Background Follow-up care is critical for childhood cancer survivors (CCS) who are at high risk for co-morbidities and late effects of cancer treatments. Understanding factors associated with maintaining follow-up care is needed, especially for Hispanic CCS who are underrepresented in previous studies. Methods Risk and protective factors for receiving cancer-related follow-up care were examined among 193 Los Angeles County CCS diagnosed between 2000–2007 (54% Hispanic; mean age=19.9, SD=2.8; mean age at diagnosis=12.1, SD=3.0; mean years since diagnosis=7.8, SD=2.0). Self-report surveys assessed follow-up care, insurance status, demographics, clinical factors, and psychosocial risk (e.g., depression) and protective [e.g., self-efficacy (SE)] factors. Multivariable logistic regression was used to determine factors associated with previous (in prior 2 years) and intent for future cancer-related follow-up care. Results Seventy-three percent of CCS reported a cancer follow-up visit in the prior 2 years, which was positively associated (p’s<.05) with having health insurance, White ethnicity (vs. Hispanic), younger age and greater treatment intensity. Sixty-nine percent reported intent for follow-up care in the next two years, which was positively associated (p’s<.05) with having health insurance and greater SE. Conclusions Hispanics and older CCS are more likely to lack previous follow-up care. Because health insurance was strongly associated with both previous follow-up care and intent to seek care, recent changes in health coverage may improve follow-up among CCS. Interventions targeting improved SE may help increase intent to receive follow-up care for this population.

Background Parents of childhood cancer survivors (CCS) experience considerable distress related to their child’s cancer. However, little is known about cultural variation in this experience. We examine parental distress, specifically symptoms of posttraumatic stress (PTSS) and depression, comparing Hispanic and non-Hispanic parents of CCS. Procedure 79 Hispanic and 60 non-Hispanic parents of CCS (currently aged 14–25, off treatment ≥2 years) completed questionnaires assessing demographics, depression, PTSS, perceived stress, and child’s health status/quality of life (QOL). T-tests and chi-square statistics were used to compare differences in demographic characteristics between Hispanic and non-Hispanic parents and multivariable regression was used to determine independent risk factors associated with parental PTSS and depression. Results Hispanic parents were significantly younger, had less education, lower incomes and reported significantly more PTSS and depressive symptoms than non-Hispanic parents (all p-values<0.0001). Among Hispanic parents, foreign birthplace predicted higher PTSS after controlling for other factors (p<0.001). Hispanic parents, regardless of birthplace, reported more depressive symptoms than non-Hispanic parents (US-born, p<0.05; foreign-born, p<0.01). For PTSS and depression, there were positive relationships with parental stress and negative relationships with the child’s psychosocial QOL. Hispanic and non-Hispanic CCS did not differ significantly on disease and treatment factors or health-related QOL. Conclusions Hispanic parents of CCS may be at greater risk for poorer mental health outcomes. Ethnic-specific factors (e.g., acculturation, immigration status and previous trauma) may influence parents’ responses and adjustment to their child’s cancer. Research is needed to determine how to meet the needs of the most vulnerable parents.

Objective Health-promoting behaviors are recommended to childhood cancer survivors (CCS) to reduce late effects resulting from cancer treatment. Understanding factors associated with substance use is needed, especially among Hispanic CCS who are underrepresented in previous studies. The objective of this study is to examine substance use behaviors of recently treated Hispanic and non-Hispanic CCS. Methods 193 Los Angeles County CCS who were diagnosed between 2000–2007 (54% Hispanic; mean age 19.9, SD=2.8; mean age at diagnosis=12.1, SD=3.0; mean years since diagnosis=7.8, SD=2.0) provided self-reported information on substance use, demographics, clinical factors, religiosity, and depressive symptoms. Risk and protective factors for substance use were examined using multivariable logistic regression. Results Prevalence of 30-day substance use was 11%, 25%, and 14% for tobacco, alcohol, and marijuana, respectively. In controlled regression models, age was positively associated with tobacco use, binge drinking, and polysubstance use (use of at least two of the three substances). Male gender, higher depressive symptoms, and higher socioeconomic status were associated with greater marijuana use. In addition religiosity was negatively associated with use of all substances. Conclusions The prevalence rates for substance use in this ethnically diverse representative sample of CCS are lower than those observed in the general population. Older CCS were at higher risk of substance use, and depression was associated with greater marijuana use. No differences by ethnicity were observed. Interventions for substance use prevention/cessation among CCS may be most effective if implemented before the age of 21 and address mental health as part of survivorship care.

This study assessed the association between ethnicity, religious service attendance (RSA), and acculturation with posttraumatic growth (PTG) in a diverse sample of 235 childhood cancer survivors (CCS). PTG scores were estimated for each ethnicity, and by level of RSA and acculturation. There was a significant curvilinear relationship (inverted U) between RSA and PTG, such that moderate levels of RSA were associated with the highest PTG scores. Hispanics reported the highest PTG, and both Hispanic and Anglo cultural orientation were significantly positively associated with PTG. CCS with high or low frequency of RSA as well as Hispanic CCS who lack a strong sense of cultural identity may benefit from targeted efforts to promote psychosocial adaptation in the aftermath of cancer.

Background Psychological stress is often associated with poor health-related outcomes. One potential biomarker for chronic stress, hair cortisol, is minimally invasive compared to other cortisol collection techniques. This pilot study examined the relationships between hair cortisol and self-reported perceived stress, stressful life events, depressive symptoms, and dispositional optimism among adolescents. Methods This cross-sectional study comprised of a convenience sample of 27 adolescents (age: M=14.96, SD=1.63) recruited from a Southern California after-school program. Along with demographic and hair characteristics (e.g., hair color, type, etc.), participants completed the Perceived Stress Scale, Stressful Life Events checklist, CES-D (depressive symptoms), and Life Orientation Test (optimism). Hair cortisol was measured by analyzing hair samples approximately 1 cm from the scalp representing one month of cortisol exposure. Results Hair cortisol had a significant inverse association with dispositional optimism (r=−0.44, p<0.05). Hair cortisol was not significantly associated with self-reported perceived stress, stressful life events, or depressive symptoms. Conclusion Assessment of hair cortisol may prove beneficial as an objective measure in research examining chronic stress-related outcomes among adolescents. Resiliency or protective dispositions, such as optimism, merit attention in relation to this biomarker.