Sex Differences in the Association of Cigarette Craving with Insula Structure

maylen perez diaz, Jean-Baptiste Pochon, Dara G. Ghahremani, Andy C. Dean, Paul Faulkner, Nicole Petersen, Rachel F Tyndale, Andrea Donis, Diana Paez, Citlaly Cahuantzi, Gerhard S Hellemann, Edythe D. London

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AbstractBackgroundCigarette craving, which can negatively impact smoking cessation, is reportedly stronger in women than in men when they initiate abstinence from smoking. Identifying approaches to counteract craving in people of different sexes may facilitate the development of personalized treatments for Tobacco Use Disorder, which disproportionally affects women. Because cigarette craving is associated nicotine dependence and structure of the insula, this study addressed whether a person’s sex influences these associations.MethodsThe research participants (n=99, 48 women) reported daily cigarette smoking and provided self-reports of nicotine dependence. After overnight abstinence from smoking, they underwent structural MRI scanning to determine cortical thickness of the left and right anterior circular insular sulcus, and self-rated their cigarette craving before and after their first cigarette of the day.ResultsWomen reported stronger craving than men irrespective of smoking condition (i.e., pre- or post-smoking) (p=0.048), and smoking reduced craving irrespective of sex (p<0.001). A three-way interaction of sex, smoking condition, and right anterior circular insular sulcus thickness on craving (p=0.033) reflected a negative association of cortical thickness with pre-smoking craving in women only (p=0.012). No effects of cortical thickness in the left anterior circular insular sulcus were detected. Nicotine dependence was positively associated with craving (p<0.001) across groups and sessions, with no sex differences in this association.ConclusionsA negative association of right anterior insula thickness with craving in women only suggests that this region may be a relevant therapeutic target for brain-based smoking cessation interventions in women.
© 2021The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See  
Original languageEnglish
JournalInternational Journal of Neuropsychopharmacology
Publication statusPublished - 8 Apr 2021

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