title: Predictors of smoking initiation and cessation among childhood cancer survivors: a report from the childhood cancer survivor study.
abstract: OBJECTIVE
  To examine the determinants of smoking behavior among participants in the Childhood Cancer Survivors Study (CCSS).
  
  
  METHODS
  This retrospective cohort survey study was conducted among 9,709 childhood cancer survivors. Main outcomes included smoking initiation and cessation.
  
  
  RESULTS
  Twenty-eight percent of patients reported ever smoking and 17% reported being current smokers. Standardized to United States population rates, the observed to expected (O/E) ratios and corresponding 95% confidence limits (95% CL) of cigarette smoking were 0.72 (95% CL, 0.69, 0.75) among all survivors and 0.71 (95% CL, 0.68 to 0.74) and 0.81 (95% CL, 0.70, 0.93) among whites and nonwhites, respectively. Significantly lower O/E ratios were present among both males (O/E, 0.73) and females (O/E, 0.70). Factors independently associated with a statistically significant relative risk of smoking initiation included older age at cancer diagnosis, lower household income, less education, not having had pulmonary-related cancer treatment, and not having had brain radiation. Blacks were less likely to start smoking. Survivors who smoked were significantly more likely to quit (O/E, 1.22; 95% CL, 1.15, 1.30). Among ever-smokers, factors associated with the likelihood of being a current smoker included age less than 13 years at smoking initiation, less education, and having had brain radiation; those age less than 3 years at cancer diagnosis were significantly more likely to be ex-smokers.
  
  
  CONCLUSIONS
  Although survivors in the CCSS cohort seem to be smoking at rates below the general population, interventions are needed to prevent smoking initiation and promote cessation in this distinct population.
authors.affiliation: Division of Community-Based Research, Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, MA 02067, USA. karen_emmons@dfci.harvard.edu
authors.forename: Karen
authors.initials: K
authors.lastname: Emmons
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Li
authors.forename: John
authors.initials: J
authors.lastname: Whitton
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: Raymond
authors.initials: R
authors.lastname: Hutchinson
authors.forename: Lisa
authors.initials: L
authors.lastname: Diller
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D016012:Poisson Distribution; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology