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Program seeks to dissuade tobacco use among children at increased risk for new cancer following chemotherapy and radiation treatments
A counseling program developed at St. Jude Children’s Research Hospital is the first of its kind to show success in reducing future intentions to use tobacco among pre-adolescents and adolescents who survived cancer.
A randomized, controlled trial of the St. Jude program resulted in significant improvement in patients’ understanding of the dangers of smoking, heightened perception of personal vulnerability to health risks posed by tobacco and increased stated intention not to smoke, according to St. Jude researchers.
The finding is important because some adolescent survivors of cancer are especially vulnerable to developing heart and lung disease or cancer in the future. Risky behaviors such as smoking can further increase their vulnerability.
“Our findings were particularly interesting because the positive effects of our intervention were apparent a year after the counseling,” said Vida Tyc, associate member of the St. Jude Department of Behavioral Medicine. “Our work suggests that one-to-one counseling in the hospital followed by personal phone calls have a long-term beneficial effect in keeping adolescent survivors of cancer from intending to smoke.”
Tyc is senior author of an article reporting the findings of this study that appears in the April issue of the Journal of Clinical Oncology.
Although the follow-up lasted only one year, a previous study by other researchers found that self-reported intentions to smoke accurately predicted subsequent self-reported smoking behavior among adolescents followed for four years, according to Tyc.
“The adolescents in that previous study were not cancer survivors,” Tyc said. “Nevertheless, the finding does suggest that adolescents who report a year after the initial counseling that they don’t intend to smoke may really abstain from smoking over the long term.”
The study included 103 pre-adolescents and adolescents who had been treated for leukemia or solid tumors (except brain tumors) at St. Jude. Five patients reported they currently used tobacco and 13 (13.3 percent) of the non-smoking patients reported having tried tobacco in the past; 39.8 percent had a best friend who used tobacco and 40.7 percent had at least one parent who used tobacco.
The patients were currently disease-free, but were at least one year away from completing therapy. The ages of the patients ranged from 10 to 18 years. The patient group was divided about evenly between males and females. The sample consisted of 78.6 percent Caucasians and 21.4 percent African-Americans. The patients included adolescents from high (20.4 percent), middle (67 percent) and low (12.6 percent) socioeconomic levels.
Patients were randomly assigned to either a Standard Care Control (SCC) or a Tobacco Intervention (TI) group and were followed over time.
The SCC group received tobacco intervention that is commonly incorporated into routine medical care and is considered standard therapy. These patients were briefly advised about the health risks associated with smoking. Smokers were advised to stop, and non-smokers were encouraged to continue to resist tobacco use.
The TI group received a single session of intervention that included an educational video on the short- and long-term physical and social consequences of tobacco use. They received counseling on the risk tobacco use poses in magnifying the adverse late effects associated with some chemotherapy and radiation treatments.
The patients also received tobacco literature containing information to help them set goals for abstaining from, or stopping tobacco use. In addition, the treating physician sent a follow-up letter to the patient after completion of treatment that reinforced the anti-tobacco message.
A specially trained research nurse made phone calls to patient after one and three months following the counseling intervention. The calls were tailored to the patient’s own situation and previous counseling.
Compared to the SCC group, patients in the TI group had significantly higher scores on knowledge of tobacco risk, higher scores in perception of personal vulnerability to risk posed by tobacco use and lower intention to smoke one year after the counseling intervention. However, there were no significant differences between the two groups six months after the intervention.
“We also found that non-smoking patients tended to have higher intentions to smoke if they had used tobacco in the past, had parents who used tobacco or perceived greater benefit from tobacco use,” Tyc said. “In contrast, adolescents whose parents did not use tobacco reported less intention to smoke after counseling. This shows the strong impact that parents who smoke can have on adolescents at risk for getting cancer again by using tobacco after getting chemotherapy and radiation therapy.”
Other authors of this study include Shesh N. Rai, Shelly Lensing, James L. Klosky, Deborah B. Steward, and Jami Gattuso all of St. Jude.
This work was supported in part by the National Cancer Institute and ALSAC.
St. Jude Children’s Research Hospital
St. Jude Children’s Research Hospital, in Memphis, Tennessee, was founded by the late entertainer Danny Thomas. The hospital is an internationally recognized biomedical research center dedicated to finding cures for catastrophic diseases of childhood. The hospital’s work is supported through funds raised by ALSAC. ALSAC covers all costs not covered by insurance for medical treatment rendered at St. Jude Children's Research Hospital. Families without insurance are never asked to pay.