Cheryl L. Cox

Noninvasive evaluation of late anthracycline cardiac toxicity in childhood cancer survivors.

UNLABELLED PURPOSEl: Childhood cancer survivors treated with anthracyclines and cardiac radiation are at risk for late-onset cardiotoxicity. The purpose of this study was to delineate the relationship between clinical factors and abnormalities of noninvasive cardiac testing (NICT). PATIENTS AND METHODS Participants were recruited from a long-term follow-up clinic. Study measures comprised physical examination, laboratory evaluation, echocardiogram, and ECG. Mean fractional shortening (FS) and afterload were compared for survivors who did (at risk [AR]) and did not (no risk [NR]) receive potentially cardiotoxic modalities, and with values expected for comparable age- and sex-matched controls. RESULTS The 278 study participants (mean age, 18.1 years; median age, 16.8 years; range, 7.5 to 39.7 years) included 223 survivors AR for cardiotoxicity after treatment with anthracyclines (median dose +/- standard deviation [SD], 202 +/- 109 mg/m(2)) and/or cardiac radiation. Mean FS (+/- SD) was lower for AR (0.33 +/- 0.06) compared with NR survivors (0.36 +/- 0.05; P = .004) and normative controls (0.36 +/- 0.04; P < .001). Mean afterload (+/- SD) was higher for AR (58 +/- 21 g/cm(2)) compared with NR survivors (46 +/- 15 g/cm(2); P < .001) and normative controls (48 +/- 13 g/cm(2); P < .001). The distribution of FS and afterload among NR survivors did not differ from that of controls. After adjustment for age group at diagnosis and time since completion of therapy, anthracycline dose predicted decline in distribution of FS (P < .001) and increase in distribution of afterload (P < .001). Treatment with anthracycline doses >or= 100 mg/m(2) increased the risk of abnormal NICT; survivors who received >or= 270 mg/m(2) had a 4.5-fold excess risk of abnormal NICT (95% CI, 2.1 to 9.6) compared with controls. CONCLUSION Childhood cancer survivors treated with anthracycline doses >or= 270 mg/m(2) are at greatest risk for abnormalities of FS and afterload.

Dimensions of adolescent health behavior

PURPOSE To determine dimensions of healthy and unhealthy behaviors of young people aged 12 to 21 years to better inform measures of adolescent health behavior and assist in targeting appropriate strategies to promote health. METHODS The study sample (N = 8730), derived from a U.S. national probability sample; 52.3% were female, 67% white, 15% African-American, 18% Hispanic, 22.2% aged 12-13 years, 38.4% aged 14-17 years, and 39.4% aged 18-21 years. Principal components analysis was done to examine the covariance structure of 42 healthy and unhealthy behaviors selected from the behavioral questions of the Youth Risk Behavior Survey (YRBS). RESULTS A four-factor oblique rotation, comprised of 18 variables with factor loadings of.50 or greater, resulted in interpretable and meaningful health behavior factors. Sexual activity, substance use (e.g., alcohol, marijuana, and other drugs), smoking, and exercise factors accounted for 74% of the variance in the composite of healthy and unhealthy behaviors. These four factors were subsequently reproduced on random samples as well as on samples defined by age (12-13 years [excluding sexual activity variables], 14-17 years, 18-21 years), gender, and race (white, African-American, Hispanic). CONCLUSIONS These results provide new information about the consistent structure of sexual activities and exercise behaviors across subgroups defined by age, gender, and racial/ethnic origins, and about differences in clusters of substance use behaviors across ethnic groups. Further study of diverse population-based samples and multiple health-promoting and health-negating behaviors should profile developmental variations and health protective factors in adolescents.

Physical performance limitations among adult survivors of childhood brain tumors.

Young adult survivors of childhood brain tumors (BTs) may have late effects that compromise physical performance and everyday task participation. The objective of this study was to evaluate muscle strength, fitness, physical performance, and task participation among adult survivors of childhood BTs.

A Model of Health Behavior to Guide Studies of Childhood Cancer Survivors

PURPOSE/OBJECTIVES To describe the Interaction Model of Client Health Behavior (IMCHB) and its application to health promotion in childhood cancer survivors. DATA SOURCES Periodical literature about cancer survivors, health behavior models, and the IMCHB. DATA SYNTHESIS Childhood cancer survivors are at risk for various late complications of treatment. The primary goal of intervention is the modification of health-related behavior. Conceptual models that extend beyond health beliefs are needed to guide explanatory and intervention studies in this group. CONCLUSIONS The IMCHB identifies background, cognitive, affective, motivational, and contextual variables that explain health-related behaviors. The model defines the interactive and collective contributions of a survivor, family, and provider to adherence to protocols, reduction of risk behavior, and promotion of health-protective behavior. IMPLICATIONS FOR NURSING This model may identify new determinants of health-related behavior that can be targeted by specific inter- or intrapersonal interventions to protect the health of childhood cancer survivors and reduce their risk of late sequelae.

Predictors of marriage and divorce in adult survivors of childhood cancers: a report from the Childhood Cancer Survivor Study.

Background/Objective: Adult survivors of childhood cancer can have altered social functioning. We sought to identify factors that predict marriage and divorce outcomes in this growing population. Methods: This was a retrospective cohort study of 8,928 ≥5-year adult survivors of childhood malignancy and 2,879 random sibling controls participating in the Childhood Cancer Survivor Study. Marital status, current health, psychological status, and neurocognitive functioning were determined from surveys and validated instruments. Results: Survivors were more likely to be never-married than siblings [relative risk (RR), 1.21; 95% confidence interval (95% CI), 1.15-1.26] and the U.S. population (RR, 1.25; 95% CI, 1.21-1.29), after adjusting for age, gender, and race. Patients with central nervous system tumors were at greatest risk of not marrying (RR, 1.50; 95% CI, 1.41-1.59). Married survivors divorced at frequencies similar to controls. In multivariable regression analysis, nonmarriage was most associated with cranial radiation (RR, 1.15; 95% CI, 1.02-1.31 for >2,400 centigray). In analysis of neurobehavioral functioning, nonmarriage was associated with worse task efficiency (RR, 1.27; 95% CI, 1.20-1.35), but not with emotional distress, or problems with emotional regulation, memory, or organization. Physical conditions predictive of nonmarriage included short stature (RR, 1.27; 95% CI, 1.20-1.34) and poor physical function (RR, 1.08; 95% CI, 1.00-1.18). Structural equation modeling suggested that cranial radiation influenced marriage status through short stature, cognitive problems, and poor physical function. Conclusions: Childhood cancer survivors married at lower frequencies compared with peers. Patients with central nervous system tumors, cranial radiation, impaired processing efficiency, and short stature were more likely to never marry. Divorce patterns in survivors were similar to peers. (Cancer Epidemiol Biomarkers Prev 2009;18(10):2626–35)

Risk Factors for Obesity in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

PURPOSE Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood. PATIENTS AND METHODS We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM). RESULTS Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form-36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity. CONCLUSION Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.

Motivation in health behavior: measurement, antecedents, and correlates.

Additional reliability, validity, and information on health behavior correlates for a recently developed measure of intrinsic motivation in health behavior are reported. A randomly selected sample of 379 elders responded to a structured interview containing the Health Self-determinism Index (HSDI) and other relevant variables. The overall reliability of the HSDI was supported with an alpha coefficient of 0.78. The multidimensionality of the instrument was reconfirmed through principal components analysis, and factor invariance across study samples was established. The total HSDI and subscale scores were associated with the practice of selected life-style behaviors. The homogeneity of the sample raises significant considerations relative to contextual item sensitivity and sample-induced response tendencies.

Relationship between beliefs, motivation, and worries about physical activity and physical activity participation in persons with rheumatoid arthritis.

To determine the relationship between beliefs, motivation, and worries about physical activity and physical activity participation in persons with rheumatoid arthritis (RA).

Advancing Discourse on Health Promotion: Beyond Mainstream Thinking

Attention must be redirected toward health promotion as nursing evaluates the goal of health for all. Confusion regarding health promotion behavior is illustrated by terms with diverse meanings and uses. In a process of critical analysis, five multidisciplinary experts in health promotion responded to a survey targeting the distinction of health promotion, health promotion behavior, health protection behavior, disease prevention behavior, preventive health behavior, health behavior, and healthy lifestyle. Descriptors of health promotion were derived from a multidimensional conception of well-being. Disagreement existed concerning health protection and health behavior. Nursing interventions are linked to reflective discourse regarding health promotion behavior.

The Impact of Lifestyle Risk Factors on Female Infertility

ABSTRACT Background: Over 2 million couples in the United States are infertile. The literature reflects a number of potential lifestyle risks that have been associated with the development of this condition; however, few studies have investigated these risks concurrently. With knowledge of the importance of behavioral threats to fertility, womens health care providers will be in a better position to screen and assist women to modify their fertility risks. Objectives: The objectives of this study were (1) to identify lifestyle factors associated with infertility in women by comparing a sample of infertile women with a group of fertile women and (2) to offer recommendations to womens health providers, on counseling women at risk for infertility. Methods: A re-examination of the 1995 National Survey of Family Growth (NSFG) allowed for the investigation of lifestyle factors associated with infertility in women. Using a conceptual model of health behavior to guide the selection of variables, together with multiple logistic regression techniques, an explanatory model of infertility was estimated on a sample of 824 women between the ages of 16 and 45 years. Results: Factors directly related to infertility included increasing age, a history of an ectopic pregnancy, current smoking, obesity, and self reported health status. Protective effects were associated with a history of condom use and having had a Pap smear in the last year. Conclusions and Implications: Routine well-women visits offer an excellent opportunity to begin to address the impact of selected risk factors for infertility. Clinicians can utilize these visits to target appropriate interventions for initiating, repeating, and reinforcing messages on fertility risk.