A Person-Centered Analysis of Craving in Smoking-Cue-Exposure Research

Smoking cue-exposure research offers a powerful method to examine craving, test new interventions, and identify at-risk smokers. Meta-analyses consistently show smoking cue-exposure increases craving levels. By focusing on mean levels, however, investigators fail to consider person-centered analyses addressing the percentage of smokers responding to cue-exposure with increased urge. We conducted preregistered analyses of the percentages of 672 nicotine-deprived daily smokers (pooled from seven studies) reporting target levels of urge before and during smoking cue-exposure. Sixty-nine percent of smokers increased their ratings during cue-exposure. Notably, 31% of non-responders reported a maximal urge prior to cue-exposure, precluding classification as a responder using traditional cue-reactivity analyses, suggesting that traditional analyses underreport cue-reactivity effects. An alternative, peak-provoked-craving analysis revealed the effectiveness of cue-exposure to generate potent urges (>¾ of sample were at least at 70% of scale maximum). Further research integrating person-centered analyses into the craving literature promises to advance addiction theory and research.