Date of Award

December 2016

Degree Type


Degree Name

Master of Science (MS)




Joseph W. Ditre


Cessation, Pain, Pain-related anxiety, Smoking, Tobacco

Subject Categories

Social and Behavioral Sciences


Pain-related anxiety has been positively associated with tobacco dependence, smoking motives, self-reported barriers to smoking cessation, and expectancies for negative affect reduction via smoking. Although emerging research suggests that pain-related anxiety may play a role in the maintenance of tobacco dependence, no previous work has examined pain-related anxiety as a predictor of smoking cessation outcomes. The goal of the current study was to test the hypothesis that pain-related anxiety would predict early lapse and relapse to cigarette smoking among a sample of 55 daily tobacco smokers who participated in an unaided cessation attempt (i.e., without psychosocial or pharmacological intervention). Pain-related anxiety was assessed at baseline using the PASS-20, which yields a total score that ranges from 0-100. Number of days to early lapse (i.e., any instance of smoking during the first 14 days post-quit) and early relapse (i.e., 7 consecutive days of smoking that began during the first 28 days post-quit) were assessed using timeline follow-back procedures. Cox regression analyses indicated that pain-related anxiety was a significant predictor of both early smoking lapse and relapse, such that for every one point increase on the PASS-20, the risk of early lapse increased by 3.7% and the risk of early relapse increased by 3.6%. These effects were evident above and beyond the variance accounted for by tobacco dependence, past four-week pain severity, anxiety sensitivity, and the presence of current Axis I psychopathology. Kaplan-Meier survival analyses further revealed that among early lapsers, greater pain-related anxiety predicted a more rapid trajectory to lapse. Pain-related anxiety was also shown to be a significant predictor of early lapse when the sample was limited to smokers who endorsed past four-week pain. These findings lend support to the notion that pain-related anxiety may contribute to the maintenance of tobacco dependence among smokers who experience varying levels of pain intensity.


Open Access