Characterizing Disparities in Risky Alcohol Use, Tobacco Smoking, E-Cigarette Use and Physical Inactivity Among Cancer Survivors in the United States

Abstract 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 survey data (Health Information National Trends Survey, HINTS 2017–2020) for 2,579 cancer survivors. We calculated the prevalence of risky alcohol use, current tobacco 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 tobacco 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, with comorbidities or psychological distress were more likely to have unhealthy behaviors. Those with lung disease or depression were 2 times more likely to smoke tobacco or e-cigarettes and those with psychological distress were more 1.6 times more 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 tobacco 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.