Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Arts and Sciences



First Advisor

Dr. Jessica L. Burris


Introduction: Unassisted attempts to quit tobacco are a well-established reason for quit failure. Nonetheless, many cancer patients prefer to make a quit attempt without using evidence-based tobacco treatment. This study aimed to understand the rationale that underlies cancer patients’ desire to quit tobacco without assistance and to track longitudinally the smoking cessation outcomes of patients with this preference. Method: In a mixed-methods, longitudinal study, 35 cancer patients who were current tobacco users and declined tobacco treatment because of the desire to quit on their own provided data via three questionnaires and 1-2 semi-structured interviews across 60 days. Participants were recruited from outpatient cancer clinics. Results: The sample was predominately White, non-Hispanic (85.71%), female (68.57%), unemployed due to disability (57.14%), and rural (54.29%). Key themes that emerged from the qualitative interviews were: self-reliance, willpower, perceived shame, social norms around unassisted quitting, and negative attitudes towards tobacco treatment. The most frequently endorsed barrier to tobacco treatment was “I know others who have quit without tobacco treatment” (82.86%, n = 29). During the study, participants reported smoking 12.20 ± 7.78 cigarettes per day on smoking days. Fourteen (43.67%) participants reported achieving 50% smoking reduction and 21.88% of participants achieved 3-day floating abstinence; none of these participants used treatment. Discussion: This study with cancer patients who use tobacco identified affective, cognitive, and personality factors related to quitting on one’s own, and social and systemic barriers to tobacco treatment use. Future interventions must address these factors to increase uptake of tobacco treatment in this population.

Digital Object Identifier (DOI)