Behavioral economics of drug self-administration. II. A unit-price analysis of cigarette smoking.

In behavioral economics, the ratio of response requirement to reinforcer magnitude is referred to as unit price. Previous research with nonhuman subjects has demonstrated that (a) comparable amounts of food are consumed at the same unit price even though different response requirements and reinforcer magnitudes comprise that unit price and (b) increases in unit price decrease food consumption in a positively decelerating fashion. The present study assessed the generality of these findings to the cigarette smoking of 5 human volunteers. During approximately 18 3-hr sessions, various combinations of response requirement (fixed-ratio 200, 400, and 1,600) and reinforcer magnitude (1, 2, and 4 puffs per bout) were arranged. Consumption (i.e., the number of puffs) generally was comparable at the same unit price independent of the response requirement and reinforcer magnitude comprising that unit price. In addition, increasing unit price generally decreased consumption in a positively decelerating fashion. These results extend the generality of the unit-price analysis to human cigarette smoking. Moreover, these results further support the position that reinforcer magnitude and response requirement are functionally equivalent and interact to determine consumption. The concept of unit price, by integrating and summarizing the effects of those two operations, provides a more parsimonious explanation of the results than do separate evaluations of the effects of response requirement and reinforcer magnitude.     

mMotiv8: A smartphone‐based contingency management intervention to promote smoking cessation

Cigarette smoking is the leading preventable cause of death and illness in the United States. We tested the usability, acceptability, and efficacy of a smartphone‐based contingency management treatment to promote cessation. We used a nonconcurrent multiple‐baseline design. Participants (N = 14) provided breath carbon monoxide (CO) samples by using a CO meter that was connected to the user's smartphone. An app (mMotiv8) housed on participants' smartphones automatically captured pictures of the CO sampling procedure to validate the end user's identity, and it prompted submissions via a push message delivered to participants' smartphones. Participants earned a $10 incentive for daily abstinence, which was added to a reloadable debit card. Overall, 4% of the CO samples were negative during baseline, and 89% were negative during treatment. Self‐reported usability and acceptability were high, and 85% of the prompted samples were submitted. A smartphone intervention could be scalable and reduce the health consequences and costs associated with cigarette smoking, particularly in rural and low‐income populations.     

Assessing the feasibility of using contingency management to modify cigarette smoking by adolescents

Cigarette smoking is a leading cause of preventable death in the United States. Many smokers initiate this dangerous behavior during adolescence. This report describes a contingency management intervention designed to initate and maintain a period of abstinence from cigarettes by adolescent smokers. Results suggest that the intervention was generally successful and that further investigation of this topic is warranted.     

吸烟利弊权衡对戒烟计划的预测作用：一个有调节的中介模型

考察吸烟利弊权衡对戒烟计划的预测,以及戒烟意愿的中介作用和未来取向的调节作用。对340名吸烟者进行问卷调查结果的统计分析发现：（1）吸烟利弊权衡显著正向预测戒烟计划;（2）戒烟意愿对吸烟利弊权衡和戒烟计划的关系起完全中介作用;（3）未来取向负向调节吸烟利弊权衡和戒烟计划的关系,但对吸烟利弊权衡和戒烟意愿关系的调节不显著。这些结果说明,吸烟者戒烟计划发展经历前决策和前行动阶段,且该过程受未来取向的调节。     

Explaining adolescents’ cigarette smoking: A comparison of four modes of action control and test of the role of self-regulatory mode

The present study compared how well four modes of action control (intentional, habitual, reactive and stereotype activation) explain adolescents’ cigarette smoking, and examined whether individual differences in self-regulation (locomotion and assessment tendencies; Higgins, Kruglanski, & Pierro, 2003 Higgins, ET, Kruglanski, AW and Pierro, A. 2003. Regulatory mode: Locomotion and assessment as distinct orientations. Advances in Experimental Social Psychology, 25: 293–344.  [Google Scholar]) moderate the behavioural impact of the respective modes. Findings from a prospective questionnaire survey showed that (a) willingness, prototype perceptions and past behaviour–but not intention–predicted smoking behaviour, and explained 63% of the variance, and (b) the assessment mode of self-regulation moderated the past behaviour–future behaviour relation such that past behaviour had less impact on future smoking behaviour at high levels of assessment. These findings suggest that adolescents’ smoking is controlled by stereotype activation, habitual and reactive processes. Implications of the results for designing effective adolescent smoking cessation programmes are considered.     

The role of stress and area‐specific self‐esteem in adolescent smoking

Stress and self‐esteem have been shown to be important risk factors for adolescent cigarette smoking, and self‐esteem has previously been implicated as a stress‐moderating and a stress‐mediating variable. This study aimed to examine the associations between stress, area‐specific self‐esteem, and adolescent smoking, and to investigate whether specific areas of self‐esteem moderate or mediate the relationship between stress and smoking. Four hundred and ninety‐five adolescents (aged 14–19) responded to a questionnaire that examined these variables. Results showed that self‐esteem in the areas of school subjects and parent relations were related to smoking. Adolescents with low self‐esteem in these areas were more likely to smoke than their high self‐esteem counterparts. Highly stressed adolescents were more likely to smoke than those with low stress. However, the relationship between stress and smoking was completely mediated by self‐esteem in the area of school subjects. No moderation was revealed. Thus, high global self‐esteem may not be sufficient to reduce the risk of smoking. To maximise benefit, prevention and intervention efforts should target self‐esteem in the areas of school subjects and parent relations. Initiatives focusing on stress are only likely to decrease smoking to the extent that they influence self‐esteem in the area of school subjects.     

A two‐part mixed effects model for cigarette purchase task data

The Cigarette Purchase Task is a behavioral economic assessment tool designed to measure the relative reinforcing efficacy of cigarette smoking across different prices. An exponential demand equation has become a standard model for analyzing purchase task data, but its utility is compromised by its inability to accommodate values of zero consumption. We propose a two‐part mixed effects model that keeps the same exponential demand equation for modeling nonzero consumption values, while providing a logistic regression for the binary outcome of zero versus nonzero consumption. Therefore, the proposed model can accommodate zero consumption values and retain the features of the exponential demand equation at the same time. As a byproduct, the logistic regression component of the proposed model provides a new demand index, the “derived breakpoint”, for the price above which a subject is more likely to be abstinent than to be smoking. We apply the proposed model to data collected at baseline from college students (N = 1,217) enrolled in a randomized clinical trial utilizing financial incentives to motivate tobacco cessation. Monte Carlo simulations showed that the proposed model provides better fits than an existing model. We note that the proposed methodology is applicable to other purchase task data, for example, drugs of abuse.     

Patient-Informed Treatment Development of Behavioral Smoking Cessation for People With Schizophrenia

The objective of this study was to use qualitative methodology to tailor and refine an existing smoking cessation intervention for the population of people who use cigarettes and are diagnosed with schizophrenia, schizoaffective, or psychotic disorder. Successive cohort design methodology was used to iteratively modify the treatment in response to qualitative participant, therapist, and consultant feedback on the intervention. Qualitative methodology for participant feedback included analysis of semistructured interviews with participants, visualization of app utilization data, and stakeholder feedback from study therapists and consultants. Using the successive cohort design, a tailored multicomponent mobile health smoking cessation intervention was developed. The intervention included mobile contingency management (i.e., financial compensation for confirmed abstinence from smoking), pharmacotherapy for smoking cessation, cognitive-behavioral counseling sessions, and the Stay Quit app for relapse prevention. Two cohorts (N = 13) were completed in the study; after each cohort, the treatment protocol was revised. The intervention is described, as well as the qualitative findings from each cohort and subsequent changes made to the intervention based upon patient and provider feedback. Metrics of patient engagement included treatment adherence (40% in Cohort 1 and 63% in Cohort 2). Both participants and therapists reported that the intervention was helpful. Over one third of participants self-reported abstinence at posttreatment. Since qualitative methodology is often underutilized in mental health treatment development, this study demonstrates the utility of the successive cohort design for treatment development of behavior change interventions for at-risk, vulnerable populations.     

Technology‐based contingency management and e‐cigarettes during the initial weeks of a smoking quit attempt

Contingency management (CM) interventions are among the most effective behavioral interventions for smoking. This study assessed the effects of CM and electronic cigarettes (ECs) on smoking reductions and abstinence for durations of 30‐36 days. Twelve participants were exposed to Baseline, EC alone, and EC + CM conditions. An internet‐based platform was used to monitor smoking via breath carbon monoxide (CO) and deliver CM for smoking abstinence (CO ≤4 ppm). A Bluetooth‐enabled EC monitored daily EC puffs. Abstinence rates were equivalent between EC (34.4%) and EC + CM (30.4%) conditions. Both conditions promoted smoking reductions. We observed an inverse correlation between smoking and EC puffs (r = ‐.62, p < .05). Results suggest the use of electronic cigarettes can promote smoking reductions and abstinence, and CM did not improve these outcomes. Larger magnitude consequences or tailoring EC characteristics (e.g., flavor) may have improved outcomes. Technology‐based methods to collect intensive, longitudinal measures of smoking and electronic cigarette use may be useful to characterize their environmental determinants.     

Effects of internet-based voucher reinforcement and a transdermal nicotine patch on cigarette smoking

Nicotine replacement products are commonly used to promote smoking cessation, but alternative and complementary methods may increase cessation rates. The current experiment compared the short-term effects of a transdermal nicotine patch to voucher-based reinforcement of smoking abstinence on cigarette smoking. Fourteen heavy smokers (7 men and 7 women) completed the four 5-day phases of the study: baseline, patch treatment, voucher treatment, and return to baseline. The order of the two treatment phases was counterbalanced across participants. In the patch treatment condition, participants wore a 14-mg transdermal nicotine patch every day. In the voucher treatment condition, participants received vouchers contingent on abstinence from smoking, defined as producing carbon monoxide (CO) readings of < or =4 parts per million. Participants e-mailed two video clips per day showing them breathing into a CO monitor and the resulting CO reading to clinic staff. In the voucher treatment, 24% of samples were negative, and 5% of samples were negative in the patch treatment. Results suggest that contingent vouchers were more effective than transdermal nicotine patches in promoting abstinence.