Longitudinal Associations Between Pain and Use of Cigarettes and E-Cigarettes in the Population Assessment of Tobacco and Health (PATH) Study

项目摘要/摘要 尼古丁/烟草的使用和疼痛非常普遍，经常同时发生，并导致每年 医疗费用和生产力损失的经济负担1-4尼古丁使用率在以下国家中要高得多 患有共病疼痛的人(与普通人群相比)，1，2和经验研究已经阐明 疼痛与尼古丁/烟草使用/依赖之间的双向联系。尼古丁可以产生急性 止痛效果5和疼痛可能是尼古丁/烟草用于止痛的有效激励因素。 更多的尼古丁暴露与疼痛的发展和加剧有关。 经验上关注疼痛和尼古丁使用的互惠作用，到目前为止，这项研究的大部分只集中在 疼痛与可燃香烟吸烟之间的关系。电子烟(电子烟)的使用 在过去的十年里，香烟和电子烟的联合使用越来越普遍，12 患有疼痛的个人可能面临开始和升级使用/共同使用电子烟的独特风险，以及 13-15因此，这项提议的目标是进行第一次关于疼痛和使用/联合的纵向研究。 利用收集的四波具有全国代表性的队列数据使用电子烟和烟草烟 用于烟草与健康人口评估(PATH)研究。16首先，拟议研究将评估 有共生疼痛(与无/低疼痛)的吸烟者是否更有可能开始联合使用电子烟。 其次，疼痛将被视为(A)吸烟和电子烟使用/合作的可能性的一个前瞻性预测因子。 使用，以及(B)使用/共同使用随时间的轨迹。据推测，有疼痛的个体更有可能 使用电子烟和/或香烟，将增加在所有四个浪潮中使用的频率和重量。 最后，在已知性行为的情况下，生物性行为将作为假设关系的调节因素进行检验。 疼痛体验和尼古丁消费的差异。这项工程的竣工时间可能提前 研究和临床实践将疼痛确立为发病中一个重要的、但未被认识到的危险因素 以及尼古丁消费的上升(通过香烟和/或电子烟)。这项建议与 奈达宣称的目标是了解各种因素的复杂相互作用，例如医学上的并存，即 影响药物使用轨迹。17这项裁决将提供资源和受保护的时间，以促进 申请人在几个关键领域的培训，包括增加对疼痛的了解和使用替代方案 尼古丁/烟草产品和与人口水平数据和轨迹分析相关的学习技能 模特儿。完成提议的项目目标所需的培训、研讨会和协作 以其他方式无法通过申请人的临床心理学研究生学习和安置获得 要求。申请人致力于从事由美国国立卫生研究院资助的独立研究人员的职业生涯，以及 目标是获得博士后奖学金和随后的教师职位，这将使她能够继续 在迅速崛起的疼痛和药物使用领域的多学科研究的方案路线。

PROJECT SUMMARY/ABSTRACT Nicotine/tobacco use and pain are highly prevalent, frequently co-occur, and engender a substantial annual economic burden in medical costs and lost productivity.1-4 Rates of nicotine use are considerably higher among persons with co-occurring pain (vs. the general population),1, 2 and empirical studies have elucidated bidirectional associations between pain and nicotine/tobacco use/dependence. Nicotine can produce acute analgesic effects,5 and pain can be a potent motivator of nicotine/tobacco use for pain-coping.6 Furthermore, greater nicotine exposure has been linked to the development and exacerbation of pain.7-9 Despite increasing empirical focus on pain and nicotine use reciprocity, a majority of this research to date has focused solely on relations between pain and combustible cigarette smoking. Use of electronic cigarettes (e-cigarettes) has drastically increased over the past decade,10, 11 co-use of cigarettes and e-cigarettes is increasingly common,12 and individuals with pain may be uniquely at risk for initiation and escalation of use/co-use of e-cigarettes and cigarettes.13-15 Therefore, the goal of this proposal is to conduct the first longitudinal study of pain and use/co- use of e-cigarettes and tobacco cigarettes utilizing four waves of nationally representative cohort data collected for the Population Assessment of Tobacco and Health (PATH) Study.16 First, the proposed study will assess whether smokers with co-occurring pain (vs. no/low pain) are more likely to initiate co-use of e-cigarettes. Second, pain will be examined as a prospective predictor of (a) likelihood of cigarette and e-cigarette use/co- use, and (b) trajectories of use/co-use over time. It is hypothesized that individuals with pain will be more likely to use e-cigarettes and/or cigarettes and will increase frequency and heaviness of use across all four waves. Finally, biological sex will be examined as a moderator of the hypothesized relationships, given known sex differences in both the experience of pain and nicotine consumption. Completion of this project may advance research and clinical practice by establishing pain as a significant, yet under-recognized risk factor in the onset and escalation of nicotine consumption (via cigarettes and/or e-cigarettes). This proposal is consistent with NIDA’s stated goal of understanding the complex interactions of factors, such as medical comorbidities, that influence drug use trajectories.17 This award would provide resources and protected time to further the applicant’s training in several key areas, including increasing knowledge of pain and use of alternative nicotine/tobacco products and learning skills relevant to analysis of population-level data and trajectory modeling. The trainings, workshops, and collaborations necessary to complete the proposed project aims would be otherwise unavailable through the applicant’s clinical psychology graduate studies and placement requirements. The applicant is committed to pursuing a career as an independent NIH-funded researcher, and aims to obtain a post-doctoral fellowship and subsequent faculty position that will allow her to pursue a programmatic line of multidisciplinary research in the rapidly emerging domain of pain and substance use.