Gender Differences in Responses to Cues Presented in the Natural Environment of Cigarette Smokers

Abstract

IntroductionMost quit attempts end in relapse, 1 and there is evidence that female smokers have more difficulty quitting smoking than male smokers. [2][3][4] This gender difference has often been observed in clinical trials, 5,6 but population-based evidence for gender differences in quit success has been mixed. 7,8 An appeal for research identifying mechanisms related to these disparate cessation outcomes has been made in the smoking literature. 9 Craving, stress, and negative affect (NA) have been hypothesized as potential factors underlying gender differences in quit rates. 10Previous research has demonstrated gender differences in reactivity to cues presented in the laboratory setting. Saladin et al. 11conducted a laboratory-based study examining gender differences in response to smoking cues (holding and viewing a cigarette), stress cues (listening to a description of a recent life event that the participant identified as stressful), and neutral cues (holding and viewing a pack of pencils and an eraser while listening to a description Original investigation Gender Differences in Responses to AbstractIntroduction: Although the evidence is mixed, female smokers appear to have more difficulty quitting smoking than male smokers. Craving, stress, and negative affect have been hypothesized as potential factors underlying gender differences in quit rates. Methods: In the current study, the cue-reactivity paradigm was used to assess craving, stress, and negative affect in response to cues presented in the natural environment of cigarette smokers using ecological momentary assessment. Seventy-six daily smokers (42% female) responded to photographs (smoking, stress, and neutral) presented 4 times per day on an iPhone over the course of 2 weeks. Results: Both smoking and stress cues elicited stronger cigarette craving and stress responses compared to neutral cues. Compared with males, females reported higher levels of post-stress cue craving, stress, and negative affect, but response to smoking cues did not differ by gender. Discussion: Findings from this project were largely consistent with results from laboratory-based research and extend previous work by measuring response to cues in the natural environment of cigarette smokers. This study extends previous cue reactivity ecological momentary assessment research by using a new platform and by measuring response to stress cues outside of the laboratory. Findings from this project highlight the importance of addressing coping in response to stress cues in clinical settings, especially when working with female smokers.

Nicotine levels, withdrawal symptoms, and smoking reduction success in real world use: A comparison of cigarette smokers and dual users of both cigarettes and E-cigarettes

“…This pattern may be related to gender differences in nicotine motivation. Women smokers appear to differ from men smokers in: nicotine reinforcement (Perkins et al, 1999), sensitivity to the nicotine content of cigarettes as reflected by withdrawal alleviation (Perkins & Karelitz, 2015), sensitivity to stressors, smoking cues, and abstinence as manifested in increased smoking motivation (Perkins, et al, 2013; Doran, 2014; Wray et al, 2015; although cf. Ferguson, et al, 2015); and negative reinforcement expectancies for smoking (Ferguson, Shiffman, & Gwaltney, 2006; Pang, et al, 2015; Perkins et al, 2006).…”

“…We were interested in whether DUs 1) smoke fewer cigarettes and have lower carbon monoxide (CO) levels than SOs; 2) show elevated levels of nicotine relative to SOs, especially during periods of smoking reduction when they could use e-cigarettes ad libitum; 3) report lower levels of withdrawal symptoms during periods of smoking reduction; and 4) are more able than SOs to reduce and/or stop their cigarette use. We sought to determine whether any observed differences between DUs and SOs were related to gender and nicotine dependence, factors implicated in smoking motivation and cessation success (Perkins, Donny, & Caggiula, 1999; Piper, McCarthy, et al, 2008; Wray et al, 2015). …”

Individual variables related to craving reduction in cue exposure treatment

“…There are gender differences in reactivity to cues; for example, females express greater craving in response to smoking-related cues when compared to men (Knott et al, 2008;Tong, Bovbjerg, & Erblich, 2007). Previous research has also found that females show higher sensitivity than males to negative emotional cues (Carpenter et al, 2014;Colamussi, Bovbjerg, & Erblich, 2007;Saladin et al, 2012;Wray et al, 2015). There are other factors that have been related to greater craving for cigarettes, including younger age, higher nicotine dependence and symptoms of anxiety (García-Rodríguez et al, 2011;Sayette, Martin, Wertz, Shiffman, & Perrott, 2001;ThompsonLake et al, 2014;Watson et al, 2012).…”

Alcohol consumption as a predictor of reactivity to smoking and stress cues presented in the natural environment of smokers

“…The current study combined EMA-based methods with a novel cue-reactivity paradigm (cue reactivity ecological momentary assessment, CREMA; Warthen and Tiffany 2009; Wray et al 2011; Wray et al 2015) in which pictorial cues are administered via an electronic device to participants in their natural environments in conjunction with EMA-based assessments. Our goal was to examine associations between alcohol consumption, tonic (non-cue-elicited) cigarette craving, and responses to smoking and stress cues presented in the natural environment of adult smokers via CREMA.…”