Emmons Karen, Li Frederick P, Whitton John, Mertens Ann C, Hutchinson Raymond, Diller Lisa, Robison Leslie L
Division of Community-Based Research, Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, MA 02067, USA.
J Clin Oncol. 2002 Mar 15;20(6):1608-16. doi: 10.1200/JCO.2002.20.6.1608.
To examine the determinants of smoking behavior among participants in the Childhood Cancer Survivors Study (CCSS).
This retrospective cohort survey study was conducted among 9,709 childhood cancer survivors. Main outcomes included smoking initiation and cessation.
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.
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.
研究儿童癌症幸存者研究（CCSS）参与者吸烟行为的决定因素。
对9709名儿童癌症幸存者进行了这项回顾性队列调查研究。主要结果包括开始吸烟和戒烟情况。
28%的患者报告曾吸烟，17%报告目前仍在吸烟。按照美国人群率进行标准化后，所有幸存者中吸烟的观察值与预期值（O/E）比率及相应的95%置信区间（95%CL）为0.72（95%CL，0.69，0.75），白人幸存者中为0.71（95%CL，0.68至0.74），非白人幸存者中为0.81（95%CL，0.70，0.93）。男性（O/E，0.73）和女性（O/E，0.70）的O/E比率均显著较低。与开始吸烟的统计学显著相对风险独立相关的因素包括癌症诊断时年龄较大、家庭收入较低、受教育程度较低、未接受过肺部相关癌症治疗以及未接受过脑部放疗。黑人开始吸烟的可能性较小。吸烟的幸存者戒烟的可能性显著更高（O/E，1.22；95%CL，1.15，1.30）。在曾经吸烟者中，与目前仍为吸烟者可能性相关的因素包括开始吸烟时年龄小于13岁、受教育程度较低以及接受过脑部放疗；癌症诊断时年龄小于3岁的人更有可能是已戒烟者。
尽管CCSS队列中的幸存者吸烟率似乎低于一般人群，但仍需要采取干预措施来预防这一特殊人群开始吸烟并促进戒烟。
