Association Between Clinical, Demographic Factors, and Substance Use Among Young Adult Survivors of Childhood Cancer

Childhood cancer survivors are at risk for late effects related to their cancer treatment, but little is known about clinical, and demographic associated with substance use behaviors. The purpose of this study is to examine the associations between substance use behaviors (tobacco, marijuana, e-cigarette, and alcohol) and cancer-related follow-up care, treatment intensity, late effects, depressive symptoms, self-rated health, race/ethnicity, and neighborhood socioeconomic status (nSES). Participants were from the Project Forward cohort, a population-based study of young adult survivors of childhood cancer. Participants (N=1,166, Mage=25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County, California). Multivariate path analyses were performed with substance use as the outcome variables and clinical and demographic factors as independent variables. Covariates included age and gender. Substance use was positively associated with depressive symptoms, and inversely associated with cancer-related follow-up care, female gender, age, Hispanic ethnicity, treatment intensity, and self-rated health. Neighborhood SES was inversely associated with tobacco use, while being positively associated with binge drinking and e-cigarette use. The results highlight the interrelationship among the clinical and demographic variables and their associations with different substance use. Findings support effective interventions targeting integrative care and health promotion efforts for polysubstance use behavior among CCS. This will help improve long-term outcomes and mitigate the risk for early morbidity.