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

I.项目总结/摘要 烟草使用是可预防的死亡和残疾的主要原因1， 经济负担2.据估计，美国13.7%的成年人目前吸烟3。然而， 烟草的使用在社会上分布不均匀。非裔美国人吸烟率上升 (14.6高达90%的非裔美国成年吸烟者使用薄荷醇香烟，而只有26%的非裔美国成年吸烟者使用薄荷醇香烟。 白色烟民4.与非西班牙裔相比，非裔美国人吸烟者不太可能保持戒烟 白色和西班牙裔吸烟者尽管戒烟人数更多。吸烟者，一般来说， 与不吸烟者相比，慢性疼痛患者的吸烟率高于 在一般人群中发现的比率7，8.事实上，具有全国代表性的调查数据表明， 吸烟在慢性疼痛患者中的流行率可能是在慢性疼痛患者中观察到的吸烟率的两倍。 总人口[26-42%对15%]9、10和非洲人吸烟率 患有慢性疼痛的美国人，由于他们的烟草使用率升高，可能会更高3。过去的工作也 表明非洲裔美国人报告疼痛阈值较低11，对疼痛的耐受性较低12，13，以及 与疼痛有关的严重残疾14.因此，公共卫生迫切需要更好地了解烟草- 非裔美国人薄荷醇吸烟者与慢性疼痛的关系。疼痛相关的焦虑，这反映了 对疼痛相关躯体感觉的关注15，可能是一个未被认识到的个体差异因素， 可能有助于了解非裔美国人薄荷醇吸烟者的吸烟维持和复发， 慢性疼痛疼痛相关的焦虑可能是这一组非洲人吸烟行为的预测 美国人越来越意识到令人厌恶的躯体症状的负面后果， 身体疾病，如疼痛16，17。因此，本项目的目的是了解 使用多模式评估吸烟行为的疼痛相关焦虑在吸烟失效方面的作用 (via地形图和自我报告）。本提案的目的是为了表明 临床上可延展的个体差异因子（即，疼痛相关的焦虑）的非裔美国人薄荷烟吸烟者 慢性疼痛。实现这些目标将具有重大的公共卫生意义，因为它们代表着进步 走向精确的医学方法戒烟，并可能导致文化的发展， 为患有慢性疼痛的非裔美国薄荷醇吸烟者量身定制的干预措施， 与疼痛有关的焦虑。

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.