Attentional bias in tobacco use disorder using eye tracking: A systematic review

Background: Attentional bias, defined as the disproportionate attentional allocation towards drug-related stimuli, is well-demonstrated in substance use disorders. However, studies investigating attentional bias in tobacco use disorder have revealed inconclusive findings. In recent years, eye-tracking technology has emerged as an innovative technique for exploring attentional bias. This systematic review aims to provide a comprehensive overview of eye-tracking studies examining attentional bias in tobacco use disorder. Methods: Using PRISMA guidelines, 18 papers that assessed attentional bias using eye-tracking technology among people who smoke cigarettes were extracted from the following databases: PsychINFO, MEDLINE, and EMBASE. Search terms included "attentional bias", "tobacco use disorder", and "eye tracking" and their respective subject headings and synonyms. Selected papers were assessed for methodological quality using a standardized procedure. Selected studies reviewed were categorized into studies making comparisons between 1) people who smoke and people who do not smoke and 2) between smoking-related cues and neutral cues among people who smoke. Results: Overall, most studies showed that people who smoke had significantly greater attentional bias to smoking-related cues, as indexed by greater dwell times and fixation counts. Although findings using measures of early orienting biases were mixed, people who smoke displayed a tendency to initially shift attention to smokingrelated cues more frequently than neutral cues. Conclusions: While methodological inconsistencies across studies preclude any definitive conclusions, findings suggest that maintained attention may be a more precise reflection of the specific attentional processes influenced by incentive salience. Suggestions for future research include establishing methodological standards for future eye-tracking studies.