Journal of Cancer Survivorship

, Volume 4, Issue 4, pp 313–321 | Cite as

Disparities in smoking and cessation status among cancer survivors and non-cancer individuals: a population-based study from National Health and Nutrition Examination Survey

  • Tung-Sung TsengEmail author
  • Hui-Yi Lin
  • Michelle Y. Martin
  • Ted Chen
  • Edward E. Partridge



Continued smoking after a cancer diagnosis is a critical problem. This study examined smoking prevalence among all and specific cancer survivors, and compared demographic profiles of the current smokers between cancer and non-cancer individuals.


We used data from 2,188 cancer survivors and 22,441 non-cancer individuals who participated in the 10-year National Health and Nutrition Examination Survey (NHANES 1999–2008). All analyses were weighted to represent the United States population.


The current smoking rates decreased as age increased in both cancer and non-cancer populations. The smoking rate was higher in young cancer survivors (age <=40) than in young non-cancer individuals. The cervical, colon cancer and melanoma survivors had higher age-adjusted smoking rates than survivors of other cancers. For non-cancer individuals, the results showed that poorer white males with lower educational levels, with widowed, divorced, or separated marital status, who were underweight and had at least 12 alcoholic beverages a year, were more likely to be current smokers.


We can observe that age, race, education, marital status, and year since cancer diagnosis were important predictors of smoking status in cancer survivors based on the results of multivariable modeling and comparisons of age-adjusted smoking rates in specific cancer sub-groups. This implies that developing smoking cessation programs for cervical cancer and melanoma is of particularly high priority because survivors of these cancers had relatively high smoking rates and low quit smoking rates after diagnosis. These efforts should improve their quality of life and health status as well as reduce smoking-related health disparities.


Cancer survivor Tobacco control Disparity 



We appreciate anonymous reviewers for helpful suggestions and comments.


  1. 1.
    Marshall L, Schooley M, Ryan H, Cox P, Easton A, Healton C, et al. Youth tobacco surveillance–United States, 2001–2002. MMWR Surveill Summ. 2006;55:1–56.PubMedGoogle Scholar
  2. 2.
    A Report of the Surgeon General. Executive summary. Tobacco use among U.S. racial/ethnic minority groups–African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, Hispanics. MMWR Recomm Rep. 1998;47:1–16.Google Scholar
  3. 3.
    American Cancer Society. Cancer Facts & Figures 2007. Atlanta: American Cancer Society; 2007.Google Scholar
  4. 4.
    Hamajima N, Hirose K, Tajima K, Rohan T, Calle EE, Heath Jr CW, et al. Alcohol, tobacco and breast cancer–collaborative reanalysis of individual data from 53 epidemiological studies, including 58, 515 women with breast cancer and 95, 067 women without the disease. Br J Cancer. 2002;87:1234–45.CrossRefPubMedGoogle Scholar
  5. 5.
    Baron JA. Smoking and estrogen-related disease. Am J Epidemiol. 1984;119:9–22.PubMedGoogle Scholar
  6. 6.
    Fink AK, Lash TL. A null association between smoking during pregnancy and breast cancer using Massachusetts registry data (United States). Cancer Causes Control. 2003;14:497–503.CrossRefPubMedGoogle Scholar
  7. 7.
    Cui Y, Miller AB, Rohan TE. Cigarette smoking and breast cancer risk: update of a prospective cohort study. Breast Cancer Res Treat. 2006;100:293–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Nagata C, Mizoue T, Tanaka K, Tsuji I, Wakai K, Inoue M, et al. Tobacco smoking and breast cancer risk: an evaluation based on a systematic review of epidemiological evidence among the Japanese population. Jpn J Clin Oncol. 2006;36:387–94.CrossRefPubMedGoogle Scholar
  9. 9.
    Gram IT, Braaten T, Terry PD, Sasco AJ, Adami HO, Lund E, et al. Breast cancer risk among women who start smoking as teenagers. Cancer Epidemiol Biomark Prev. 2005;14:61–6.Google Scholar
  10. 10.
    Fentiman IS, Allen DS, Hamed H. Smoking and prognosis in women with breast cancer. Int J Clin Pract. 2005;59:1051–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Manjer J, Andersson I, Berglund G, Bondesson L, Garne JP, Janzon L, et al. Survival of women with breast cancer in relation to smoking. Eur J Surg. 2000;166:852–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.CrossRefPubMedGoogle Scholar
  13. 13.
    Ostroff JS, Jacobsen PB, Moadel AB, Spiro RH, Shah JP, Strong EW, et al. Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer. Cancer. 1995;75:569–76.CrossRefPubMedGoogle Scholar
  14. 14.
    Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer. 2000;88:674–84.CrossRefPubMedGoogle Scholar
  15. 15.
    Mayer DK, Terrin NC, Menon U, Kreps GL, McCance K, Parsons SK, et al. Health behaviors in cancer survivors. Oncol Nurs Forum. 2007;34:643–51.CrossRefPubMedGoogle Scholar
  16. 16.
    Eakin EG, Youlden DR, Baade PD, Lawler SP, Reeves MM, Heyworth JS, et al. Health behaviors of cancer survivors: data from an Australian population-based survey. Cancer Causes Control. 2007;18:881–94.CrossRefPubMedGoogle Scholar
  17. 17.
    Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005;23:8884–93.CrossRefPubMedGoogle Scholar
  18. 18.
    Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci. 2003;58:82–91.PubMedGoogle Scholar
  19. 19.
    Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med. 2005;40:702–11.CrossRefPubMedGoogle Scholar
  20. 20.
    Cox LS, Africano NL, Tercyak KP, Taylor KL. Nicotine dependence treatment for patients with cancer. Cancer. 2003;98:632–44.CrossRefPubMedGoogle Scholar
  21. 21.
    Yu GP, Ostroff JS, Zhang ZF, Tang J, Schantz SP. Smoking history and cancer patient survival: a hospital cancer registry study. Cancer Detect Prev. 1997;21:497–509.PubMedGoogle Scholar
  22. 22.
    Richardson GE, Tucker MA, Venzon DJ, Linnoila RI, Phelps R, Phares JC, et al. Smoking cessation after successful treatment of small-cell lung cancer is associated with fewer smoking-related second primary cancers. Ann Intern Med. 1993;119:383–90.PubMedGoogle Scholar
  23. 23.
    Clark TG, Murphy MF, Hey K, Drury M, Cheng KK, Aveyard P. Does smoking influence survival in cancer patients through effects on respiratory and vascular disease? Eur J Cancer Prev. 2006;15:87–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Aveyard P, Adab P, Cheng KK, Wallace DM, Hey K, Murphy MF. Does smoking status influence the prognosis of bladder cancer? A systematic review. BJU Int. 2002;90:228–39.CrossRefPubMedGoogle Scholar
  25. 25.
    Khuri FR, Kim ES, Lee JJ, Winn RJ, Benner SE, Lippman SM, et al. The impact of smoking status, disease stage, and index tumor site on second primary tumor incidence and tumor recurrence in the head and neck retinoid chemoprevention trial. Cancer Epidemiol Biomark Prev. 2001;10:823–9.Google Scholar
  26. 26.
    Gritz ER, Fingeret MC, Vidrine DJ, Lazev AB, Mehta NV, Reece GP. Successes and failures of the teachable moment: smoking cessation in cancer patients. Cancer. 2006;106:17–27.CrossRefPubMedGoogle Scholar
  27. 27.
    Ganz PA. A teachable moment for oncologists: cancer survivors, 10 million strong and growing. J Clin Oncol. 2005;23:5458–60.CrossRefPubMedGoogle Scholar
  28. 28.
    Faeh D, Viswanathan B, Chiolero A, Warren W, Bovet P. Clustering of smoking, alcohol drinking and cannabis use in adolescents in a rapidly developing country. BMC Public Health. 2006;6:169.CrossRefPubMedGoogle Scholar
  29. 29.
    Tseng TS, Lin HY. Gender and age disparity in health-related behaviors and behavioral patterns based on a National Survey of Taiwan. Int J Behav Med. 2008;15:14–20.CrossRefPubMedGoogle Scholar
  30. 30.
    Canoy D, Wareham N, Luben R, Welch A, Bingham S, Day N, et al. Cigarette smoking and fat distribution in 21, 828 British men and women: a population-based study. Obes Res. 2005;13:1466–75.CrossRefPubMedGoogle Scholar
  31. 31.
    Robb CA, Huston SJ, Finke MS. The mitigating influence of time preference on the relation between smoking and BMI scores. Int J Obes (Lond). 2008;32:1670–7.CrossRefGoogle Scholar
  32. 32.
    Centers for Disease Control and Prevention. (2005). Analytic and reporting guidelines, The National Health and Nutrition Examination Survey (NHANES). National Center for Health Statistics, Centers for Disease Control and Prevention Hyattsville, Maryland.Google Scholar
  33. 33.
    American Cancer Society. Available at: Accessed October 10, 2008.
  34. 34.
    American Cancer Society. Cancer Facts & Figures 2009. Atlanta: American Cancer Society; 2009.Google Scholar
  35. 35.
    National Center for Health Statistics. Continuous NHANES Web Tutorial- Specifying Weighting Parameters- How to Create Appropriate Subsets of Data for NHANES Analyses in SAS. Available at: Accessed April 2009.
  36. 36.
    Humpel N, Magee C, Jones SC. The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends. Support Care Cancer. 2007;15:621–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Tung-Sung Tseng
    • 1
    Email author
  • Hui-Yi Lin
    • 2
  • Michelle Y. Martin
    • 3
  • Ted Chen
    • 4
  • Edward E. Partridge
    • 5
  1. 1.School of Public HealthLouisiana State University Health Sciences CenterNew OrleansUSA
  2. 2.Biostatistics DepartmentMoffitt Cancer Center & Research InstituteTampaUSA
  3. 3.Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Department of Community Health SciencesTulane UniversityNew OrleansUSA
  5. 5.Comprehensive Cancer CenterUniversity of Alabama at BirminghamBirminghamUSA

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