Skip to main content
SpringerLink
Log in

Smoking behavior among adult childhood cancer survivors: what are we missing?

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Childhood cancer survivors are a growing population at increased risk for smoking-related health complications. This study compared smoking prevalence, age at smoking initiation, and time trend of smoking prevalence from 1997 to 2010 between adult survivors of childhood cancer and adults without a cancer history (controls) and identified predictors of smoking among these survivors.

Methods

Data were pooled from the 1997–2010 National Health Interview Survey (survivors, n = 1438; controls, n = 383,805). Smoking prevalence by age group was calculated using weighted least square regression analysis and weighted linear regression of prevalence on year for trend analysis. Logistic regression analyses adjusting for sample weights and design effects were performed to identify predictors of smoking among survivors.

Results

Compared to controls, survivors were significantly more likely to be younger, female, non-Hispanic White, unemployed, with lower income, and to weigh less and smoke more. Survivors initiated smoking earlier than controls. Smoking prevalence among survivors peaked at age 30 and 40 years old, compared to age 25 years in controls. Smoking prevalence decreased consistently from 1997 to 2010 among controls, with larger significant declines in survivors that were subject to more year-to-year variability. Compared to nonsmoking survivors, those who smoke were significantly more likely to be non-Hispanic White, young, uninsured, poor, to have a high school education or less, and to report drinking alcohol.

Conclusion

Smoking in adult survivors of childhood cancer continues as a persistent risk factor across socioeconomic groups.

Implications for Cancer Survivors

Targeted and tailored smoking cessation/prevention interventions for these survivors are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ward E et al. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):83–103.

    Article  PubMed  Google Scholar 

  2. Jemal A et al. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225–49.

    Article  PubMed  Google Scholar 

  3. Armstrong GT et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27(14):2328–38.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Hudson MM et al. Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. JAMA. 2003;290(12):1583–92.

    Article  PubMed  CAS  Google Scholar 

  5. Ness KK, Gurney JG. Adverse late effects of childhood cancer and its treatment on health and performance. Annu Rev Public Health. 2007;28:279–302.

    Article  PubMed  Google Scholar 

  6. Ness KK et al. Physical performance limitations and participation restrictions among cancer survivors: a population-based study. Ann Epidemiol. 2006;16(3):197–205.

    Article  PubMed  Google Scholar 

  7. Hudson MM et al. Clinical ascertainment of health outcomes among adults treated for childhood cancer. JAMA. 2013;309(22):2371–81.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Mertens AC et al. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2008;100(19):1368–79.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Benoist MR et al. Effects of pulmonary function of whole lung irradiation for Wilm’s tumour in children. Thorax. 1982;37(3):175–80.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. O’Driscoll BR et al. Active lung fibrosis up to 17 years after chemotherapy with carmustine (BCNU) in childhood. N Engl J Med. 1990;323(6):378–82.

    Article  PubMed  Google Scholar 

  11. Lipshultz SE et al. Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med. 1991;324(12):808–15.

    Article  PubMed  CAS  Google Scholar 

  12. Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000–2004. MMWR Morb Mortal Wkly Rep 2008. 57(45): p. 1226–8.

  13. Fiore MC et al. eds. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. ed. A.f.H.R.a. Quality. 2008, U.S. Department of Health and Human Services Rockville, MD.

  14. USDHHS. The health consequences of smoking-50 years of progress: a report of the surgeon general. Chapter 13: patterns of tobacco use among U.S. Youth, young adults, and adults 2014. 2014; Available from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/exec-summary.pdf.

  15. Oestreicher P. Cancer survivors’ health behaviors present challenges and teachable moments for oncology nurses. ONS Connect. 2007;22(5):20–1.

    Google Scholar 

  16. Cox LS et al. Nicotine dependence treatment for patients with cancer. Cancer. 2003;98(3):632–44.

    Article  PubMed  Google Scholar 

  17. Emmons K et al. Predictors of smoking initiation and cessation among childhood cancer survivors: a report from the childhood cancer survivor study. J Clin Oncol. 2002;20(6):1608–16.

    Article  PubMed  Google Scholar 

  18. Foster MC et al. Tobacco use in adult long-term survivors of retinoblastoma. Cancer Epidemiol Biomarkers Prev. 2006;15(8):1464–8.

    Article  PubMed  CAS  Google Scholar 

  19. Haupt R et al. Smoking habits in survivors of childhood and adolescent cancer. Med Pediatr Oncol. 1992;20(4):301–6.

    Article  PubMed  CAS  Google Scholar 

  20. Tao ML et al. Smoking in adult survivors of childhood acute lymphoblastic leukemia. J Natl Cancer Inst. 1998;90(3):219–25.

    Article  PubMed  CAS  Google Scholar 

  21. Bauld C et al. Health-risk behaviours among adolescent survivors of childhood cancer. Pediatr Blood Cancer. 2005;45(5):706–15.

    Article  PubMed  Google Scholar 

  22. Larcombe I, Mott M, Hunt L. Lifestyle behaviours of young adult survivors of childhood cancer. Br J Cancer. 2002;87(11):1204–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  23. Carswell K et al. Smoking and binge drinking among Canadian survivors of childhood and adolescent cancers: a comparative, population-based study. Pediatr Blood Cancer. 2008;51(2):280–7.

    Article  PubMed  Google Scholar 

  24. Troyer H, Holmes GE. Cigarette smoking among childhood cancer survivors. Am J Dis Child. 1988;142(2):123.

    Google Scholar 

  25. Verrill JR et al. Aggression, antisocial behavior, and substance abuse in survivors of pediatric cancer: possible protective effects of cancer and its treatment. J Pediatr Psychol. 2000;25(7):493–502.

    Article  PubMed  CAS  Google Scholar 

  26. Corkery JC et al. Kids who really shouldn’t smoke. N Engl J Med. 1979;300(22):1279.

    PubMed  CAS  Google Scholar 

  27. Emmons KM et al. Smoking among participants in the childhood cancer survivors cohort: the Partnership for Health Study. J Clin Oncol. 2003;21(2):189–96.

    Article  PubMed  Google Scholar 

  28. Massey JT et al. Design and estimation for the national health interview survey 1985–94. Vital and health statistics. series 2: data evaluation and methods research, 1989(110): p. 1–33.

  29. Fowler Jr FJ. The redesign of the National Health Interview Survey. Public Health Rep. 1996;111(6):508.

    PubMed  PubMed Central  Google Scholar 

  30. US Department of Health and Human Services. Healthy people 2010 operational definition. November 4, 2014]; Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/DATA2010/Focusarea22/O2202.pdf.

  31. Jensen MD et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. J Am Coll Cardiol 2013.

  32. Shah BV. SUDAAN user’s manual: professional software for survey data analysis for multi-stage sample designs: release 6.0, 1992. 1992: research triangle institute.

  33. Botman SL, Jack SS. Combining national health interview survey datasets: issues and approaches. Stat Med. 1995;14(5–7):669–77.

    Article  PubMed  CAS  Google Scholar 

  34. Incidence of initiation of cigarette smoking--United States, 1965–1996. MMWR Morb Mortal Wkly Rep, 1998. 47(39): p. 837–40.

  35. Taylor A et al. Long‐term follow‐up of survivors of childhood cancer in the UK. Pediatr Blood Cancer. 2004;42(2):161–8.

    Article  PubMed  Google Scholar 

  36. Mulhern RK et al. Health-related behaviors of survivors of childhood cancer. Med Pediatr Oncol. 1995;25(3):159–65.

    Article  PubMed  CAS  Google Scholar 

  37. Castellino SM et al. Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study. J Clin Oncol. 2005;23(27):6499–507.

    Article  PubMed  Google Scholar 

  38. Demark-Wahnefried W et al. Survivors of childhood cancer and their guardians. Cancer. 2005;103(10):2171–80.

    Article  PubMed  Google Scholar 

  39. Hawkins RP et al. Understanding tailoring in communicating about health. Health Educ Res. 2008;23(3):454–66.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Flay BR et al. Differential influence of parental smoking and friends’ smoking on adolescent initiation and escalation of smoking. J Health Soc Behav. 1994;35(3):248–65.

    Article  PubMed  CAS  Google Scholar 

  41. De Moor JS et al. Availability of smoking prevention and cessation services for childhood cancer survivors. Cancer Causes Control. 2007;18(4):423–30.

    Article  PubMed  Google Scholar 

  42. Ruhm CJ. Are recessions good for your health? 1996, National bureau of economic research.

  43. McClure CB et al. Economic crisis and smoking behaviour: prospective cohort study in Iceland. BMJ Open 2012 2(5).

  44. Reh M. Policy board recommends raising prices to cut tobacco use. J Natl Cancer Inst. 1998;90(3):190–2.

    Article  PubMed  CAS  Google Scholar 

  45. Laaksonen M et al. Socioeconomic status and smoking Analysing inequalities with multiple indicators. Eur J Pub Health. 2005;15(3):262–9.

    Article  Google Scholar 

  46. Cavelaars AE et al. Educational differences in smoking: international comparison. BMJ. 2000;320(7242):1102–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  47. Ross CE, Mirowsky J. Does employment affect health? J Health Soc Behav 1995: p. 230–243.

  48. Koocher GP, O’Malley JE. The damocles syndrome: psychosocial consequences of surviving childhood cancer. New York: McGraw-Hill; 1981.

    Google Scholar 

  49. Feldman FL, McBroom E, Roberts RW. Work and cancer health histories: work expectations and experiences of youth with cancer histories (ages 13–23). 1980: California Division, American Cancer Society.

  50. Park ER et al. Health insurance coverage in survivors of childhood cancer: the Childhood Cancer Survivor Study. J Clin Oncol. 2005;23(36):9187–97.

    Article  PubMed  Google Scholar 

  51. Virgo KS et al. Health care policy and cancer survivorship. Cancer. 2013;119:2187–99.

    Article  PubMed  Google Scholar 

  52. Land T et al. Medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in smoking prevalence. PLoS One. 2010;5(3), e9770.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Funding for this study was provided by the Bankhead Coley Cancer Research grant 1BG06-341963 (P.I. Dr. Lee); European Regional Development Fund and European Social Fund to the University of Exeter Medical School (PI Dr Fleming).

This submitted manuscript or any similar manuscript has not been published anywhere, in whole or in part, previously and it is not simultaneously being considered for any other publication. Approval from all coauthors was obtained prior to submission.

Conflict of interest

None of the authors have any proprietary interests or conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA

    Taghrid Asfar, Noella A. Dietz, Kristopher L. Arheart, Lora E. Fleming & David J. Lee

  2. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Noella A. Dietz, Stacey L. Tannenbaum, Laura A. McClure & David J. Lee

  3. European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK

    Lora E. Fleming

Authors
  1. Taghrid Asfar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Noella A. Dietz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristopher L. Arheart
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stacey L. Tannenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura A. McClure
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lora E. Fleming
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David J. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taghrid Asfar.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Figure S1

(DOCX 42 kb)

Figure S2

(DOCX 51 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Asfar, T., Dietz, N.A., Arheart, K.L. et al. Smoking behavior among adult childhood cancer survivors: what are we missing?. J Cancer Surviv 10, 131–141 (2016). https://doi.org/10.1007/s11764-015-0459-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-015-0459-6

Keywords

Search

Navigation