Bidirectional relationships between cigarette use and spinal pain in adolescents accounting for psychosocial functioning

Objectives The objective of this study was to determine the presence of possible bidirectional causal pathways between cigarette use and spinal pain in adolescents controlling for psychosocial functioning, using a prospective longitudinal research design. Design The data for this study was collected from a cohort of Australian adolescents at 14 (n = 1596) and 17 (n = 1291) years of age. Methods Multivariable logistic regression was used to assess i) if cigarette use at 14 predicted low back pain ( LBP ), mid back pain ( MBP ) or neck shoulder pain ( NSP ) at 17 in those adolescents without each condition at 14, and ii) if back pain only ( BP ), neck shoulder pain only ( NSP ) or comorbid BP and NSP at 14 predicted cigarette use at 17 in those adolescents who did not smoke at 14. Results After controlling for psychosocial factors, cigarette use at 14 predicted MBP at 17 ( OR = 3.05, p = 0.049, 95% CI [1.01‐9.24]). BP only at 14 was a significant risk factor for smoking at 17 ( OR = 1.84, p = 0.006, 95% CI [1.19‐2.84]) after controlling for psychosocial factors. Conclusion The findings indicate that there are bi‐directional relationships between cigarette use and spinal pain and that these relationships vary with pain location. Statement of contribution What is already known about the subject? Cigarette use, psychosocial problems and spinal pain are common in adolescents and evidence suggests bi‐directional relationships. What does this study add? Cigarette use, psychosocial problems and spinal pain are correlated in adolescents. BP only at 14 years of age predicted cigarette use at 17 years of age after controlling for psychosocial factors. Cigarette use at 14 years of age predicted mid BP at 17 years of age after controlling for psychosocial factors.