Pain-Related Anxiety and Smoking Lapse/Topography among African American Menthol Smokers with Chronic Low Back Pain

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I. Project Summary/Abstract Tobacco use is the leading cause of preventable death and disability1 and results in substantial economic burden2. Estimates suggest that 13.7% of adults in the United States (US) are current smokers3. Yet, tobacco use is not equally distributed in society. African American smokers evince elevated smoking rates (14.6%)3 and up to 90% of African American adult smokers use menthol cigarettes compared to just 26% of White smokers4. African American smokers are less likely to maintain cessation compared to non-Hispanic White and Hispanic smokers despite making more quit attempts5. Smokers, in general, report greater pain intensity compared to nonsmokers6 and the rate of smoking among individuals with chronic pain is higher than the rates found within the general population7, 8. In fact, nationally-representative survey data indicates that the prevalence of cigarette smoking among individuals with chronic pain may exceed twice the rate observed in the general population [26-42% compared to 15%]9, 10 and the prevalence of smoking among African Americans with chronic pain, may be even higher given their elevated rates of tobacco use3. Past work also indicates that African Americans report a lower pain threshold11 and lower tolerance to pain12, 13, as well as greater pain-related disability14. Accordingly, there is a critical public health need to better understand tobacco- pain relations among African American menthol smokers with chronic pain. Pain-related anxiety, which reflects concern about pain-related somatic sensations15, may be one underrecognized individual difference factor that may help in understanding smoking maintenance and relapse among African American menthol smokers with chronic pain. Pain-related anxiety may be predictive of smoking lapse behavior for this group as African Americans have an increased awareness of the negative outcomes of aversive somatic symptoms and physical illnesses such as pain symptoms16, 17. Therefore, the purpose of the current project is to understand the role of pain-related anxiety in terms of smoking lapse using a multimodal assessment of smoking behavior (via topography and self-report). The aims of this proposal are designed to demonstrate the importance of a clinically malleable individual difference factor (i.e., pain-related anxiety) for African American menthol smokers with chronic pain. Meeting the aims will have substantial public health significance as they represent progress toward a precision medicine approach to smoking cessation and may lead to the development of culturally tailored interventions for African American menthol smokers with chronic pain that targets the malleable construct of pain-related anxiety.