title: Adolescent survivors: a secondary analysis of a clinical trial targeting behavior change.
abstract: 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.
  
  
  METHODS
  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 < or = 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 < or = 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.
authors.affiliation: Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. cheryl.cox@stjude.org
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Cox
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: McLaughlin
authors.forename: Shesh N
authors.initials: SN
authors.lastname: Rai
authors.forename: Brenda D
authors.initials: BD
authors.lastname: Steen
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D009369:Neoplasms / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D012309:Risk-Taking; D012737:Sex Factors; D013714:Tennessee