ABSTRACT
PURPOSE: To examine the association between posttraumatic stress symptoms (PTSS), neurocognitive and psychosocial late-effects, health behaviors, and healthcare utilization in long-term survivors of childhood cancer. METHODS: Participants included individuals (N = 6844; 52.5% female; mean [SD] age at diagnosis = 7.6 [5.8], at follow-up = 34.9 [7.5]) in the Childhood Cancer Survivor Study (CCSS). Follow-up included the Posttraumatic Stress Scale, Brief Symptom Inventory-18, Short-form 36 Health-related quality of life (HRQOL) survey, CCSS Neurocognitive Questionnaire, and questions about sociodemographics, physical health, health behaviors, and healthcare utilization. Modified Poisson regression and multinomial logistic regression models examined associations between posttraumatic stress symptoms (PTSS) and neurocognitive, HRQOL, health behavior, and healthcare outcomes when adjusting for sociodemographics, disease, and treatment. RESULTS: Long-term survivors with PTSS (N = 995, 14.5%) reported more impairment in mental (relative risk [RR] 3.42, 95% confidence interval [CI] 3.05-3.85), and physical (RR = 2.26, CI = 1.96-2.61) HRQOL. PTSS was also associated with increased impairment in task efficiency (RR = 3.09, CI = 2.72-3.51), working memory (RR = 2.55, CI = 2.30-2.83), organization (RR = 2.11, CI = 1.78-2.50), and emotional regulation (RR = 3.67, CI = 3.30-4.09). Survivors with PTSS were significantly more likely to attend cancer-specific health visits in the past 2 years (OR = 1.89, CI = 1.50-2.39), and showed greater likelihood of either high frequency (OR = 1.89, CI = 1.50-2.39) or complete lack of (OR = 1.63, CI = 1.32-2.01) primary care visits compared to survivors without PTSS. CONCLUSIONS: Survivors with PTSS reported significantly more psychosocial and neurocognitive late effects, and were more likely to engage in variable use of healthcare. IMPLICATIONS FOR CANCER SURVIVORS: PTSS is associated with additional challenges for a population vulnerable to adverse late effects. Inclusion of integrative services during follow-up visits may benefit functional outcomes.
Subject(s)
Cancer Survivors/psychology , Health Behavior/physiology , Neoplasms/psychology , Patient Acceptance of Health Care/psychology , Quality of Life/psychology , Stress Disorders, Post-Traumatic/complications , Adult , Child , Female , Humans , Male , Neoplasms/mortality , Outcome Assessment, Health Care , Retrospective Studies , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Better communication between families, schools, communities, and clinicians is critical for improved skin cancer prevention initiatives for children and adolescents. Contributions from research in this area, as exemplified by the two studies in this special issue, will help shape priorities for future sun protection research and will be useful in generating evidence-based policy to support sun safety for children and reduce their future skin cancer risk.
Subject(s)
Behavior Therapy , Communication , Health Behavior , Health Education , Skin Neoplasms/prevention & control , Ultraviolet Rays/adverse effects , Adolescent , Child , Evidence-Based Medicine , Female , Humans , Male , SchoolsABSTRACT
This study evaluated whether a self-administered stress management training (SSMT) could improve quality of life (QOL) and reduce distress among Hispanics receiving chemotherapy across multiple community clinical settings. Participants were randomized to receive SSMT (n = 106) or usual care (UCO) (n = 113). The primary outcome-QOL (SF-36) and secondary outcomes depression (CES-D), and anxiety (STAI) were assessed longitudinally over four chemotherapy cycles. Acculturation (BAS) and patients' intervention adherence were assessed. About 63% of participants reported distress after the initial chemotherapy cycle. Hispanics with lower acculturation reported greater STAI-Trait scores (p = .003). No significant treatment effects on outcomes measures were observed for participants receiving SSMT. SSMT intervention techniques were reported useful and improved mental health scores were observed with patients on a psychotropic agent (p = .04). Hispanics experience an elevated level of distress, yet SSMT did not significantly improve primary outcomes. SSMT may be potentially effective when combined with a psychotropic agent. SSMT enhancing strategies are discussed.
Subject(s)
Hispanic or Latino/psychology , Self Care/methods , Stress, Psychological/ethnology , Stress, Psychological/therapy , Adult , Aged , Antineoplastic Agents/therapeutic use , Female , Health Status , Humans , Longitudinal Studies , Male , Mental Health , Middle Aged , Neoplasms/drug therapy , Neoplasms/ethnology , Patient Compliance , Psychotropic Drugs/therapeutic use , Quality of Life , Socioeconomic Factors , Stress, Psychological/drug therapyABSTRACT
To guide skin cancer preventive interventions, this study examined correlates of sun safety behaviors in a racially and ethnically diverse sample of 407 adolescents completing a self-report survey at the time of their pediatric wellness visit. Adolescents regularly practiced few sun safety behaviors, and greater interest in cancer prevention was associated with more sun safety behaviors, ever smoking cigarettes was associated with fewer sun safety behaviors, and nonwhite minority adolescents practiced fewer sun safety behaviors than non-Hispanic whites. Clinical preventive interventions to increase sun safety practices among adolescents of all racial and ethnic backgrounds could be integrated into general cancer prevention education, including combining skin cancer prevention with antismoking counseling.
Subject(s)
Ethnicity , Health Behavior/ethnology , Skin Neoplasms/ethnology , Skin Neoplasms/prevention & control , Sunlight/adverse effects , Sunscreening Agents/therapeutic use , Adolescent , Ethnicity/statistics & numerical data , Female , Health Knowledge, Attitudes, Practice , Health Promotion , Health Surveys , Humans , Male , Patient Education as Topic , Self Report , Young AdultABSTRACT
This study examined whether an intervention designed to reduce secondhand smoke exposure (SHSe) among children being treated for cancer had effects in the specific setting of a motor vehicle. The parents or guardians (n = 71) of children being treated for cancer were randomized to either a behavioral secondhand smoke (SHS) reduction program or a standard care control group. Parental reports of SHSe were collected over the course of 12 months. Younger children were exposed at baseline more than their older counterparts. The greatest initial declines in car exposure were observed among children ≤5 years old in the intervention group compared with same-aged peers in the control group. After the 3-month time point, the control group showed greater reductions in car exposure in comparison with the intervention group. Interventions that teach parents strategies to manage their smoking while driving in their personal vehicles may produce even greater reductions in child exposure and should be developed. Based on the age-specific results reported here, future studies should account for effects of child age and use setting-specific measures of SHS.
Subject(s)
Neoplasms/nursing , Nursing Process , Parents/psychology , Risk Reduction Behavior , Tobacco Smoke Pollution/prevention & control , Adult , Child, Preschool , Female , Humans , Infant , Male , Oncology Nursing , Pediatric Nursing , Treatment OutcomeABSTRACT
INTRODUCTION: The current study examined home and full (i.e., home plus car) smoking ban adoption as secondary outcomes to a randomized controlled trial targeting reduced secondhand smoke exposure (SHSe) for children under treatment for cancer. METHODS: Families with at least 1 adult smoker who reported SHSe for their children (n = 119) were randomized to control or intervention conditions and followed for 1 year with 5 assessments. Both groups were advised of the negative health outcomes associated with SHSe; the intervention group provided more in-depth counseling from baseline to 3 months. Parents reported on household and car smoking behavior, demographic, psychosocial, and medical/treatment-related information. RESULTS: Regardless of group assignment, there was an increase in home (odds ration [OR] = 1.16, p = .074) and full (OR = 1.37, p = .001) smoking ban adoption across time. Families in the intervention group were more likely to adopt a full ban by 3 months, but this difference was nonsignificant by 12 months. Married parents (OR = 2.33, p = .006) and those with higher self-efficacy for controlling children's SHSe (OR = 1.11, p = .023) were more likely to have a home smoking ban; parents who reported smoking fewer cigarettes were more likely to adopt a home (OR = 1.62, p < .0001) or full (OR = 7.32, p = .038) ban. CONCLUSIONS: Smoking bans are in-line with Healthy People 2020's tobacco objectives and may be more feasible for parents with medically compromised children for immediate SHSe reduction. Furthermore, interventions targeting full smoking bans may be a more effective for comprehensive elimination of SHSe.
Subject(s)
Smoking Prevention , Tobacco Smoke Pollution/prevention & control , Adult , Air Pollution, Indoor/prevention & control , Child , Family Characteristics , Family Health , Follow-Up Studies , Housing , Humans , Neoplasms/complications , Neoplasms/therapy , Odds Ratio , Parents/psychology , Patient Education as Topic , Randomized Controlled Trials as Topic , Self Efficacy , Tobacco Use DisorderABSTRACT
Tobacco use and exposure are preventable causes of morbidity and mortality. Whereas the impact of this public health issue is well described in adults with kidney disease, its role in the pediatric chronic kidney disease (CKD) population is largely unknown. This review discusses the prevalence of tobacco use and exposure in children with CKD, updates the reader on how tobacco affects the kidney, and presents intervention strategies relevant to this patient population.
Subject(s)
Renal Insufficiency, Chronic , Smoking/adverse effects , Tobacco Smoke Pollution/adverse effects , Adolescent , Child , Female , Humans , MaleABSTRACT
INTRODUCTION: Adolescents with cancer are susceptible to the health consequences associated with secondhand smoke exposure (SHSE) and tobacco use. The present study compared tobacco use, exposure, and risk factors between patients and population peers. METHOD: Self-reported data on tobacco use, SHSE, and tobacco-related risk factors were drawn from a pediatric oncology hospital and the National Youth Tobacco Survey. Conditional logistic regression was used to estimate odds ratios for patients and control subjects. RESULTS: Patients were as likely to have tried tobacco and report home SHSE as control subjects. Patients were more likely to report car SHSE, less likely to report that SHSE is harmful, and less likely to report home smoking bans. DISCUSSION: Patients experienced SHSE, tobacco use, and tobacco-related risk factors at rates greater than or equal to control subjects. These results provide support for consideration of intervention targets, health status, and delivery mechanisms, particularly by health care providers, when developing comprehensive tobacco control strategies.
Subject(s)
Neoplasms/epidemiology , Tobacco Smoke Pollution/statistics & numerical data , Tobacco Use/epidemiology , Adolescent , Case-Control Studies , Female , Humans , Logistic Models , Male , Neoplasms/etiology , Risk Factors , Tobacco Smoke Pollution/adverse effects , Tobacco Use/adverse effects , United States/epidemiologyABSTRACT
BACKGROUND: Survivors of pediatric brain tumors (BT) and acute lymphoblastic leukemia (ALL) are at risk for neurocognitive late effects related to executive function. PROCEDURE: Survivors of BT (48) and ALL (50) completed neurocognitive assessment. Executive function was compared to estimated IQ and population norms by diagnostic group. RESULTS: Both BT and ALL demonstrated relative executive function weaknesses. As a group, BT survivors demonstrated weaker executive functioning than expected for age. Those BT survivors with deficits exhibited a profile suggestive of global executive dysfunction, while affected ALL survivors tended to demonstrate specific rapid naming deficits. CONCLUSION: Findings suggest that pediatric BT and ALL survivors may exhibit different profiles of executive function late effects, which may necessitate distinct intervention plans.
Subject(s)
Brain Neoplasms/complications , Cognition Disorders/etiology , Executive Function/physiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Survivors/psychology , Adolescent , Child , Female , Humans , Longitudinal Studies , Male , Neuropsychological TestsABSTRACT
Treatments for childhood cancer can impair pulmonary function. We assessed the potential impact of cigarette smoking on pulmonary function in 433 adult childhood cancer survivors (CCS) who received pulmonary-toxic therapy, using single breath diffusion capacity for carbon monoxide corrected for hemoglobin (DLCOcorr), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (TLC). FEV1/FVC median values among current [1.00; interquartile range (IQR): 0.94-1.04] and former smokers (0.98; IQR: 0.93-1.04) were lower than those who had never smoked (1.02; IQR: 0.96-1.06; P = 0.003). Median FEV1/FVC values were lower among those who smoked ≥ 6 pack-years (0.99; IQR: 0.92-1.03) and those who smoked <6 pack-years (1.00; IQR: 0.94-1.04), than among those who had never smoked (P = 0.005). Our findings suggest that CCSs have an increased risk for future obstructive and restrictive lung disease. Follow-up is needed to determine whether smoking imparts more than additive risk. Smoking prevention and cessation need to be a priority in this population.
Subject(s)
Lung/physiopathology , Neoplasms/physiopathology , Smoking/physiopathology , Adult , Cohort Studies , Female , Humans , Male , Respiratory Function Tests , Risk Factors , SurvivorsABSTRACT
OBJECTIVES: Elevated body mass index (BMI) has been reported in pediatric cancer survivors. It is unclear whether this is related to altered energy intake (via disordered eating), decreased energy expenditure (via limited exercise), or treatment-related direct/indirect changes. The aims of this study are to describe the occurrence of overweight and obesity, exercise frequency, and the extent of disordered eating patterns in this sample of survivors, and to examine relationships among BMI, eating patterns, exercise frequency, and demographic and disease and treatment-related variables to identify those survivors most at risk for overweight/obesity. METHODS: This cross-sectional study recruited 98 cancer survivors (50 acute lymphoblastic leukemia [ALL], 48 brain tumor [BT]), aged 12 to 17 years and ≥12 months posttreatment from a large pediatric oncology hospital. Survivors completed health behavior measures assessing disordered eating patterns and physical activity. Clinical variables were obtained through medical record review. Univariate analyses were conducted to make comparisons on health behaviors by diagnosis, gender, treatment history, and BMI category. RESULTS: Fifty-two percent of ALL survivors and 41.7% of BT survivors were classified as overweight/obese. Overweight/obesity status was associated with higher cognitive restraint (odds ratio = 1.0; 95% confidence interval = 1.0-1.1). Only 12% of ALL survivors and 8.3% of BT survivors met Centers for Disease Control and Prevention guidelines for physical activity. Males reported more physical activity, t(96) = 2.2, P < .05. CONCLUSIONS: Overweight/obese survivors may attempt to purposefully restrict their food intake and rely less on physiological cues to regulate consumption. Survivors should be screened at follow-up for weight-related concerns.
Subject(s)
Body Mass Index , Feeding Behavior , Precursor Cell Lymphoblastic Leukemia-Lymphoma/physiopathology , Survivors , Adolescent , Female , Humans , MaleABSTRACT
Few studies have examined adolescent reporting accuracy for secondhand smoke exposure (SHSe), and never for youth with cancer. SHSe reporting from adolescents being treated for cancer (Mage=14.92 years, SD=1.67) was examined against parent/guardian reports and urine cotinine among 42 adolescent-parent dyads. Number of days in hospital-based lodgings prior to assessment emerged as the strongest predictor of urine cotinine (ß=-0.46, p=0.003) and adolescent SHSe reporting significantly predicted urine cotinine (ß=0.37, p=0.011) beyond relevant demographic and contextual variables (overall R2=0.40, F(6, 35)=3.90, p=0.004). Findings support adolescents as accurate reporters of discrete SHSe occurrences.
ABSTRACT
OBJECTIVES: To examine smoking restrictions in households of children with cancer and their effect on biological measures of children's secondhand smoke exposure (SHSe). METHODS: A sample of 135 parents of nonsmoking children with cancer who lived with a smoker completed structured interviews. RESULTS: Approximately 43% of families prohibited smoking in the home. Children living in homes that prohibited smoking had median cotinine levels that were 71% and 52% lower than did those from homes with no and partial restrictions. CONCLUSIONS: Parents should be directed to completely ban all smoking from the home and car to best protect their children from SHSe.
Subject(s)
Family Characteristics , Health Behavior , Neoplasms , Parents/psychology , Smoking , Tobacco Smoke Pollution/prevention & control , Tobacco Smoke Pollution/statistics & numerical data , Adolescent , Adult , Child , Child, Preschool , Cotinine/urine , Female , Health Knowledge, Attitudes, Practice , Humans , Infant , Male , Middle Aged , Neoplasms/urine , Smoking/psychology , Smoking/urineABSTRACT
PURPOSE: This study assessed the prevalence of smoking restrictions among households of survivors of childhood and young adult cancer who smoke. It also examined the relationship between home smoking restrictions and motivation to quit smoking, as well as other smoking, psychosocial, and environmental factors. METHODS: Participants included 374 smokers who were childhood or young adult cancer survivors (between the ages of 18 and 55 years) recruited from five cancer centers to participate in a randomized smoking cessation trial. Survivors completed baseline measures about the smoking restrictions in their households, their smoking behavior, and related psychological and environmental factors, which are the focus of the current manuscript. RESULTS: Almost 54% of survivors reported that smoking was prohibited in their households. Living with a nonsmoking partner, having a strict smoking policy at work, and not being nicotine dependent all increased the likelihood of having a total home smoking ban. Participants who were older, smoked more cigarettes per day over the prior week, and received prior chemotherapy were less likely to reside in households that adopted total bans. CONCLUSION: Findings suggest that socio-environmental factors and current smoking behaviors are associated with complete smoking restrictions in the homes of survivors. These factors should be considered when communicating with survivors about the importance of establishing strict smoking policies in their private residences.
ABSTRACT
BACKGROUND: Acute lymphoblastic leukemia (ALL) and brain tumor (BT) survivors are at risk for post-treatment IQ declines. The extent to which lower scores represent global cognitive decline versus domain-specific impairment remains unclear. This study examined discrepancies between processing speed and estimated IQ (EIQ) scores and identified clinical characteristics associated with score discrepancies in a sample of pediatric cancer survivors. PROCEDURE: Survivors (50 ALL, 50 BT) ages 12-17 years completed cognitive testing. The Wechsler Abbreviated Scale of Intelligence provided an untimed measure of general reasoning ability (EIQ). The age-appropriate Wechsler Intelligence Scale provided a Processing Speed Index (PSI) score. Scores were examined and compared. RESULTS: Survivors' PSI scores were lower than their EIQ scores (BT t(45) =6.3, p<0.001; ALL t(49) =6.9, p<0.001). For BT survivors, lower PSI scores were associated with history of craniospinal irradiation, t(44) =3.3, p<0.01. For ALL survivors, lower PSI scores were associated with male gender, grade retention, and time since diagnosis, F(3, 46) =10.1, p<0.001. Clinically significant EIQ-PSI score discrepancies were identified in 41.3% of BT and 14.0% of ALL survivors. CONCLUSIONS: Many pediatric BT and ALL survivors exhibit slower processing speed than expected for age, whereas general reasoning ability remains largely intact. Risk factors associated with larger EIQ-PSI discrepancies include the following: BT diagnosis, craniospinal irradiation (BT only), male gender, and younger age at diagnosis (ALL only). Grade retention was frequent and associated with lower EIQ scores (both groups) and PSI scores (ALL only). Describing post-treatment cognitive declines using global measures of intellectual ability may underestimate dysfunction or fail to isolate specific underlying deficits contributing to impairment.
Subject(s)
Brain Neoplasms/psychology , Cognition Disorders/physiopathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology , Survivors/psychology , Adolescent , Age Factors , Antineoplastic Agents/adverse effects , Brain Neoplasms/complications , Brain Neoplasms/therapy , Child , Cognition Disorders/etiology , Female , Humans , Male , Neuropsychological Tests , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Radiotherapy/adverse effects , Sex Factors , Time Factors , Wechsler ScalesABSTRACT
BACKGROUND: Adolescent survivors of childhood cancer engage in risky behaviors. OBJECTIVE: This study tested a decision aid for cancer-surviving adolescents aimed at difficult decisions related to engaging in substance use behaviors. METHODS: This randomized controlled trial recruited 243 teen survivors at 3 cancer centers. The cognitive-behavioral skills program focused on decision making and substance use within the context of past treatment. Effects at 6 and 12 months were examined for decision making, risk motivation, and substance use behaviors using linear regression models. RESULTS: The majority of the teen cancer survivors (90%) rated the program as positive. There was an intermediate effect at 6 months for change in risk motivation for low riskers, but this effect was not sustained at 12 months. For quality decision making, there was no significant effect between treatment groups for either time point. CONCLUSIONS: The overall program effects were modest. Once teen survivors are in the program and learn what quality decision making is, their written reports indicated adjustment in their perception of their decision-making ability; thus, a more diagnostic baseline decision-making measure and a more intensive intervention are needed in the last 6 months. With 2 of 3 teen participants dealing with cognitive difficulties, the data suggest that this type of intervention will continue to be challenging, especially when 90% of their household members and 56% of their close friends model substance use. IMPLICATIONS FOR PRACTICE: This effectiveness trial using late-effects clinics provides recommendations for further program development for medically at-risk adolescents, particularly ones with cognitive difficulties.
Subject(s)
Adolescent Behavior , Alcohol Drinking , Counseling , Neoplasms/nursing , Smoking , Substance-Related Disorders/nursing , Survivors , Adolescent , Adolescent Behavior/psychology , Adult , Counseling/methods , Female , Health Services Needs and Demand , Humans , Male , Neoplasms/psychology , Prospective Studies , Risk-Taking , Substance-Related Disorders/prevention & control , Surveys and Questionnaires , Survivors/psychology , United StatesABSTRACT
OBJECTIVE: This randomized controlled trial tested the efficacy of parent-based behavioral counseling for reducing secondhand smoke exposure (SHSe) among children with cancer. It also examined predictors of smoking and SHSe outcomes. METHODS: Participants were 135 parents or guardians of nonsmoking children with cancer, <18 years, at least 30 days postdiagnosis, and living with at least one adult smoker. Parents were randomized to either a standard care control group or an intervention consisting of six counseling sessions delivered over 3 months. Parent-reported smoking and child SHSe levels were obtained at baseline, 3, 6, 9, and 12 months. Children provided urine samples for cotinine analyses. RESULTS: Reductions in parent-reported smoking and exposure were observed in both the intervention and control conditions. There was a significantly greater reduction in parent-reported smoking and child SHSe at 3 months for the intervention group compared with the control group. Child SHSe was significantly lower at 12 months relative to baseline in both groups. Children's cotinine levels did not show significant change over time in either group. Exposure outcomes were influenced by the number of smokers at home, smoking status of the parent participating in the trial, and the child's environment (home versus hospital) the day before the assessment. CONCLUSIONS: Children's SHSe can be reduced by advising parents to protect their child from SHSe, combined with routine reporting of their child's exposure and cotinine testing, when delivered in the context of the pediatric cancer setting. More intensive interventions may be required to achieve greater reductions in SHSe.
Subject(s)
Neoplasms , Tobacco Smoke Pollution/prevention & control , Adolescent , Adult , Child , Child, Preschool , Cotinine/urine , Counseling , Female , Humans , Male , Parents/education , Parents/psychology , Smoking PreventionABSTRACT
OBJECTIVES: To describe the psychological needs of adolescent survivors of acute lymphoblastic leukemia (ALL) or brain tumor (BT), we examined the following: (i) the occurrence of cognitive, behavioral, and emotional concerns identified during a comprehensive psychological evaluation and (ii) the frequency of referrals for psychological follow-up services to address identified concerns. METHODS: Psychological concerns were identified on measures according to predetermined criteria for 100 adolescent survivors. Referrals for psychological follow-up services were made for concerns previously unidentified in formal assessment or not adequately addressed by current services. RESULTS: Most survivors (82%) exhibited at least one concern across domains: behavioral (76%), cognitive (47%), and emotional (19%). Behavioral concerns emerged most often on scales associated with executive dysfunction, inattention, learning, and peer difficulties. Cranial radiation therapy was associated with cognitive concerns, χ(2) (1, N = 100) = 5.63, p < 0.05. Lower income was associated with more cognitive concerns for ALL survivors, t(47) = 3.28, p < 0.01, and more behavioral concerns for BT survivors, t(48) = 2.93, p < 0.01. Of the survivors with concerns, 38% were referred for psychological follow-up services. Lower-income ALL survivors received more referrals for follow-up, χ(2) (1, N = 41) = 8.05, p < 0.01. Referred survivors had more concerns across domains than non-referred survivors, ALL: t(39) = 2.96, p < 0.01; BT: t(39) = 3.52, p < 0.01. Trends suggest ALL survivors may be at risk for experiencing unaddressed cognitive needs. CONCLUSIONS: Many adolescent survivors of cancer experience psychological difficulties that are not adequately managed by current services, underscoring the need for long-term surveillance. In addition to prescribing regular psychological evaluations, clinicians should closely monitor whether current support services appropriately meet survivors' needs, particularly for lower-income survivors and those treated with cranial radiation therapy.
Subject(s)
Brain Neoplasms/psychology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology , Survivors/psychology , Adolescent , Behavioral Symptoms/psychology , Child , Cognition Disorders/psychology , Cohort Studies , Cranial Irradiation/psychology , Emotions , Female , Humans , Male , Needs Assessment , Referral and Consultation/statistics & numerical dataABSTRACT
Children with cancer are at greater risk for the negative consequences of secondhand smoke exposure, making the identification of predictors of exposure critical. The current study investigated the impact of parents' psychosocial variables (perceived stress and vulnerability, self-efficacy), as well as health-related and demographic variables, on children's current exposure levels. Data were from 135 families whose children (M = 8.6 years old) lived with a smoker and were being treated for cancer. Self-efficacy was the consistent significant psychosocial predictor of exposure and the time since a child's diagnosis was indicative of lower exposure when limiting the sample to only smoking parents (n = 95). Both predictors of exposure have implications on motivation for behavioral change and may be suggestive of a teachable moment. Interventions may profit from tailoring programs to families based on these predictors of exposure, in particular for tobacco-based interventions for parents of medically compromised children, such as children with cancer.
Subject(s)
Neoplasms/therapy , Parents/psychology , Tobacco Smoke Pollution/adverse effects , Adolescent , Adult , Child , Child, Preschool , Female , Forecasting , Humans , Male , Middle Aged , Parent-Child Relations , Self Efficacy , Self Report , Young AdultABSTRACT
BACKGROUND: Few studies have examined risk factors for smoking among adolescent survivors of childhood cancer. The present study reports on the rate of smoking and identifies factors associated with smoking in a sample of adolescent survivors from the Childhood Cancer Survivor Study (CCSS). PROCEDURE: Participants included 307 adolescent survivors and 97 healthy siblings (ages 14-20) who completed a self-report survey of health, quality of life, and health behaviors. RESULTS: Smoking rates did not differ significantly between survivor and sibling groups (ever smokers: 28% vs. 33%, recent smokers: 10% vs. 9%, respectively). Ever smoking was significantly associated with peer smoking, smokers in the household, binging, suicidal behavior, and no history of CRT. There were significant interactions of peer smoking with gender and CRT for ever smoking and with binging for recent smoking. Recent smoking was more likely for survivors with other household smokers (RR=2.24, CI=1.21-4.16), past suicidality (RR=1.89, CI=1.00-3.56), and no CRT (RR=2.40, CI=1.12-5.17). Among survivors with few smoking friends, ever smoking was more likely for survivors with no CRT (RR=4.47, CI=1.43-13.9), and recent smoking was more likely among survivors who binged (RR=3.37, CI=1.17-9.71). CONCLUSIONS: Despite the health risks associated with survivorship, nearly one in three adolescent survivors of childhood cancer has smoked. Exposure to other smokers, in particular, appears to increase the likelihood of smoking for some survivors. Providing smoking cessation programs targeted to family members, helping survivors choose non-smoking friends, and teaching ways to resist smoking influences from peers may be important pathways for smoking prevention with adolescent survivors.