Rita M. Butterfield

Peer-delivered smoking counseling for childhood cancer survivors increases rate of cessation: the partnership for health study.

PURPOSE Cancer survivors smoke at rates that are only slightly lower than the general population. This article reports on the final outcomes of Partnership for Health, a smoking cessation intervention for smokers in the Childhood Cancer Survivors Study (CCSS). METHODS This study is a randomized control trial with follow-up at 8 and 12 months that involved smokers (n = 796) enrolled onto the CCSS cohort. Participants were randomly assigned to either a self-help or a peer-counseling program that included up to six telephone calls from a trained childhood cancer survivor, tailored and targeted materials, and free nicotine replacement therapy. The intervention was delivered by telephone and postal service mail. RESULTS The quit rate was significantly higher in the counseling group compared with the self-help group at both the 8-month (16.8% v 8.5%; P < .01) and 12-month follow-ups (15% v 9%; P < or = .01). Controlling for baseline self-efficacy and readiness to change, the intervention group was twice as likely to quit smoking, compared with the self-help group. Smoking cessation rate increased with an increase in the number of counseling calls. The cost of delivering the intervention was approximately 300 dollars per participant. The incremental cost-effectiveness of the intervention compared with controls was 5,371 dollars per additional quit. CONCLUSION Interventions to prevent future illnesses are of critical importance to childhood cancer survivors. The Partnership for Health intervention resulted in a doubling of smoking cessation quit rates. Because of the seriousness of smoking among childhood cancer survivors, this intervention model may be appropriate as a multicomponent treatment program for survivors who smoke.

Smoking Among Participants in the Childhood Cancer Survivors Cohort: The Partnership for Health Study

PURPOSE This article describes baseline data collection and the intervention design of Partnership for Health, a smoking cessation intervention for smokers in the Childhood Cancer Survivors Study. The purpose of this article is to evaluate demographic, psychosocial, and cancer-related factors that are associated with smoking behavior and mediators of smoking cessation. PATIENTS AND METHODS This study includes 796 smokers from the Childhood Cancer Survivors Study database who were diagnosed with cancer before the age of 21, had survived at least 5 years, and were at least 18 years of age at the time of the baseline survey. Correlates of smoking behaviors included smoking rate, number of recent quit attempts, and nicotine dependence; two key mediators of smoking cessation, readiness to quit smoking and self-efficacy, were also assessed. RESULTS Participants smoked, on average, 14 cigarettes/day; 53.2% were nicotine dependent, and 58% had made at least one quit attempt in the past year. Smoking behaviors were primarily associated with demographic variables; mediators of cessation were primarily associated with age at cancer diagnosis and perceived vulnerability to smoking-related illnesses. Severity of psychologic symptoms was associated with increased smoking rate, high nicotine dependence, and low self-efficacy. Support for quitting was related to smoking rate, number of quit attempts, readiness to quit smoking, and self-efficacy. CONCLUSION These findings indicate that many cancer survivors who smoke are receptive to smoking cessation interventions. Factors related to mediators of smoking cessation might be particularly good targets for intervention.

Health-Related Social Influence: A Social Ecological Perspective on Tactic Use:

The present study investigated predictors of health-related social influence tactic use in close relationships. According to the social ecological perspective, predictors were classified as reflecting characteristics of the agent of social influence, characteristics of the target of social influence, characteristics of the agent and targets relationship, and characteristics of the social influence situation. One hundred and nine married couples reported on situations in which each partner was attempting to influence his or her spouse to change a health-related behavior. Using the actor-partner interdependence analysis approach, results revealed only actor effects for characteristics of the agent, primarily partner effects for characteristics of the target, and both actor and partner effects for characteristics of the situation when predicting health-related tactic use. Effects for relationship characteristics only emerged in interactions with respondent sex. These results indicate that social influence in marriage involves reciprocity and interdependence. The importance of examining the dyadic nature of health-related social influence in close relationships is also highlighted.

The conceptualization and assessment of health-related social control:

Three studies examined the conceptualization and assessment of health-related social control in marriage. Using a sample of 100 couples, Study 1 tested the idea that social control is best thought of as the exercise of power and control in close relationships. Results did not support this conceptualization or assessment of health-related social control in marriage. Based on these results, Study 2 collected qualitative data from husbands and wives via focus groups to explore the use of social control tactics that couples use to change health behavior. Results indicated that many tactics reported by spouses are not contained in the social influence literature, and that the exercise of social control in marriage may best be characterized of as an interdependent communally oriented process between spouses. Using another sample of 109 married couples, Study 3 tested the reliability and validity of a measure developed from the qualitative data. Results indicated the new measure of health-related social control tactics evidenced better reliability and validity than the measure used in Study 1.

Antecedents and Reactions to Health-Related Social Control

A model of the antecedents and reactions to health-related social control is proposed. This model suggests health behavior characteristics, including type, frequency, and severity of consequences, are social control antecedents. Social control is then thought to elicit better health behavior and emotions. Attributions to explain social control are proposed to effect emotional reactions and behavior. Undergraduates read hypothetical scenarios to test the proposed model. Study 1 found that health-compromising behaviors and behaviors with more severe consequences elicited more social control. Study 2 found that, compared to negative tactics, positive social control tactics elicited more behavior change, and compared to social/appearance concerns, attributions to health elicited positive emotions. Attributions did not moderate the impact of social control on emotions or behavior.

Availability of smoking prevention and cessation services for childhood cancer survivors

ObjectiveTo characterize the smoking-related services available to childhood cancer survivors and describe organizational characteristics that were related to institutions’ capacity to provide smoking services.MethodsInstitutions affiliated with the Children’s Oncology Group were surveyed from 2003 to 2004.ResultsOf the 132 responding institutions, 85% assessed the smoking status of their cancer survivors intermittingly, but only 3% assessed smoking status at every visit, as recommended by the PHS guidelines. A minority of sites offered either smoking prevention (39%) or cessation (25%) services; 58% of sites had a mechanism in place to refer survivors for cessation services. In multivariate analyses, the most parsimonious model predicting capacity for smoking service delivery included barriers, respondents’ attitudes, complexity, and institutional stability.ConclusionsThese data highlight an important need to improve the availability of smoking services for childhood cancer survivors. Additionally, these findings will inform the development of future interventions that are sensitive to barriers and facilitators to providing prevention services.

HIV Risk and Protection Among Gay Male Couples: The Role of Gay Community Integration:

This study examined the association between different types of integration in the gay community and HIV risk among gay male couples. Previous research linking gay community integration and involvement among couples to HIV risk has been equivocal. Each partner in 59 gay couples completed a separate anonymous questionnaire that assessed two types of social involvement in the gay community, assimilation into the gay community, and sexual HIV risk behaviors. We used the actor-partner interdependence analysis approach, which maintains the couple as the unit of analysis while allowing for tests of within-couple, between-couple, actor, and partner effects. Analyses revealed that, controlling for symptoms of alcohol problems, going to gay bars and clubs independently predicted more HIV risk.