Feather Abigayle R, Shelton Brent J, Blair Courtney, Davis D Bront, Scales Joan, Darville Audrey, Valentino Joseph, McLouth Laurie E, Burris Jessica L
Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, United States.
Markey Cancer Center, University of Kentucky, Lexington, United States.
Tob Induc Dis. 2025 Sep 4;23. doi: 10.18332/tid/207082. eCollection 2025.
Smoking after a cancer diagnosis is associated with poor outcomes whereas smoking cessation improves survival and other outcomes. Although professional societies and practice guidelines call for equitable tobacco treatment delivery in healthcare, disparities in tobacco-related disease burden persist.
In the context of an outpatient US cancer center's population-based tobacco treatment program, this study examines associations between cancer survivors' rural and Appalachian residence status and: 1) current tobacco use status, 2) decision to decline tobacco treatment, and 3) reason for declining assistance. A cross-sectional, retrospective analysis was conducted using electronic health record data from 16839 adults: 64.04% female, 88.49% non-Hispanic White, mean age 59.19 ± 14.52 years, 35.97% rural residence, 53.14% Appalachian residence, who sought cancer care in 2019. Descriptive statistics and logistic regression models were applied.
The portion of patients that reported current tobacco use was 21.75%. Rural patients had higher odds of tobacco use than urban (OR=1.22; 95% CI: 1.12- 1.34), as did Appalachian patients compared to non-Appalachian (OR=1.41; 95% CI: 1.28-1.54). Neither rural nor Appalachian residence status was significantly associated with responses to tobacco treatment offers (76.65% declined the offer) or reason for declining (65.19% declined because they were 'not ready to quit').
Findings highlight continued need for population-level tobacco use screening and proactive tobacco treatment offers, given elevated tobacco use in some minority groups and overall low rates of tobacco treatment acceptance. This large study helps shed light on the association between geographical residence and tobacco-related outcomes among patients with cancer, and underscores room for improvement in tobacco treatment uptake in cancer care.
癌症诊断后吸烟与不良预后相关，而戒烟可提高生存率和改善其他预后。尽管专业协会和实践指南要求在医疗保健中提供公平的烟草治疗，但烟草相关疾病负担的差异仍然存在。
在美国一家门诊癌症中心基于人群的烟草治疗项目背景下，本研究调查了癌症幸存者的农村和阿巴拉契亚居住状况与以下方面的关联：1）当前烟草使用状况，2）拒绝烟草治疗的决定，以及3）拒绝援助的原因。使用来自16839名成年人的电子健康记录数据进行了横断面回顾性分析：64.04%为女性，88.49%为非西班牙裔白人，平均年龄59.19±14.52岁，35.97%居住在农村，53.14%居住在阿巴拉契亚地区，这些人在2019年寻求癌症治疗。应用了描述性统计和逻辑回归模型。
报告当前吸烟的患者比例为21.75%。农村患者吸烟的几率高于城市患者（OR=1.22；95%CI：1.12-1.34），阿巴拉契亚患者与非阿巴拉契亚患者相比也是如此（OR=1.41；95%CI：1.28-1.54）。农村和阿巴拉契亚居住状况均与对烟草治疗提议的反应（76.65%拒绝了提议）或拒绝原因（65.19%因“还没准备好戒烟”而拒绝）无显著关联。
研究结果凸显了在人群层面进行烟草使用筛查和积极提供烟草治疗的持续必要性，因为一些少数群体的烟草使用率较高，而总体烟草治疗接受率较低。这项大型研究有助于阐明癌症患者的居住地理位置与烟草相关预后之间的关联，并强调了癌症护理中烟草治疗接受率仍有改善空间。
