title: Smoking behavior among adult childhood cancer survivors: what are we missing?
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Smoking in adult survivors of childhood cancer continues as a persistent risk factor across socioeconomic groups.
  
  
  CONCLUSIONS
  Targeted and tailored smoking cessation/prevention interventions for these survivors are needed.
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA. tasfar@med.miami.edu.
authors.forename: Taghrid
authors.initials: T
authors.lastname: Asfar
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA.|Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Noella A
authors.initials: NA
authors.lastname: Dietz
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA.
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.affiliation: Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Tannenbaum
authors.affiliation: Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: McClure
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA.|European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK.
authors.forename: Lora E
authors.initials: LE
authors.lastname: Fleming
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA.|Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000534:rehabilitation; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000706:statistics & numerical data; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
keywords: Childhood cancer survivors; Predictors of current smoking; Smoking initiation; Smoking prevalence; Smoking trends