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

一、项目摘要/摘要 烟草使用是可预防的死亡和残疾的主要原因1，并导致大量 经济负担2.据估计，美国有13.7%的成年人是目前吸烟者。然而， 烟草的使用在社会上分布不均。非裔美国吸烟者吸烟率上升 (14.6%)3%和高达90%的非裔美国成年吸烟者使用薄荷醇香烟，而只有26%的非洲裔美国人吸烟者使用薄荷醇香烟 白人吸烟者4。与非西班牙裔吸烟者相比，非裔美国吸烟者保持戒烟的可能性较小 白人和西班牙裔吸烟者，尽管戒烟尝试更多。一般来说，吸烟者报告的疼痛更大。 6与不吸烟者相比，慢性疼痛患者的吸烟率高于 在普通人群中发现的比率7，8。事实上，具有全国代表性的调查数据表明 慢性疼痛患者中吸烟的流行率可能超过#年观察到的两倍。 总人口[26-42%，而不是15%]9，10和非洲吸烟率 患有慢性疼痛的美国人可能会更高，因为他们的烟草使用率很高。过去的工作也是 表明非裔美国人报告的疼痛阈值较低，对疼痛的耐受性较低，以及 更大的疼痛相关的残疾14。因此，公共卫生迫切需要更好地了解烟草-- 患有慢性疼痛的非裔美国人薄荷醇吸烟者之间的疼痛关系。疼痛相关的焦虑，这反映了 对疼痛相关的躯体感觉15的担忧，可能是一个被低估的个体差异因素， 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预示着这一非洲人的吸烟减少行为 美国人越来越多地意识到令人厌恶的躯体症状和 身体疾病，如疼痛症状16，17.因此，当前项目的目的是了解 使用吸烟行为的多模式评估，疼痛相关焦虑在吸烟减少方面的作用 (通过地形和自我报告)。这项提议的目的是为了证明 非裔美国人薄荷醇吸烟者的临床可延展性个体差异因素(即疼痛相关焦虑) 伴随着慢性疼痛。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 走向戒烟的精准医学方法，并可能导致文化上的发展 为患有慢性疼痛的非裔美国人薄荷醇吸烟者量身定做的干预措施 疼痛相关焦虑的结构。

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.