand under varying contexts: (a) solitary, typical responsibilities; (b) social, typical responsibilities; (c) solitary, substantial responsibilities; and (d) social, substantial responsibilities. RESULTS: The presence of peers significantly increased demand intensity (consumption at zero price) and Omax (maximum expenditure) relative to the solitary conditions. Substantial responsibilities significantly decreased intensity, breakpoint (price at which consumption is fully suppressed), and Pmax (price at which maximum expenditure occurs) and increased elasticity (greater price sensitivity). Demand was most inelastic in the social, typical responsibilities condition relative to other conditions. Cannabis use severity was associated with less elastic demand in the solitary, typical responsibilities condition. Those with higher cannabis use severity reported larger differences in demand intensity and Omax between solitary and social conditions, and in demand elasticity between typical and substantial responsibility conditions. CONCLUSIONS: Results are consistent with previous research illustrating social and opportunity costs as determinants of cannabis use behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Matching, behavioral economics, and teleological behaviorism: Final cause analysis of substance use and health behavior.

Howard Rachlin and his contemporaries pioneered basic behavioral science innovations that have been usefully applied to advance understanding of human substance use disorder and related health behaviors. We briefly summarize the innovations of molar behaviorism (the matching law), behavioral economics, and teleological behaviorism. Behavioral economics and teleological behaviorism's focus on final causes are especially illuminating for these applied fields. Translational and applied research are summarized for laboratory studies of temporal discounting and economic demand, cohort studies of alcohol and other drug use in the natural environment, and experimental behavioral economic modeling of health behavior-related public health policies. We argue that the teleological behavioral perspective on health behavior is conducive to and merges seamlessly with the contemporary socioecological model of health behavior, which broadens the contextual influences (e.g., community, economic, infrastructure, health care access and policy) of individuals' substance use and other health risk behaviors. Basic-to-applied translations to date have been successful and bode well for continued applications of basic science areas pioneered by Howard Rachlin and his contemporaries.