Supplementary Material for: Smoking Prevalence and Cessation in Skin Cancer Survivors

Introduction: Smoking is associated with worse skin cancer outcomes yet smoking cessation after skin cancer diagnosis remains poorly characterized. This study aimed to examine and compare prevalences of smoking and cessation among skin cancer and internal cancer survivors using nationally representative data. Methods: This survey-weighted analysis included 2003-2018 National Health and Nutrition Examination Survey data from adults (age 20+) with self-reported cancer history (skin cancers only or internal cancers only). Skin cancer survivors were categorized as those who had non-melanoma skin cancer (NMSC) only or any melanoma. Smoking cessation after first cancer diagnosis was the primary outcome, with smoking status confirmed using serum cotinine. Prevalence outcomes were age-standardized using the direct method and compared by cancer type using age-adjusted logistic regression. Results: Among 3,711 cancer survivors, 1,098 (29.6%) had skin cancer exclusively. Age-standardized smoking prevalence at cancer diagnosis did not differ by cancer type and was 29.7% (22.8%–36.6%) among skin cancer survivors and 42.3% (37.9%–46.7%) among internal cancer survivors. Among those who smoked at diagnosis, age-standardized post-diagnosis cessation prevalences were low and did not differ between survivors of skin cancers and internal cancers, with 18.1% (12.5%–23.6%) for skin cancer survivors, 20.6% (10.7%–30.5%) for NMSC-only survivors, 11.9% (4.07%–19.6%) for melanoma survivors, and 18.7% (13.9%–23.4%) for internal cancer survivors. Conclusion: Smoking at skin cancer diagnosis was common with low cessation prevalence across all skin cancer types, highlighting opportunities for dermatologists and clinic staff to implement targeted smoking cessation interventions for skin cancer survivors.