Smokers are highly reactive to smoking-related cues that are directly linked, or most proximal, to actual smoking behavior (e.g., lit cigarettes). However, over the course of smoking, proximal cues may not be the only stimuli to become strongly associated with smoking. Distal cues, such as the environments in which smoking occurs (e.g., bar) might also gain associative properties and come to evoke robust reactivity from smokers. To test this, a pilot study was first conducted to develop standard pictorial stimuli of smoking and nonsmoking environments, all of which were completely devoid of proximal smoking cues. A comparison set of smoking and nonsmoking proximal cues was then created. Using the 12 total pictorial cues developed, 62 adult smokers participated in a cuereactivity study during which they viewed and rated pictorial smoking and nonsmoking environment and proximal cues. Results demonstrate that, similar to proximal cues, environments associated with smoking can alone function as stimuli capable of evoking strong subjective reactivity from smokers. This work supports a broader conceptualization of drug-related cues in cue-based research and treatment development that includes proximal and distal cues as distinct categories.
Keywordscraving; cue reactivity; proximal and distal stimuli; environments; smoking Cue-based research offers a wealth of information regarding how smokers respond to smokingrelated stimuli, or cues, associated with past cigarette use. Studies aimed at eliciting responses to such cues in smokers typically employ a paradigm in which smokers are exposed to smokingand nonsmoking-related stimuli through in vivo (e.g., watching someone smoke), imaginal (e.g., imagining smoking scenes), audio (e.g., hearing a description of smoking), and less commonly video (e.g., seeing a film of someone smoking), and/or pictorial (e.g., viewing pictures of smoking-related paraphernalia) stimulus modes. On balance this research has revealed that, regardless of presentation mode, smokers consistently show robust subjective