Prevalence of Tobacco Use in Adults with Chronic Pain: Results from the National Health Interview Survey 2014-2023.

INTRODUCTION: Chronic pain is linked to elevated tobacco use, but long-term trends in combustible smoking and e-cigarette use in this group remain unclear. Understanding these trajectories is vital for designing effective public health interventions. This study examined national trends in exclusive cigarette smoking (E-CS), exclusive e-cigarette use (E-EC), and dual use (2014-2023) among United States (U.S.) adults with and without chronic pain. METHODS: This was a serial cross-sectional analysis using 2014-2023 (excluding 2022) National Health Interview Survey data from 195,632 U.S. adults. Chronic pain (yes/no) was defined by self-reported pain frequency (past 3 months): "everyday" or "most days" versus "some days" or "never". Primary outcomes were E-CS, E-EC, and dual use prevalence by pain status and year, assessed via logistic regression. Secondary analyses examined pain frequency (continuous) and high-impact chronic pain (yes/no). Analyses were conducted in 2025. RESULTS: E-CS prevalence was significantly higher and declined more slowly among individuals with chronic pain (17.7%-2014, 13.1%-2023) versus without (12.5%-2014, 7.5%-2023; p<0.001). Adjusting for age, sex, and race/ethnicity, both E-EC and dual use prevalence were higher in the chronic pain group across all years. E-EC use increased at similar rates among individuals with (1.4%-2014, 5.6%-2023) and without (1.2%-2014, 4.5%-2023; p's<0.001) chronic pain; dual use prevalence declined at similar rates among individuals with (4.6%-2014, 2.7%-2023) and without (2.3%-2014, 1.5%-2023) chronic pain. CONCLUSIONS: While U.S. E-CS prevalence has decreased, individuals with chronic pain remain disproportionately impacted, emphasizing the need for targeted tobacco interventions.

Duke Scholars

Author Maggie Sweitzer Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...