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Purpose   A significant proportion of adults surviving childhood cancer are smokers. Although these estimated rates of smoking are slightly lower than those in the US population, they remain alarmingly high for this high-risk group. The purpose of this study was to examine the predictive validity of adolescent self-reported smoking intentions for later smoking among childhood cancer survivors.Patients and Methods   Baseline tobacco intentions were collected from 119 nonsmoking cancer survivors, age 10 to 18 years, who participated in a tobacco-based clinical trial during the late 1990s. Follow-up smoking status was systematically collected annually up to 10 years postintervention (median follow-up, 6.0 years; interquartile range, 3.0 to 6.9 years) as part of clinical survivorship care.Results   Twenty-seven participants (22.7%) subsequently initiated tobacco use within 5 years of study enrollment. The 5-year cumulative incidence was 29.8% ± 6.0% for those who were susceptible to smoking compared with 12.8% ± 5.4% for those who were committed never smokers (P = .022). Past use (P &lt; .001) and having friends who smoked (P = .038) were also associated (univariate model) with tobacco initiation, and there was a trend for an association for older adolescents (P = .073). Every unit increase on the intentions scale was associated with a 17% increase in the risk for tobacco initiation (P = .002) after adjusting for age group and past tobacco use in a multivariable model.Conclusion   Because early intentions to smoke are predictive of later tobacco use, survivors as young as 10 years of age who waver in their commitment to remain tobacco abstinent should be targeted for tobacco prevention interventions.

Establishing the Predictive Validity of Intentions to Smoke Among Preadolescents and Adolescents Surviving Cancer