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Browsing by Author "Stein, Jeffrey S."

Now showing 1 - 18 of 18
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    Choice Bundling Increases Valuation of Delayed Losses More Than Gains in Cigarette Smokers
    Stein, Jeffrey S.; Brown, Jeremiah M.; Tegge, Allison N.; Freitas-Lemos, Roberta; Koffarnus, Mikhail N.; Bickel, Warren K.; Madden, Gregory J. (Frontiers, 2022-01-13)
    Choice bundling, in which a single choice produces a series of repeating consequences over time, increases valuation of delayed monetary and non-monetary gains. Interventions derived from this manipulation may be an effective method for mitigating the elevated delay discounting rates observed in cigarette smokers. No prior work, however, has investigated whether the effects of choice bundling generalize to reward losses. In the present study, an online panel of cigarette smokers (N = 302), recruited using survey firms Ipsos and InnovateMR, completed assessments for either monetary gains or losses (randomly assigned). In Step 1, participants completed a delay-discounting task to establish Effective Delay 50 (ED50), or the delay required for an outcome to lose half of its value. In Step 2, participants completed three conditions of an adjusting-amount task, choosing between a smaller, sooner (SS) adjusting amount and a larger, later (LL) fixed amount. The bundle size (i.e., number of consequences) was manipulated across conditions, where a single choice produced either 1 (control), 3, or 9 consequences over time (ascending/descending order counterbalanced). The delay to the first LL amount in each condition, as well as the intervals between all additional SS and LL amounts (where applicable), were set to individual participants' ED50 values from Step 1 to control for differences in discounting of gains and losses. Results from Step 1 showed significantly higher ED50 values (i.e., less discounting) for losses compared to gains (p < 0.001). Results from Step 2 showed that choice bundling significantly increased valuation of both LL gains and losses (p < 0.001), although effects were significantly greater for losses (p < 0.01). Sensitivity analyses replicated these conclusions. Future research should examine the potential clinical utility of choice bundling, such as development of motivational interventions that emphasize both the bundled health gains associated with smoking cessation and the health losses associated with continued smoking.
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    Choice bundling, unpacked: Predicted and observed effects on intertemporal choice in an additive model of hyperbolic delay discounting
    Stein, Jeffrey S.; Madden, Gregory J. (PLoS, 2021-11-12)
    One method known to increase preference for larger, later rewards (LLRs) over smaller, sooner rewards (SSRs) is choice bundling, in which a single choice produces a series of repeating consequences over time. The present study examined whether effects of choice bundling on preference for LLRs: (1) increase with the number of rewards in the bundle (i.e., bundle size); (2) are independent of differences in reward magnitude between conditions; and (3) accord with predictions of an additive model of hyperbolic delay discounting, in which the value of a bundle of rewards can be expressed as the summed discounted value of all rewards in that bundle. Participants (N = 252) completed a choice task to assess valuation of monetary LLRs at bundle sizes of 1 (control), 3, and 9 rewards per choice (ascending/descending order counterbalanced). To control for the magnitude effect, the total reward amounts were held constant across conditions. Choice bundling significantly increased LLR preference (p < .001), with the largest effect observed at the largest bundle size. The descending bundle-size order produced significantly greater LLR preference than the ascending order (p < .05), although order did not significantly interact with bundle size. Difference scores between observed measures and those predicted by an additive model of hyperbolic discounting were small and not significantly different than zero, but were not equivalent to zero. Future research should investigate the clinical utility of choice bundling for reducing the maladaptive health behavior (e.g., substance use) with which delay discounting is associated.
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    COVID-19-Related Financial Scarcity is Associated with Greater Delay Discounting But Not Probability Discounting
    Downey, Haylee; Freitas-Lemos, Roberta; Curran, Kelsey M.; Serrano, Elena L.; Davis, George C.; Stein, Jeffrey S. (2023-01-01)
    Prior laboratory studies suggest that scarcity increases delay discounting (devaluation of delayed outcomes) and disturbs other decision-making processes. Recent evidence on the effect of COVID-19 on delay discounting is mixed. In addition, no study has examined the effect of COVID-19-related scarcity on probability discounting (devaluation of probabilistic outcomes). The present study examined cross-sectional associations between COVID-19-related scarcity, delay discounting, and probability discounting. During April 2020, 1012 participants with low income were recruited on Amazon Mechanical Turk (MTurk) and completed measures of delay and probability discounting of money and food (grocery gift card), COVID-19-related financial impacts, stress, and food security. Regression analyses indicate that compared to those with no COVID-19 related financial impacts, those with severe COVID-19 related financial impacts had greater delay discounting of money and greater delay discounting of food. In addition, greater food insecurity in the past month was associated with greater delay discounting of food but not money. COVID-19 related financial impact was not associated with probability discounting of money or probability discounting of food. Combined with laboratory experiments, the present study provides additional support for the idea that scarcity or income shock may increase delay discounting, particularly during the onset of COVID-19.
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    Cumulative Vulnerabilities: Substance Use in Adolescence and in Recovery
    Tomlinson, Devin Christine (Virginia Tech, 2023-07-27)
    Substance use and substance use disorders (SUDs) pose a significant health and economic concern in the United States. Conditions and comorbidities exist that are associated with substance use onset, continuation, and outcomes. In the theory of Reinforcer Pathology, we can categorize these conditions into vulnerabilities, or factors that may be associated with susceptibility to substance use onset and poorer outcomes in substance use recovery. The theory of vulnerabilities and reinforcer pathology is tested through three investigations. The first investigation sought to establish the relationship between cumulative vulnerabilities and adolescent substance use in a cross-sectional analysis. The second investigation evaluates the temporal relationship of cumulative vulnerabilities and substance use among adolescents. The final investigation establishes the relationship of cumulative vulnerabilities and substance use among individuals in recovery from Opioid Use Disorder. Collectively, these reports suggest that the intersection and cumulation of vulnerabilities to substance use and substance use disorders are directly related to substance use outcomes. Future research and reports in the substance use domain should consider these constructs, their accumulation, and their co-occurrence patterns.
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    The Effect of Episodic Future Thinking on a Novel Measure of Behavioral Economic Demand for Exercise
    Brown, Jeremiah M. (Virginia Tech, 2024-05-06)
    Physical inactivity is a major contributor to increased disease prevalence and reduced quality of life. Measuring behavioral economic demand for exercise may enable more effective physical activity intervention development. In study one, we developed the leisure-time-as-price exercise purchase task (LT-EPT), wherein participants (n = 175) indicate hypothetical likelihood to trade leisure time for access to exercise time. We observed weak to moderate correlations between demand indices (Q1%, α, BP1, and Pmax) generated from the LT-EPT and self-reported leisure and exercise time, demonstrating initial validation of the LT-EPT. In study two, we examine the effect of episodic future thinking (EFT; vivid, personalized prospection of future events) in adults not meeting physical activity guidelines (n = 127) on demand for exercise and delay discounting (sensitivity to delayed rewards). We observed reduced delay discounting in participants randomized to engage in EFT, but no difference between EFT and health information thinking (HIT) controls. In study three, we further examined the effect of EFT on demand for exercise in adults with type 2 diabetes and obesity participating in a 24-week randomized controlled trial (n = 71). All participants engaged in a multicomponent behavioral intervention focused on weight loss and glycemic control; additionally, participants were randomized to engage in EFT or HIT thrice daily beginning in week 3. We measured demand for exercise and delay discounting (among other outcomes) at weeks 0, 8, and 24, observing no differences between EFT or HIT groups in demand indices (Q1%, α) or delay discounting at any time point. In conclusion, early evidence suggests that the LT-EPT may be a valid method to measure behavioral economic demand for exercise; however, EFT may not be an effective intervention to increase demand for exercise.
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    Episodic Future Thinking about Smoking-Related Illness: A Preliminary Investigation of Effects on Delay Discounting, Cigarette Craving, and Cigarette Demand
    Ruhi-Williams, Perisa; King, Mary J.; Stein, Jeffrey S.; Bickel, Warren K. (MDPI, 2022-06-10)
    Cigarette smokers show excessive delay discounting (devaluation of delayed rewards), which may contribute to tobacco use disorder. Episodic future thinking (EFT), or mental simulation of future events, has been shown to reduce both delay discounting and laboratory smoking behavior. Traditionally, EFT involves vividly imagining positive future events. In this preliminary investigation, we examined the effects of EFT specifically about smoking-related illness (SRI) on delay discounting, cigarette craving, and behavioral economic demand for cigarettes. In a 2 (episodic thinking) × 2 (smoking-related illness) factorial design, we randomly assigned smokers from Amazon Mechanical Turk to one of two EFT groups: EFT alone or EFT + SRI; or one of two episodic “recent” thinking (ERT) control groups: ERT alone or ERT + SRI. Both EFT groups generated and imagined positive future events, while both ERT groups imagined real events from the recent past. Both EFT + SRI and ERT + SRI groups imagined these events while also experiencing SRI symptoms. Participants then completed assessments of delay discounting, cigarette craving, and measures of cigarette demand. We observed significant main effects on delay discounting of both EFT (reduced discounting) and SRI (increased discounting), as well as significant main effects of both EFT and SRI on cigarette craving (in both cases, reduced craving). No significant main effect of EFT was observed on cigarette demand measures, although we observed a main effect of SRI on quantity of demand when cigarettes were free (Q0) (reduced demand). In all analyses, we observed no significant EFT × SRT interactions, indicating that these variables operate independently of one another. These methods may be adapted for use in clinical treatment to aid in smoking cessation interventions.
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    Estimating the Impact of Tobacco Parity and Harm Reduction Tax Proposals Using the Experimental Tobacco Marketplace
    Freitas Lemos, Roberta; Keith, Diana R.; Tegge, Allison N.; Stein, Jeffrey S.; Cummings, Kenneth Michael; Bickel, Warren K. (MDPI, 2021-07-23)
    Taxes are a demonstrably effective method to suppress tobacco use. This study examined the effects of the tobacco parity (i.e., imposing taxes equally on all tobacco products) and the harm reduction (i.e., applying taxes in proportion to the products’ levels of harm) tax proposals on demand and substitution across products. A crowdsourced sample of cigarette smokers (n = 35) completed purchasing trials with increasing tax magnitudes across different tax tiers in the Experimental Tobacco Marketplace in a repeated-measures design. Products were placed in three tax tiers (high, medium, and no tax) according to each proposal’s goal. The results indicated that total nicotine (mg) purchased was not significantly different between the proposals, with higher taxes yielding lower demand. However, as taxes increased, the tobacco parity proposal decreased the purchasing of all tobacco products and increased the purchasing of medicinal nicotine (i.e., the no tax tier). Conversely, the harm reduction proposal resulted in greater purchases of electronic nicotine delivery systems and smokeless tobacco (i.e., the medium tax tier). These findings support tobacco taxation as a robust tool for suppressing purchasing and suggest that differential taxation in proportion to product risk would be an effective way to incentivize smokers to switch from smoked to unsmoked products. Further studies should investigate the unintended consequences of their implementation.
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    The Impact of Pain on Key Outcomes in Opioid Use Disorder Recovery
    Craft III, William Hugh (Virginia Tech, 2023-07-24)
    Opioid misuse and addiction constitute a significant public health challenge in the 21st century, with opioids involved in the majority of drug overdose deaths since 1999. A vigorously researched area that contributes substantially to the opioid misuse and addiction challenge is pain. The impact of pain, however, on important health outcomes for individuals in recovery from opioid use is less well understood. The effects of pain on substance use and mental health outcomes was investigated among individuals in recovery from opioid use disorder. Two studies are reported. First, the relationships between pain status and severity on substance use, treatment utilization, and mental health outcomes (e.g., depressive symptoms) was characterized cross-sectionally. Second, subgroups of OUD recovery defined by depression, opioid withdrawal, and pain were identified. Relationships between recovery subgroups, OUD symptoms, remission, opioid use, and quality of life were assessed. Finally, transitions among subgroups across 4 years of recovery were characterized. The present findings support pain as a key dimension of opioid use disorder recovery, highlighting the distinction between acute and chronic pain, the dynamic nature of opioid use disorder recovery, and emphasizing the necessity of integrating pain into opioid use disorder treatment.
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    Improving Mindfulness Outcomes and Measurements to Support Self-Regulation
    Lynn, Sarah (Virginia Tech, 2022-06-08)
    The field of mindfulness research is rapidly growing as mindfulness is being utilized as a tool to improve mental and cognitive health. Mindfulness is paying attention in the present moment with non-judgmental awareness. As the research body increases, weaknesses in mindfulness research have surfaced. There is a need for improved measurement tools, an increased understanding of, meditation techniques used, the dose of meditation, and the population samples being studied. Meditation and movement are both tools that can improve an individual's mindfulness. The proposed dissertation will investigate mindfulness through three studies. Study 1 was completed in a population of individual members of the International Quit and Recovery Registry and met the Diagnostic and Statistical Manual, 5th edition criteria for substance use disorder. It was found that individuals with higher mindfulness and engagement with Integrative Health Practices demonstrate success in recovery, measured by the World-Health Organization Quality of Life Scale, craving, and Days in Recovery and are more likely to have reached remission. Engagement with meditation showed more and higher correlations with success in recovery than other Integrative Health Practices measured. Study 2 investigated how mindfulness is taught. Participants were divided into two groups, comparing traditional cueing to compassion cueing. Participants received neuroscience education paired with weekly meditation techniques. There were no group differences; however, all participants expressed improvements in mindfulness, self-compassion, decreased depression symptoms, and gains in neuroscience knowledge. The impact of mindfulness curriculum development can be seen through differences in daily outcomes assessing participants' thoughts, emotions, and body on a 10-point Likert scale from settled to active. Study 3 validated a new tool to measure the multidimensional impacts of movement based on a traditional yogic framework and validated with neuroscience tools. The Multidimensional Impacts of Movement Scale (MIMS) is a valid and reliable tool showing stability over time (r = 0.737, p<0.001) and strong Cronbach's Alpha for each scale ranging from α = 0.775 to α = 0.840. These three studies combine as a body of work supporting continued research in the field of mindfulness by adding new knowledge about teaching mindfulness, measuring mindfulness, and how mindfulness can be applied to improve quality of recovery for individuals with substance use disorder.
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    Influence of a High-Fat Diet on Delay Discounting, Food Reinforcement, and Eating Behaviors in Sedentary and Endurance Trained Men
    Privitera, Olivia Frances (Virginia Tech, 2018-06-13)
    People make food choices based upon the motivation to consume foods that are reinforcing compared to alternatives that may be available.1 Delay discounting (DD) is a measure used to assess impulsivity, quantifying how people make decisions based on time to receive and amount of the choice presented. The food purchase task (FPT) assesses the demand for a food and how reinforcing this item is at various prices. Using a controlled feeding study design, 10 males (n=7 sedentary, n=10 endurance trained) consumed an iso-caloric, standard diet (55% carbohydrate, 30% fat, and 15% protein) for 10 days, followed by a high-fat diet (55% fat, 30% carbohydrate, 15% protein) for 5 days. DD, FPT, and Three Factor Eating Questionnaire (TFEQ) were assessed at three time points: baseline, after the standard diet/before high-fat diet, and after the high-fat diet. Discounting rates were significantly different at baseline between sedentary and endurance trained males, with the sedentary males having higher discounting rates (mean difference 1.43, p=.037). Discounting rates for the whole sample significantly decreased between baseline (time 1) and post-STD diet/before HFD (time 2), between time 2 and after the HFD (time 3), and between time 1 and time 3 (all indicated by p<0.05). No group differences were noted over time for demand elasticity, intensity, or TFEQ measures (all indicated by p<0.05). Results could be used to advance the understanding of factors that influence impulsive and unhealthy eating behaviors and inform the development of interventions that use reinforcers to positively influence eating behaviors.
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    Internal Validity of Two Promising Methods of Altering Temporal Orientation among Cigarette Smokers
    O'Connor, Richard J.; Carl, Ellen; Shevorykin, Alina; Stein, Jeffrey S.; Vantucci, Darian; Liskiewicz, Amylynn; Bensch, Lindsey; Thorner, Hannah; Marion, Matthew; Hyland, Andrew; Sheffer, Christine E. (MDPI, 2021-11-29)
    Relapse to smoking continues to be among the most urgent global health concerns. Novel, accessible, and minimally invasive treatments to aid in smoking cessation are likely to improve the reach and efficacy of smoking cessation treatment. Encouraging prospection by decreasing delay discounting (DD) is a new therapeutic target in the treatment of smoking cessation. Two early-stage interventions, delivered remotely and intended to increase prospection, decrease DD and promote cessation are Episodic Future Thinking (EFT) and Future Thinking Priming (FTP). EFT and FTP have demonstrated at least modest reductions in delay discounting, but understanding whether these interventions are internally valid (i.e., are accomplishing the stated intention) is key. This study examined the internal validity of EFT and FTP. Participants (n = 20) seeking to quit smoking were randomly assigned to active or control conditions of EFT and FTP. Linguistic Inquiry Word Count (LIWC2015) was used to examine the language participants used while engaged in the tasks. Results revealed significant differences in the language participants used in the active and control conditions. Women employed more words than men, but no other demographic differences were found in language. The active conditions for both tasks showed a greater emphasis on future orientation. Risk-avoidance was significantly higher in the active vs. control condition for EFT. Remote delivery of both EFT and FTP was valid and feasible as participants adhered to instructions in the remote prompts, and trends in DD were in the expected directions.
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    Long-term recovery from opioid use disorder: recovery subgroups, transition states and their association with substance use, treatment and quality of life
    Craft, William H.; Shin, Hwasoo; Tegge, Allison N.; Keith, Diana R.; Athamneh, Liqa N.; Stein, Jeffrey S.; Ferreira, Marco A. R.; Chilcoat, Howard D.; Le Moigne, Anne; DeVeaugh-Geiss, Angela; Bickel, Warren K. (Wiley, 2022-12)
    Background and AimsLimited information exists regarding individual subgroups of recovery from opioid use disorder (OUD) following treatment and how these subgroups may relate to recovery trajectories. We used multi-dimensional criteria to identify OUD recovery subgroups and longitudinal transitions across subgroups. Design, Setting and ParticipantsIn a national longitudinal observational study in the United States, individuals who previously participated in a clinical trial for subcutaneous buprenorphine injections for treatment of OUD were enrolled and followed for an average of 4.2 years after participation in the clinical trial. MeasurementsWe identified recovery subgroups based on psychosocial outcomes including depression, opioid withdrawal and pain. We compared opioid use, treatment utilization and quality of life among these subgroups. FindingsThree dimensions of the recovery process were identified: depression, opioid withdrawal and pain. Using these three dimensions, participants were classified into four recovery subgroups: high-functioning (minimal depression, mild withdrawal and no/mild pain), pain/physical health (minimal depression, mild withdrawal and moderate pain), depression (moderate depression, mild withdrawal and mild/moderate pain) and low-functioning (moderate/severe withdrawal, moderate depression and moderate/severe pain). Significant differences among subgroups were observed for DSM-5 criteria (P < 0.001) and remission status (P < 0.001), as well as with opioid use (P < 0.001), treatment utilization (P < 0.001) and quality of life domains (physical health, psychological, environment and social relationships; Ps < 0.001, Cohen's fs >= 0.62). Recovery subgroup assignments were dynamic, with individuals transitioning across subgroups during the observational period. Moreover, the initial recovery subgroup assignment was minimally predictive of long-term outcomes. ConclusionsThere appear to be four distinct subgroups among individuals in recovery from OUD. Recovery subgroup assignments are dynamic and predictive of contemporaneous, but not long-term, substance use, substance use treatment utilization or quality of life outcomes.
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    The Predictive Utility of Valuing the Future for Smoking Cessation: Findings from the ITC 4 Country Surveys
    Borland, Ron; Le Grande, Michael; Heckman, Bryan W.; Fong, Geoffrey T.; Bickel, Warren K.; Stein, Jeffrey S.; East, Katherine A.; Hall, Peter A.; Cummings, Kenneth Michael (MDPI, 2022-01-06)
    Background: Delay discounting (DD) and time perspective (TP) are conceptually related constructs that are theorized as important determinants of the pursuit of future outcomes over present inclinations. This study explores their predictive relationships for smoking cessation. Methods: 5006 daily smokers at a baseline wave provided 6710 paired observations of quitting activity between two waves. Data are from the International Tobacco Control (ITC) smoking and vaping surveys with samples from the USA, Canada, England, and Australia, across three waves conducted in 2016, 2018 and 2020. Smokers were assessed for TP and DD, plus smoking-specific predictors at one wave of cessation outcomes defined as either making a quit attempt and/or success among those who tried to quit which was ascertained at the subsequent survey wave. Results: TP and DD were essentially uncorrelated. TP predicted making quit attempts, both on its own and controlling for other potential predictors but was negatively associated with quit success. By contrast, DD was not related to making quit attempts, but high DD predicted relapse. The presence of financial stress at baseline resulted in some moderation of effects. Conclusions: Understanding the mechanisms of action of TP and DD can advance our understanding of, and ability to enhance, goal-directed behavioural change. TP appears to contribute to future intention formation, but not necessarily practical thought of how to achieve goals. DD is more likely an index of capacity to effectively generate competing future possibilities in response to immediate gratification.
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    Rural Community Perspectives and Actions Taken to Build Consensus on the Opioid Crisis in Southern Virginia: A Community-Based Participatory Multiphase Mixed Methods Study
    Hargrove, Angelina J. (Virginia Tech, 2022-06-07)
    Background: Opioid use disorder (OUD), prescription opioid misuse, and increased heroin use are major public health crises in the US. Excessive non-medical use of prescription opioids and illicit drugs can alter the brain, disrupt mental health, and increase the risk of blood-borne illnesses and bacterial infections. The CDC reported that opioids caused nearly 70% of the 67,367 overdose deaths in 2018. Rural areas have high prescription and illicit drug use rates, limited resources, and unique challenges. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. A community-based participatory research (CBPR) approach addresses the need for a systematic participatory solutions, and reduces community opposition and promotes sustainable, culturally appropriate interventions that can reduce the health-related harms caused by substance abuse. Methods: Two studies were conducted using CBPR principles to address the opioid crisis in a rural Southern Virginia community. Study I aimed to provide insight into community members' perceptions, knowledge, and experiences with OUD/SUD to inform community-led strategies. Study II assessed whether a virtual community platform with a Nominal Group Technique (NGT) can build consensus around Comprehensive Harm Reduction (CHR) in the same rural Southern Virginia community. Study II used the Community Readiness Model (CRM) and assessment tool. Stakeholder focus groups were conducted by a participatory research team, EM, as part of a larger project using the Stakeholder Engagement in quEstion Development (SEED) method. To assess the community's readiness to implement CHR using the CRM, Study II used semi-structured qualitative interviews with key stakeholders. The results of the readiness assessment were then used to inform a virtual community forum with members of a drug-free coalition. On the basis of CRM interview themes and findings, the forum used the NGT consensus-building technique. Results: The primary themes identified in the analysis of the community stakeholder focus groups conducted for Study I included the importance of family dynamics and social networks as risk and resiliency factors, addressing hopelessness as a preventive strategy, the need for holistic approaches to treatment, childhood exposure resulting in intergenerational substance use, the needs of overburdened healthcare providers, the expansion of long-term rehabilitation programs, and the need for judicial reform towards those with OUD. Comprehensive methods to address OUD's complexity require specific and well-defined strategies. Understanding the factors that contribute to OUD in rural communities should be the first step in developing actions. The overall community readiness score for Study II was 4.07, indicating the community is still in the pre-planning stage for bring CHR to the community. The majority of key informants believe that leaders and community members recognize the problem of SUD/OUD harms and that something should be done to improve and integrate harm reduction efforts. The forum had 12 attendees. The community forum produced 13 topics and a list of action priorities that at least 80% of participants agreed on. The two areas of high priority included: (1) raising awareness of secondary harms of SUD/OUD and available resources to assist the community, and (2) reducing the stigma associated with CHR and appeal to people's sense of humanity in order to create an environment conducive to understanding and increase buy-in around CHR. Implications: Both studies show rural stakeholders can help curb the drug epidemic. Their knowledge of internal community dynamics and needs allows them to prioritize actions to improve health outcomes. In addition, Study II demonstrated the effectiveness of the CR Model in determining community readiness to adopt CHR and the value of a virtual community forum in conjunction with an NGT process in fostering stakeholder consensus.  
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    Selective Reduction of Socioeconomic Disparities in the Experimental Tobacco Marketplace: Effects of Cigarette and E-cigarette Flavor Restrictions
    Freitas-Lemos, Roberta; Tegge, Allison N.; Shevorykin, Alina; Tomlinson, Devin C.; Athamneh, Liqa N.; Stein, Jeffrey S.; Sheffer, Christine E.; Shields, Peter G.; Hatsukami, Dorothy K. (Oxford University Press, 2024-06)
    Introduction: Cigarette smoking accounts for >30% of the socioeconomic gap in life expectancy. Flavored restrictions claim to promote equity; however, no previous studies have compared the effect of cigarette and e-cigarette flavor restrictions among individuals who smoke with lower and higher socioeconomic status (SES). Aims and Methods: In a between-group within-subject design, individuals with lower (n = 155) and higher (n = 125) SES completed hypothetical purchasing trials in the experimental tobacco marketplace (ETM). Conditions were presented in a 2 × 2 factorial design (cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted) with increasing cigarette prices across trials. Results: Results show (1) SES differences in cigarette, e-cigarette, and NRT purchases under unrestricted policies, with lower SES showing higher cigarette demand and lower e-cigarette and NRT substitution than higher SES, (2) cigarette restrictions decreased cigarette and increased NRT purchases among lower SES, but no significant changes among higher SES, (3) decreased SES differences in cigarette demand under cigarette restrictions, but persistence under e-cigarette restrictions or their combination, (4) persistence of SES differences in e-cigarette purchases when all restrictions were enforced, and (5) waning of SES differences in NRT purchasing under all restrictions. Conclusions: Flavor restrictions differentially affected individuals based on SES. Within-group comparisons demonstrated restrictions significantly impacted lower SES, but not higher SES. Between-group comparisons showed SES differences in cigarette purchasing decreased under cigarette restrictions, but persisted under e-cigarette-restrictions or their combination. Additionally, SES differences in NRT substitution decreased under flavor restrictions. These findings highlight the utility of the ETM to investigate SES disparities. Implications: With increasing trends of socioeconomic differences in smoking prevalence and cessation rates, smoking-related health disparities are expected to continue to widen. Restricting menthol flavor in cigarettes while enhancing the availability and affordability of NRT have the potential to alleviate SES disparities in tobacco use, therefore, positively impacting health equity. However, this effect may depend on flavor availability in other tobacco products.
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    Testing the Reinforcer Pathology Theory: A New Insight into Novel Targets for Drug Addiction
    Athamneh, Liqa (Virginia Tech, 2019-12-17)
    Despite decades of effort in developing evidence-based treatments, drug addiction remains one of the most problematic and enduring public health crises. Developing a new generation of theoretically-derived interventions constitutes an important clinical and scientific gap that, if addressed, may open innovative treatment opportunities. Based on the Reinforcer Pathology theory, altering the temporal window over which reinforcers are integrated (i.e., measured by delay discounting) would alter drug valuation and consumption. The first investigation—in 2 separate studies— test the Reinforcer Pathology theory by examining the effect of expanding and constricting the temporal window of integration using two mating narratives (long-term and short-term relationships, respectively) on cigarette valuation among cigarette smokers. The second investigation, test the Reinforcer Pathology theory by assessing the effect of remotely delivered Episodic Future Thinking (EFT) narratives (expands the temporal window) on real-world alcohol consumption among individuals with alcohol use disorder (AUD). Together, these investigations supported the Reinforcer Pathology theory and demonstrated its relevance for understanding and intervening in addiction. The current findings provide scientific justification to further investigate Reinforcer Pathology based interventions that expand the temporal window to change drug valuation and consumption. The construction of multi-component treatments that incorporate Reinforcer Pathology based interventions to systematically alter the temporal window may provide a novel intervention to reduce alcohol consumption.
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    Tobacco Dependence Treatment in Oncology: Initial Patient Clinical Characteristics and Outcomes from Roswell Park Comprehensive Cancer Center
    Sheffer, Christine E.; Stein, Jeffrey S.; Petrucci, Cara; Mahoney, Martin C.; Johnson, Shirley; Giesie, Pamela; Carl, Ellen; Krupski, Laurie; Tegge, Allison N.; Reid, Mary E.; Bickel, Warren K.; Hyland, Andrew (MDPI, 2020-05-31)
    Despite the importance of smoking cessation to cancer care treatment, historically, few cancer centers have provided treatment for tobacco dependence. To address this gap, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative (C3i). As part of this effort, this study examined implementation outcomes in a cohort of cancer survivors (CSs) who smoked cigarettes in the first year of an ongoing process to develop and implement a robust Tobacco Treatment Service at Roswell Park Comprehensive Cancer Center. We provide a comprehensive description of the new tobacco use assessment and referral process, and of the characteristics of cancer survivors who agreed to treatment including traditional tobacco-related psychosocial and cancer treatment-related characteristics and novel characteristics such as delay discounting rates. We also examine characteristic differences among those who agreed to treatment between those who attended and those who did not attend treatment. As the new tobacco assessment was implemented, the number of referrals increased dramatically. The mean number of treatment sessions attended was 4.45 (SD = 2.98) and the six-month point prevalence intention to treat abstinence rate among those who attended was 22.7%. However, only 6.4% agreed to treatment and 4% attended at least one treatment session. A large proportion of cancer survivors who agreed to treatment were women, of older age, of lower socioeconomic status (SES), and who had high levels of depressive symptomology. The findings demonstrate that the implementation of system changes can significantly improve the identification of cancer survivors who use tobacco and are referred to tobacco use treatment. Among those who attend, treatment is effective. However, the findings also suggest that a systematic assessment of barriers to engagement is needed and that cancer survivors may benefit from additional treatment tailoring. We present plans to address these implementation challenges. Systematic electronic medical record (EMR)-sourced referral to tobacco treatment is a powerful tool for reaching cancer survivors who smoke, but more research is needed to determine how to enhance engagement and tailor treatment processes.
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    Trust in Healthcare and Trust in Science Predict Readiness to Receive the COVID-19 Vaccine in Appalachia
    Rockwell, Michelle S.; Stein, Jeffrey S.; Gerdes, Julie; Brown, Jeremiah; Ivory, Adrienne Holz; Epling, John W. (2021-04-06)
    BACKGROUND: The Appalachian Region faces multiple barriers to widespread COVID-19 vaccination. The purpose of this research study was to explore the role of trust in healthcare and trust in science on Appalachian residents’ readiness to receive the COVID-19 vaccine. Trust in health influencers and health information sources were also explored. METHODS: A cross sectional survey study of Appalachian Region residents (n=1048) was completed between February 25 and March 6, 2021, with equivalent rural and non-rural sampling methods employed. Participants were >35 years of age and had not received the COVID-19 vaccine at the time of survey administration. RESULTS: Overall, 31% of participants were extremely likely to receive the vaccine, while 42% were somewhat likely/neither unlikely or likely/somewhat unlikely, and 27% were extremely unlikely. Based on multiple linear regression analysis with backwards selection, trust in healthcare, trust in science, residence (rural vs. non-rural) and age were positive predictors of readiness to receive the vaccine (F(5, 1042)= 38.9, R2= 0.157, p< 0.01). Gender, education, household income, and political affiliation did not predict vaccine readiness. Trust in media for health information was modest, with ratings of none or not much for social media (64%), podcasts (61%), magazines (46%), radio (37%), newspapers (36%), and television (35%). Primary care providers emerged as the highest trusted health influencer of 15 options and a primary care provider’s office was the most common preference for location for receiving the COVID-19 vaccine, particularly in participants who rated themselves as extremely unlikely to receive the COVID-19 vaccine. CONCLUSIONS: These findings suggest that trust in healthcare and science are prospective foci for initiatives aimed at improving vaccine acceptance in Appalachia, particularly in younger residents of rural areas. As highly trusted health influencers, primary care providers should be leveraged and supported in COVID-19 vaccine education and distribution.