Smoking prevalence among cancer survivors by state: A population based estimate

Introduction: Due to advances in cancer treatment, approximately 13.3 million cancer survivors are living in the US. Smoking among survivors decreases treatment efficacy and increases the risk of treatment complications, cancer recurrence, and the development of other chronic illnesses. Our objective in this study was to provide descriptive state-level estimates of the prevalence and trends in smoking among survivors. Methods: To determine prevalence of current smoking among survivors age ≥18 years (N=30,239; representing 15,133,691 people), we used data from the 1997-2010 National Health Interview Survey. Trend analysis with weighted linear regression of smoking prevalence by year and group (with and without cancer) was performed to look for time trends of smoking among survivors.

Results: Overall, 17.6% of survivors were current smokers compare to 21.8% of persons with no cancer history. The prevalence of smoking among survivors was over 20% in 17 states with adequate sample size; approximately one third of Southern states were in the highest quartile of smoking prevalence. Smoking prevalence among survivors was highest in Kentucky (30.7%, 95% CI 27.2 - 34.4) and lowest in Massachusetts (11.8%, 9.1 - 15.1) and Connecticut (11.8%, 8.8 - 15.7). Across years, survivors showed a similar downward trend to those with no cancer history.

Conclusions: Smoking prevalence among survivors varies by state. Public health efforts should assess the needs of survivors for effective smoking cessation and prevention interventions at the state level, and allocate appropriate resources to address those needs, particularly in states with highest prevalence.