Adolescent cancer survivors' smoking intentions are associated with aggression, attention, and smoking history.

INTRODUCTION: The present study examines behavioral and psychosocial factors associated with smoking intentions and experimentation among adolescent survivors of pediatric cancer.

METHODS: Adolescent survivors of brain tumor and acute lymphoblastic leukemia (n  =  99) provided information about their smoking histories and their intentions to smoke in the future. Behavior rating scales were completed by survivors, parents, and teachers.

RESULTS: Past experimentation with smoking and higher levels of self-reported aggression were associated with intentions to smoke in the future (OR  =  4.18, 95% CI 1.02-17.04, and OR  =  1.08, 95% CI 1.01-1.15, respectively), while teacher-ratings of inattention in the classroom were negatively associated with intentions to smoke (OR  =  0.94, 95% CI.88-.99), all p  < .05. Experimentation with smoking was more likely among older survivors (OR  =  1.76, 95% CI 1.16-2.66, p  < .01) and those whose parents had divorced (OR  =  4.40, 95% CI 1.21-16.06, p  < .05).

DISCUSSION: A concerning minority of adolescent survivors have clear intentions to smoke, a behavior that adds to their overall health risk. Smoking intentions and experimentation are important precursors to regular smoking. Prevention efforts are needed to interrupt the progression from intentions and experimentation to established smoking and nicotine dependence in this medically vulnerable population.

IMPLICATIONS FOR CANCER SURVIVORS: Assessment of an adolescent's history of parental divorce, past experimentation with smoking, and aggressive behavior will identify those survivors who are likely to consider smoking in the future. Screening for these characteristics will allow clinicians to be more vigilant in health promotion.