Bidirectional associations between pain and e-cigarette use among young adults using data from PATH Waves 7 and 7.5

E-cigarette use and pain commonly co-occur in young adulthood, yet little is known about their temporal association, particularly in both directions. This study examined bidirectional prospective associations between past-week pain severity and current established e-cigarette use in a national sample of young adults.

Participants were 5495 young adults aged 18 to 22 who completed both Wave 7 (2022-2023) and Wave 7.5 (2023) of the Population Assessment of Tobacco and Health Study, approximately 6 months apart. Two baseline-adjusted prospective regression models were estimated, one testing the e-cigarette-to-pain direction and the other testing the pain-to-e-cigarette direction, adjusting for the Wave 7 value of each outcome, sex, race/ethnicity, current other tobacco product use, past 30-day alcohol use, and past 30-day cannabis use.

Current established e-cigarette use at Wave 7 was associated with greater past-week pain severity at Wave 7.5 (B = 0.30, SE = 0.10, p = 0.003). Greater past-week pain severity at Wave 7 was associated with increased odds of current established e-cigarette use at Wave 7.5 (aOR = 1.06, 95 % CI [1.01, 1.13], p = 0.032).

Findings support bidirectional prospective associations between past-week pain severity and current established e-cigarette use in young adults. Effects were modest, and results should not be interpreted as causal. E-cigarette prevention and cessation efforts may benefit from considering pain as a factor associated with persistent use or difficulty quitting while clinical care for young adults with pain may benefit from considering e-cigarette use when identifying factors associated with greater pain severity.