Characterizing risky alcohol use, cigarette smoking, e-cigarette use, and physical inactivity among cancer survivors in the USA-a cross-sectional study

J Cancer Surviv. 2023 Dec;17(6):1799-1812. doi: 10.1007/s11764-022-01245-5. Epub 2022 Aug 14.


Purpose: Unhealthy lifestyle behaviors are associated with inferior health outcomes among cancer survivors, including increased mortality. It is crucial to identify vulnerable subgroups, yet investigations have been limited. Thus, this study aimed to examine sociodemographic and clinical characteristics associated with risky health behaviors among cancer survivors.

Methods: We used national, cross-sectional survey data (Health Information National Trends Survey, HINTS 2017-2020) for 2579 cancer survivors. We calculated the prevalence of risky alcohol use, current cigarette smoking, e-cigarette use, and not meeting physical activity guidelines. We performed weighted logistic regression to obtain multivariable-adjusted odds ratios (OR) for the association between each unhealthy behavior with sociodemographic and clinical characteristics.

Results: Overall, 25% showed risky alcohol use, 12% were current cigarette smokers, 3% were current e-cigarette users, and 68% did not meet physical activity guidelines. Cancer survivors who were males, non-Hispanic Whites or African Americans, without a college education, not married and with comorbidities or psychological distress were more likely to have unhealthy behaviors. Those with lung disease or depression were 2 times as likely to smoke cigarette or e-cigarettes and those with psychological distress were 1.6 times as likely to be physically inactive. Moreover, risky drinkers (OR = 1.75, 95% CI = 1.22-2.52) and e-cigarette smokers (OR = 16.40, 95% CI 3.29-81.89) were more likely to be current cigarette smokers.

Conclusions: We identified vulnerable subpopulations of cancer survivors with multiple unhealthy lifestyle behaviors.

Implications for cancer survivors: Our findings inform clinicians and program and policy makers of the subgroups of cancer survivors to target for multiple health behavior interventions.

Keywords: Alcohol consumption; Cancer survivors; Cigarette smoking; E-cigarette use; Physical inactivity; Unhealthy behavior.

MeSH terms

  • Cancer Survivors* / psychology
  • Cigarette Smoking* / epidemiology
  • Cigarette Smoking* / psychology
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Male
  • Neoplasms* / epidemiology
  • Sedentary Behavior
  • United States / epidemiology
  • Vaping* / epidemiology