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Patterns and predictors of clustered risky health behaviors among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
Author(s) -
Lown E. Anne,
Hijiya Nobuko,
Zhang Nan,
Srivastava Deo Kumar,
Leisenring Wendy M.,
Nathan Paul C.,
Castellino Sharon M.,
Devine Katie A.,
Dilley Kimberley,
Krull Kevin R.,
Oeffinger Kevin C.,
Hudson Melissa M.,
Armstrong Gregory T.,
Robison Leslie L.,
Ness Kirsten K.
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30106
Subject(s) - medicine , odds ratio , confidence interval , cluster (spacecraft) , demography , logistic regression , educational attainment , childhood cancer , cancer , distress , gerontology , clinical psychology , sociology , computer science , economics , programming language , economic growth
BACKGROUND Health complications related to childhood cancer may be influenced by risky health behaviors (RHBs), particularly when RHBs co‐occur. To the authors' knowledge, only limited information is available describing how RHBs cluster among survivors of childhood cancer and their siblings and the risk factors for co‐occurring RHBs. METHODS Latent class analysis was used to identify RHB clusters using longitudinal survey data regarding smoking, alcohol use, and physical activity from adult survivors (4184 survivors) and siblings (1598 siblings) in the Childhood Cancer Survivor Study. Generalized logistic regression was used to evaluate associations between demographic characteristics, treatment exposures, psychological distress, health conditions, and cluster membership. RESULTS Three RHB clusters were identified: a low‐risk cluster, an insufficiently active cluster, and a high‐risk cluster (tobacco and risky alcohol use and insufficient activity). Compared with siblings, survivors were more likely to be in the insufficiently active cluster (adjusted odds ratio [OR adj ], 1.17; 95% confidence interval [95% CI], 1.06‐1.27) and were less likely to be in the high‐risk cluster (OR adj , 0.79; 95% CI, 0.69‐0.88). Risk factors for membership in the high‐risk cluster included psychological distress (OR adj , 2.76; 95% CI, 1.98‐3.86), low educational attainment (OR adj , 7.49; 95% CI, 5.15‐10.88), income <$20,000 (OR adj , 2.62; 95% CI, 1.93‐3.57), being divorced/separated or widowed (OR adj , 1.36; 95% CI, 1.03‐1.79), and limb amputation (OR adj , 1.52; 95% CI, 1.03‐2.24). Risk factors for the insufficiently active cluster included chronic health conditions, psychological distress, low education or income, being obese or overweight, female sex, nonwhite race/ethnicity, single marital status, cranial radiation, and cisplatin exposure. CONCLUSIONS RHBs co‐occur in survivors of childhood cancer and their siblings. Economic and educational disadvantages and psychological distress should be considered in screening and interventions to reduce RHBs. Cancer 2016 . © 2016 American Cancer Society . Cancer 2016;122:2747–2756. © 2016 American Cancer Society.