A brain signature of vaping cue-elicited craving

Abstract

E-cigarette use among young adults has grown rapidly, raising concerns about nicotine dependence and motivating a better understanding of the neurobiology of vaping. We used a cue-induced craving fMRI paradigm to develop and evaluate a brain signature of vaping cue-elicited craving, and to compare it with smoking- and food-craving signatures developed using the same analytic pipeline. Using LASSO-PCR with leave-one-subject-out cross-validation, we identified a distributed pattern of brain activity that reliably predicted normative vaping craving from an independent sample (hereafter, normative craving). The vaping-craving signature was also substantially distinct from smoking- and food-craving signatures, both spatially and functionally, and showed specificity relative to previously established craving signatures. Moreover, greater signature expression was associated with greater e-cigarette dependence severity and showed a positive, though modest, prospective association with daily puff counts over four weeks, demonstrating the signature's behavioral and clinical relevance. Together, these findings establish a cross-validated brain signature of vaping cue-elicited craving, demonstrate its differentiation from other craving-related neural patterns, and link its expression to e-cigarette dependence and real-world use. More broadly, they support the potential of this framework for developing reproducible neural markers of craving.