Gender differences in responses to cues presented in the natural environment of cigarette smokers

Nicotine Tob Res. 2015 Apr;17(4):438-42. doi: 10.1093/ntr/ntu248.


Introduction: 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Cues*
  • Female
  • Gender Identity*
  • Humans
  • Male
  • Nicotine / administration & dosage*
  • Smoking / psychology*
  • Smoking Cessation / methods*
  • Smoking Prevention
  • Social Environment*
  • Substance Withdrawal Syndrome / psychology*
  • Surveys and Questionnaires


  • Nicotine