African Americans who smoke cigarettes are at high risk for tobacco-related diseases (Oshunbade et al., 2021). Data from the 2017 National Health Interview Survey indicate that non-Hispanic African Americans who attempt to quit smoking cigarettes are less successful than White, Asian, and Hispanic people who smoke (U.S. Department of Health and Human Services, 2020). Given the high rates of smoking-related health issues, it is important to consider important factors that complicate or impede quit attempts for this group.

Comorbid smoking among individuals with anxiety disorders is high (30–40% depending on the diagnosis; Smith et al., 2020). According to negative reinforcement models of smoking, individuals with anxiety smoke to relieve negative affect and anxiety symptoms that arise during withdrawal (Baker et al., 2004; for review, see Tidey and Miller, 2015). Furthermore, individuals who smoke and have anxiety experience more severe withdrawal than those without anxiety, contributing to greater smoking recurrence during quit attempts (Piper et al., 2011). Existing research has found that different anxiety-related disorders (e.g. social anxiety, panic, and posttraumatic stress disorder [PTSD]) may vary in the prevalence, severity of dependence, age of smoking onset, and context-related smoking urges among people who smoke (Beckham et al., 1997, Buckner and Vinci, 2013, Cougle et al., 2010, Farris et al., 2015, Lasser et al., 2000, Mahaffey et al., 2016, Tidey and Miller, 2015, Zvolensky et al., 2005), making it important to study each symptom type separately. Of the various anxiety-related disorders, social anxiety, PTSD, and panic disorder are highly prevalent and tend to have consistent associations with smoking (Smith et al., 2020). While specific phobias (e.g., spiders, claustrophobia) are also associated with smoking (Smith et al., 2020), these syndromes are case-dependent and thus less promising targets for translational research on anxiety-smoking comorbidity.

The research on anxiety symptoms and smoking in African Americans is scant. There is a documented history of underdiagnosis and treatment of anxiety disorders among African Americans compared to Whites (Stockdale et al., 2008). Few studies have examined smoking and anxiety among African Americans, with only one study with a majority-Black sample investigating anxiety and general cessation barriers. This study found that anxiety symptoms are associated with greater barriers to quitting (Zvolensky et al., 2017). However, it is unknown whether these findings would generalize to samples of only African Americans, and how examining specific types of anxiety symptoms and barriers to cessation may affect these findings.

The barriers to cessation construct may identify why individuals who smoke cigarettes find quitting to be difficult and can be an important target for improving quit attempt outcomes in addition to anxiety symptoms. Three main personal barrier components have been identified in this construct: internal barriers (i.e., ability to regulate emotion, coping), external barriers (i.e., peer influence, social support), and addiction barriers to cessation (i.e., nicotine dependence, withdrawal symptoms; Macnee and Talsma, 1995). This construct has been identified as a valid predictor of quit attempt outcomes (Macnee and Talsma, 1995), emphasizing its utility in clinical settings and individually-informed treatments. One study examined perceived barriers to quitting among African Americans who smoke cigarettes, finding external (i.e., social) barriers to be especially prevalent (Stillman et al., 2007). Whether anxiety symptoms may have influenced these findings is unknown, but it is important to investigate this topic further to better develop interventions that potentially address the anxiety-smoking comorbidity in African Americans.

The current cross-sectional correlational study of non-treatment seeking African Americans who smoke aims to test the following hypotheses: (1) Based on negative reinforcement models of addictions (e.g., Baker et al., 2004; Tidey and Miller, 2015), we hypothesized that all anxiety-related (panic, social anxiety, and traumatic stress) symptoms will be associated with internal barriers to cessation. (2) Because individuals who smoke and experience anxiety may have more severe withdrawal symptoms or affective distress during cessation (e.g., Baker et al., 2004; Piper et al., 2011), we hypothesized that all anxiety symptom types will be associated with addiction barriers to cessation. Additionally, prior research has found that relative to social anxiety and panic disorder, smoking outcomes such as nicotine dependence are more strongly associated with PTSD (Cougle et al., 2010). Furthermore, PTSD symptoms (e.g., re-experiencing) have been associated with smoking for both positive and negative reinforcement motives (Mathew et al., 2015). Thus, we tentatively expect that the associations of addiction barriers with trauma-related symptoms will be particularly strong among the symptoms assessed. (3) Because peer acceptance and social pressure play key roles in social anxiety disorder (Stein and Stein, 2008), we hypothesized that social anxiety symptoms will be associated with external barriers to cessation.