Negative interpretation bias and repetitive negative thinking as mechanisms in the association between insomnia and depression in young adults.

Tobacco use remains one of the leading preventable causes of morbidity and mortality worldwide (). Despite substantial reductions in smoking prevalence in many high-income countries, tobacco consumption continues to represent a major public health challenge, contributing to cardiovascular disease, respiratory disorders, and multiple forms of cancer (; ). Tobacco addiction has traditionally been conceptualized primarily as a pharmacological dependence driven by nicotine exposure. Nicotine acts on nicotinic acetylcholine receptors in the central nervous system, stimulating dopaminergic pathways involved in reward and reinforcement, thereby contributing to the development and maintenance of dependence (; ). However, increasing evidence suggests that tobacco use cannot be fully understood solely through the pharmacological effects of nicotine. In addition to its biochemical mechanisms, smoking behavior involves a complex set of learned routines, environmental cues, and sensorimotor experiences that may reinforce tobacco use independently of nicotine intake (). The repetitive motor patterns associated with smoking—such as holding the cigarette, bringing it to the mouth, inhaling smoke, and manipulating the cigarette between the fingers—constitute ritualized behaviors that become strongly embedded within daily routines (). These ritualistic components of smoking may provide sensory and behavioral reinforcement that contributes to the persistence of tobacco use even when nicotine exposure is reduced. Indeed, behavioral models of addiction emphasize that repeated actions can gradually evolve into habits through reinforcement processes involving neural circuits linking the basal ganglia and prefrontal cortex (; ). Within this perspective, smoking can be understood not only as a pharmacological dependence but also as a habitual behavioral pattern sustained by environmental and emotional triggers. The importance of behavioral and ritualistic aspects of smoking is also supported by research examining alternative nicotine delivery systems. Several studies have shown that smokers often value the sensorimotor aspects of smoking, including the hand-to-mouth movement and the inhalation ritual, which may contribute to the subjective satisfaction derived from smoking (; ). This phenomenon has also been observed in studies investigating electronic cigarettes and other smoking substitutes, where the replication of smoking gestures has been identified as an important factor influencing user acceptance and perceived effectiveness as cessation aids (; ). These findings suggest that the motor and ritualistic dimensions of smoking may play a meaningful role in reinforcing tobacco use behavior.