The relationship between nicotine craving and state anxiety in daily and non-daily nicotine users

Anxiety as a broad construct has been linked to nicotine craving, frequency of use, and relapse rates. However, there is limited research on the relationship between state anxiety and nicotine craving. This study explored the association between state anxiety and pre-cue versus post-cue craving among adults who use nicotine and tobacco products (NTPs) at different frequencies. Participants with either non-daily (n = 34) or daily (n = 80) NTP use completed a laboratory assessment including a virtual reality (VR) NTP cue-exposure paradigm and self-report assessments of state anxiety and nicotine craving. NTP use group membership was a significant predictor of pre-cue and post-cue craving, with daily NTP users exhibiting greater pre-cue (p = 0.001) and post-cue (p < 0.001) craving than non-daily users. State anxiety was positively associated with pre-cue craving (p = 0.03) but not post-cue craving. Notably, non-daily users showed a significant negative relationship between state anxiety and post-cue craving (p = 0.01). The results of this study suggest that NTP use (especially daily use), and state anxiety are more strongly associated with pre-cue craving, as opposed to post-cue-induced craving. This study provides insight into how the relationship between state anxiety and nicotine craving varies pre and post cue-exposure, which may inform treatment and intervention efforts targeting transient affective states to prevent or reduce nicotine craving.