The Attentional Bias in Current and Former Smokers

Investigating the selective attention, attentional bias and smoking among Turkish University students: A cross-sectional study

The aim of this study was to investigate the relationship between selective attention, attentional bias and smoking in Turkish university students. The study was conducted with 64 individuals with an average age of 20.3 ± 0.83 years. While the d2 Test of Attention was used to measure various aspects of attention including processing speed, accuracy and selective attention; the Smoking Stroop Test evaluated the attentional bias toward smoking-related stimuli by comparing reaction times to smoking-related and neutral words. Also, the Fagerström Nicotine Dependence Test and Questionnaire of Smoking Urges assessed the level of nicotine dependence and cravings of participants. Findings showed that smoking status (B: 0.05, 95%CI:0.03,0.07) was statistically explanatory of attentional bias, but there was no significant difference in selective attention performance in terms of smoking status. These results are important for the development of intervention methods targeting cognitive processes associated with smoking.

The imbalance of self-reported wanting and liking is associated with the degree of attentional bias toward smoking-related stimuli in low nicotine dependence smokers

Background and aims

The Incentive Sensitization Theory (IST) offers a comprehensive framework that explains how attentional mechanisms contribute to the maintenance and relapse of addictive behavior. However, the extent to which the underlying neuropsychological mechanisms are consciously accessible for report remains unknown. Thus, the aim of this study was to investigate the association between self-reported wanting and liking among smokers and its relationship with detecting changes in smoking-related stimuli.

Design

An online experiment was designed deploying a flicker paradigm with neutral and smoking-related changes, completed by 422 individuals (mean age = 29.1 years, 214 non-smokers, 123 current smokers, and 85 former smokers). Additionally, the Fagerström Test for Cigarette Dependence and the Imaginative Wanting and Liking Questionnaire were administered.

Findings

Consistent with prior research findings, smokers exhibited faster detection of smoking-related changes compared to non-smokers, while former smokers displayed an intermediate level of attentional bias, falling between the levels observed in smokers and non-smokers. Further, higher levels of nicotine dependence were associated with a greater discrepancy between self-reported wanting and liking, which was associated with better change detection performance for high salience smoking-related stimuli in smokers.

Conclusion

These findings support the predictions of IST and support the notion that attentional bias might develops early in the course of nicotine addiction. Furthermore, the results indicate that the underlying cognitive mechanisms might be partially within conscious awareness, which opens up potential avenues for research design, treatment, and interventions.

Attentional Bias Toward Cigarette-Related Cues in Male Smokers is Modulated by Cognitive Control Mechanisms

Background: Many studies have found that smokers' attentional bias toward cigarette-related cues and cognitive control impairment significantly impacts their cigarette use. However, there is limited research on how the interaction between attentional bias and cognitive control may modulate smokers' cigarette-seeking behavior. Objectives: This study used a cigarette Stroop task to examine whether smokers with different attentional control ability had different levels of attentional bias toward cigarette-related cues. Methods: A total of 130 male smokers completed the Flanker task to measure their attentional control ability. The attentional control scores of all participants were ranked from low to high, with the top 27% placed in the high attentional control group and the bottom 27% in the low attentional control group. Subsequently, both groups completed the cigarette Stroop task to measure their attentional bias toward cigarette-related cues. Results: Smokers with low attentional control responded more slowly to cigarette-related cues than to neutral cues, while smokers with high attentional control showed no significant difference in their response time to either condition. Conclusions/Importance: Attentional control ability can regulate smokers' attentional bias toward cigarette-related cues. Smokers with low attentional control ability are more likely to have attentional bias toward cigarette-related cues, offering insights for targeted prevention of cigarette addiction.

Reliability of and associations between cognitive bias measures and response inhibition in smoking

BACKGROUND AND OBJECTIVE

Theoretical models propose that different cognitive biases are caused by a common underlying mechanism (incentive salience/"wanting") and should, therefore, be interrelated. Additionally, stronger impulsive processes should be related to weaker inhibitory abilities. However, these assumptions have hardly been empirically tested and key psychometric information have hardly been reported in samples of smokers. To extent previous research, the present study aimed (1) to estimate the reliability (split-half) of different cognitive bias measures and (2) to investigate associations between attention, approach and associative biases, response inhibition, and smoking-related variables.

METHODS

Eighty current, non-deprived smokers completed the following tasks in random order: Approach-Avoidance Task (AAT), Stimulus-Response Compatibility Task (SRCT), Implicit-Association Tests (IAT, approach-avoid, valence), Dotprobe Task, Go-/NoGo Task (GNGT). Additionally, different smoking-related variables were assessed. Split-half reliabilities of the different cognitive (bias) measures and correlations between them were calculated.

RESULTS

Split-half reliabilities of the AAT, the SRCT, and the Dotprobe Task were unacceptable whereas both IATs and the GNGT showed good to excellent reliability. Smoking-approach associations were significantly related to nicotine dependence; however, none of the cognitive bias measures correlated with response inhibition or smoking-related variables.

LIMITATIONS

Pictorial stimuli were the same across paradigms and might not have been relevant to all participants.

CONCLUSIONS

This is the first study to investigate the association between different cognitive biases, response inhibition, and smoking-related variables. Although findings are at odds with theoretical assumptions, their interpretation is clearly restricted by the low reliability of the cognitive bias measures.

Cue-reactivity targeted smoking cessation intervention in individuals with tobacco use disorder: a scoping review

Objectives

Cue-reactivity is a critical step leading to the emergence of addictive psychology and the triggering of addictive behaviors within the framework of addiction theory and is considered a significant risk factor for addiction-related behaviors. However, the effect of cue-reactivity targeted smoking cessation intervention and the cue-reactivity paradigms used in the randomized controlled trials varies, which introduces more heterogeneity and makes a side-by-side comparison of cessation responses difficult. Therefore, the scoping review aims to integrate existing research and identify evidence gaps.

Methods

We searched databases in English (PubMed and Embase) and Chinese (CNKI and Wanfang) using terms synonymous with 'cue' and 'tobacco use disorder (TUD)' to April 2023, and via hand-searching and reference screening of included studies. Studies were included if they were randomized controlled trials taking cue-reactivity as an indicator for tobacco use disorder (TUD) defined by different kinds of criteria.

Results

Data were extracted on each study's country, population, methods, timeframes, outcomes, cue-reactivity paradigms, and so on. Of the 2,944 literature were retrieved, 201 studies met the criteria and were selected for full-text screening. Finally, 67 pieces of literature were selected for inclusion and data extraction. The results mainly revealed that non-invasive brain stimulation and exercise therapy showed a trend of greater possibility in reducing subjective craving compared to the remaining therapies, despite variations in the number of research studies conducted in each category. And cue-reactivity paradigms vary in materials and mainly fall into two main categories: behaviorally induced craving paradigm or visually induced craving paradigm.

Conclusion

The current studies are still inadequate in terms of comparability due to their heterogeneity, cue-reactivity can be conducted in the future by constructing a standard library of smoking cue materials. Causal analysis is suggested in order to adequately screen for causes of addiction persistence, and further explore the specific objective cue-reactivity-related indicators of TUD.

Tobacco Smoking Behaviors in Cancer Survivors: The Mediation Effect of Personality and Emotional Intelligence

The smoking behaviour of patients following a cancer diagnosis is a critical risk factor for several physical diseases; it can increase the risk of second primary tumors and lower cancer treatment efficacy. Despite this, a great number of survivors continue to smoke after the diagnosis. This observational, cross-sectional on-line study aimed to assess the relationship between the impact of cancer diagnosis on survivors and their smoking behavior, and whether emotional intelligence and personality might mediate this relationship. Ninety-four Italian survivors completed a set of questionnaires: Big Five Inventory; Fagerström Test for Nicotine Dependence; Impact of Event Scale; Brief Emotional Intelligence Scale. The results obtained from the mediation analyses highlighted that the indirect effect on the relationship between the psychological impact of the diagnosis and smoking behaviors was partially mediated by neuroticism (Intrusion: 95% CI [0.00; 0.11]; Avoidance: 95% CI [0.00; 0.18]). Additionally, the data suggested that the relationship between the psychological impact of the diagnosis and smoking behaviors was partially mediated by the utilization of emotions dimension of emotional intelligence (Intrusion: 95% CI [0.00; 0.10]; Avoidance: 95% CI [0.00; 0.22]). Overall, this study suggests the importance of designing interventions to support smoking interruption based on the "mapping" of individual needs and emotional regulation strategies.

Trial-level bias score versus mean bias score: Comparison of the reliability and external validity using dot-probe task among daily smokers

INTRODUCTION

Attentional bias (AB) is an individual difference risk factor that represents the extent to which cigarette cues capture one's attention. AB is typically indexed by mean bias score (MBS), theoretically assuming that AB is static. However, poor reliability of MBS has threatened valid interpretation of the results on AB. Based on observed trial-by-trial temporal fluctuation and variability of attentional allocation, trial-level bias score (TLBS) has been introduced as an alternative index with evidence of better psychometric properties in various populations, as compared to MBS. However, such evidence is limited among daily smokers. The current study aimed to replicate and extend extant findings in a sample of daily smokers by hypothesizing that TLBS, as compared to MBS, would demonstrate superior reliability and external validity.

METHODS

Forty-eight daily smokers completed self-reports, ad-libitum smoking, and a dot-probe task three times, which was comprised of 36 pairs of pictorial stimuli of cigarette and neutral cues, yielding 144 total trials.

RESULTS

The TLBS demonstrated superior internal (range intra class correlation [ICC] = 0.79-0.95) and test-retest reliability (range ICC = 0.64-0.88) compared to MBS (range ICC = 0.31-0.40 and 0.06-0.16, respectively). However, few significant relations between either the MBS or TLBS and measures of biobehavioral and self-report indices of smoking reinforcement were observed.

CONCLUSIONS

The current findings demonstrate that TLBS, as compared to MBS, is a more reliable measure of AB among daily smokers, while evidence of its external validity is limited.

Effects of fun-seeking and external locus of control on smoking behaviour: a cross-sectional analysis on a cohort of working men in Singapore

OBJECTIVES

We examined the combined effects of behavioural inhibition and behavioural activation, on one hand, and locus of control, on the other hand, on different categories of smoking behaviour (non-smoking, ex-smoking, occasional smoking, daily smoking).

DESIGN

This study adopted a cross-sectional design. Participants completed questionnaires regarding demographics, smoking patterns, behavioural inhibition/behavioural activation systems and locus of control.

SETTING

The study was conducted across four companies from the transportation, cooling plant and education sectors in Singapore.

PARTICIPANTS

Three hundred sixty-nine male working adults were included in the final sample.

RESULTS

Corroborating previous research, a logistic regression model examining behavioural inhibition/behavioural activation systems revealed that the fun-seeking aspect of behavioural activation was a unique predictor in distinguishing non-smokers from daily smokers (OR=1.24, p=0.012). By contrast, in a separate model examining locus of control, external locus of control was found to be a unique predictor in distinguishing non-smokers from daily smokers (OR=1.13, p<0.001). In addition, a third model combining both behavioural inhibition/behavioural activation systems and locus of control found that only external locus of control remained a significant predictor (OR=1.12, p<0.001). Further analyses revealed a mediating effect of external locus of control on the relationship between fun-seeking and smoking behaviour. That is, the increase in the odds of daily smoking due to fun-seeking was explained by external locus of control (direct pathway OR=1.20, p=0.058; indirect pathway OR=1.04, p<0.050).

CONCLUSIONS

Overall, fun-seeking through its influence on external locus of control indirectly affects daily smoking behaviour, suggesting a more complex relationship than shown in previous research.

Attentional Bias in Non-Smoking Electronic Cigarette Users: An Eye-Tracking Study

INTRODUCTION

This study examined attentional bias (AB) to e-cigarette cues among a sample of non-smoking daily e-cigarette users (n = 27), non-smoking occasional e-cigarette users (n = 32), and control participants (n = 61) who did not smoke or use e-cigarettes. The possibility that e-cigarette users develop a transference of cues to traditional cigarettes was also examined.

METHODS

AB was assessed using a free-viewing eye-gaze tracking methodology, in which participants viewed 180 pairs of images for 4 seconds (e-cigarette and neutral image, e-cigarette and smoking image, smoking and neutral image).

RESULTS

Daily and occasional e-cigarette users attended to pairs of e-cigarette and neutral images equally, whereas non-users attended to neutral images significantly more than e-cigarette images. All three groups attended to e-cigarette images significantly more than smoking images, with significantly larger biases for e-cigarette users. There were no between-group differences in attention to pairs of smoking and neutral images. A moderation analysis indicated that for occasional users but not daily users, years of vaping reduced the bias toward neutral images over smoking images.

CONCLUSIONS

Taken together, the results indicate that e-cigarette users exhibit heighted attention to e-cigarettes relative to non-users, which may have implications as to how they react to e-cigarette cues in real-world settings. AB for e-cigarettes did not transfer to traditional cigarette cues, which indicates that further research is required to identify the mechanisms involved in the migration of e-cigarettes to traditional cigarettes.

IMPLICATIONS

This study is the first attempt to examine attentional biases for e-cigarette cues among non-smoking current e-cigarette users using eye-gaze tracking. The results contribute to the growing literature on the correlates of problematic e-cigarette use and indicate that daily and occasional e-cigarette use is associated with attentional biases for e-cigarettes. The existence of attentional biases in e-cigarette users may help to explain the high rate of failure to quit e-cigarettes and provides support for the utility of attentional bias modification in the treatment of problematic e-cigarette use.

Top-down and bottom-up attentional biases for smoking-related stimuli: Comparing dependent and non-dependent smokers

INTRODUCTION

Substance use causes attentional biases for substance-related stimuli. Both bottom-up (preferential processing) and top-down (inhibitory control) processes are involved in attentional biases. We explored these aspects of attentional bias by using dependent and non-dependent cigarette smokers in order to see whether these two groups would differ in terms of general inhibitory control, bottom-up attentional bias, and top-down attentional biases. This enables us to see whether consumption behaviour would affect these cognitive responses to smoking-related stimuli.

METHODS

Smokers were categorised as either dependent (N = 26) or non-dependent (N = 34) smokers. A further group of non-smokers (N = 32) were recruited to act as controls. Participants then completed a behavioural inhibition task with general stimuli, a smoking-related eye tracking version of the dot-probe task, and an eye-tracking inhibition task with smoking-related stimuli.

RESULTS

Results indicated that dependent smokers had decreased inhibition and increased attentional bias for smoking-related stimuli (and not control stimuli). By contrast, a decreased inhibition for smoking-related stimuli (in comparison to control stimuli) was not observed for non-dependent smokers.

CONCLUSIONS

Preferential processing of substance-related stimuli may indicate usage of a substance, whereas poor inhibitory control for substance-related stimuli may only emerge if dependence develops. The results suggest that how people engage with substance abuse is important for top-down attentional biases.