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The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. Winter 2017 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text University of North Carolina at Chapel Hill Degree granting institution Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors; e-cigarettes; psychosocial factors; smoking beliefs; smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text University of North Carolina at Chapel Hill Degree granting institution Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors, e-cigarettes, psychosocial factors, smoking beliefs, smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors; e-cigarettes; psychosocial factors; smoking beliefs; smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Yael Symes Creator Department of Health Behavior Gillings School of Global Public Health Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions. 2017-12 2017 Public health cancer survivors; e-cigarettes; psychosocial factors; smoking beliefs; smoking cessation eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Shelley Golden Thesis advisor Kurt Ribisl Thesis advisor Marcella Boynton Thesis advisor Deborah Mayer Thesis advisor J. Westmaas Thesis advisor text Symes_unc_0153D_17432.pdf uuid:476f4516-a9df-43d3-82ea-70dddbe49d6b 2019-12-31T00:00:00 2017-11-29T18:24:20Z proquest application/pdf 781784