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.