The Chicago Healthy Living Study is designed to examine the health behaviors of adult African-American and Hispanic childhood cancer survivors and compare these to the health behaviors of their Non-Hispanic White and their non-cancer affected peers. The study seeks to recruit a sample that is majority Non-Hispanic White. Unlike CHLS, samples of previous childhood cancer survivor studies have been predominantly Non-Hispanic White.4, 10, 11, 13–17, 19–26, 57
For example, the Childhood Cancer Survivor Study (CCSS), perhaps the largest and most well-known study of adult survivors, has a sample that is 87% Non-Hispanic Whites, 2% African-Americans, and 5% Hispanics.57
Whereas CCSS includes non-cancer affected siblings as a comparison group, CHLS includes non-cancer affected peers. This is a major contribution to the literature as only one of the two published studies12, 18
that addresses health behaviors in African-American and Hispanic survivors included a non-cancer affected comparison group.18
Using a listed, targeted digit dial approach, CHLS will recruit 300 racially/ethnically matched non-cancer affected controls. Inclusion of the control sample will allow CHLS to provide important insight into the similarities and differences in health behaviors and their mediators between minority cancer survivors and their peers who have been unaffected by such an experience.
CHLS is further set apart from prior studies of health behaviors in adult childhood cancer survivors by its use of validated measures to assess diet, smoking and physical activity. Additionally, BMI is calculated based on a standardized measurement for height and weight, contrasted to much of the published work to date which relies upon self-report weight and non-standardized measures of health behaviors.11, 12, 14, 20, 22, 25, 27, 29
A final strength of CHLS is the underlying goal of collecting data that will inform future interventions. This goal guided much of the study methodology. Thus far, the majority of research on the diet, smoking and physical activity patterns of childhood cancer survivors has been descriptive.10–12, 14, 18, 19
Few studies have examined factors that potentially influence health behaviors and that require attention for interventions to be successful in promoting behavior change.16, 17, 22, 25
CHLS assesses a number of mediators whose selection was guided by the principals of well established health behavior theories. CHLS also includes socio-cultural mediators. Understanding the cultural beliefs and attitudes that are part of one’s “health culture” will be key in developing interventions that serve the needs of minority survivors.
In sum, studies of Non-Hispanic White survivors of childhood cancer report diet, physical activity and smoking behaviors similar to those in the general population. Few studies have considered the status of these behaviors in minority survivors of childhood cancers. Several lines of research support the rationale for the current study’s focus on minority survivors. First, health disparities are prevalent in minority populations, second up to 75% of adult survivors of childhood cancer experience adverse late effects of treatment. Third, obesity, CVD, and secondary cancers are late effects that may be amenable to preventive health behaviors. In the general population, minorities are more likely to exhibit high BMIs and fewer health promotion behaviors, have inadequate knowledge of preventive lifestyles and have less healthful attitudes than Non-Hispanic Whites. Thus, minority survivors of childhood cancer are potentially at higher risk than non-minorities for developing the late effects of obesity, CVD and secondary cancers. There is insufficient data to support or refute this hypothesis at this time. CHLS will provide critical data with which this hypothesis can be considered, and upon which appropriate interventions can be developed.