title: Tobacco Use Among Siblings of Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study.
abstract: BACKGROUND
  Having a brother or sister with childhood cancer may influence health behaviors during adulthood. The aim of this study was to compare tobacco use in siblings of survivors with peers and to identify factors associated with sibling tobacco use.
  
  
  METHODS
  A retrospective cohort study was conducted using adult siblings (N = 1,974) of 5+ year cancer survivors in the Childhood Cancer Survivor Study (CCSS) and participants (N = 24,105, weighted to match CCSS) in the 2007 National Health Interview Survey. Self-reported tobacco use, sociodemographic, and cancer-related risk factors were analyzed.
  
  
  RESULTS
  Siblings were equally likely to have ever smoked compared to their peers (odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.12). Siblings were less likely to be current smokers (OR 0.83, 95%CI 0.73-0.94), but more likely to be former smokers (OR 1.21, 95%CI 1.08-1.35). Siblings with low education were more likely to ever smoke (OR 1.51, 95%CI 1.15-2.00) and be current smokers (OR 1.67, 95%CI 1.24-2.26) compared to their peers. Among siblings, risk factors for current tobacco use included the following: low income <$20,000 (OR 1.66, 95%CI 1.09-2.54), low education (OR 6.68, 95%CI 4.07-10.97), psychological distress (OR 5.36, 95%CI 2.21-13.02), and heavy alcohol use (OR 3.68, 95%CI 2.50-5.41).
  
  
  CONCLUSIONS
  Siblings of survivors take up smoking at similar rates to their peers, but are more likely to quit. Efforts are needed to address disparities by providing greater psychosocial support and education for the lowest socioeconomic status families facing childhood cancer.
authors: Division of Hematology, Department of Pediatrics, Children's Hospital of Orange County, Orange, California.
authors: David
authors: D
authors: Buchbinder
authors: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Kevin
authors: K
authors: Oeffinger
authors: Department of Biostatistics, School of Public and Health, University of Alberta, Alberta, Canada.
authors: Conrado
authors: C
authors: Franco-Villalobos
authors: Department of Biostatistics, School of Public and Health, University of Alberta, Alberta, Canada.
authors: Yutaka
authors: Y
authors: Yasui
authors: Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware.|Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Melissa A
authors: MA
authors: Alderfer
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Gregory T
authors: GT
authors: Armstrong
authors: David Geffen School of Medicine at University of California at Los Angeles (UCLA) and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California.
authors: Jacqueline
authors: J
authors: Casillas
authors: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Jennifer
authors: J
authors: Ford
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Kevin R
authors: KR
authors: Krull
authors: Cancer Prevention Program at Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Wendy
authors: W
authors: Leisenring
authors: Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Christopher
authors: C
authors: Recklitis
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Leslie L
authors: LL
authors: Robison
authors: David Geffen School of Medicine at University of California at Los Angeles (UCLA) and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California.
authors: Lonnie K
authors: LK
authors: Zeltzer
authors: Department of Social and Behavioral Sciences, University of California at San Francisco, San Francisco, California.
authors: E Anne
authors: EA
authors: Lown
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D009369:Neoplasms; D012189:Retrospective Studies; D035781:Siblings / Q000523:psychology*; D012907:Smoking / Q000523:psychology*; D012959:Socioeconomic Factors; D017741:Survivors
keywords: childhood cancer survivors; health behavior; siblings; smoking; tobacco