Cannabis demand is sensitive to next-day responsibilities, such as job interviews; however, it is unclear how demand is affected by non-work-related responsibilities and how reported compatibility of cannabis use (i.e., how suitable one perceives cannabis use to be in a situation) influences demand. This study examined the effects of a range of responsibilities on cannabis demand in a crowdsourced sample of adults who smoked cannabis at least monthly (n = 177; 78% White; 47% women; mean age = 36.52). Participants completed hypothetical marijuana purchase tasks asking how much cannabis they would consume at escalating prices in the context of no responsibilities and next-day responsibilities spanning work, leisure, and caregiving. Cannabis demand was significantly reduced in all responsibility conditions (ps < .008; ds .28-.94), with the largest reductions for the job interview and caring-for-kids conditions. Higher ratings of suitability of cannabis use in each situation were correlated with higher demand. Finally, a qualitative thematic analysis characterized why cannabis use was considered suitable or unsuitable with each responsibility. These results suggest that demand is sensitive to next-day responsibilities. However, these effects are not uniform, and future research is needed to examine these individual differences and the timing of upcoming responsibilities.

CONCLUSIONS: Tobacco product design features, including flavors and cigarette filter ventilation, are subject to regulation. This study examined the effects of cigarette and e-cigarette flavors on demand and substitution by preferred cigarette flavor and ventilation in the Experimental Tobacco Marketplace (ETM).
METHODS: In a mixed between-group (usual cigarette flavor and ventilation)/within-subject design (policy conditions), individuals who use tobacco (n=176 cigarette (60.5 % female); n=91 multiple products (26.7 % female)) were recruited using Ipsos and InnovateMR, completed purchasing trials with increasing cigarette prices in the ETM. Participants were exposed to four conditions in a 2×2 factorial design with cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted.
RESULTS: In individuals who exclusively smoke cigarettes: 1) Cigarette menthol restrictions decreased willingness to purchase cigarettes (OR: 0.001; 95 % CI: 0.00002, 0.015) for individuals that prefer menthol cigarettes and increased willingness to purchase NRT (OR: 4.02; 95 % CI: 1.47, 11.0), 2) cigarette menthol restrictions reduced demand for cigarettes in individuals who smoke menthol cigarettes (p<0.001), 3) e-cigarette flavor restrictions reduced the degree of e-cigarette substitution in individuals who smoke menthol cigarettes (p=0.028), and 4) preference for higher cigarette filter ventilation was associated with higher demand for cigarettes (p=0.003) and lowered substitution of smokeless tobacco products (p=0.028). In individuals who use multiple tobacco products, restrictions did not impact product purchasing.
CONCLUSIONS: Strategies to reduce flavored product sales and increase cessation resource accessibility may improve population health by reducing smoking and increasing NRT use in individuals who use menthol cigarettes.

BACKGROUND: Overdose deaths remain high for opioid use disorder, emphasizing the need to pursue innovative therapeutics. Classic psychedelic drugs that engage many monoamine receptors mitigate opioid use. Here, we tested the hypothesis that the preferential serotonin 5-HT2AR agonist, 2,5-dimethoxy-4-iodoamphetamine (DOI) could reduce the demand for fentanyl in a preclinical model of fentanyl self-administration.
METHODS: Male and female Sprague-Dawley rats (n = 25-29) were implanted with indwelling jugular catheters and allowed to self-administer fentanyl (3.2μg/kg/infusion). Rats progressed to a novel low price twice within-session threshold procedure where rats sampled the lowest price twice before decreasing the dose of fentanyl by a ¼ log every 10minutes across 11 doses. Once stable, rats were pretreated with saline or DOI (0.01, 0.03, 1mg/kg). Fentanyl consumption was analyzed using an exponentiated demand function to extract the dependent variables, Q0 and α.
RESULTS: Male and female rats acquired fentanyl self-administration in the lowest price twice within-session threshold procedure. DOI dose-dependently altered fentanyl intake such that 5-HT2AR activation decreased Q0 in female rats but increased Q0 in male rats. For demand elasticity, DOI increased α in male rats but did not alter α in female rats. DOI did not alter inactive lever presses or latency.
CONCLUSIONS: DOI reduces consumption at minimally constrained costs but did not affect the reinforcement value of fentanyl in female rats. Alternatively, DOI significantly reduced the reinforcement value of fentanyl in male rats. Biological sex alters the therapeutic efficacy of DOI and 5-HT2AR activation sex-dependently alters opioid reinforcement.

Alcohol consumption and related problems are common among college students. Prior research links behavioral economic (BE) constructs of alcohol demand and relative reinforcement (RR), and alcohol expectancies, with alcohol consumption/problems. However, research has yet to examine the associations between BE, expectancy theory, and alcohol use outcomes. In this study, college students (n = 287) completed a single online survey assessing demand, RR, alcohol expectancies, and alcohol use/problems. We examined the cross-sectional indirect association of expectancies and drinking on the relationship between demand and alcohol problems and between RR and alcohol problems. The final model showed adequate fit, χ2(26) = 67.23, RMSEA = .07, CFI = .95, SRMR = .06. Higher demand and RR were associated with stronger alcohol expectancies, which demonstrated an indirect association on the relationship between demand, and RR, and alcohol problems. Findings suggest that demand and RR may be directly related to alcohol expectancies; a relationship that has not been previously identified. Moreover, alcohol expectancies may impact the associations among demand, RR, and alcohol problems. Thus, alcohol expectancies may be an important intervention target for reducing alcohol problems. Future longitudinal research is needed to evaluate this association over time and assess if these findings have potential impact for intervention research.

The deleterious health effects of prolonged sitting and physical inactivity are well-established, yet these behaviors are pervasive in modern culture. To inform interventions aimed at reducing sedentary behavior and increasing lifestyle activity, this study examined psychological and behavioral economic factors that may be associated with these behaviors. This cross-sectional study was conducted among 4072 adults in Israel. Participants completed a survey pertaining to lifestyle behaviors and economic preferences using an online platform in September 2020. The psychological and behavioral economic factors of interest were patience, self-control, risk-taking, grit, and general self-efficacy. Sedentary behavior and lifestyle activity (e.g., time spent moving about) was assessed using the Rapid Assessment Disuse Index (RADI) tool (higher score indicative of more sitting and less activity). Multivariable linear and logistic regression analyses examined the association between psychological and behavioral economic factors and RADI score. Among 4072 participants, those who were impatient (vs. patient, β: -1.13; 95% CI: -1.89, -0.38) had higher grit (β: -1.25, 95% CI: -1.73, -0.77), and those who were more risk-seeking (β: -0.23; 95% CI: -0.33, -0.13) had lower RADI scores (i.e., less sedentary, more active). Significant associations for grit and risk-taking were also observed when the RADI score was dichotomized, such that individuals who had higher grit or were more risk-seeking were more likely to be non-sedentary/active. No significant associations were observed for self-control or general self-efficacy. Higher grit and more risk-seeking were associated with a decreased propensity for sedentary behaviors and inactivity; these factors may provide targets for interventions aimed at reducing sedentary behavior and increasing lifestyle activity.

BACKGROUND: Recent behavioural economic models of substance use suggest that low access to environmental reward may increase risk for heavy substance use and associated harms. Most prior studies of these associations have been cross-sectional and have focused on alcohol. The current study extends this research using longitudinal data to examine the within-person and between-person associations of environmental reward access with both alcohol and cannabis outcomes.
METHODS: Young adults (N = 119, 64.71 % female) completed an online survey at three time points, spaced six months apart. The survey included measures of alcohol and cannabis use and consequences, and two facets of environmental reward access: reward probability (i.e., likelihood of experiencing environmental reward) and environmental suppression (i.e., diminished availability of environmental reward).
RESULTS: Multilevel models revealed that at the between-person level (i.e., averaged across time points), greater environmental suppression (but not reward probability) was significantly associated with more frequent cannabis use, and greater reward probability (but not environmental suppression) was significantly associated with heavier alcohol use. Higher environmental suppression (but not reward probability) was also associated with greater alcohol and cannabis consequences at the between-person level, over and above level of use. A significant within-person association also was observed, wherein participants reported relative increases in cannabis consequences during time periods when they also reported relative decreases in the availability of environmental reward.
CONCLUSIONS: Results highlight environmental suppression as a risk factor for more frequent cannabis use and for both alcohol and cannabis consequences, and provide novel support for a within-person association between environmental suppression and cannabis consequences over time. Findings may inform contextual interventions for young adult substance use.

BACKGROUND: Low loss aversion (LA) and high delay discounting (DD) are behavioral-economic decision-making biases that independently predict cigarette smoking and other risky substance use. Here we examine (1) whether low-LA and high-DD co-occur, (2) does co-occurrence increase the odds of current smoking and other substance use compared to only low-LA, high-DD, or neither; and (3) potential gender differences in these associations.
METHODS: Data are from five studies with U.S. adults who currently smoked or never-smoked cigarettes recruited using online convenience sampling matching on gender and education. Participants completed identical sociodemographic, substance use (cigarette, other drugs, alcohol), and LA (hypothetical 50-50 gambles) and DD (monetary-choice questionnaire) measures. LA and DD scores were dichotomized as low and high using Receiver-Operating-Characteristic Curve logistic regression.
RESULTS: LA and DD each independently predicted substance use and with few exceptions were not influenced by gender. Low-LA compared to high-LA predicted two-fold greater odds of co-occurring high-DD (AOR = 2.120, 95%CI:1.749-2.571, p < .0001). Similarly, high-DD compared to low DD predicted two-fold greater odds of low-LA (AOR = 2.118, 95%CI:1.747-2.568, p < .0001). Among those with co-occurring low-LA and high-DD, odds of substance use were 5-10 times greater than those exhibiting neither, and 2-3 times greater than those exhibiting only low-LA or high-DD.
CONCLUSIONS: Low-LA and high-DD cluster in women and men such that exhibiting one of these decision-making biases doubles the odds of exhibiting the other. These results demonstrate reliable clustering of low-LA and high-DD and a striking increase in risk for substance use relative to having only one or neither decision-making bias.

Underutilization of mental health services is a complex problem that requires the investigation of new strategies to facilitate treatment-seeking. Nudging is a relatively new approach which has shown promise in promoting healthy behaviors in a variety of domains, though little work has investigated how nudges may be applied to the initiation of mental health treatment. In this paper, we review the limited work examining nudging related to treatment initiation and discuss findings from a study evaluating the impact of nudges on treatment-seeking. Findings provide insights into the acceptability and efficacy of nudging as a strategy for increasing treatment, and implications for future work exploring this approach for improving treatment access are discussed.

BACKGROUND: Germline genetic testing is recommended for an increasing number of conditions with underlying genetic etiologies, the results of which impact medical management. However, genetic testing is underutilized in clinics due to system, clinician, and patient level barriers. Behavioral economics provides a framework to create implementation strategies, such as nudges, to address these multi-level barriers and increase the uptake of genetic testing for conditions where the results impact medical management.
METHODS: Patients meeting eligibility for germline genetic testing for a group of conditions will be identified using electronic phenotyping algorithms. A pragmatic, type 3 hybrid cluster randomization study will test nudges to patients and/or clinicians, or neither. Clinicians who receive nudges will be prompted to either refer their patient to genetics or order genetic testing themselves. We will use rapid cycle approaches informed by clinician and patient experiences, health equity, and behavioral economics to optimize these nudges before trial initiation. The primary implementation outcome is uptake of germline genetic testing for the pre-selected health conditions. Patient data collected through the electronic health record (e.g. demographics, geocoded address) will be examined as moderators of the effect of nudges.
CONCLUSIONS: This study will be one of the first randomized trials to examine the effects of patient- and clinician-directed nudges informed by behavioral economics on uptake of genetic testing. The pragmatic design will facilitate a large and diverse patient sample, allow for the assessment of genetic testing uptake, and provide comparison of the effect of different nudge combinations. This trial also involves optimization of patient identification, test selection, ordering, and result reporting in an electronic health record-based infrastructure to further address clinician-level barriers to utilizing genomic medicine. The findings may help determine the impact of low-cost, sustainable implementation strategies that can be integrated into health care systems to improve the use of genomic medicine.
BACKGROUND: ClinicalTrials.gov. NCT06377033. Registered on March 31, 2024. https://clinicaltrials.gov/study/NCT06377033?term=NCT06377033&rank=1.

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.