Patterns and predictors of clustered risky health behaviors among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.
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.



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.



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 [ORadj ], 1.17; 95% confidence interval [95% CI], 1.06-1.27) and were less likely to be in the high-risk cluster (ORadj , 0.79; 95% CI, 0.69-0.88). Risk factors for membership in the high-risk cluster included psychological distress (ORadj , 2.76; 95% CI, 1.98-3.86), low educational attainment (ORadj , 7.49; 95% CI, 5.15-10.88), income <$20,000 (ORadj , 2.62; 95% CI, 1.93-3.57), being divorced/separated or widowed (ORadj , 1.36; 95% CI, 1.03-1.79), and limb amputation (ORadj , 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.



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.
Social and Behavioral Sciences, University of California, San Francisco, California.
E Anne
0000-0002-7502-4459
EA
Lown
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Nobuko
N
Hijiya
Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona.
Nan
N
Zhang
Biostatistics Division, Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee.
Deo Kumar
DK
Srivastava
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Wendy M
WM
Leisenring
Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Paul C
PC
Nathan
Department of Pediatric Hematology/Oncology, Emory School of Medicine, Atlanta, Georgia.
Sharon M
SM
Castellino
Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey.
Katie A
KA
Devine
General Pediatrics & Academic Medicine, Advocate Children's Hospital, Oak Lawn, Illinois.
Kimberley
K
Dilley
Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee.
Kevin R
KR
Krull
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Kevin C
KC
Oeffinger
Cancer Survivorship Division, Cancer Prevention & Control Program, St. Jude Children's Research Hospital, Memphis, Tennessee.
Melissa M
MM
Hudson
Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee.
Gregory T
GT
Armstrong
Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee.
Leslie L
LL
Robison
Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee.
Kirsten K
KK
Ness
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D002648:Child; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D012309:Risk-Taking; D035781:Siblings / Q000523:psychology*; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014481:United States / Q000453:epidemiology
alcohol; childhood cancer; health behavior; psychosocial; smoking; survivors