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Supporting Tailored Approaches to Reducing Tobacco – Decreasing Breast Cancer Incidence, or START, is a program of research dedicated to developing health messages and other strategies to address the issue of tobacco exposure among adolescents as a modifiable risk factor for breast cancer.

Studies show that breast tissue, in its growth stage during puberty and before first pregnancy, is highly sensitive to exposure to carcinogens. Many young adolescent girls continue to take up smoking, and the average age at first pregnancy is older than in the past, thus potentially extending the period of vulnerability. In addition, adolescent girls who are exposed to second hand smoke on a regular basis are also at risk.

Because most other established risk factors for breast cancer are not modifiable (e.g., family history, age at menarche), and tobacco exposure impacts the lives of many young women, reducing tobacco exposure represents an important untapped opportunity to decrease breast cancer incidence. To date, there have been few efforts to raise awareness of the connection between active smoking and second hand smoke to risk factors for breast cancer.

Reaching out to this population through the development of new health messages tailored to both genders about this modifiable risk factor for breast cancer is now paramount.

This research has been funded by a grant from the Canadian Breast Cancer Research Alliance and the Canadian Breast Cancer Foundation.

Our Team


  • Joan BottorffJoan L. Bottorff
    Principal Investigator
  • Chris RichardsonChris Richardson
    Principal Investigator
  • John OliffeJohn Oliffe
  • Carolyn GotayCarolyn Gotay
  • Pamela RatnerPamela A. Ratner
  • Chizimuzo OkoliChizimuzo T.C. Okoli
  • Rebecca Haines-SaahRebecca Haines-Saah
  • Peter HutchinsonPeter Hutchinson
  • Ken JohnsonKen Johnson
  • Jennifer SchwartzJennifer Schwartz
    Postdoctoral Fellow

Other Contributors

  • Laura Struik – Research Coordinator
  • Laura Bissell – Research Coordinator
  • Raquel Graham – Research Assistant
  • Jodie Stevens – Research Assistant
  • Andrew Munroe – Web Development



Richardson, C. G. (2015). Can gender-specific online messages change young Canadian’s awareness about cancer prevention? Blog post, Centre of Excellence in Cancer Prevention, University of British Columbia, Vancouver, BC. Read the post here.


Canadian Cancer Society (2014). Raising awareness of cancer risk through tailored videos. In FOCUS. Canadian Cancer Society Research Institute: Research Impact Report 2014, Page 43. Read the report here.

Stubbing out breast cancer. (2014). UBC Annual Report 2013-2014. Read the story here.

Bottorff, J. L., Struik, L.L., Bissell, L.J.L., Graham, R., Stevens, J., & Richardson, C.G. (2014). A social media approach to inform youth about breast cancer and smoking: An exploratory descriptive study. Collegian: The Australian Journal of Nursing Practice, Scholarship and Research, 21 (2), 159-168. DOI: 10.1016/j.colegn.2014.04.002 Full Article [Open Access]

Schwartz, J., Graham, R.B., Richardson, C.G., Okoli, C.T., Struik, L.L., & Bottorff, J.L. (2014). An examination of exposure and avoidance behavior related to second-hand cigarette smoke among adolescent girls in Canada. BMC Public Health, 14: 468. doi:10.1186/1471-2458-14-468. Full Article [Open Access]

Bottorff, J.L., Haines-Saah, R., Oliffe, J.L., Struik, L., Bissell, L., Gotay, C., Hutchinson, P., Richardson, C. & Johnson, K. (2014). Designing tailored messages about smoking and breast cancer for youth. Canadian Journal of Nursing Research, 46(1), 66-86.

Glantz, S.A. & Johnson, K.C. (2014). The Surgeon General report on smoking and health 50 years later: Breast cancer and the cost of increasing caution. Cancer Epidemiology Biomarkers and Prevention, 23(1), 37-46.


Richardson, C.G., Struik, L.L., Johnson, K.C., Ratner, P.A., Gotay, C., Memetovic, J., Okoli, C.T., & Bottorff, J.L. (2013). Initial impact of tailored web-based messages about cigarette smoke and breast cancer risk on boys’ and girls’ risk perceptions and information seeking: Randomized control trial. JMIR Research Protocols, 2(2), e53.


Johnson, K.C. (2012). Tobacco Smoke and Breast Cancer Risk: Rapid evolution of evidence and understanding in the early 21st Century. In Chen, G.G. (Ed), Cigarettes: Chemical composition, consumption and health effects (pp. 1-20). Hauppauge, NY: Nova Science Publishers.


Johnson, K.C., Miller, A.B., Collishaw, N.E., Palmer, J.R., Hammond, S.K., Salmon, A.G., et al. (2011). Active smoking and secondhand smoke increase breast cancer risk: The report of the Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk (2009). Tobacco Control, 20(1): e2.


Haines, R. J., Bottorff, J. L., Barclay McKeown, S., Ptolemy, E., Carey, J., & Sullivan, K. (2010). Breast cancer messaging for younger women: Gender, femininity, and risk. Qualitative Health Research, 20: 731-742.

Bottorff, J.L., McKeown, S.B., Carey, J., Haines, R., Okoli, C., Johnson, K.C., et al. (2010). Young women’s responses to smoking and breast cancer information. Health Education Research, 25(4): 668-677.

Conlon, M.S., Johnson, K.C., Bewick, M.A., Lafrenie, R.M., Donner, A. (2010). Smoking (active and passive), N-acetyltransferase 2, and risk of breast cancer. Cancer Epidemiology, 34(2): 142-149.

2009 and Earlier

Collishaw, N.E., Boyd, N.F., Cantor, K.P., Hammond, S.K., Johnson, K.C., Millar, J., et al. (2009). Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk. 2009. OTRU Special Report Series.

Bottorff, J.L., McKeown, S., & Ptolemy, E. (2008). Increasing awareness of smoking and breast cancer for young women. Network News,Canadian Breast Cancer Network, 12: 23-24.

Johnson, K.C. & Glantz, S.A. (2008). Evidence secondhand smoke causes breast cancer in 2005 stronger than for lung cancer in 1986. Preventive Medicine, 46(6): 492-496.

Johnson, K.C. (2005). Accumulating evidence on passive and active smoking and breast cancer risk. International Journal of Cancer, 117(4): 619-628.

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Kelowna bus bench showing prevention messaging tailored to girls (October 2014)