Abstract 6235: Cancer risk behaviors and adverse childhood experiences among cancer survivors

Introduction: Adults who have experienced Adverse Childhood Experiences (ACEs) are at a higher risk of engaging in health-risk behaviors. While previous studies have examined the connection between ACEs and health-risk behaviors in the general population, there is a scarcity of research specifically addressing cancer survivors. This study investigates the association between three individual ACEs—mental illness in family members, physical abuse, and sexual abuse—and cancer-related risk behaviors (binge drinking and smoking) among cancer survivors. Methods: Using cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System, we analyzed a sample of 7,896 cancer survivors aged 18 and older. The exposure variables included three ACEs: having a family member with a mental illness, experiencing physical abuse, and experiencing sexual abuse before the age of 18 dichotomized as yes/no. The outcome measures were cancer risk behaviors: smoking status (categorized as current, former, or never smoker) and binge alcohol use (yes or no). Binge drinking was defined as consuming five or more drinks on one occasion for males and four or more drinks for females in past seven days or/and past 30 days of the survey. Weighted multivariable logistic regression models were used to evaluate the association between ACEs and binge drinking, while multinomial logistic regression models assessed the relationship between ACEs and smoking status, adjusting for sociodemographic factors. Results: In this sample of cancer survivors, 15.5%, 23.6%, and 6.3% reported experiencing the three ACEs: mental illness in family members, physical abuse, and sexual abuse, respectively. Regarding smoking history, 50.9% were never smokers, 34.3% were former smokers, and 15.0% were current smokers, while 7.8% reported binge alcohol use. Adjusted models revealed that cancer survivors with a history of mental illness in family members had significantly higher odds of being current smokers (aOR: 2.15, 95% CI: 1.41-3.26) or former smokers (aOR: 1.70, 95% CI: 1.27-2.29). Similarly, those who experienced physical abuse had increased odds of being current smokers (aOR: 2.29, 95% CI: 1.64-3.20) or former smokers (aOR: 1.53, 95% CI: 1.22-1.91). Survivors who reported sexual abuse had higher odds of being current smokers (aOR: 3.61, 95% CI: 2.18-5.99) or former smokers (aOR: 1.96, 95% CI: 1.15-3.32). However, the adjusted models showed no statistically significant association between the three ACEs and binge alcohol use among cancer survivors. Conclusion: Among cancer survivors, ACEs are independent predictors of former and current smoking status in adulthood, a well-established risk factor for cancer. As such, individuals with a history of ACEs may constitute a critical target group for preventive interventions designed to mitigate this risk and promote healthier behaviors. Citation Format: Oluwole Adeyemi Babatunde, Melanie Jefferson, Swann Adams, Chanita Hughes Halbert, Nosayaba Osazuwa Peters, Frank Clark, Jessica Obeysekare, Anusuiya Nagar, Eric Adjei Boakye. Cancer risk behaviors and adverse childhood experiences among cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 6235.