TY - JOUR AU - Courtney, Kelly Elizabeth AU - Liu, Weichen AU - Andrade, Gianna AU - Schulze, Jurgen AU - Doran, Neal PY - 2024 DA - 2024/6/27 TI - Attentional Bias, Pupillometry, and Spontaneous Blink Rate: Eye Characteristic Assessment Within a Translatable Nicotine Cue Virtual Reality Paradigm JO - JMIR Serious Games SP - e54220 VL - 12 KW - nicotine KW - craving KW - cue exposure KW - virtual reality KW - attentional bias KW - pupillometry KW - spontaneous blink rate KW - eye-tracking KW - tobacco KW - VR KW - development KW - addiction KW - eye KW - pupil KW - biomarker KW - biomarkers KW - tobacco product AB - Background: Incentive salience processes are important for the development and maintenance of addiction. Eye characteristics such as gaze fixation time, pupil diameter, and spontaneous eyeblink rate (EBR) are theorized to reflect incentive salience and may serve as useful biomarkers. However, conventional cue exposure paradigms have limitations that may impede accurate assessment of these markers. Objective: This study sought to evaluate the validity of these eye-tracking metrics as indicators of incentive salience within a virtual reality (VR) environment replicating real-world situations of nicotine and tobacco product (NTP) use. Methods: NTP users from the community were recruited and grouped by NTP use patterns: nondaily (n=33) and daily (n=75) use. Participants underwent the NTP cue VR paradigm and completed measures of nicotine craving, NTP use history, and VR-related assessments. Eye-gaze fixation time (attentional bias) and pupillometry in response to NTP versus control cues and EBR during the active and neutral VR scenes were recorded and analyzed using ANOVA and analysis of covariance models. Results: Greater subjective craving, as measured by the Tobacco Craving Questionnaire–Short Form, following active versus neutral scenes was observed (F1,106=47.95; P<.001). Greater mean eye-gaze fixation time (F1,106=48.34; P<.001) and pupil diameter (F1,102=5.99; P=.02) in response to NTP versus control cues were also detected. Evidence of NTP use group effects was observed in fixation time and pupillometry analyses, as well as correlations between these metrics, NTP use history, and nicotine craving. No significant associations were observed with EBR. Conclusions: This study provides additional evidence for attentional bias, as measured via eye-gaze fixation time, and pupillometry as useful biomarkers of incentive salience, and partially supports theories suggesting that incentive salience diminishes as nicotine dependence severity increases. SN - 2291-9279 UR - https://games.jmir.org/2024/1/e54220 UR - https://doi.org/10.2196/54220 DO - 10.2196/54220 ID - info:doi/10.2196/54220 ER -