title: The role of posttraumatic growth and timing of quitting smoking as moderators of the relationship between stigma and psychological distress among lung cancer survivors who are former smokers.
abstract: OBJECTIVE
  Patients diagnosed with lung cancer report high levels of stigma and psychological distress. This study examined posttraumatic growth among lung cancer survivors as a potential buffer against this relationship between stigma and psychological distress and examined how these relationships differed by the timing of quitting smoking (pre versus post-diagnosis).
  
  
  METHODS
  Stages IA and IB non-small-cell lung cancer survivors (N = 141) who were former smokers, 1-6 years post-treatment, and had no evidence of disease completed standardized questionnaires assessing stigma, posttraumatic growth, timing of quitting smoking history, and psychological distress.
  
  
  RESULTS
  Hierarchical linear regression and simple slope analyses indicated that among those who quit smoking prior to diagnosis (pre-diagnosis quitters), stigma had a positive association with psychological distress at high levels of posttraumatic growth (p = 0.003) and had a positive (but non-significant) association with psychological distress among those with low levels of posttraumatic growth (p = 0.167). Among those who quit smoking after diagnosis (post-diagnosis quitters), stigma had a positive association with psychological distress among those with low levels of posttraumatic growth (p = 0.004) but had no relationship among those with high levels of posttraumatic growth (p = 0.880).
  
  
  CONCLUSIONS
  Findings indicate that posttraumatic growth buffers against the negative effects of stigma on psychological distress but only among post-diagnosis quitters. Future interventions could focus on fostering posttraumatic growth as a way to decrease the negative effects of stigma.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Megan Johnson
authors.initials: MJ
authors.lastname: Shen
authors.affiliation: Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Coups
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Yuelin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jimmie C
authors.initials: JC
authors.lastname: Holland
authors.affiliation: Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Hamann
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Ostroff
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety / Q000523:psychology; D002289:Carcinoma, Non-Small-Cell Lung / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012907:Smoking; D016540:Smoking Cessation / Q000523:psychology* / Q000706:statistics & numerical data; D057545:Social Stigma; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: lung cancer survivor; posttraumatic growth; psychological distress; smoking cessation; stigma