Integrating Self-Management Education with Cancer Survivorship Care

• Find the latest publication in this study along with others in the project here.
• Read more about Dr. Schwartz and the Childhood Cancer Survivorship Program on the CHOP Research blog.

Citation:

King-Dowling S, Psihogios AM, Hill-Kayser C, Szalda D, O’Hagan B, Darabos K, Daniel LC, Barakat LP, Fleisher L, Maurer LA, Velázquez-Martin B, Jacobs LA, Hobbie W, Ginsberg JP, Vachani CC, Metz JM, Schwartz LA. Acceptability and feasibility of survivorship care plans and accompanying mobile health intervention for adolescent and young adult survivors of childhood cancer. Pediatr Blood Cancer. 2021 Mar;68(3):e28884. doi: 10.1002/pbc.28884. PMID: 33416214

The transition between adolescence and adulthood can be a bumpy ride. Add overcoming cancer to that journey and self-care can get swept up among the many developmental landmarks. A study has been underway where researchers aim to reach these young adults through a mobile app, delivering a survivorship plan and management of their post-cancer care.

“Ultimately, this study could inform a more tailored approach to intervention to keep AYA (Adolescent & Young Adult) survivors at risk for poor self-management and disengagement more motivated and engaged,” Dr. Schwartz said. “They survived cancer. We want to protect that investment and have them live long healthy adult lives.” Lisa Schwartz, PhD is Associate Professor of Pediatrics at the University of Pennsylvania and a psychologist in the Division of Oncology and the Childhood Cancer Survivorship Program at CHOP. Integrating Self-Management Education with Cancer Survivorship Care was funded by the Centers for Disease Prevention and Control (CDC) as a Special Interest Project (SIP) in the UPenn Prevention Research Center from 2015-2018. The SIPs receive funding through competitive calls for proposals to address topics of interest or gaps in scientific evidence.

Pediatric Blood & Cancer published the study’s findings in their article “Acceptability and feasibility of survivorship care plans and an accompanying mobile health intervention for adolescent and young adult survivors of childhood cancer.” It was concluded that the mobile intervention was accessible and helpful to users, but it needs more refinement and research.

 

 

Linking a Child’s Environment to Obesity

The Issue

There is a global childhood obesity epidemic and researchers in the United States are working toward solutions, including prevention. Compared to adults, there has been relatively little research linking a child’s environment to their weight. This report was published in The Obesity Journal on August 23,2018. It is a continuation of findings from the Neighborhood Impact on Kids (NIK) study, and focuses on both physical activity and nutrition environments. Two factors that can affect a child’s weight, in addition to behavioral factors, like daily energy intake and sedentary behavior.

The Study

A team of researchers gathered data twice over a two year span, in four types of different metropolitan neighborhoods in two large cities. They looked at several factors, like the age of the parents and the proximity of a quality park, then compared these data for each child to the child’s BMI. A favorable neighborhood in the study had a supermarket nearby with good nutrition and a quality park within walking distance of the child’s home. Less favorable neighborhoods had fast food easily accessible, no supermarkets nearby and nowhere for the children to play within a 1/2 mile. The findings looked at whether the neighborhood characteristics predicted the children outcomes going forward over the two years of the study.

As a result, the study showed that children living in less favorable neighborhoods were 41% to 49% more likely to be overweight, and that these effects were found across two years. City planners and developers can use this evidence when designing neighborhoods that support healthy families.

The Importance of Environments

Karen Glanz, PhD, MPH, a co-author on the study, noted “This study is unique and important in that it allowed us to make clear comparisons between ‘healthier’ and ‘less healthy’ food and activity environments over multiple years. The findings underscore how important environments can be in shaping behaviors and the health of children.”

Neighborhoods Impact on Kids (NIK) is an observational study, evaluating cross-sectional and longitudinal associations of neighborhood-level activity and nutrition environments with children’s weight status and obesity. The study is led by Dr. Brian Saelens, currently at Seattle Children’s Hospital.

Tobacco Taxes Help Tackle Smoking Addiction: Cheryl Bettigole, MD

In a recent Philadelphia Inquirer Commentary,  Cheryl Bettigole, MD, UPenn PRC Community Advisory Board member and Director of the Division of Chronic Disease Prevention at the Philadelphia Department of Public Health, advocates broadening the tobacco tax increase adopted by the Pennsylvania legislature last summer.

The tax increase was applied only to cigarettes, e-cigarettes, roll-your-own and smokeless tobacco. Bettigole advocates including cigars and cigarillos.

“More than 10 percent of high school boys now smoke cigars and the failure to tax these products is likely to make them disproportionately cheap and hence more attractive to teens. Like e-cigarettes, cigarillos come in a multitude of flavors that seem designed to draw kids in, and are often displayed in Philadelphia’s neighborhood stores next to displays of candy and gum.”

Flavored tobacco products are a particular draw to young people.  According to Bettigole, seven out of ten teens who start smoking begin with a flavored tobacco product. Bettigole notes, “More than 90 percent of smokers start as teens and that addiction, once begun, can be impossible to break.”

 

One Year After Disneyland: Buttenheim & Asch on Leveraging Behavioral Insights to Promote Vaccine Acceptance

In a JAMA Pediatrics Viewpoint, UPenn PRC Researchers Alison Buttenheim, PhD, and David Asch, MD, look at the 2014 Disney measles outbreak and what it showed about the effect of vaccination refusal on disease risk. Since the outbreak, parents continue to skip vaccinating their children, affecting “everyone by weakening the herd immunity conferred by widespread vaccination,” according to the authors.

Buttenheim and Asch identify interventions which might make the reasons for vaccinating more salient to parents and health behavior theories which recognize the complex ways people make decisions about their children’s well-being. “There is so much more known today than 2 decades ago about not just the errors in people’s judgment, but how predictable those errors are and therefore how well they can be anticipated. This knowledge should be used to promote health for individuals and populations.”

 

USDA Announces $3.8 Million in Grants and Additional $7 Million Available for Critical Research to Prevent Childhood Obesity

The USDA National Institute of Food and Agriculture (NIFA) is seeking research grant funding applications for projects that focus on the “… societal challenge to end obesity among children, the number one nutrition-related problem in the US.”  Read more here.

“Decades of research supports the fact that children who are hungry don’t do well in the classroom and suffer from related health issues like obesity, diabetes and other serious chronic diseases. USDA has invested and will continue to invest in our children so that all of them, no matter where they are born or what their parents’ income levels are, have a shot at a healthy and productive future,” said Secretary Vilsack. “Since implementation of the Healthy, Hunger-Free Kids Act, kids are now eating 16 percent more vegetables and 23 percent more fruit at lunch, more low-income children are benefiting from breakfast and lunch programs, and nearly four million children have access to healthy food in the summer when school is out and meals are scarce. Data show some signs of progress on childhood obesity, particularly among our youngest children, and the projects these researchers are undertaking will ensure we have evidence-based tools to continue moving the dial.”