A Novel Visual Cue-Induced Craving Task for Cigarette Smokers: Development and Validation Publisher



Niknamfar S ; Mokri A ; Nazar E ; Rafaiee R ; Seyedhosseini Tamijani S M ; Hosseini S H ; Ghazvini H
Source: Basic and Clinical Neuroscience Published:2026

Abstract

Introduction: Nicotine addiction, driven by cue-induced cravings, significantly contributes to high relapse rates among smokers. Craving, particularly cue-induced craving, plays a critical role in relapse and is influenced by culturally specific environmental cues. This study aimed to develop and validate a culturally adapted visual cue-based craving induction task for cigarette smokers to enhance research on nicotine dependence. Methods: This study included 240 treatment-seeking Iranian smokers (120 males, 120 females) who smoked ≥10 cigarettes/day for ≥2 years, assessed using the diagnostic and statistical manual of mental disorders, 5th edition (DSM-5) criteria and the Fagerstrom test for nicotine dependence. Culturally relevant craving-inducing cues were selected through focus groups and expert validation, categorized into seven groups (neutral, instrument, bill, smoking, smoking environment, smoking shop, and consumption type). Participants rated craving intensity via a Visual Analog Scale during cue exposure (10-15 sec/image). A final task comprising 30 evocative and 4 neutral cues was developed for standardized craving induction. Results: The cue-induced craving task (CICT-34) demonstrated significant reliability, with a Cronbach’s α of 0.701 and McDonald’s omega of 0.79. Significant positive correlations were found between total craving scores and categories, such as smoking, consumption type, instrument, environment, bill, and smoking shop (P<0.05). However, no significant correlation was found between age and craving scores (P>0.05). Conclusion: This study showed that visual cues reliably induce nicotine craving, with cue reactivity influenced by addiction severity but not demographic factors. The CICT-34 is a valid tool for measuring cue-induced craving, highlighting the importance of personalized approaches in tobacco addiction treatment. Copyright © 2026 The Author(s)