Association of neighborhood social vulnerability with cigarette dependence and abstinence in patients with cancer who smoke

Tobacco use after cancer diagnosis is associated with reduced survival poorer treatment response, and higher recurrence risk. While individual-level predictors of abstinence are well documented, less is known about the role of neighborhood disadvantage in shaping abstinence outcomes among patients with cancer. We analyzed 4913 patients with cancer who smoked and enrolled in the MD Anderson Tobacco Research and Treatment Program between 2006 and 2021. Residential addresses were geocoded to census tracts and linked to the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI). The primary outcome was self-reported 7-day point-prevalence smoking abstinence at 3 months under an intention-to-treat definition, and the secondary outcome was baseline nicotine dependence, assessed with the Fagerström Test for Cigarette Dependence (FTCD). Multivariable logistic and linear regression models adjusted for demographic, clinical, and socioeconomic covariates were used to estimate associations between SVI and outcomes. The overall 3-month intention-to-treat abstinence rate was 40.7%; rates were 43.8%, 40.8%, 39.2%, and 38.6% across SVI quartiles from lowest to highest vulnerability. In adjusted models, higher overall SVI was associated with lower odds of abstinence (full 0-to-1 scale OR = 0.76, 95% CI = 0.61 to 0.95, p = .018; per 0.10 increase OR = 0.97, 95% CI = 0.95 to 1.00). Housing/transportation vulnerability showed the strongest domain association with abstinence (OR = 0.74, 95% CI = 0.60 to 0.90, p = .003). Higher overall SVI was associated with greater FTCD scores (beta = 0.55, 95% CI = 0.29 to 0.82, p < .001), with a stepwise increase across SVI quartiles. Even among patients receiving comprehensive evidence-based tobacco treatment, higher neighborhood social vulnerability was associated with lower abstinence and greater baseline nicotine dependence. These findings support prospective evaluation of SVI-informed assessment and evidence-based treatment intensification to reduce disparities in tobacco treatment outcomes for patients with cancer.