Cue-reactivity in the natural environment of cigarette smokers: the impact of photographic and in vivo smoking stimuli.

The cue-reactivity paradigm has been used extensively in laboratory settings to study cue-specific craving responses to drug-related cues. However, this procedure has been used in only one study to assess craving in the drug user's natural environment (Warthen & Tiffany, 2009). The present study combined cue-reactivity with ecological momentary assessment (CREMA) to evaluate smokers' cue reactions in natural environments as a further validation and extension of this procedure. A total of 66 daily cigarette smokers carried a personal digital assistant (PDA) and had the opportunity to respond to 32 cue-reactivity sessions across 8 days. Cues were presented through in vivo and photographic modes. During in vivo sessions, participants handled and looked at a cigarette or neutral object, while during photographic sessions, participants looked at a smoking-related or neutral photograph on the PDA. Craving and mood were assessed before and after cue presentations. Cues were also presented in the laboratory both before (Lab I) and after (Lab II) the 8-day CREMA procedure. Participants completed over 90% of cue-reactivity sessions delivered with the CREMA procedure. Analyses revealed robust cue-reactivity in the natural environment and laboratory across both modes of presentation. Photographic cues elicited significantly stronger cue-reactivity effects than in vivo cues across all sessions. The CREMA procedure has been shown to elicit robust cue-reactivity effects across multiple modes of cue presentation. Results support the use of the CREMA procedure for examining cue-specific craving in the natural environment of smokers.