• head and neck cancer;
  • tobacco use;
  • smoking;
  • alcohol drinking;
  • sexual behavior;
  • human papillomavirus


Use of tobacco products, excessive alcohol consumption, and high-risk sexual behaviors increase the risk of developing head and neck cancer and impacts treatment effectiveness after diagnosis. This study examined smoking and engagement in other modifiable behavioral risk factors and human papillomavirus (HPV) status in patients with head and neck cancer in order to facilitate identification and foster development of targeted interventions in high-risk patients.


Participants were 102 patients with head and neck cancer at a large urban cancer center who completed a self-report background and health questionnaire and provided a saliva sample for determination of the long-acting nicotine metabolite cotinine.


Compared with former and never-smokers, current smokers were less educated, less likely to be married or living with a partner, and consumed more alcohol. Cotinine analysis indicated that 4 of 16 (25%) patients who denied past-month cigarette use misrepresented their true smoking status. Of patients with oropharyngeal cancer, 74% were confirmed as HPV-positive, and compared with HPV-negative patients, they were younger, more likely to be married/partnered and of Caucasian race, and reported more past vaginal and oral sexual partners. Only one-third of HPV-positive patients were aware of their HPV disease status.


Cigarette smoking is associated with engagement in other modifiable risk factors in patients with head and neck cancer. Self-report measures of smoking may not accurately depict true smoking status. HPV-positive cancer patients were more likely to endorse a history of multiple sexual partners. Regular screening and targeted interventions for these distinct risk factors are warranted. Cancer 2013;119:2419-2426. © 2013 American Cancer Society.