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Back pain is a chronic disease epidemic and the most common chronic painful condition in Americans. It is associated with human suffering and enormous financial and social burdens. Smoking is a prevalent and harmful health behavior and is the greatest modifiable risk factor for many chronic diseases. Cigarette smoking is associated with back pain, but there is little research on this relationship among adults in the United States. Using biopsychosocial theory, this study examined (a) the prevalence of back pain (dependent variable) among smokers, former smokers, and never smokers (independent variable), and (b) the influence of age, sex, race, body mass index, level of physical activity, level of education, depression, and anxiety on predicting the likelihood of back pain. This cross-sectional secondary analysis of the 2012 National Health Interview Survey included over 34,000 respondents and utilized chi-square distribution, t test, one-way analysis of variance, and multiple logistic regression analysis. People who self-reported being anxious or worried, had been diagnosed with depression by a health care provider, were current or former smokers, obese, or failed to meet recommended levels of physical activity were more likely to have back pain. This study has implications for social change in the United States because it shows that anxiousness, depression, smoking, obesity, and low physical activity are risk factors for back pain in Americans. Further, it indexes the need for primary studies of the relationship between smoking and back pain to determine whether smoking is causal for back pain. These studies could lead to public health interventions that develop strategies to prevent back pain and thereby alleviate some of the social burden associated with this common and costly ailment.