The Role of Sleep Impairment in Associations Between Pain and Nicotine/Tobacco Dependence in Wave 6 of the Population Assessment of Tobacco and Health (PATH) Study

Tobacco use is a significant national health concern that frequently co-occurs with chronic pain. Both pain and use of nicotine/tobacco have been linked to greater sleep impairments (i.e., trouble initiating and maintaining sleep), and there is reason to believe that more severe pain may indirectly contribute to greater nicotine dependence via sleep impairments. Therefore, the goal of this study was to examine indirect associations between pain severity and nicotine dependence via sleep impairment severity among adults who use cigarettes and electronic nicotine delivery systems (ENDS). Data were drawn from Wave 6 (March – November 2021) of the Population Assessment of Tobacco and Health Study (PATH), limited to N = 9,682 (54% male; 22% ages 25–24; 77% White) participants who reported regular cigarette smoking and/or ENDS use. Pain severity and sleep impairment were assessed using single items, and nicotine/tobacco dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Results indicated positive indirect associations between pain severity and both tobacco and ENDS dependence via sleep impairment severity. Sleep impairment may play an important role in associations between pain severity and nicotine dependence among adults who use cigarettes or ENDS. These findings and future work may warrant the development of interventions that address sleep dysfunction to support nicotine and tobacco cessation, particularly among adults who experience pain.