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

Julianna Lazzari; Dana Rubenstein; Jessica M Powers; Francis J Keefe; F Joseph McClernon; Lauren R Pacek; Maggie M Sweitzer

doi:10.1016/j.amepre.2025.108251

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

Am J Prev Med. 2025 Dec 26:108251. doi: 10.1016/j.amepre.2025.108251. Online ahead of print.

Authors

Julianna Lazzari¹, Dana Rubenstein¹, Jessica M Powers², Francis J Keefe¹, F Joseph McClernon¹, Lauren R Pacek³, Maggie M Sweitzer⁴

Affiliations

¹ Duke University School of Medicine (Durham, NC.
² Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine (Chicago, IL.
³ Rutgers Robert Wood Johnson Medical School (New Brunswick, NJ; Rutgers Institute for Nicotine & Tobacco Studies (New Brunswick, NJ.
⁴ Duke University School of Medicine (Durham, NC. Electronic address: maggie.sweitzer@duke.edu.

PMID: 41456621
DOI: 10.1016/j.amepre.2025.108251

Abstract

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.