The aims of this study were to compare decision making and substance use risk behaviors of a cohort of cancer-surviving adolescents to those of 2 earlier cohorts as well as adolescents in the US general population and to determine the relationship of decision making to substance use risk behaviors. This correlational study used a semistructured interview at the time of the annual clinic visit to obtain data. Teen cancer survivors (N = 76), ages 14-19 years, were recruited from 5 clinics within the United States. Adherence to quality decision-making skills reported by different cancer-surviving adolescent cohorts appears to remain the same over time. However, reported substance use risk behaviors by these teen survivor cohorts have decreased over time. The prevalence rates for lifetime use for the 2004 cohort of teen cancer survivors were 25%, 49%, and 16%, for cigarettes, alcohol, and marijuana use, respectively. These rates are somewhat lower than those in the US general population; yet, they are high given the health vulnerability of cancer-surviving adolescents. Poor-quality decision making was significantly associated with higher levels of substance use risk behaviors for these teen cancer survivors. In conjunction with the statistics related to higher health risks in this vulnerable group of teens, these findings support continued efforts in developing interventions for risk behavior counseling.

Study results characterize a presenting clinical profile for adolescent survivors with poor-quality decision making regarding substance use risk behaviors that will be helpful to health professionals counseling teen survivors about the impact of risk behaviors on disease-and treatment-related late effects.

Background Adolescent survivors of childhood cancer engage in risky behaviors. Objective This study tested a decision aid for cancer-surviving adolescents aimed at difficult decisions related to engaging in substance use behaviors. Methods/Intervention This RCT recruited 243 teen survivors at three cancer centers. The cognitive-behavioral skills program focused on decision making and substance use within the context of past treatment. Effects at 6- and 12-months were examined for decision making, risk motivation, and substance use behaviors using linear regression models. Results The majority (90%) of the teen cancer survivors rated the program as positive. There was an intermediate effect at 6 months for change in risk motivation for low riskers; but, this effect was not sustained at 12 months. For quality decision making, there was no significant effect between treatment groups for either time point. Conclusions The overall program effects were modest. Once teen survivors are in the program and learn what quality decision making is, their written reports indicated adjustment in their perception of their decision-making ability; thus, a more diagnostic baseline decision-making measure and a more intensive intervention is needed in the last six months. With two out of three teen participants dealing with cognitive difficulties, the data suggest that this type of intervention will continue to be challenging, especially when 90% of their household members and 56% of their close friends model substance use. Implications for Practice This effectiveness trial utilizing late effects clinics provides recommendations for further program development for medically-at-risk adolescents, particularly ones with cognitive difficulties.