There are 36,000 long-term survivors of childhood cancer in the United States. Organ compromise and oncogenesis may result from late effects of multi-modal treatments for these survivors. It is imperative that these teen survivors question the decision to smoke and to consume alcohol due to potential late effects (fibrotic lung damage and myocardial dysfunction and liver damage). Studies of risk behaviors of cancer-surviving adolescents have been limited, no studies have linked quality decision making to these risks, and intervention in this area has not been studied to date. Based on a pilot study of teen survivors, the prevalence of current alcohol use (4O percent) warrants further study since it was slightly higher than the national figure. In this study, quality decision-making skills significantly correlated with risk behaviors; as decision-making skills increased, risk behaviors decreased. The major objective for this study is to increase quality decision-making skills in long-term cancer-surviving teens in order to decrease risk-taking behaviors of smoking and alcohol consumption. Phase I will be a cross-sectional descriptive study (two years and four months timeframe). Data will be collected by: a) semi-structured interviews for teen survivors; b) a mailed survey approach for parents; and c) home interviews for age-matched peers. Phase II will use the findings from Phase 1 to develop a health promotional program to reduce the risk behaviors of smoking and alcohol use, a program tailored specifically to the needs of these adolescent survivors. The program will integrate: a) information specific to survivorship, adolescence, and parenting; b) decision-making skills with values clarification, c) modeling; and d) social support. Phase II will also include a pre-test post-test randomized clinical trial with the same survivors and their parents; follow-up will involve repeated measures at one, six, and twelve months for survivors and six months for parents. Survivors who refuse the clinical trial will be compared, using characteristics drawn from clinical records, to survivors who participate in the program.
