Association between pain and e-cigarette use stratified by cigarette smoking status: Results from National Health Interview Survey (NHIS) 2019-2020

Introduction: Previous studies have shown frequent co-morbidities between pain and tobacco use. However, the investigation in use of e-cigarettes, a relatively new tobacco product, at the intersection of pain and cigarette smoking is still lacking. This study used a US national dataset to examine associations between pain experience (pain lasting 3 months) and e-cigarette use, stratified by cigarette smoking status.Methods: This study used a pooled dataset of the 2019 and 2020 National Health Interview Survey (NHIS) (N = 63,565). We estimated multivariable binomial logistic regressions predicting current e-cigarette use by pain experience, after controlling for survey year, age, sex, race/ethnicity, sexual orientation, education level, health insurance status, other tobacco use, diagnosis of anxiety and depression, use of pain management methods (e.g., physical therapy, behavioral therapy), and prescribed opioid pain reliever use among the overall population, and stratified by cigarette smoking status - never, former, and current cigarette smoking.Results: After controlling for covariates, past-3-month pain experience was associated with current e-cigarette use (aOR = 1.26; 95 % CI = 1.08, 1.46) in the overall population. When stratified by current cigarette smoking, pain experience was associated with current e-cigarette use among current combustible cigarette smokers (aOR = 1.62, 95 % CI = 1.20, 2.18). However, there was no significant difference in e-cigarette use by pain experience among non-current cigarette smokers (p = 0.103).Conclusions: We observed a higher likelihood of e-cigarette use among US adults experiencing pain. Future studies are needed to investigate mechanisms linking pain and e-cigarette use to inform smoking/vaping pre-vention and cessation interventions.

Automated summary

Previous studies have shown a link between pain and tobacco use, but the relationship between pain, smoking, and e-cigarette use is still not well understood. This study examined the association between pain experience and e-cigarette use using a national dataset in the US, stratified by smoking status. The results showed that pain experience was associated with current e-cigarette use, but there was no significant difference among non-smokers.