Substance use among adolescent and young adult cancer survivors

Abstract

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.

The Associations of Age and Ethnicity on Substance Use Behaviors of Adolescent and Young Adult Childhood Cancer Survivors

“…Current alcohol use is reported in 35% of high school students, but only 5.6% in the present study of adolescent cancer survivors. Other studies have demonstrated similar findings when compared with age‐matched peers and siblings . National rates of alcohol use among Hispanic and NHW adolescents were similar, but smoking rates among NHW adolescents were slightly higher, similar to our findings.…”

“…Of the few studies examining substance use behaviors among minority CCS, only 1 included adolescent survivors. Milam and colleagues recently reported no difference in substance use behaviors among Hispanic and NHW CCS . Another study on minority young adult survivors reported similar rates of smoking among Hispanic, Black, and NHW survivors .…”

“…Multivariable logistic regression analyses were used to identify whether age group and ethnicity were predictors of substance use behaviors. Covariates selected included household income to capture socioeconomic status (SES) and gender based on previous research . Insurance status was not included because of a low frequency of uninsured CCS, thus not appropriate for multivariable logistic regression models.…”

“…Substance use behaviors were similar compared with age‐matched controls, smoking rates were similar across ethnic groups, but alcohol consumption was lower among Black and Hispanic survivors . Both studies mentioned above reported on health behaviors of Hispanic young adult CCS (≥18 years); however, only 1 recent study included health behaviors of Hispanic adolescents, 15 to 17 years of age . Milam et al reported lower prevalence rates of substance use among both adolescent and young adult groups compared to national controls but reported no differences between ethnic groups.…”

“…Studies have focused on evaluating adverse health behaviors including tobacco, alcohol, and illicit drug use in AYA CCS in an attempt to reduce long‐term morbidities . Few studies have examined substance use behaviors among racial/ethnic minority AYA survivors …”