Roberta Freitas-Lemos

Cigarette smoking is a leading cause of death and disease in the United States and a significant concern for U.S. military veterans, who use tobacco at higher rates than nonveterans. Veterans face multiple obstacles to achieving long-term abstinence from smoking and might benefit from remotely delivered, novel approaches to smoking cessation treatment. This study employed reinforcer pathology theory to design a novel, accessible treatment approach that combined episodic future thinking with contingency management (EFT + CM) in a remotely delivered treatment for military veterans. Veterans (n = 97) participated in a 16-week, randomized control, single-blind, remotely delivered, feasibility study. The treatment phase was conducted from Week 1 to 12 with EFT delivered from Week 1 to 12 and CM delivered from Week 1 to 4. All participants received 12 weeks of nicotine patches. Feasibility measures included demand, adherence, practicality, acceptability, and limited efficacy testing. Across conditions, all feasibility measures were within acceptable ranges. The study enrolled 88% of eligible participants, and about two thirds completed the final outcome assessment. Adherence to submitting daily breath samples and to reviewing daily cues was over 80% and was acceptable across conditions. Relative to baseline, delay discounting rates decreased in the EFT + CM condition showing large effect sizes across time and small effect sizes in the control condition. The EFT + CM condition also showed a higher proportion of breath samples that reflected abstinence than those in the control condition. In conclusion, multiple indicators of feasibility suggest that a remotely delivered EFT + CM combined with nicotine patches is feasible and warrants further investigation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Significance Understanding how integrated tobacco tax policies influence purchasing decisions across socioeconomic groups is critical to advancing tobacco control in an equitable manner in the context of the rapidly evolving tobacco and nicotine product market. Using an Experimental Tobacco Marketplace (ETM), this study examined the effects of four multitiered tax policies on tobacco purchasing among people who smoke cigarettes. Each policy used a different strategy to attain the goal of reducing cigarette purchasing among three socioeconomic groups. The policies were: tobacco parity, nicotine content, harm reduction and modified risk tobacco products. Methods A sample representative of the US population (N=481) was recruited from a national survey panel (Prolific). Using a within-subject/between-subject factorial design, participants completed hypothetical purchasing trials in the ETM with products priced under the four multitiered tax policies. Higher tiers equated to higher taxes. Results Higher taxes consistently reduced relative spending, while relative spending on medium-tax and no-tax tier products varied by tax proposal. The nicotine content tax policy led to the largest reduction in high-tax tier spending and the greatest shift toward no-tax products (eg, nicotine replacement). No socioeconomic differences were observed. Conclusions These findings indicate that strategic taxation is a robust and adaptable tool for shifting tobacco purchasing. Integrated tobacco tax policies are likely to be effective at reducing consumption of the highest-risk products without a disproportionate socioeconomic impact. Trial registration number NCT06795997.

Aim Government regulations can control the design features of tobacco products, including flavours. Understanding how cigarette and e-cigarette flavour availability affects purchasing behaviour among adults who smoke menthol cigarettes can help determine the impact of such policies. Conducted in Roanoke, Virginia, USA, this study investigated how restrictions on menthol cigarettes and non-tobacco e-cigarette flavours affect purchases in the Experimental Tobacco Marketplace (ETM), a simulated environment designed to mimic real-world tobacco purchasing behaviour. Methods In a within-subject design, 25 individuals who smoke menthol cigarettes completed purchasing trials with increasing cigarette prices in the ETM under different scenarios: (1) cigarette flavour restricted and e-cigarette flavour restricted, (2) cigarette flavour unrestricted and e-cigarette flavour restricted, (3) cigarette flavour restricted and e-cigarette flavour unrestricted and (4) cigarette flavour unrestricted and e-cigarette flavour unrestricted. Results Menthol cigarette flavour restrictions significantly decreased cigarette purchases (pConclusion This study experimentally demonstrated that menthol cigarette bans reduce cigarette purchases. Additionally, flavour restrictions on cigarettes and e-cigarettes distinctly influence substitution patterns, with a menthol cigarette ban encouraging switching to e-cigarettes, while an e-cigarette flavour restriction increases NRT purchasing. As policymakers consider strategies to reduce tobacco-related harms, these findings highlight the need to carefully evaluate broader impacts of flavour restrictions on consumer behaviour.

Traditionally, cigarettes are flavoured through two primary mechanisms: (1) directly to the tobacco blend and (2) the inclusion of a capsule (also marketed as menthol crush beads) in the cigarette filter, which can be crushed to release menthol during use.3 After the implementation of menthol bans, researchers documented the emergence of flavour capsules sold separately from cigarettes, enabling flavouring post-purchase.2 A growing variety of these products has been used to circumvent regulations, such as aroma cards, filters, markers, sprays and stones.4 The most frequently reported products are flavour capsules, aroma cards and menthol filters,4 6 with up to 42.5% of individuals who smoke menthol reporting their use post-ban.1 7 12 Although the WHO has identified these products as emerging regulatory targets,12 13 few jurisdictions have enacted menthol cigarette policies that explicitly address them. In the USA, a proposed national rule restricting menthol cigarettes included ‘components’ that could impart flavour in cigarettes (ie, cigarette paper, filter and flavour additives).14 Nonetheless, this proposal was withdrawn in early 2025, while states and localities continued leading menthol tobacco control efforts. The legislation in both California and Massachusetts prohibits the sale of ‘flavor enhancers’.15–17 Because these products are sold separately from tobacco, understanding how they are marketed and whether they are presented …

BACKGROUND Our health is shaped significantly by health-related behaviors as diverse as tobacco and other substance use, diet, physical activity, sleep, sexual activities, treatment and care-seeking, and adherence to treatment regimens. Historically, health behavior change models have focused on social and cognitive factors, however, behavior change interventions derived from these models are less than optimally effective. Behavioral economic constructs, such as delay discounting and behavioral economic demand, currently unaccounted for in traditional health behavior change models, are relatively new targets for health behavior change. The application of these constructs in health behavior research represents the novel approach of examining underlying processes generalizable to a wide variety of unhealthy behaviors; however, the clinical utility of these constructs has yet to be explicated. OBJECTIVE This systematic review aims to offer a rigorous, comprehensive, replicable synthesis of the available published scientific literature that examines concomitant changes in delay discounting and/or demand and targeted health behaviors as a consequence of an intervention or treatment. Our objective is to provide evidence, insights, and recommendations that will advance the science in this domain. METHODS The development of this systematic review protocol followed the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. This protocol has been registered on PROSPERO International Prospective Register of Systematic Reviews (CRD420261284218). RESULTS Preliminary searches and reviews were conducted in 2024 and 2025. Formal study selection and data extraction are expected to be complete in February 2026. Data synthesis is expected to be complete in May 2026. CONCLUSIONS This systematic review will identify key aspects of intervention type, health behaviors, delay discounting and demand measures, and analyses useful in identifying knowledge gaps, informing future research, and advancing science in this domain. We expect that these findings will contribute valuable insights for understanding the clinical utility of delay discounting and demand as therapeutic targets for improving health behaviors.