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

Abstract

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, exclusive E-cigarette use, and dual use (2014-2023) among U.S. adults with and without chronic pain. 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): every day or most days versus some days or never. Primary outcomes were exclusive cigarette smoking, exclusive E-cigarette use, and dual use prevalence by pain status and year, assessed through logistic regression. Secondary analyses examined pain frequency (continuous) and high-impact chronic pain (yes/no). Analyses were conducted in 2025. Exclusive cigarette smoking prevalence was significantly higher and declined more slowly among individuals with chronic pain (17.7% in 2014 and 13.1% in 2023) than among those without (12.5% in 2014 and 7.5% in 2023; p<0.001). Adjusting for age, sex/gender, and race/ethnicity, both exclusive E-cigarette use and dual use prevalence were higher in the chronic pain group across all years. Exclusive E-cigarette use increased at similar rates among individuals with (1.4% in 2014 and 5.6% in 2023) and without (1.2% in 2014 and 4.5% in 2023; ps<0.001) chronic pain; dual use prevalence declined at similar rates among individuals with (4.6% in 2014 and 2.7% in 2023) and without (2.3% in 2014 and 1.5% in 2023) chronic pain. Although U.S. exclusive cigarette smoking prevalence has decreased, individuals with chronic pain remain disproportionately impacted, emphasizing the need for targeted tobacco interventions.