ABSTRACT
Background
U.S. health surveillance data suggests that alcohol consumption is similar among cancer survivors and those without a cancer history. However, comparisons of the correlates of alcohol consumption between cancer survivors and those without a cancer history are lacking.
Aims
The purpose of this study was to examine correlates of alcohol use, particularly cancer‐related beliefs, and if correlates differed by cancer history.
Methods
Merged data from the Health Information National Trends Survey (HINTS) 5, cycles 2–4 and HINTS 6 were analyzed to estimate patterns of current drinking among US adults with and without a cancer history. Multivariable logistic regression models examined associations among cancer history, cancer‐related beliefs, and drinking. Stratified models by cancer history were also examined.
Results
Cancer history was not associated with current drinking in adjusted models (aOR: 0.97, 95% CI: 0.82–1.15, p = 0.742). After adjusting for demographic, behavioral, socio‐economic, and health factors, cancer‐related beliefs were not associated with current drinking. Correlates of drinking differed between adults with and without a cancer history. For example, among those without a cancer history, Black compared to White adults had lower odds of current drinking (OR: 0.80, 95% CI: 0.67–0.96, p = 0.017); among cancer survivors, no association was found.
Conclusions
Alcohol use is similar among adults regardless of cancer history; yet the correlates of alcohol use differed by cancer history. A better understanding of the determinants of alcohol use among cancer survivors is needed to inform tailored alcohol reduction interventions.
Keywords: alcohol, cancer, cancer survivorship, cancer‐related beliefs, Health Information National Trends Survey (HINTS), oncology, risk perception
1. Background
In 1988, the International Agency on Cancer Research classified alcohol as a carcinogen; since then, alcohol has been classified as causally associated with seven alcohol related‐cancers (ARCA) sites [1]. In the United States (US), 5.6% of cancer cases and 4.0% of cancer mortality is associated with alcohol use [2]. Continued alcohol consumption after diagnosis is also of concern due to evidence of associations between alcohol consumption and recurrent primary tumors [3], new secondary tumors [4], prolonged and more difficult treatments and recovery [5], and greater treatment and recovery costs [5]. There is also evidence that cessation of alcohol decreases risk, especially for head and neck cancers [6].
Health surveillance data currently suggests similar alcohol consumption among cancer survivors (henceforth called “survivors”) and those without a cancer history in the US. Zhang et al. reported comparable consumption rates between survivors and matched non‐cancer respondents from the 1999‐2010 National Health and Nutrition Examination Surveys [7]. LeMasters et al. had similar findings between survivors of breast, colorectal, or prostate cancer and their matched non‐cancer controls in the 2009 Behavioral Risk Factor Surveillance System survey [8]. However, using the 2005 US National Health Interview Survey (NHIS), Yaghjyan et al. found that among White women, breast cancer survivors had higher odds of current drinking and among Hispanic women, breast cancer survivors had higher odds of heavy drinking compared to women never diagnosed with cancer [9]. Lastly, Lin et al. found similar odds of current consumption by cancer history across six cycles of NHIS data (2012–2017) [10].
Among survivors, demographic correlates of consumption have been examined [9, 10, 11]. Sanford et al. found that from 2000 to 2017 survivors who were younger, male, current or former smokers, and 6–10 years since diagnosis (vs. 1–5 years since diagnosis) had higher odds of current drinking [11]. Lin et al. found that ARCA survivors had lower odds of consumption than non‐ARCA survivors and that compared to more recently diagnosed survivors (within 2–4 years), survivors 5–10 years since diagnosis had higher odds of consumption [10].
While the literature suggests that consumption is similar by cancer history, important questions remain which can inform interventions to address alcohol use in the population. e.g., while consumption rates may be similar by cancer history, the correlates of consumption could vary. However, to our knowledge, there has never been a direct comparison of the correlates of consumption by cancer history. Additionally, current literature has focused on demographic correlates of consumption alone rather than other potentially relevant health characteristics or potentially important psychological factors, such as cancer‐related beliefs, despite the fact that alcohol consumption is also associated with a number of environmental, social, and cognitive factors, including one's beliefs about their own control in engaging in health behaviors [12].
In particular, ambiguity in the perception of cancer causes (e.g., “cause ambiguity”) and fatalism about preventing or surviving cancer (e.g., “cancer fatalism”) are associated with lower engagement in cancer prevention behaviors, such as fruit and vegetable consumption and higher engagement in cancer risk behaviors, such as smoking [13, 14, 15]. Given the previous findings on dietary factors, it is possible that a similar relationship would be found with other dietary behaviors, like alcohol use. The association between alcohol consumption and awareness of alcohol as a cancer risk factor has been examined [16]. But, it is unknown if cause ambiguity and cancer fatalism are associated with alcohol consumption. Cancer‐related beliefs have also been shown to differ by cancer history [17, 18]. Yet, it is unknown if differing beliefs also leads to different associations between beliefs and alcohol consumption across these groups. To our knowledge, there have been no comparisons of the associations between cancer‐related beliefs and alcohol consumption by cancer history. Having a better understanding of the role of a cancer diagnosis on these associations could identify potential targets for educational interventions developed specifically for survivors.
We used data from multiple waves of a nationally representative survey of US adults to examine correlates of alcohol use in respondents with different cancer histories with an emphasis on cancer‐related beliefs. Specifically, we sought to explore the relationship between cancer‐related beliefs and alcohol consumption, and to determine the consistency of these associations by cancer history. We hypothesized that cancer‐related beliefs would be more salient correlates of consumption among those with a history of cancer compared to those without.
2. Methods
2.1. Data and Study Population
The results presented here are a secondary analysis of data from the National Cancer Institute Health Information National Trends Survey (HINTS) 5 (cycles 2 through 4) and HINTS 6 [19]. HINTS data are collected via a contract with Westat, with IRB approval and consent is obtained through Westat. HINTS 5 Cycle 2 was administered in 2018, HINTS 5 Cycle 3 was administered in 2019, HINTS 5 Cycle 4 was administered in 2020, and HINTS 6 was administered in 2022. All HINTS iterations produce nationally representative estimates. Response rates of each HINTS iteration ranged from 28% to 37% [20]. In all samples, respondents who were missing information on alcohol use, gender, or cancer status were excluded (2308 excluded: 1559 were missing alcohol only, 123 missing gender only, 37 missing cancer history only, 426 missing alcohol and one or more other item, and 126 missing multiple non‐alcohol items. Data were merged prior to analyses, with 16,751 respondents included in the final dataset.
2.2. Measures
Current drinking was measured by asking, “During the last 30 days, how many days per week did you have at least one drink of any alcoholic beverage?” [21]. Respondents reported the number of days (range: 0–7). Those who reported any drinking were asked, “During the past 30 days, on the days when you drank, about how many drinks did you drink on average?” and could enter as many drinks as they wanted in response. Current drinking was defined as drinking at least once in the last 30 days (yes or no). Due to inconsistent use of items, binge drinking could not be estimated across all waves.
All respondents were asked, “Have you ever been diagnosed as having cancer?” with respondents coded as yes, ever had cancer, or no. Survivors were then asked, “What type of cancer did you have?” and were provided a list of 22 specific cancers and the option to report another type of cancer. Multiple selections and write in responses were allowed for this item, which were reviewed and categorized. Survivors (N = 2674) were categorized as having an ARCA (i.e., cancer of the oral cavity/pharynx/larynx, esophagus, female breast, colon, rectum, liver, or stomach, inclusive of those who reported multiple cancers) or non‐ARCA.
Cause ambiguity asked level of agreement with the statements, “It seems like everything causes cancer” and “There are so many different recommendations about preventing cancer, it's hard to know which ones to follow.” Cancer fatalism asked level of agreement with the statement, “There's not much you can do to lower your chances of getting cancer.” Responses were dichotomized similarly to previous examinations from four response categories to strongly/somewhat agree or strongly/somewhat disagree [22]. Health self‐efficacy (“Overall, how confident are you about your ability to take good care of your health?”) was also examined with responses categorized as completely confident, very confident or somewhat confident/a little confident/not confident at all, also similarly to previous examinations [22].
Potentially relevant covariates included age (18–59 or 60+ years), gender (male or female), race (Black, Other/Multiple races, or White), ethnicity (Hispanic or not Hispanic), education (< college or at least a college degree), smoking status (current smoker or not current smoker), physical activity (meet guidelines of at least 150 min of moderate physical activity per week or do not meet guidelines), seeing a healthcare provider in the last year (seen at least once in last 12 months or not seen in last 12 months), cancer information seeking (ever looked for cancer information or never looked for cancer information), heart condition (ever told have heart condition or never told have heart condition), diabetes (ever told have diabetes or never told have diabetes), and high blood pressure (ever told have high blood pressure or never told have high blood pressure). Depression/anxiety was assessed with the Patient Health Questionnaire‐4 (PHQ‐4), assessing symptoms of depression and anxiety over the past 2 weeks, scored on a 0‐12 scale, and categorized into four categories of psychological distress: none (0–2), mild (3–5), moderate (6–8), severe (9–12). Time since cancer diagnosis (≤ 1, 2–5, 6–10, or more than 10 years ago, for survivors only) was also included.
2.3. Statistical Analyses
Statistical analyses were conducted in R and jack‐knife replicate weights using the R package survey were used to provide US representative estimates with adjusted standard errors [19]. After calculating descriptive statistics, logistic regression modeling assed the association between all variables of interest and alcohol use (outcome referent = not a current drinker) by including all the independent variables in one model. To assess for potential multicollinearity, the variance inflation factor (VIF) was calculated for each independent variable. All VIF values were low (less than 2), indicating no multicollinearity issues. An additional model was created to consider potential differences in the associations between alcohol use and cause ambiguity, cancer fatalism, and health self‐efficacy by cancer history by including individual interaction terms between each cause ambiguity, cancer fatalism, and health self‐efficacy variable and cancer history.
Two separate multivariable logistic regression models were created by cancer history, including all the statistically significant variables from the overall logistic regression model with the goal of comparing the correlates of alcohol consumption from the full sample between those with and without a cancer history. Type of cancer and time since cancer diagnosis, is by nature only available only for survivors and so were excluded from the overall regression model using the full sample. However, both were also included in the model among survivors.
Listwise deletion was used for all regression models.
3. Results
Almost one half of US adults reported current drinking (48.50%, Table 1). More than 9% were survivors; 24.55% had an ARCA. Among non‐current drinkers, 9.88% were survivors; among current drinkers, 8.66% were survivors. A majority (70.03%) of adults endorsed cause ambiguity and 31.50% endorsed cancer fatalism. A quarter (25.50%) were completely confident in their ability to take care of their health, while 44.21% were very confident, and 30.29% were somewhat, a little, or not at all confident.
TABLE 1.
Descriptive frequencies, HINTS 5 cycles 2 to 4 and HINTS 6. Overall and current drinking.
| Overall (N = 16,751) | Current drinking (N = 8,034, 48.50% a ) | Non‐current drinking (n = 8,717, 51.50% a ) | ||||
|---|---|---|---|---|---|---|
| N (% a ) | 95% CI a | N (% a ) | 95% CI a | N (% a ) | 95% CI a | |
| Drinking days per week | ||||||
| 1 | 2713 (34.20) | (32.43, 35.98) | ||||
| 2–3 | 2768 (36.32) | (34.40, 38.24) | ||||
| 4+ | 2553 (29.48) | (27.69, 31.27) | ||||
| Ever had cancer | ||||||
| No | 14,077 (90.71) | (90.48, 0.94) | 6824 (91.34) | (90.73, 91.94) | 7253 (90.12) | (89.56, 90.67) |
| Yes | 2674 (9.29) | (9.06, 9.52) | 1210 (8.66) | (8.06, 9.27) | 1464 (9.88) | (9.33, 10.44) |
| Alcohol‐related cancer b | ||||||
| No | 1928 (75.45) | (72.94, 77.96) | 935 (77.69) | (74.06, 81.33) | 993 (73.56) | (70.19, 76.94) |
| Yes c | 705 (24.55) | (22.04, 27.06) | 267 (22.31) | (18.67, 25.94) | 438 (26.44) | (23.06, 29.81) |
| Time since diagnosis b | ||||||
| Within last year | 302 (13.03) | (10.75, 15.31) | 131 (12.53) | (9.02, 16.03) | 171 (13.45) | (10.53, 16.37) |
| 2–5 years | 553 (22.42) | (19.71, 25.12) | 270 (24.54) | (20.63, 28.44) | 283 (20.63) | (17.37, 23.89) |
| 6–10 years | 476 (18.03) | (15.73, 20.32) | 224 (19.30) | (15.67, 22.94) | 252 (16.95) | (13.97, 19.92) |
| 11+ years | 1232 (46.53) | (43.48, 49.58) | 550 (43.63) | (39.30, 47.97) | 682 (48.97) | (44.82, 53.13) |
| Gender | ||||||
| Male | 6919 (49.15) | (48.79, 49.52) | 3842 (54.22) | (52.82, 55.62) | 3077 (44.39) | (42.95, 45.82) |
| Female | 9832 (50.85) | (50.48, 51.21) | 4192 (45.78) | (44.38, 47.18) | 5640 (55.61) | (54.18, 57.05) |
| Age d | ||||||
| 18–59 years | 8722 (72.24) | (71.92, 72.56) | 4678 (75.86) | (74.92, 76.79) | 4044 (68.83) | (67.82, 69.85) |
| 60+ years | 7848 (27.76) | (27.44, 28.08) | 3296 (24.14) | (23.21, 25.08) | 4552 (31.17) | (30.15, 32.18) |
| Race d | ||||||
| Black | 2473 (11.92) | (11.51, 12.32) | 999 (10.39) | (9.47, 11.30) | 1474 (13.41) | (12.52, 14.29) |
| Other | 1654 (11.38) | (10.86, 11.91) | 679 (9.23) | (8.04, 10.41) | 975 (13.48) | (12.43, 14.53) |
| White | 11,730 (76.70) | (76.11, 77.29) | 6033 (80.39) | (79.05, 81.73) | 5697 (73.11) | (71.82, 74.40) |
| Ethnicity d | ||||||
| Non‐hispanic | 13,296 (83.86) | (83.49, 84.24) | 6585 (85.77) | (84.67, 86.87) | 6711 (82.04) | (80.96, 83.12) |
| Hispanic | 2485 (16.14) | (15.76, 16.51) | 1091 (14.23) | (13.13, 15.33) | 1394 (17.96) | (16.88, 19.04) |
| Education d | ||||||
| < College | 8735 (68.43) | (68.11, 68.75) | 3491 (60.85) | (59.58, 62.12) | 5244 (75.63) | (74.59, 76.67) |
| ≥ College | 7865 (31.57) | (31.25, 31.89) | 4493 (39.15) | (37.88, 40.42) | 3372 (24.37) | (23.34, 25.41) |
| Current smoker d | ||||||
| No | 14,701 (86.52) | (85.51, 87.52) | 6976 (84.62) | (83.06, 86.17) | 7725 (88.31) | (87.00, 89.62) |
| Yes | 1902 (13.48) | (12.48, 14.49) | 1001 (15.38) | (13.83, 16.94) | 901 (11.69) | (10.38, 13.00) |
| Physical activity d | ||||||
| Does not meet weekly PA guidelines | 10,425 (62.14) | (60.80, 63.47) | 4604 (57.68) | (55.76, 59.60) | 5821 (66.38) | (64.42, 68.33) |
| Meets weekly PA guidelines | 5993 (37.86) | (36.53, 39.20) | 3315 (42.32) | (40.40, 44.24) | 2678 (33.62) | (31.67, 35.58) |
| Seen health provider in last year d | ||||||
| Not seen | 2001 (16.18) | (15.16, 17.20) | 914 (15.70) | (14.17, 17.23) | 1087 (16.64) | (15.03, 18.24) |
| Seen | 14,619 (83.82) | (82.80, 84.84) | 7075 (84.30) | (82.77, 85.84) | 7544 (83.36) | (81.76, 84.96) |
| Cancer information seeking d | ||||||
| Never looked for cancer information | 7681 (51.00) | (49.80, 52.20) | 3453 (47.05) | (45.04, 49.05) | 4228 (54.78) | (52.96, 56.59) |
| Ever looked for cancer information | 8380 (49.00) | (47.80, 50.19) | 4327 (52.95) | (50.95, 54.96) | 4053 (45.22) | (43.41, 47.04) |
| Believes everything causes cancer d | ||||||
| Disagrees e | 5506 (29.97) | (28.75, 31.20) | 2592 (29.53) | (27.83, 31.22) | 2914 (30.40) | (28.68, 32.11) |
| Agrees f | 11,030 (70.03) | (68.80, 71.25) | 5373 (70.47) | (68.78, 72.17) | 5657 (69.60) | (67.89, 71.32) |
| Believes there are too many recommendations for preventing cancer d | ||||||
| Disagrees e | 4724 (26.45) | (25.40, 27.50) | 2326 (26.54) | (25.01, 28.07) | 2398 (26.36) | (24.62, 28.09) |
| Agrees f | 11,760 (73.55) | (72.51, 74.60) | 5626 (73.46) | (71.93, 74.99) | 6134 (73.64) | (71.91, 75.38) |
| Believes there is little you can do to decrease cancer risk d | ||||||
| Disagrees e | 11,639 (68.50) | (67.20, 69.80) | 5812 (70.98) | (69.17, 72.79) | 5827 (66.15) | (64.23, 68.06) |
| Agrees f | 4825 (31.50) | (30.20, 32.80) | 2139 (29.02) | (27.21, 30.83) | 2686 (33.85) | (31.94, 35.77) |
| Confidence in ability to take good care of one's healthd | ||||||
| Somewhat, a little, or not at all confident | 4711 (30.29) | (29.02, 31.56) | 2040 (27.19) | (25.50, 28.88) | 2671 (33.21) | (31.40, 35.03) |
| Very confident | 7707 (44.21) | (42.91, 45.52) | 3856 (46.76) | (44.92, 48.61) | 3851(41.80) | (39.90, 43.71) |
| Completely confident | 4237 (25.50) | (24.26, 26.74) | 2103 (26.05) | (24.38, 27.72) | 2134 (24.98) | (23.33, 26.65) |
| Ever had heart condition d | ||||||
| No | 14,951 (92.36) | (91.79, 92.93) | 7370 (94.17) | (93.43, 94.92) | 7581 (90.65) | (89.75, 91.54) |
| Yes | 1654 (7.64) | (7.07, 8.21) | 611 (5.83) | (5.08, 6.57) | 1043 (9.35) | (8.46, 10.25) |
| Ever had diabetes d | ||||||
| No | 13,103 (83.46) | (82.57, 84.35) | 6749 (87.81) | (86.50, 89.13) | 6354 (79.34) | (77.99, 80.69) |
| Yes | 3444 (16.54) | (15.65, 17.43) | 1213 (12.19) | (10.87, 13.50) | 2231 (20.66) | (19.31, 22.01) |
| Ever had high blood pressure d | ||||||
| No | 9220 (64.39) | (63.33, 65.45) | 4804 (67.95) | (66.39, 69.51) | 4416 (61.03) | (59.42, 62.63) |
| Yes | 7354 (35.61) | (34.55, 36.67) | 3163 (32.05) | (30.49, 33.61) | 4191 (38.97) | (37.37, 40.58) |
| PHQ‐4 total score d , g | ||||||
| Normal | 11,598 (68.07) | (66.82, 69.33) | 5603 (69.28) | (67.49, 71.07) | 5995 (66.94) | (65.09, 68.79) |
| Mild | 2993 (18.42) | (17.25, 19.59) | 1468 (18.64) | (16.90, 20.37) | 1525 (18.21) | (16.71, 19.72) |
| Moderate | 1140 (7.87) | (6.94, 8.79) | 545 (7.33) | (6.06, 8.61) | 595 (8.37) | (7.22, 9.52) |
| Severe | 729 (5.64) | (4.96, 6.32) | 314 (4.76) | (3.92, 5.60) | 415 (6.47) | (5.46, 7.49) |
Abbreviations: CI = 95% confidence interval, PA= Physical activity.
Weighted using jack‐knife replicate weights to provide US representative estimates with design‐adjusted standard errors.
Only among those who reported a history of cancer.
Reported history of oral cavity/pharynx/larynx, esophagus, female breast, colon, rectum, liver, or stomach cancer.
Sum does not add to total due to missing.
Strongly disagree or somewhat disagree.
Strongly agree or somewhat agree.
Normal PHQ‐4 score is 0–2, mild is 3‐5, moderate is 6‐8, severe is 9–12.
No interactions were found between ambiguity, cancer fatalism, or health self‐efficacy and cancer history (Table S1); therefore, Table 2 reports the logistic regression results with no interaction terms. Older age, female gender, and identifying as Black or Other race were associated with lower odds of current drinking. Adults with a college degree had higher odds of current drinking compared to adults without a college degree (OR: 1.85, 95% CI: 1.62–2.12). Adults who smoked had higher odds of current drinking compared to adults who did not currently smoke (OR: 1.63, 95% CI: 1.33–1.99) and adults who met weekly US physical activity guidelines had higher odds of current drinking compared to adults who did not meet these guidelines (OR: 1.25, 95% CI: 1.09–1.44). Adults reporting looking for cancer information had higher odds of current drinking compared to adults who did not report looking for cancer information (OR: 1.22, 95% CI: 1.07–1.40). Adults with heart disease or diabetes had lower odds of current drinking (OR: 0.77, 95% CI: 0.60–0.97, and OR: 0.57, 95% CI: 0.47–0.69 for heart disease and diabetes, respectfully). Cancer history was not associated with current drinking (OR: 0.97, 95% CI: 0.82–1.15). Cause ambiguity was not associated with current drinking (OR: 1.13, 95% CI: 0.98–1.30 for believing that everything causes cancer and OR:1.04, 95% CI: 0.89–1.21 for believing there are too many recommendations for preventing cancer) nor was cancer fatalism (OR: 0.87, 95% CI: 0.74–1.02). Although those who were very confident (reference category: somewhat, a little, or not at all confident) in their ability to take good care of their health had higher odds of current drinking, this association was not statistically significant as the 95% confidence interval was bounded by one (OR: 1.18, 95% CI: 1.00–1.40).
TABLE 2.
Weighted logistic regression examining correlates of current drinking (N = 13,518).
| Or (95% CI) | p | |
|---|---|---|
| Age | ||
| 18–59 years | Referent | |
| 60+ years | 0.81 (0.71, 0.92) | 0.001 |
| Gender | ||
| Male | Referent | |
| Female | 0.68 (0.59, 0.78) | < 0.001 |
| Race | ||
| White | Referent | |
| Black | 0.75 (0.62, 0.90) | 0.002 |
| Other | 0.61 (0.49, 0.76) | < 0.001 |
| Ethnicity | ||
| Non‐hispanic | Referent | |
| Hispanic | 0.94 (0.78, 1.14) | 0.551 |
| Education | ||
| < College degree | Referent | |
| ≥ College degree | 1.85 (1.62, 2.12) | < 0.001 |
| Smoking status | ||
| Not a current smoker | Referent | |
| Current smoker | 1.63 (1.33, 1.99) | < 0.001 |
| Physical activity | ||
| Does not meet weekly PA guidelines | Referent | |
| Meets weekly PA guidelines | 1.25 (1.09, 1.44) | 0.002 |
| Seen health provider in last year | ||
| Not seen | Referent | |
| Seen | 1.11 (0.89, 1.38) | 0.359 |
| Cancer information seeking | ||
| Never looked for cancer information | Referent | |
| Ever looked for cancer information | 1.22 (1.07, 1.40) | 0.004 |
| Believes everything causes cancer | ||
| Disagrees | Referent | |
| Agrees | 1.13 (0.98, 1.30) | 0.097 |
| Believes there are too many recommendations for preventing cancer | ||
| Disagrees | Referent | |
| Agrees | 1.04 (0.89, 1.21) | 0.615 |
| Believes there is little you can do to decrease cancer risk | ||
| Disagrees | Referent | |
| Agrees | 0.87 (0.74, 1.02) | 0.089 |
| Confidence in ability to take good care of one's health | ||
| Somewhat, a little, or not at all confident | Referent | |
| Very confident | 1.18 (1.00, 1.40) | 0.053 |
| Completely confident | 1.08 (0.90, 1.29) | 0.404 |
| Ever had cancer | ||
| No | Referent | |
| Yes | 0.97 (0.82, 1.15) | 0.742 |
| Ever had heart condition | ||
| No | Referent | |
| Yes | 0.77 (0.60, 0.97) | 0.030 |
| Ever had diabetes | ||
| No | Referent | |
| Yes | 0.57 (0.47, 0.69) | < 0.001 |
| Ever had high blood pressure | ||
| No | Referent | |
| Yes | 0.96 (0.83, 1.10) | 0.518 |
| PHQ‐4 total score | ||
| Normal | Referent | |
| Mild | 1.01 (0.85, 1.21) | 0.868 |
| Moderate | 1.02 (0.76, 1.37) | 0.881 |
| Severe | 0.86 (0.65, 1.14) | 0.285 |
Note: Italics indicates statistical significance (i.e., p < 0.05). Normal PHQ‐4 score is 0–2, mild is 3‐5, moderate is 6‐8, severe is 9–12. Model fit information: Pseudo R 2: 0.07, AIC: 17,896.10, BIC: 17,975.51.
Abbreviations: CI = 95% Confidence Interval, OR = Odds Ratio, PA=Physical activity, PHQ‐4 = Patient Health Questionnaire‐4.
For survivors, identifying as a race other than Black or White was associated with lower odds of current drinking compared to survivors who identified as White (OR: 0.36, 95% CI: 0.17–0.77, Table 3). Survivors with diabetes had lower odds of current drinking compared those without diabetes (OR: 0.58, 95% CI: 0.48–0.80). Survivors with a college degree had higher odds of current drinking compared to survivors without a college degree (OR: 1.56, 95% CI: 1.19–2.12). Survivors who met physical activity guidelines had higher odds of current drinking compared to survivors who did not meet physical activity guidelines (OR: 1.70, 95% CI: 1.24–2.32). Having an ARCA was not associated with current drinking (OR: 0.90, 95% CI: 0.66–1.23). Time since diagnoses was not associated with current drinking. Among adults without a cancer history, all variables were associated with current drinking, with no differences in the direction of association from the overall logistic regression model.
TABLE 3.
Weighted multivariable logistic regression examining correlates of current drinking by history of cancer.
| Among people with a history of cancer (N = 2237) | Among people without a history of cancer (N = 12,224) | |||
|---|---|---|---|---|
| OR (95% CI) | p | OR (95% CI) | p | |
| Age | ||||
| 18–59 years | Referent | Referent | ||
| 60+ years | 0.78 (0.54, 1.12) | 0.169 | 0.80 (0.71, 0.91) | < 0.001 |
| Gender | ||||
| Male | Referent | Referent | ||
| Female | 0.78 (0.56, 1.07) | 0.122 | 0.67 (0.58, 0.77) | < 0.001 |
| Race | ||||
| Black | 0.63 (0.37, 1.07) | 0.089 | 0.80 (0.67, 0.96) | 0.017 |
| Other | 0.36 (0.17, 0.77) | 0.008 | 0.62 (0.50, 0.77) | < 0.001 |
| White | Referent | Referent | ||
| Education | ||||
| < College degree | Referent | Referent | ||
| ≥ College degree | 1.56 (1.19, 2.12) | 0.002 | 1.94 (1.69, 2.22) | < 0.001 |
| Smoking status | ||||
| Not a current smoker | Referent | Referent | ||
| Current smoker | 1.35 (0.83, 2.20) | 0.232 | 1.62 (1.33, 1.97) | < 0.001 |
| Physical activity | ||||
| Does not meet weekly PA guidelines | Referent | Referent | ||
| Meets weekly PA guidelines | 1.70 (1.24, 2.32) | < 0.001 | 1.28 (1.11, 1.47) | < 0.001 |
| Cancer information seeking | ||||
| Never looked for cancer information | Referent | Referent | ||
| Ever looked for cancer information | 1.20 (0.87, 1.65) | 0.273 | 1.27 (1.10, 1.46) | 0.001 |
| Ever heart condition | ||||
| No | Referent | Referent | ||
| Yes | 0.72 (0.48, 1.09) | 0.124 | 0.74 (0.58, 0.95) | 0.019 |
| Ever diabetes | ||||
| No | Referent | Referent | ||
| Yes | 0.58 (0.43, 0.80) | < 0.001 | 0.58 (0.48, 0.70) | < 0.001 |
| Alcohol‐related cancer a , b | ||||
| No | Referent | — | ||
| Yes | 0.90 (0.66, 1.23) | 0.505 | ||
| Time since cancer diagnosis a | ||||
| Within last year | Referent | — | ||
| 2–5 years | 1.32 (0.79, 2.20) | 0.296 | ||
| 6–10 years | 1.29 (0.74, 2.23) | 0.367 | ||
| 11+ years | 1.00 (0.62, 1.62) | 0.994 |
Note: Italics indicates statistical significance (i.e., p < 0.05). Multivariable model adjusted for all listed variables except those denoted with “—”. Model fit for model among people with a history of cancer: Pseudo R 2: 0.08, AIC:2971.62, BIC: 3014.65. Model fit for model among people without a history of cancer: Pseudo R 2: 0.07, AIC: 15,848.81, BIC: 15,894.98.
Abbreviations: CI = 95% Confidence Interval, OR = Odds Ratio.
Only among those who reported a history of cancer.
Reported history of oral cavity/pharynx/larynx, esophagus, female breast, colon, rectum, liver, or stomach cancer.
4. Discussion
This study used four waves of a nationally representative survey to examine associations between cancer‐related beliefs and alcohol consumption and the consistency of associations with alcohol use by cancer history. This paper has three main results. First, after considering a range of demographic, psychological, behavioral, socio‐economic, and health factors, cancer history was not associated with alcohol use, indicating similar rates of drinking between survivors and those without a cancer history. Second, across three separate measures of cancer‐related beliefs, none were associated with current drinking. Lastly, there were few shared correlates of current drinking by cancer history.
The similar levels of drinking between those with and without cancer history are consistent with the previous literature [7, 8, 10]. Given that this and the previous research have used nationally representative samples and spanned 2 decades (1999 [7] to 2022 in the current study), there is an indication of consistency in the lack of association between cancer history and current alcohol consumption. It is perhaps not surprising that rates of alcohol consumption are similar between these two groups as there are currently no specific guidelines on recommended levels of alcohol consumption for people with a cancer history. The potential impact of a lack of recommendations is highlighted by the fact that, in the current study, having diabetes overall and by cancer history was associated with lower odds of current drinking. Among those without a cancer history, having a heart condition was also associated with lower odds of current drinking. The professional organizations for both of these chronic diseases have published information with drinking guidelines [23, 24]. Additionally, few adults report providers discussing the potential harms of alcohol [25], and it is unknown if discussions of the potential harms of alcohol differ by cancer history. Exploring the extent to which conversations about alcohol differ by cancer history could help explain similar rates of alcohol consumption between the groups investigated in this study.
To our knowledge, the association between cancer‐related beliefs and alcohol use have not been previously explored. We hypothesized that cause ambiguity and cancer fatalism, if associated with alcohol use, would be associated with increased odds of use, based on previous literature showing that both are associated with engagement in behaviors that increase cancer risk. [13, 14, 15]. However, despite our large sample, we found no associations with these beliefs and alcohol use. We also found no evidence of effect modification between cancer‐related beliefs and cancer history with alcohol use. It is possible that unmeasured psychological factors affected the estimated associations, e.g., worrying about cancer, which was not available for these analyses. Alternatively, social or religious characteristics could be associated with both fatalism [26] and lower levels of alcohol consumption, but were not measured. Lack of awareness of the link between alcohol and cancer might weaken the associations between cancer‐related beliefs and alcohol consumption. But, cancer information seeking, which has been correlated with increased awareness [22], was included in our final models. Additionally, some of the previous literature has specifically considered other cancer risk behaviors that might have lower cancer awareness, like fruit and vegetable intake [27] and still found an association between cancer‐related beliefs and worse behavioral outcomes [14, 15]. Future research is needed to further explore these constructs and their impact on behavior by cancer history.
Other correlates of alcohol use also differed by cancer history. Among adults without a cancer history, female gender, older age, Black race, and having a heart condition were uniquely associated with lower odds of current drinking while current smoking and cancer information seeking were associated with an increased odds of current drinking. For survivors, there were no unique correlates of current drinking. The remaining shared correlates were being a race other than Black or White, which was associated with reduced odds of current drinking in both groups, while education and meeting current physical activity guidelines were associated with increased odds of current drinking in both groups. Our finding that meeting physical activity guidelines was associated with increased alcohol consumption is consistent with previous research among adults in general and adult survivors [28, 29]. However, their relative influence differed as education was more strongly associated with current drinking for adults without a cancer history, and meeting physical activity guidelines more strongly associated with current drinking for survivors. Therefore, their importance in potential alcohol reduction interventions could differ depending on the population of interest.
Among survivors, our cancer‐specific associations also differed. Previously, having an ARCA was associated with lower odds of currently drinking [10], but we found no statistically significant association. Survivors farther from their diagnosis (i.e., 5–10 years) also had higher odds of consumption [10], while we did not find an association between time since cancer diagnosis and current drinking. Our point estimates were in similar directions, but our sample sizes were vastly different (N = 2237 in the current study vs. N = 16,504 for Lin et al.); therefore, with a larger sample and improved statistical power, we may see more consistent patterns among survivors. If survivors who are closer to their diagnosis are in fact drinking more often, there is the potential to intervene within clinical survivorship care. Additionally, to our knowledge, no studies have assessed longitudinal patterns of alcohol use to explore the potential impact of treatment completion on this behavior, which could be an area of future research.
It is concerning that on average survivors are consuming alcohol at similar levels to their non‐cancer survivor counterparts because of the potential for alcohol use to interfere with treatment and increase the risk of cancer recurrence. One possible explanation is lack of awareness of the link between alcohol and cancer and prognosis in survivors [3, 4, 5, 30, 31]. If people are unaware that alcohol consumption increases risk or response to treatment and recurrence, drinking levels might well be determined by other factors. Current research suggests that regardless of cancer history, awareness of alcohol as a risk factor for cancer is low [32], with only 35%–38% of US adults endorsing an association between alcohol consumption and cancer risk [22, 25]. It is also unknown if survivors are aware of the impact of continued consumption on cancer outcomes and recurrence. Qualitative research may help us understand the motivations for continued alcohol use among survivors.
Alternatively, a cancer diagnosis has also been promoted as a “teachable moment” for modifiable cancer risk behaviors, which could lead to healthier lifestyles [33, 34]. Behavior change strategies targeting other behaviors, such as a smoking cessation or weight loss and maintenance could prove fruitful when trying to change a behavior that is ingrained into social and cultural norms. For example, an exploratory secondary analyses of a weight reduction study among a small sub‐sample (n = 37) of breast cancer survivors who reported regular alcohol use at baseline, found a reduction in alcohol use by 1.2 US standard drinks during a 6‐month study [35]. More research in this area could better estimate the potential impact of this strategy.
4.1. Implications
Given the impact of alcohol use on cancer morbidity and mortality, it has been recommended that oncologists consider discussing alcohol use with their patients [36]. There is some evidence that a provider recommendation to reduce alcohol use among survivors may result in decreased consumption [37], but the full impact of these discussions on alcohol consumption in survivors is unknown. In the absence of specific recommendations about alcohol consumption after a cancer diagnosis, it is also unknown how effective these conversations might be, or how comfortable oncologists might be in starting these discussions, particularly given the complexity of alcohol use behaviors in the population. For example, even for smoking, where concrete recommendations support cessation [38], rates of smoking continue to be similar, or slightly higher among adults by cancer history [39]. Similar rates of continued substance use potentially highlight shared challenges of discussing these behaviors or promoting behavior change among survivors. Survivors may also have low motivation to change their alcohol consumption [40], which may need to be addressed first before reduction interventions can be effectively implemented. Survivors who currently meet physical activity guidelines may also be an important group for targeted interventions to reduce alcohol use due to their increased rates of use, and potential shared reward pathways promoting both behaviors [28]. Future research is also needed to understand the intersection of provider communication, patient beliefs, and patient behaviors to develop interventions and innovations in this area.
4.2. Limitations
This study has several limitations. This was a cross‐sectional study, and thus temporality of the associations cannot be determined, nor were we able to estimate any changes in patterns over time. By combining four waves of a nationally representative survey, we were able to explore correlates of alcohol consumption among a robust sample of survivors, however, the total size of our subgroup remained modest and may have had reduced power. Response rates to these four HINTS cycles were low and while weighting was used to adjust values in relation to several demographic variables, bias could remain in relation to other variables. Data were all self‐reported, introducing the possibility of reporting bias. Lack of items capturing binge drinking across all surveys and a low prevalence of heavy drinking limited our ability to compare to some of the existing literature. As this was a secondary data analysis, we were not involved in the selection of the specific items used to measure our variables of interest, however, the HINTS survey uses standard questions when available and undergoes cognitive testing of any new items added to the survey before it is fielded. A notable strength of the study is the availability of the cancer‐related belief variables of cause ambiguity and cancer fatalism. Thus, we were able to consider demographic, behavioral, and psychological correlates of alcohol use in adults by cancer history, an advance on past analyses.
5. Conclusions
In this study, despite potential risks associated with continued alcohol use following a cancer diagnosis, survivors had similar patterns of alcohol use as adults in the US. Interestingly, few of the previously identified correlates of alcohol use were found in the current study as there were few statistically significant associations with alcohol use among survivors. Cancer‐related beliefs had mixed relationships with drinking patterns and may not be a salient intervention target for changing alcohol behaviors. Results suggest a need to better understand the interplay between awareness of links between alcohol and cancer and drinking behavior in people by cancer history. Given that survivors are interacting with the healthcare system, clinical interventions may be well‐suited and are recommended to reduce alcohol use in this population [36]. But, while oncologists and other health care providers could communicate a need for healthy behavior change among survivors, barriers exist such as a lack of consensus for implementation and timing of discussing alcohol, and alcohol use among providers themselves [33]. Leveraging lessons learned from other settings where alcohol use was found to be lower, such as among adults with diabetes, could help inform clinical discussions in the oncology setting. Alternatives to oncologist administered interventions in this population are also needed, including interventions delivered by other healthcare providers and educational campaigns by cancer support organizations to increase awareness of this cancer‐relevant behavior.
Author Contributions
K.P.W., R.H.E., D.B., and T.A.‐C. conceptualized the project. K.P.W. and T.E.G. led analyses, K.P.W. and R.H.E. drafted the manuscript, and all authors reviewed, edited, and approved the final manuscript.
Funding
The HINTS data discussed in this manuscript were collected via an NCI contract to Westat. During part of the conduct of this study, Kara P. Wiseman was an iTHRIV Scholar. The iTHRIV Scholars Program is supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR003015 and KL2TR003016.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Table S1: Weighted logistic regression examining correlates of current drinking with interactions between each cause ambiguity, cancer fatalism, and health self‐efficacy variable and cancer history (N=13,518).
Acknowledgments
The authors have nothing to report.
Wiseman, Kara P. , Glasgow Trevin E., Eck Raimee H., Agurs‐Collins Tanya, and Berrigan David. 2025. “Associations Between Beliefs About Cancer and Alcohol Use Among Cancer Survivors: A US Representative Cross‐Sectional Survey,” Psycho‐Oncology: e70329. 10.1002/pon.70329.
Data Availability Statement
The Health Information National Trends Survey (HINTS) is publicly available. Information about downloading and using the data can be found at https://hints.cancer.gov/.
References
- 1. World Cancer Research Fund/American Institute for Cancer Research , “Continuous Update Project Expert Report 2018,” Alcoholic Drinks and the Risk of Cancer (2018). [Google Scholar]
- 2. Islami F., Goding Sauer A., Miller K. D., et al., “Proportion and Number of Cancer Cases and Deaths Attributable to Potentially Modifiable Risk Factors in the United States,” A Cancer Journal for Clinicians 68, no. 1 (2018): 31–54, 10.3322/caac.21440. [DOI] [PubMed] [Google Scholar]
- 3. Simapivapan P., Boltong A., and Hodge A., “To What Extent is Alcohol Consumption Associated With Breast Cancer Recurrence and Second Primary Breast Cancer?: A Systematic Review,” Cancer Treatment Reviews 50 (2016): 155–167, 10.1016/j.ctrv.2016.09.010. [DOI] [PubMed] [Google Scholar]
- 4. Li Y., Mao Y., Zhang Y., et al., “Alcohol Drinking and Upper Aerodigestive Tract Cancer Mortality: A Systematic Review and Meta‐Analysis,” Oral Oncology 50, no. 4 (2014): 269–275, 10.1016/j.oraloncology.2013.12.015. [DOI] [PubMed] [Google Scholar]
- 5. Genther D. J. and Gourin C. G., “The Effect of Alcohol Abuse and Alcohol Withdrawal on Short‐Term Outcomes and Cost of Care After Head and Neck Cancer Surgery,” Laryngoscope 122, no. 8 (2012): 1739–1747, 10.1002/lary.23348. [DOI] [PubMed] [Google Scholar]
- 6. Gapstur S. M., Bouvard V., Nethan S. T., et al., “The IARC Perspective on Alcohol Reduction or Cessation and Cancer Risk,” New England Journal of Medicine 389, no. 26 (2023): 2486–2494, 10.1056/nejmsr2306723. [DOI] [PubMed] [Google Scholar]
- 7. Zhang F. F., Liu S., John E. M., Must A., and Demark‐Wahnefried W., “Diet Quality of Cancer Survivors and Noncancer Individuals: Results From a National Survey,” Cancer 121, no. 23 (2015): 4212–4221, 10.1002/cncr.29488. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. LeMasters T. J., Madhavan S. S., Sambamoorthi U., and Kurian S., “Health Behaviors Among Breast, Prostate, and Colorectal Cancer Survivors: A US Population‐Based Case‐Control Study, With Comparisons by Cancer Type and Gender,” Journal of Cancer Survivorship 8, no. 3 (2014): 336–348, 10.1007/s11764-014-0347-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Yaghjyan L., Wolin K., Chang S.‐H., and Colditz G., “Racial Disparities in Healthy Behaviors and Cancer Screening Among Breast Cancer Survivors and Women Without Cancer: National Health Interview Survey 2005,” Cancer Causes and Control 25, no. 5 (2014): 605–614, 10.1007/s10552-014-0365-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Lin H. Y., Fisher P., Harris D., and Tseng T. S., “Alcohol Intake Patterns for Cancer and Non‐Cancer Individuals: A Population Study,” Translational Cancer Research 8, no. 4 (2019): S334–S345, 10.21037/tcr.2019.06.31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Sanford N. N., Sher D. J., Xu X., et al., “Alcohol Use Among Patients With Cancer and Survivors in the United States, 2000–2017,” Journal of the National Comprehensive Cancer Network 18, no. 1 (2020): 69–79, 10.6004/jnccn.2019.7341. [DOI] [PubMed] [Google Scholar]
- 12. Cooke R., Dahdah M., Norman P., and French D. P., “How Well Does the Theory of Planned Behaviour Predict Alcohol Consumption? A Systematic Review and Meta‐Analysis,” Health Psychology Review 10, no. 2 (2016): 148–167, 10.1080/17437199.2014.947547. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Klein W. M., Ferrer R. A., Graff K. A., Kaufman A. R., and Han P. K., “Perceived Ambiguity, Fatalism, and Believing Cancer is More Prevalent Than Heart Disease,” American Journal of Preventive Medicine 46, no. 4 (2014): e45–e47, 10.1016/j.amepre.2014.01.003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Welch J. D. and Ellis E. M., “Sex Differences in the Association of Perceived Ambiguity, Cancer Fatalism, and Health‐Related Self‐Efficacy With Fruit and Vegetable Consumption,” Journal of Health Communication 23, no. 12 (2018): 984–992, 10.1080/10810730.2018.1534905. [DOI] [PubMed] [Google Scholar]
- 15. Niederdeppe J. and Levy A. G., “Fatalistic Beliefs About Cancer Prevention and Three Prevention Behaviors,” Cancer Epidemiology, Biomarkers and Prevention 16, no. 5 (2007): 998–1003, 10.1158/1055-9965.epi-06-0608. [DOI] [PubMed] [Google Scholar]
- 16. Kiviniemi M. T., Orom H., Hay J. L., and Waters E. A., “Limitations in American Adults' Awareness of and Beliefs About Alcohol as a Risk Factor for Cancer,” Preventive Medicine Reports 23 (2021): 101433, 10.1016/j.pmedr.2021.101433. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Lykins E. L., Graue L. O., Brechting E. H., Roach A. R., Gochett C. G., and Andrykowski M. A., “Beliefs About Cancer Causation and Prevention as a Function of Personal and Family History of Cancer: A National, Population‐based Study,” Psycho‐Oncology 17, no. 10 (2008): 967–974, 10.1002/pon.1306. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Rodríguez V. M., Gyure M. E., Corona R., Bodurtha J. N., Bowen D. J., and Quillin J. M., “What Women Think: Cancer Causal Attributions in a Diverse Sample of Women,” Journal of Psychosocial Oncology 33, no. 1 (2015): 48–65, 10.1080/07347332.2014.977419. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Westat . Health Information National Trends Survey 5 (HINTS 5) Cycle 3 Methodology Report. 2019.
- 20. National Cancer Insitute HINTS . “Frequently Asked Questions About HINTS, What are the Response Rates for the Available HINTS Data?,” https://hints.cancer.gov/about‐hints/frequently‐asked‐questions.aspx#accordion‐4.
- 21. National Institute on Alcohol Abuse and Alcoholism . “What is a Standard Drink?,”2019, https://www.niaaa.nih.gov/what‐standard‐drink.
- 22. Wiseman K. P. and Klein W. M. P., “Evaluating Correlates of Awareness of the Association Between Drinking Too Much Alcohol and Cancer Risk in the United States,” Cancer Epidemiology, Biomarkers and Prevention 28, no. 7 (2019): 1195–1201, 10.1158/1055-9965.epi-18-1010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. ElSayed N. A., Aleppo G., Aroda V. R., et al., “5. Facilitating Positive Health Behaviors and Well‐Being to Improve Health Outcomes: Standards of Care in Diabetes—2023,” Diabetes Care 46, no. 1 (2022): S68–S96, 10.2337/dc23-s005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Piano M. R., Marcus G. M., Aycock D. M., et al., “Alcohol Use and Cardiovascular Disease: A Scientific Statement From the American Heart Association,” Circulation 152, no. 1 (2025): e7–e21, 10.1161/cir.0000000000001341. [DOI] [PubMed] [Google Scholar]
- 25. Wiseman K. P., Seidenberg A. B., and Klein W. M. P., “Clinician Role in Patient Awareness Regarding Carcinogenic Nature of Alcohol Consumption in the US: A Nationally Representative Survey,” Journal of General Internal Medicine 37, no. 8 (2021): 2116–2119, 10.1007/s11606-021-07113-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Moss J. L., Ehrenkranz R., Perez L. G., Hair B. Y., and Julian A. K., “Geographic Disparities in Cancer Screening and Fatalism Among a Nationally Representative Sample of US Adults,” Journal of Epidemiology and Community Health 73, no. 12 (2019): 1128–1135, 10.1136/jech-2019-212425. [DOI] [PubMed] [Google Scholar]
- 27. American Institute for Cancer Research . AICR Cancer Risk Awareness Survey. 2019.
- 28. Leasure J. L., Neighbors C., Henderson C. E., and Young C. M., “Exercise and Alcohol Consumption: What We Know, What We Need to Know, and Why It is Important,” Frontiers in Psychiatry 6 (2015): 156, 10.3389/fpsyt.2015.00156. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29. Mama S. K., Heredia N. I., Johnston H., and Conroy D. E., “Associations Between Physical Activity and Alcohol Consumption in Rural Cancer Survivors,” Frontiers Oncology 12 (2022): 871192, 10.3389/fonc.2022.871192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30. Druesne‐Pecollo N., Keita Y., Touvier M., et al., “Alcohol Drinking and Second Primary Cancer Risk in Patients With Upper Aerodigestive Tract Cancers: A Systematic Review and Meta‐Analysis of Observational Studies,” Cancer Epidemiology, Biomarkers & Prevention 23, no. 2 (2014): 324–331, 10.1158/1055-9965.epi-13-0779. [DOI] [PubMed] [Google Scholar]
- 31. O'Shea R., Byrne H., Tuckett J., O'Leary G., and Sheahan P., “Impact of Current Smoking and Alcohol Consumption on Gastrostomy Duration in Patients With Head and Neck Cancer Undergoing Definitive Chemoradiotherapy,” JAMA Otolaryngology–Head and Neck Surgery 141, no. 5 (2015): 463–469, 10.1001/jamaoto.2015.0279. [DOI] [PubMed] [Google Scholar]
- 32. US Department of Health and Human Services . Alcohol and Cancer Risk: The U.S. Surgeon General’s Advisory. 2025.
- 33. Coa K. I., Smith K. C., Klassen A. C., et al., “Capitalizing on the ‘Teachable Moment’ to Promote Healthy Dietary Changes Among Cancer Survivors: The Perspectives of Health Care Providers,” Supportive Care in Cancer 23, no. 3 (2015): 679–686, 10.1007/s00520-014-2412-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34. Demark‐Wahnefried W., Aziz N. M., Rowland J. H., and Pinto B. M., “Riding the Crest of the Teachable Moment: Promoting Long‐Term Health After the Diagnosis of Cancer,” Journal of Clinical Oncology 23, no. 24 (2005): 5814–5830, 10.1200/jco.2005.01.230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35. Fazzino T. L., Fleming K., and Befort C., “Alcohol Intake Among Breast Cancer Survivors: Change in Alcohol Use During a Weight Management Intervention,” JMIR Cancer 2, no. 2 (2016): e15, 10.2196/cancer.6295. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36. LoConte N. K., Brewster A. M., Kaur J. S., Merrill J. K., and Alberg A. J., “Alcohol and Cancer: A Statement of the American Society of Clinical Oncology,” Journal of Clinical Oncology 36, no. 1 (2018): 83–93, 10.1200/jco.2017.76.1155. [DOI] [PubMed] [Google Scholar]
- 37. Eng L., Pringle D., Su J., et al., “Patterns, Perceptions and Their Association With Changes in Alcohol Consumption in Cancer Survivors,” European Journal of Cancer Care 28, no. 1 (2019): e12933, 10.1111/ecc.12933. [DOI] [PubMed] [Google Scholar]
- 38. National Cancer Institute . National Institutes of Health. Treating Smoking in Cancer Patients: An Essential Component of Cancer Care National Cancer Institute, (2022), 43. [PubMed] [Google Scholar]
- 39. National Cancer Institute . “National Institutes of Health. Cancer Survivors and Smoking,”2024, https://progressreport.cancer.gov/after/smoking.
- 40. Matin J., Lucia R. M., Lal K., et al., “Factors Associated With Women's Unwillingness to Decrease Alcohol Intake to Decrease Breast Cancer Risk,” Journal of Primary Care and Community Health 12 (2021): 21501327211000211, 10.1177/21501327211000211. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Table S1: Weighted logistic regression examining correlates of current drinking with interactions between each cause ambiguity, cancer fatalism, and health self‐efficacy variable and cancer history (N=13,518).
Data Availability Statement
The Health Information National Trends Survey (HINTS) is publicly available. Information about downloading and using the data can be found at https://hints.cancer.gov/.