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

项目总结/摘要 尼古丁/烟草使用和疼痛非常普遍，经常同时发生，并每年产生大量的 1 -4尼古丁的使用率在以下人群中要高得多： 患有共同发生的疼痛的人（与普通人群相比），1，2和实证研究已经阐明 疼痛与尼古丁/烟草使用/依赖之间的双向关联。尼古丁可引起急性 镇痛作用，5和疼痛可能是尼古丁/烟草用于疼痛应对的有力动机。6此外， 更多的尼古丁暴露与疼痛的发展和加剧有关。 经验集中在疼痛和尼古丁使用的相互作用，迄今为止，大多数这项研究只集中在 疼痛与吸烟的关系电子烟（Electronic Cigarettes） 在过去十年中急剧增加，10，11香烟和电子烟的共同使用越来越普遍，12 疼痛的个体可能是开始和升级使用/共同使用电子烟的唯一风险， 13 -15因此，本提案的目标是对疼痛和使用/共同使用进行首次纵向研究。 使用电子烟和烟草香烟，利用收集的四波全国代表性队列数据 16首先，拟议的研究将评估 同时存在疼痛（与无/低疼痛相比）的吸烟者是否更有可能开始同时使用电子烟。 其次，将检查疼痛作为（a）香烟和电子烟使用/共同使用的可能性的前瞻性预测因子。 使用，以及（B）随时间的使用/共同使用的轨迹。据推测，疼痛的个体更有可能 使用电子烟和/或香烟，并将增加所有四个波的使用频率和沉重程度。 最后，在已知性别的情况下，生物性别将作为假设关系的调节剂进行检查 疼痛和尼古丁摄入量的差异。这个项目的完成可能会提前 研究和临床实践，通过建立疼痛作为一个重要的，但认识不足的风险因素，在发病 尼古丁消耗量增加（通过香烟和/或电子烟）。这一提议符合 NIDA的既定目标是了解复杂的相互作用的因素，如医疗合并症， 17该奖项将提供资源和保护时间，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药物 尼古丁/烟草制品以及与分析人口数据和轨迹有关的学习技能 建模完成拟议项目目标所需的培训、研讨会和合作 将无法通过申请人的临床心理学研究生学习和安置 要求.申请人致力于追求职业生涯作为一个独立的NIH资助的研究人员， 旨在获得博士后奖学金和随后的教师职位，这将使她能够追求 在迅速兴起的疼痛和物质使用领域进行多学科研究的纲领性路线。

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.