# Exploring Tobacco Use in Young Childhood Cancer Survivors: the Role of Social Acceptance, Workplace Environments, and Stress Reduction

## TL;DR

Young childhood cancer survivors use tobacco to cope with stress and socialize, often influenced by workplace norms rather than health concerns.

## Contribution

This study reveals that social and workplace factors, not health risks, drive tobacco use among young cancer survivors.

## Key findings

- Survivors primarily use tobacco for stress relief and social connection, not fear of cancer recurrence.
- Workplace smoking norms and peer influence significantly impact tobacco initiation and continued use.
- Generational factors, rather than cultural background, most strongly influence tobacco use behaviors.

## Abstract

Recent advancements in childhood cancer treatment have significantly improved survival rates, yet survivors continue to face considerable morbidity and mortality, rendering them a vulnerable population. Tobacco use, linked to heightened cancer risk, is discouraged among survivors for long-term health preservation; however, many persist in its use, mirroring rates among their non-cancer peers. Through 25 in-depth interviews, we explored the interplay of perceived risk and social integration on tobacco use post-treatment among both Latine and non-Latine young adult survivors. Sixty percent of respondents were male, 44% identified as Latine, with ages ranging from 22 to 38 years (mean age 30 years; mean age at diagnosis 9 years), representing diverse cancer types. Despite awareness of tobacco-related health hazards, including general and respiratory health impacts, addiction potential, and financial burdens, survivors consistently cited stress alleviation as a primary motive for tobacco use. Fearof cancer recurrence was seldom cited as a deterrent, rather survivors identified tobacco as a means to foster peer connections, particularly in workplace settings, where smoking norms prevailed. Co-workers influenced initiation, and smoking breaks served as crucial socializing opportunities, endorsed as acceptable coping mechanisms. Notably, generational factors overshadowed cultural influences on tobacco use. These insights underscore the need for targeted interventions, in which clinicians can emphasize alternative stress management strategies over risk-centric messaging, prioritize social skill development, and address workplace environments as high-risk settings.