The Experimental Tobacco Marketplace: Demand and Substitutability as a Function of Cigarette Taxes and e-Liquid Subsidies.

INTRODUCTION: The experimental tobacco marketplace (ETM) approximates real-world situations by estimating the effects of several, concurrently available products and policies on budgeted purchasing. Although the effects of increasing cigarette price on potentially less harmful substitutability are well documented, the effects of other, nuanced pricing policies remain speculative. This study used the ETM as a tool to assess the effects of two pricing policies, conventional cigarette taxation and e-liquid subsidization, on demand and substitutability. METHODS: During sampling periods, participants were provided 2-day samples of 24 mg/mL e-liquid, after which ETM purchase sessions occurred. Across two ETM sessions, conventional cigarettes were taxed or e-liquid was subsidized in combination with increasing cigarette price. The other four available products were always price constant and not taxed or subsidized. RESULTS: E-liquid functioned as a substitute for conventional cigarettes across all conditions. Increasing cigarette taxation and e-liquid subsidization increased the number of participants for which e-liquid functioned as a substitute. Cigarette taxation decreased cigarette demand, by decreasing demand intensity, and marginally increased the initial intensity of e-liquid substitution, but did not affect the functions' slopes (substitutability). E-liquid subsidization resulted in large increases in the initial intensity of e-liquid substitution, but did not affect e-liquid substitutability nor cigarette demand. IMPLICATIONS: 24 mg/mL e-cigarette e-liquid was the only product to significantly substitute for cigarettes in at least one condition throughout the experiment; it functioned as a significant substitute throughout all four tax and all four subsidy conditions. Increasing cigarette taxes decreased cigarette demand through decreases in demand intensity but did not affect e-cigarette substitution. Increasing e-liquid subsidies increased e-liquid initial intensity of substitution but did not affect cigarette demand. CONCLUSIONS: This study extended research on the behavioral economics of conventional cigarette demand and e-liquid substitutability in a complex marketplace. The results suggest that the most efficacious method to decrease conventional cigarette purchasing and increase e-liquid purchasing may involve greatly increasing cigarette taxes while also increasing the value of e-liquid through potentially less harmful product subsidization or differential taxation.

The effect of nicotine and nicotine+monoamine oxidase inhibitor on the value of alcohol.

Alcohol is the most commonly abused drug in the USA and many people suffer from alcohol use disorder. Many factors are associated with alcohol use disorder, but the causal role of comorbid nicotine use has not been extensively considered. Nicotine has reward-enhancing properties and may increase the value of alcohol. Monoamine oxidase inhibition increases nicotine self-administration and may increase the reward-enhancing effects of nicotine. We assessed the effect of nicotine and nicotine in combination with a commonly used monoamine oxidase inhibitor (tranylcypromine) on the value of alcohol using a progressive ratio schedule of reinforcement in rats. Nicotine administration increased the breakpoint for alcohol, but nicotine in combination with tranylcypromine decreased the breakpoint for alcohol. The current study adds to previous research showing that nicotine increases the value of alcohol. This finding has important implications for the etiology of addiction because of the comorbidity of smoking with many drugs of abuse. The finding that nicotine in combination with tranylcypromine reduces the value of alcohol warrants further investigation.

The Value of Clean Air: Comparing Discounting of Delayed Air Quality and Money Across Magnitudes.

The detrimental health effects of exposure to air pollution are well established. Fostering behavioral change concerning air quality may be challenging because the detrimental health effects of exposure to air pollution are delayed. Delay discounting, a measure of impulsive choice, encapsulates this process of choosing between the immediate conveniences of behaviors that increase pollution and the delayed consequences of prolonged exposure to poor air quality. In Experiment 1, participants completed a series of delay-discounting tasks for air quality and money. We found that participants discounted delayed air quality more than money. In Experiment 2, we investigated whether the common finding that large amounts of money are discounted less steeply than small amounts of money generalized to larger and smaller improvements in air quality. Participants discounted larger improvements in air quality less steeply than smaller improvements, indicating that the discounting of air quality shares a similar process as the discounting of money. Our results indicate that the discounting of delayed money is strongly related to the discounting of delayed air quality and that similar mechanisms may be involved in the discounting of these qualitatively different outcomes. These data are also the first to demonstrate the malleability of delay discounting of air quality, and provide important public health implications for decreasing delay discounting of air quality.

Subjective stressors moderate effectiveness of a multi-component, multi-site intervention on caregiver depression and burden.

OBJECTIVES: The present study assessed whether caregiving contextual factors moderated outcomes of a caregiver intervention. METHODS: Extant data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II study, a randomized-control trial of a multi-component, multi-site intervention for dementia caregivers was utilized. 498 caregivers {83.1% women; mean [standard deviation (SD)] age = 60.3 (13.1)}, and their care recipients [58.6% women, mean (SD) age = 78.5 (9.6)] were randomly assigned to intervention or control group. Multiple regression was used to regress Center for Epidemiological Studies of Depression Scale (CES-D) and Zarit burden scores on the interaction between group membership and various factors reflecting the caregiving context. RESULTS: Lower follow-up CES-D scores in the intervention group were found only for those: in the fourth quartile of baseline CES-D (ß = -0.13, p = 0.05; overall interaction p = 0.009), with high Revised Memory and Behavior Problems Checklist (RMBPC) stress (ß = -0.16, p = 0.03) and with a home health aide (ß = -0.29, p = 0.009). Diminished burden was found in the intervention group only for the following: those in the fourth quartile of baseline burden (ß = -0.16, p = 0.01), and in the fourth quartile (ß = -0.16, p = 0.05) of Mini Mental State Examination, and with high RMBPC stress (ß = -0.18, p = 0.008), with a trend for diminished burden among those with a paid homemaker (ß = -0.19, p = 0.075). CONCLUSION: Results suggest greater intervention efficacy among caregivers experiencing subjective stress.

An Introduction to Reviewing Research Articles for Academic Journals.

Description Among the pillars of science is the galvanizing process of peer review. Editors of medical and scientific publications recruit specialty leaders to evaluate the quality of manuscripts. These peer reviewers help to ensure that data are collected, analyzed, and interpreted as accurately as possible, thereby moving the field forward and ultimately improving patient care. As physician-scientists, we are given the opportunity and responsibility to participate in the peer review process. There are many benefits to engaging in the peer review process including exposure to cutting-edge research, growing your connection with the academic community, and fulfilling the scholarly activity requirements of your accrediting organization. In the present manuscript, we discuss the key components of the peer review process and hope that it will serve as a primer for the novice reviewer and as a useful guide for the experienced reviewer.

Magic Medicine.

Background: A superstition is a belief or practice that is considered irrational, resulting from ignorance, fear of the unknown, trust in magic or chance or a false conception of causation. In medical settings superstitions often arise from attempts to assign causation to events that are either random, or in which all information is not available. In this manuscript, we present a descriptive review of the literature related to superstition in medicine and present the results of our own data; that one's age is equal to the chance of being admitted from the emergency department. Methods: In the descriptive review of superstitious beliefs in medicine, we identified 295 articles in which specific superstitions were studied. These articles were then organized by field and specific superstition. To investigate the age and admission correlation, we retrospectively quarried over 250,000 charts. Results: 295 papers on specific medical superstitions were reviewed and presented according to specialty, population and commonly investigated superstitions. Psychiatry had the largest number of articles addressing superstitious behavior, followed by OB/GYN. Importantly, significant heterogeneity exist within these papers suggesting that superstitious beliefs can be found in all fields of medicine. In addition, our data did not support the superstition that a patient's age will mirror their admission rate. Conclusions: The majority of the superstitions identified were "harmless" in that they would not result in significant patient harm. The exponential growth in medical knowledge presents a challenge for many to stay up to date. Our findings suggest a need for a continued emphasis of scientific literacy among physicians and further establish the expectation that physicians be engaged in consuming the latest scientific evidence in their field.

Reinforcer Pathology: Implications for Substance Abuse Intervention.

The rate at which individuals discount future rewards (i.e., discounting rate) is strongly associated with their propensity for substance abuse as well as myriad other negative health behaviors. An excessive preference for immediately available rewards suggests a shortened time horizon in which immediate rewards are overvalued and future, potentially negative consequences are undervalued. This review outlines Reinforcer Pathology Theory (i.e., the interaction between excessive preference for immediately available rewards and the overvaluation of a particular commodity that offers brief, intense reinforcement), its neurobiological/behavioral underpinnings, and its implications for treating substance use disorders. In doing so, the current review provides an overview of a variety of ways in which interventions have been used to manipulate aspects of reinforcer pathology in an individual, including narrative theory, framing manipulations, and neuromodulation (e.g., working memory training, TMS) which may serve as promising avenues for the modulation of the temporal window and/or valuation of reinforcers.

Applying mixed-effects modeling to single-subject designs: An introduction.

Behavior analysis and statistical inference have shared a conflicted relationship for over fifty years. However, a significant portion of this conflict is directed toward statistical tests (e.g., t-tests, ANOVA) that aggregate group and/or temporal variability into means and standard deviations and as a result remove much of the data important to behavior analysts. Mixed-effects modeling, a more recently developed statistical test, addresses many of the limitations of more basic tests by incorporating random effects. Random effects quantify individual subject variability without eliminating it from the model, hence producing a model that can predict both group and individual behavior. We present the results of a generalized linear mixed-effects model applied to single-subject data taken from Ackerlund Brandt, Dozier, Juanico, Laudont, & Mick, 2015, in which children chose from one of three reinforcers for completing a task. Results of the mixed-effects modeling are consistent with visual analyses and importantly provide a statistical framework to predict individual behavior without requiring aggregation. We conclude by discussing the implications of these results and provide recommendations for further integration of mixed-effects models in the analyses of single-subject designs.

Evaluating the effect of delay spacing on delay discounting: carry-over effects on steepness and the form of the discounting function.

Most delay discounting studies use tasks that arrange delay progressions in which the spacing between consecutive delays becomes progressively larger. To date, little research has examined delay discounting using other progressions. The present study assessed whether the form or steepness of discounting varied across different delay progressions. Human participants completed three discounting tasks with delay progressions that varied in the time between consecutive delays: a standard (increasing duration between delays), linear (equal duration between delays), and an inverse progression (decreasing duration between delays). Steepness of discounting was generally reduced, and remained so, following experience with the inverse progression. Effects of the delay progression on the best fitting equation were order-dependent. Overall the hyperbola model provided better fits, but the exponential model performed better with data from the inverse progression. Regardless, differences in which model fit best were often small. The finding that the best fitting model was dependent, in some cases, on the delay progression suggests that a single quantitative model of discounting may not be applicable to describe discounting across all procedural contexts. Ultimately, changes in steepness of discounting following experience with the inverse progression appeared similar to anchoring effects, whose mechanism will require further study to delineate.

A Monte Carlo method for comparing generalized estimating equations to conventional statistical techniques for discounting data.

Discounting is the process by which outcomes lose value. Much of discounting research has focused on differences in the degree of discounting across various groups. This research has relied heavily on conventional null hypothesis significance tests that are familiar to psychologists, such as t-tests and ANOVAs. As discounting research questions have become more complex by simultaneously focusing on within-subject and between-group differences, conventional statistical testing is often not appropriate for the obtained data. Generalized estimating equations (GEE) are one type of mixed-effects model that are designed to handle autocorrelated data, such as within-subject repeated-measures data, and are therefore more appropriate for discounting data. To determine if GEE provides similar results as conventional statistical tests, we compared the techniques across 2,000 simulated data sets. The data sets were created using a Monte Carlo method based on an existing data set. Across the simulated data sets, the GEE and the conventional statistical tests generally provided similar patterns of results. As the GEE and more conventional statistical tests provide the same pattern of result, we suggest researchers use the GEE because it was designed to handle data that has the structure that is typical of discounting data.

The phenotype of recovery III: Delay discounting predicts abstinence self-efficacy among individuals in recovery from substance use disorders.

Abstinence self-efficacy (ASE) and delay discounting predict treatment outcomes and risk of relapse. Associations between delay discounting and ASE among individuals in recovery from substance use have not been investigated. Data from 216 individuals in recovery from substance abuse recruited from The International Quit & Recovery Registry, an ongoing online data collection program used to understand addiction and how people succeed in recovery, were included in the analysis. Discounting rates were assessed using an adjusting-delay task, and ASE was assessed using the Relapse Situation Efficacy Questionnaire (RSEQ). Delay discounting was a significant predictor of ASE, even after controlling for age, gender, race, ethnicity, annual income, education level, marital status, and primary addiction. Context-specific factors of relapse included Negative Affect, Positive Affect, Restrictive Situations (to drug use), Idle Time, Social-Food Situations, Low Arousal, and Craving. A principal component analysis of RSEQ factors in the current sample revealed that self-efficacy scores were primarily unidimensional and not situation specific. The current study expands the generality of delay discounting and indicates that discounting rates predict ASE among individuals in recovery from substance use disorders. This finding supports the recent characterizations of delay discounting as a candidate behavioral marker of addiction and may serve as a basis to better identify and target subgroups that need unique or more intensive interventions to address higher risks of relapse and increase their likelihood of abstinence. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Excessive discounting of delayed reinforcers as a trans-disease process: Update on the state of the science.

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.

The effects of outcome unit framing on delay discounting.

We examined the effects of outcome framing on delay discounting. In Experiment 1, participants completed four delay-discounting tasks. In one monetary task, money was framed in units of dollars (＄50), and in the other, money was framed in units of handfuls of quarters (equal to ＄50). In one food task, food was framed in clear units of food (e.g., 100 M&Ms), and in the other, food was framed in units of servings (e.g., 10 servings of M&Ms). When money was framed in units of dollars, participants discounted less by delay compared to discounting of handfuls of quarters. When food was framed as clear units, participants also discounted less compared to how they discounted servings. In Experiment 2, participants completed two delay-discounting tasks for dollars and quarters (e.g., ＄50 or 200 quarters) to determine if the results of Experiment 1 were due to the differences in handling costs. In one delay-discounting task, money was framed in units of dollars. In the other delay-discounting task, money was framed in units of quarters. There was no difference in how participants discounted delayed money framed as dollars or quarters. Clear unit framing may result in less discounting by delay than fuzzy unit framing.

The effects of 100 dB 1-kHz and 22-kHz tones as punishers on lever pressing in rats.

Aversive control is an important yet understudied process of learning. One reason aversive control may be relatively understudied is ethical concerns about painful stimuli (e.g., electric shock). High decibel broad-band noise and 22-kHz vocalizations both demonstrably affect rodent behavior while not necessarily being painful. The goal of this study was to determine if 100-dB 22-kHz-pure tones were differentially more effective in reducing operant response rates in rats. We examined whether 22-kHz pure tones would function as aversive stimuli, specifically as positive punishers. The effects of response-dependent as well as continuously presented 22-kHz and 1-kHz tones on rate of response maintained by variable interval 30-s food deliveries were assessed across several conditions. We found that response rates were lower when tones were presented response dependently than when tones were presented continuously throughout a session. We also found that the lower response rates obtained with response-dependent 22-kHz tones were not significantly different from response rates obtained with response-dependent 1-kHz tones. The primary conclusion of this experiment is that both 1-kHz and 22-kHz tones functioned as punishers, but that the 22-kHz tones were not differentially more effective in reducing response rate.

The Effects of Financial Education on Impulsive Decision Making.

Delay discounting, as a behavioral measure of impulsive choice, is strongly related to substance abuse and other risky behaviors. Therefore, effective techniques that alter delay discounting are of great interest. We explored the ability of a semester long financial education course to change delay discounting. Participants were recruited from a financial education course (n = 237) and an abnormal psychology course (n = 80). Both groups completed a delay-discounting task for $100 during the first two weeks (Time 1) of the semester as well as during the last two weeks (Time 2) of the semester. Participants also completed a personality inventory and financial risk tolerance scale both times and a delay-discounting task for $1,000 during Time 2. Delay discounting decreased in the financial education group at the end of the semester whereas there was no change in delay discounting in the abnormal psychology group. Financial education may be an effective method for reducing delay discounting.

Discounting of qualitatively different delayed health outcomes in current and never smokers.

In delay discounting, temporally remote outcomes have less value. Cigarette smoking is associated with steeper discounting of money and consumable outcomes. It is presently unclear whether smokers discount health outcomes more than nonsmokers. We sought to establish the generality of steep discounting for different types of health outcomes in cigarette smokers. Seventy participants (38 smokers and 32 nonsmokers) completed 4 hypothetical outcome delay-discounting tasks: a gain of $500, a loss of $500, a temporary boost in health, and temporary cure from a debilitating disease. Participants reported the duration of each health outcome that would be equivalent to $500; these durations were then used in the respective discounting tasks. Delays ranged from 1 week to 25 years. Smokers' indifference points for monetary gains, boosts in health, and temporary cures were lower than indifference points from nonsmokers. Indifference points of 1 outcome were correlated with indifference points of other outcomes. Smokers demonstrate steeper discounting across a range of delayed outcomes. How a person discounts 1 outcome predicts how they will discount other outcomes. These 2 findings support our assertion that delay discounting is in part a trait.

Impulsivity and cigarette smoking: discounting of monetary and consumable outcomes in current and non-smokers.

RATIONALE: In delay discounting, temporally remote rewards have less value. Cigarette smoking is associated with steeper discounting of delayed money. The generality of this to nonmonetary outcomes, however, is unknown. OBJECTIVES: We sought to determine whether cigarette smokers also show steep discounting of other delayed outcomes. METHODS: Sixty-five participants (32 smokers and 33 non-smokers) completed four delay-discounting tasks, each involving different hypothetical outcomes. In the monetary task, participants indicated their preference for a smaller amount of money available immediately (titrated across trials) and $100 awarded at delays ranging from 1 week to 25 years (tested in blocks). In the three other discounting tasks the larger-later reward was $100 worth of a favorite food, alcoholic drink, or a favorite form of entertainment. All other aspects of these discounting tasks were identical to the monetary discounting task. RESULTS: As previously shown, smokers discounted delayed money more steeply than non-smokers did. In addition, smokers discounted delayed food and entertainment rewards more steeply than did nonsmokers. A person's discounting of one outcome was correlated with discounting of other outcomes. Non-smokers discounted money less steeply than all other outcomes; smokers discounted money significantly less than food. CONCLUSIONS: When compared to nonsmokers, cigarette smokers more steeply discount several types of delayed outcomes. This result, together with the finding that cross-commodity discounting rates were correlated within subjects, suggests that delay discounting is a trait that extends across domains.