27, 95% CI 1.10�C1.47), task efficiency (RR = 2.01, 95% CI 1.80�C2.25), and memory (RR = 1.90, 95% CI 1.66�C2.17) and (b) survivors with executive dysfunction were more likely to be smokers (reported above). Discussion With improving success treating childhood cancers, the promotion of healthy behaviors within the growing survivor population is an emergent priority. The late effects of disease Gemcitabine injection and treatment present unique challenges to survivors that can affect functioning, health, and long-term survival. To our knowledge, this is the first study to examine the relationship between possible cognitive late effects and smoking in a sample of childhood cancer survivors. Results demonstrated strong concurrent and longitudinal associations between attentional/executive dysfunction and smoking.

Childhood attention problems emerged as a striking predictor of adult smoking close to a decade later on average. Nearly half of the survivors who experienced attention problems in childhood reported having smoked as adults. Furthermore, they were almost twice as likely to be current smokers in adulthood compared with survivors without attention problems. Similar associations were found between adult executive dysfunction and adult smoking. While the mechanism underlying the associations between smoking and attention/EF in survivors remains unclear, there are reasonable possibilities warranting further study. In the general population, the association between attention problems and smoking behavior is often explained in terms of a self-medication model in which smokers benefit from the stimulant property of nicotine by experiencing enhanced attention and concentration.

This model is supported by clinical and laboratory studies showing improvement on cognitive and behavioral measures of attention after nicotine administration in both clinical (Levin, Conners, Silva, Canu, & March, 2001; Levin & Rezvani, 2000; Levin et al., 1996; Potter & Newhouse, 2004) and nonclinical samples (Ernst, Heishman, Spurgeon, & London, 2001; Levin et al., 1998). Following this conceptualization, childhood cancer survivors who experience certain cognitive late effects may have a vulnerability to smoking similar to their healthy peers with attention problem symptoms. This similarity may have important implications for health promotion in this medical population.

Survivors Carfilzomib have demonstrated improvements in attentional and behavioral functioning on methylphenidate trials (Conklin et al., 2007; Mulhern et al., 2004; Thompson et al., 2001), increasing the clinical use of stimulants for posttreatment attentional deficits. If stimulant therapy reduces or renders inconsequential the attention-enhancing benefits of nicotine, treating survivors�� cognitive symptoms may also reduce their smoking risk. Our findings identified two components of EF (emotion regulation and memory) associated with smoking. Smoking to regulate emotion (e.g.