Smoking-related Gestures and Anxiety: A Preliminary Study in Treatment-Seeking Smokers

Lorenzo Zamboni^1*Francesca LOCATELLI²Roberta Vesentini²Rebecca Casari³Alessio Congiu⁴Anna Guerra⁴Daniela Bettoni³Silvia Carli⁴Sara Cappelletti⁵Silvia Melchiori⁴Simone Campagnari⁴Giuseppe Verlato²Maurizio Infante³Fabio Lugoboni³

• ¹Integrated University Hospital Verona, Verona, Italy
• ²Universita degli Studi di Verona Sezione di Epidemiologia e Statistica Medica, Verona, Italy
• ³Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
• ⁴Azienda Ospedaliera Universitaria Integrata Verona Unita Operativa Oncologia, Verona, Italy
• ⁵Regione Autonoma Trentino Alto Adige, Trento, Italy

Background The act of smoking is not solely driven by nicotine dependence, but also involves behavioral and sensorimotor components that may independently contribute to addiction maintenance. Among these, gestural rituals such as holding and bringing the cigarette to the mouth may play a role in emotional regulation and self-soothing, particularly in individuals with anxiety. This study aimed to explore the relationship between smoking-related gestures, nicotine dependence, and anxiety symptoms in a sample of smokers seeking addiction treatment. Methods A total of 81 treatment-seeking smokers were recruited from an Addiction Medicine Unit. Nicotine dependence was assessed using the Fagerström Test for Nicotine Dependence (FTND), anxiety symptoms were measured with the Beck Anxiety Inventory (BAI), and the importance of smoking-related gestures was rated on a 7-point Likert scale via a single-item question. Correlational and non-parametric tests (Spearman’s rho, Kruskal–Wallis, Fisher’s exact test) were used to analyze associations among the variables. Results A significant positive correlation was found between anxiety levels and the perceived importance of smoking gestures (ρ = 0.254, p = 0.0224). No significant association emerged between BAI categorical levels and FTND categories (p = 0.346). A trend toward significance was observed between anxiety severity and FTND levels (χ²(4) = 8.521, p = 0.0742), but no significant correlation was detected between gesturality and FTND measures. Conclusions These preliminary findings suggest that smoking-related gestures may be particularly salient for individuals with elevated anxiety, potentially functioning as ritualized coping behaviors independent of nicotine intake. This dimension may help explain why some smokers struggle to quit despite low biochemical dependence. Future studies should develop validated instruments to assess smoking-related motor patterns and explore tailored interventions targeting the behavioral components of tobacco use.