# Exploring gender differences in tobacco cue-induced craving and heart rate variability in individuals with a tobacco use disorder

## TL;DR

This study explores how tobacco cues affect craving and heart rate variability in men and women with a tobacco use disorder, finding gender-specific patterns in physiological responses.

## Contribution

The study reveals gender-specific associations between cue-induced craving and heart rate variability in tobacco use disorder, emphasizing women's unique autonomic responses.

## Key findings

- Tobacco cues increased both reward and relief craving and reduced heart rate variability in abstinent individuals with tobacco use disorder.
- Women showed significant links between cue-induced craving and heart rate variability changes, while men did not.
- Women with higher reward craving had larger heart rate variability reductions, and those with lower relief craving had stronger HRV declines.

## Abstract

Women face greater challenges quitting smoking and higher health risks than men, yet gender remains understudied in tobacco use disorder (TUD). This study investigates gender differences in subjective craving and heart rate variability (HRV) following tobacco cue exposure in abstinent individuals with a tobacco use disorder. Unlike heart rate, HRV reflects parasympathetic modulation, critical for understanding risk and resilience in addiction, but has rarely been studied as a cue-reactivity biomarker.

Data from 41 men and 40 women who smoked cigarettes for more than 10 years were analyzed. Participants underwent a cue-exposure paradigm consisting of a relaxation phase (75 s), exposure to smoking videos (150 s) and pictures (150 s), and handling tobacco paraphernalia (120 s). Relief craving (the urge to use nicotine to alleviate negative emotions) and reward craving (the urge to use nicotine for its pleasurable effects) were measured pre/post cue exposure via the brief Questionnaire on Smoking Urges. HRV was continuously measured as root mean square of successive differences (RMSSD).

Cue exposure increased relief and reward craving and reduced HRV across participants (p < .001) without gender differences. Significant craving-HRV associations emerged only in women: those with higher exposure-induced reward craving showed the largest HRV reductions and recovery during paraphernalia handling (p < 0.01), whereas those with higher exposure-induced relief craving had smaller HRV declines and weaker recovery (p < 0.01).

These findings reinforce HRV as a clinically relevant biomarker for tobacco cue reactivity and highlight gender differences in the autonomic nervous system’s role in craving among individuals with TUD, suggesting stronger involvement in women.

•Tobacco cues increased reward/relief craving and reduced HRV in abstinent individuals with a tobaccu use disorder.•No gender differences appeared in subjective or physiological cue reactivity.•Links between cue-induced craving and HRV were observed in women, but not in men.•Women with highest cue-induced reward craving had largest cue-induced HRV reductions.•Women with lowest cue-induced relief craving had largest cue-induced HRV reductions.

Tobacco cues increased reward/relief craving and reduced HRV in abstinent individuals with a tobaccu use disorder.

No gender differences appeared in subjective or physiological cue reactivity.

Links between cue-induced craving and HRV were observed in women, but not in men.

Women with highest cue-induced reward craving had largest cue-induced HRV reductions.

Women with lowest cue-induced relief craving had largest cue-induced HRV reductions.