Patterns of exclusive, dual and poly tobacco products use among cancer survivors in the United States

Abstract

Purpose: Identifying tobacco products use (TPU) patterns among cancer survivors (CSs) is critical to optimize survivorship care. This study examines exclusive cigarette/e-cigarette, dual (two tobacco-products) and poly (≥ 3 tobacco-products) use among CSs (vs. no cancer history) and its sub-types: smoking-related-cancers (SRCs) vs. non-smoking-related cancers (NSRCs) while also exploring socio-demographic factors.

Methods: The study analyzed 86,551 adults from the 2021-2023 National Health Interview Survey, including 10,846 (9.7%) CSs. Participants were categorized and analyzed based on their CSs status and TPU patterns. Weighted logistic regression models assessed the relationship between TPU and CSs status while adjusting for socio-demographic characteristics.

Results: CSs (vs. no cancer history) had a higher likelihood of ever-poly (aOR:1.24, 95%CI: 1.15-1.33), former-cigarette-only (aOR:1.22, 95%CI: 1.13-1.32), and former-dual (aOR:1.21, 95%CI: 1.14-1.29) use. SRC survivors had greater odds of being current-cigarette-only (aOR:2.26, 95%CI: 1.63-3.11), ever e-cigarette-only (aOR:3.41, 95%CI: 1.51-7.70), and ever-poly (aOR:1.32, 95%CI: 1.11-1.57) use than NSRC survivors. Among CSs, being male, single after marriage, or having lower educational attainment was linked to higher odds of exclusive, dual, or poly-tobacco use. CSs aged over 44 years had lower odds of being dual or ever-poly users compared to younger adults.

Conclusion: Disparities in TPU among CSs particularly between SRC and NSRC survivors calls for proactive cessation support. Oncologists must account for patients' former and current TPU pattern, related perceptions, and socio-demographic barriers in cessation by systematically incorporating tailored and integrated counseling into routine oncology visits.

Implications for cancer survivors: Persistent disparities in tobacco product use requires tailored cessation support in routine oncology visits.

Keywords: Cancer; Cigarettes; Dual use; E-cigarettes; Poly-use; Survivors; Tobacco; Tobacco-related cancers.

Figure 1.

Tobacco Use Pattern among U.S. adults by (a) Cancer Status (b) Cancer Survivors Sub-types, NHIS (2021–2023). Notes: p-values corresponds to Chi-Square test which assess whether tobacco patterns significantly differs between two populations (a) CSs vs no cancer history and (b) SRC survivors vs. NSRC survivors: while w% are respective to each group separately. Bars follow the same chronological order as listed in the legend (Legends: Top to bottom = Bars: Left to Right). As per Surgeon General Report (2014), SRCs includes cancers of the bladder, cervix, colon, esophagus, kidney, larynx, liver, lung, mouth, pancreas, rectum, stomach, and throat while NSRCs include cancers of the bone, brain, breast, gallbladder, lymphoma, melanoma, nervous system, ovary, prostate, skin, soft tissue, testis, and uterine.