title: Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study.
abstract: OBJECTIVE
  To determine the influence of race/ethnicity on outcomes in the Childhood Cancer Survivor Study (CCSS).
  
  
  METHODS
  Of CCSS adult survivors in the United States, 443 (4.9%) were black, 503 (5.6%) were Hispanic and 7,821 (86.6%) were white. Mean age at interview, 26.9 years (range, 18 to 48 years); mean follow-up, 17.2 years (range, 8.7 to 28.4 years). Late mortality, second malignancy (SMN) rates, health care utilization, and health status and behaviors were assessed for blacks and Hispanics and compared with white survivors.
  
  
  RESULTS
  Late mortality rate (6.5%) and 15-year cumulative incidence of SMN (3.5%) were similar across racial/ethnic groups. Minority survivors were more likely to have lower socioeconomic status (SES); final models were adjusted for income, education, and health insurance. Although overall health status was similar, black survivors were less likely to report adverse mental health (females: odds ratio [OR], 0.6; 95% CI, 0.4 to 0.9; males: OR, 0.5; 95% CI, 0.3 to 0.8). Differences in health care utilization and behaviors noted: Hispanic survivors were more likely to report a cancer center visit (females: OR, 1.5; 95% CI, 1.1 to 2.0; males: OR, 1.7; 95% CI, 1.2 to 2.3); black females were more likely (OR, 1.6; 95% CI, 1.1 to 2.4), and Hispanic females less likely to have a recent Pap smear (OR, 0.7; 95% CI, 0.5 to 1.0); black and Hispanic survivors were less likely to report smoking; black survivors were less likely to report problem drinking.
  
  
  CONCLUSIONS
  Adjusted for SES, adverse outcomes in CCSS were not associated with minority status. Importantly, black survivors reported less risky behaviors and better preventive practices. Hispanic survivors had equitable access to cancer related care.
authors.affiliation: Department of Pediatrics, East Tennessee State University Quillen College of Medicine, Johnson City, St. Jude Children's Research Hospital, Memphis, TN, USA. scastell@wfubmc.edu
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Castellino
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Casillas
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: John
authors.initials: J
authors.lastname: Whitton
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Brooks
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
authors.forename: Arthur
authors.initials: A
authors.lastname: Ablin
authors.forename: Robert
authors.initials: R
authors.lastname: Castleberry
authors.forename: Wendy
authors.initials: W
authors.lastname: Hobbie
authors.forename: Sue
authors.initials: S
authors.lastname: Kaste
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001294:Attitude to Health / Q000208:ethnology*; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D010349:Patient Compliance; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015996:Survival Rate; D017741:Survivors; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American