A randomized controlled pilot trial of a Web-based resource to improve cancer knowledge in adolescent and young adult survivors of childhood cancer.

OBJECTIVE: This study examined cancer knowledge in adolescent and young adult (AYA) survivors and pilot tested a Web-based resource to provide individually tailored information regarding cancer treatment history, late effects risk, and resources. METHODS: Fifty-two survivors (15-28 years old) who completed cancer treatment were recruited from the University of Minnesota oncology clinics. Participants were randomly assigned to receive access to personalized health history, late effects information, and resources via a password-protected Web portal or to standard of care (physician counseling) only. Participants completed surveys measuring cancer knowledge, health locus of control, and psychosocial well-being prior to randomization and approximately 1 year later. RESULTS: Overall, few participants accurately reported their chemotherapy history with detail (19% at baseline and 33% at follow-up), and many did not recognize that previous cancer treatments could impact future health (60% at baseline and 54% at follow-up). Among those randomized to the receive access to the website, utilization was very low, making it difficult to draw conclusions about efficacy. Nonetheless, these data suggest that offering tailored information through the Web was not more effective than standard of care at improving cancer knowledge. Anxiety and health beliefs were associated with cancer knowledge, including knowledge of steps survivors could take to mitigate late effects risks (p < 01). CONCLUSIONS: Knowledge gaps exist among AYA survivors regarding important aspects of their treatment histories and ongoing health risks. Offering purely educational information (either in person by providers or via the Web) does not appear to be enough to close this gap. Copyright © 2015 John Wiley & Sons, Ltd.

Increasing support for smoking cessation during pregnancy and postpartum: results of a randomized controlled pilot study.

OBJECTIVES: We examined the feasibility and effectiveness of an intervention to mobilize women in the social networks of pregnant smokers to support smoking cessation. METHODS: This study was conducted in St. Paul, Minnesota, and Columbus, Ohio, from 2005 through 2007. Pregnant smokers (n=82) identified a woman in their social network to help them quit smoking. The resulting dyads were randomized to either intervention (n=54) or control (n=28) conditions. Supporters of intervention subjects received monthly contacts from a counselor about providing effective support; supporters in the control condition were not contacted. Interviews with subjects and supporters were conducted at baseline, end of pregnancy and 3 months postpartum. RESULTS: Compared with control subjects, intervention group subjects reported that their supporters had provided support behaviors more frequently and were more committed to helping them quit. There was a non-significant trend for more validated quits in the intervention group at the end of pregnancy: 13.0% vs. 3.6% among the controls. Quit rates decreased to 9.3% in the intervention group and 0% in the control group at 3 months postpartum. CONCLUSIONS: Increasing the frequency and quality of support from a woman in the smoker's social network is a promising prenatal smoking cessation strategy.

Predictors of risk-based medical follow-up: a report from the Childhood Cancer Survivor Study.

PURPOSE: The purpose of this study is to conduct an intervention study designed to assess the effectiveness of using a newsletter to increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications. METHODS: Survivors participating in the Childhood Cancer Survivor Study who were at least 25 years of age and at risk of cardiovascular disease, breast cancer, or osteoporosis related to previous cancer treatment were randomly assigned to receive a newsletter featuring brief health risk information or a newsletter including an insert providing more comprehensive health risk information. A follow-up survey distributed 24 months after the newsletter intervention assessed predictors of medical follow-up. RESULTS: Overall, there were no differences found among the groups in terms of access to a treatment summary, medical follow-up, discussion of childhood cancer health risks, and medical screening for the targeted health behaviors. One exception, indicating borderline significance was that women at risk for osteoporosis who received the newsletter insert were more likely to have discussed their risk with a doctor than those who only received the brief information (10.1 % vs. 4.0 % p = 0.05). Discussion of breast cancer (OR = 2.15; 95 % CI = 1.74-2.66), heart disease (OR = 5.54; 95 % CI = 4.67-6.57) and osteoporosis (OR = 10.6; 95 % CI = 8.34-13.47) risk with physician significantly predicted report of undergoing screening for targeted behavior in previous 2 years as did physician access to treatment summary. CONCLUSIONS: More detailed content in a newsletter had minimal effect on recommended screening. However, survivor's discussion of cancer-related risks with one's doctor significantly influenced participation in health screening. These results highlight the integral role of communication in health behavior. IMPLICATIONS FOR CANCER SURVIVORS: This study is designed to assess communication strategies that increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications. The results are of great importance not only to the pediatric oncology community but also the broad range of adult oncology medical specialties who are directly involved in the long-term medical care of this ever increasing population of cancer survivors.

A comparative study of sociocultural factors and young adults' smoking in two Midwestern communities.

Young adults were the only age group to defy the downward trend in cigarette use seen in the 1980s and 1990s. To help explain this phenomenon, we conducted an exploratory study to examine the association between the sociocultural contexts of young adults' everyday lives and their smoking attitudes and behaviors. "Context" was operationalized by (a) including students and nonstudents in the study population, and (b) selecting two distinctly different areas of Minnesota for examination. The study sites were Hibbing and environs (Range), the sparsely populated hub of the state's once-thriving iron ore industry, and the Twin Cities metropolitan area (Metro), center of state government, finance, transportation, education, and industry. This report focuses on the first phase of the study, which consisted of a computer-assisted telephone interview of 995 randomly selected young adults, aged 18-24. Approximately equal numbers of students and nonstudents were selected from each site. Exploratory factor analysis yielded four distinct scales related to alcohol consumption and partying (Drinking Behavior), the social attractiveness and utility of smoking (Social Utility), outdoor recreation (Outdoor Rec), and media use and hours of free time. We decided not to use the media and free time scale, however, because of its low Cronbach alpha (.42). We used polynomial logistic regression to evaluate the association between smoking status, gender, student status, location (Range vs. Metro), and the three retained scales. Results indicated that living on the Iron Range (OR = 2.6), being female (OR = 1.3), and scoring higher on the Social Utility scale (OR = 3.06) increased the risk of smoking, whereas being a student (OR = 0.53) decreased the risk substantially.