Smoking-related gestures as a behavioral dimension of tobacco use: associations with psychological distress and smoking patterns in treatment-seeking smokers.

Smoking behavior is influenced not only by nicotine dependence but also by behavioral rituals and psychological factors. The motor routines associated with smoking, such as holding and manipulating the cigarette, may represent an important behavioral component of tobacco addiction. However, the relationship between smoking-related gestures, psychological distress, and smoking behavior has received limited empirical attention. This cross-sectional study analyzed data from 787 treatment-seeking smokers undergoing clinical evaluation for tobacco dependence. Smoking behavior was assessed through the number of cigarettes smoked per day and the Fagerström Test for Nicotine Dependence (FTND). Psychological distress was evaluated using the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS). Smoking-related gesturality was measured through a clinical item assessing the perceived importance of smoking gestures. Associations were examined using Spearman correlations, non-parametric group comparisons, and multivariate logistic regression. Gesturality showed a weak but statistically significant association with anxiety (ρ = -0.12, p = 0.001) and depressive symptoms (ρ = -0.13, p < 0.001). Higher gestural involvement was also associated with greater cigarette consumption (ρ = 0.10, p = 0.01). In multivariate analysis, the number of cigarettes smoked per day emerged as the only independent predictor of high gesturality (OR = 1.03, p = 0.02), while anxiety and depressive symptoms showed non-significant trends. Smoking-related gestures appear to reflect a behavioral dimension of tobacco use that is primarily associated with smoking intensity and habitual motor routines, while showing only weak inverse associations with anxiety and depressive symptoms.