Smoking rates are especially high among those who had cancers strongly linked to smoking, such as lung and bladder cancer, say researchers who questioned nearly 3,000 survivors nine years after diagnosis. The results are published Wednesday in the journal Cancer Epidemiology, Biomarkers & Prevention.

The study suggests “just how difficult it is to quit,” even in the face of dire health consequences, including cancer recurrence, says lead author Lee Westmaas, an American Cancer Society researcher.