Survivors of pediatric cancer should avoid smoking and heavy alcohol use due to health risks associated with intensive cancer treatments they received. Data were analyzed from a multi-centre, population-based study of pediatric cancer survivors in Canada (n=1231) and a frequency matched control group (n=1372). Logistic regression analyses showed that survivors were significantly less likely to be smokers and alcohol drinkers than the controls. Still, a substantial proportion of survivors were

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... okers (23%), binge drinkers (25%), alcohol drinkers (69%) and concurrent users (20%). Low education, poor life satisfaction, and high stress were the most consistent predictors of substance use. Results from the structural equation modeling analysis to describe pathways to concurrent smoking and alcohol use showed significant pathways from education and chronic stress to concurrent use in the cancer survivors. This study identifies potential risk factors for smoking and alcohol use in cancer survivors and suggests a need for preventive education.