Adolescent survivors: A secondary analysis of a clinical trial targeting behavior change
Corresponding Author
Cheryl L. Cox PhD
Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
St. Jude Children's Research Hospital, 332 N. Lauderdale Street, Memphis, TN 38105-2794.===Search for more papers by this authorRosemary A. McLaughlin MSN
Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorShesh N. Rai PhD
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorBrenda D. Steen RN, CCRA
Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorMelissa M. Hudson MD
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorCorresponding Author
Cheryl L. Cox PhD
Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
St. Jude Children's Research Hospital, 332 N. Lauderdale Street, Memphis, TN 38105-2794.===Search for more papers by this authorRosemary A. McLaughlin MSN
Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorShesh N. Rai PhD
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorBrenda D. Steen RN, CCRA
Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorMelissa M. Hudson MD
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorAbstract
Background
The late effects of radiation and chemotherapy increase childhood cancer survivors' risk of chronic health problems. Survivors' behavior is important in modifying this risk, yet adolescent and young adult survivors fail to engage in important health-promoting behaviors and frequently practice high-risk behaviors. This secondary analysis re-evaluated a multi-component behavior-change intervention that had previously demonstrated no impact in adolescent survivors of childhood cancer.
Procedure
The parent trial compared 132 adolescent survivors in the intervention arm with 135 in the standard-care arm at baseline and at 1 year for disease and treatment knowledge, perception of late effects risk, and the frequency of health-risk and health-protective behaviors (combined as a single summative measure). In contrast, the secondary analysis examined each of the 14 behaviors separately. Additionally, an analysis of covariance (ANCOVA) was conducted to examine the change in health behaviors while statistically controlling for age, gender, and the wide variation in baseline behaviors.
Results
Knowledge (P = 0.038), breast self-examination (BSE) (P ≤ 0.0001) and testicular self-examination (P = 0.004) increased, as did perceptions about the need to change behavior (P = 0.004) and the effort needed to stay healthy (P ≤ 0.0001). In the treatment group, junk food consumption decreased (P = 0.052) and smoking abstinence was maintained (P = 0.088). Significant interactions between gender and treatment group were demonstrated.
Conclusions
Health-risk and health-protective behaviors cannot be effectively combined in a one-dimensional measure. Gender and age influence the impact of interventions targeting health behavior in survivors. Future trials should include observation of the patient-clinician encounter, more complex sampling methods, and pre-trial knowledge of the distribution of the study behaviors. © 2005 Wiley-Liss, Inc.
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