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Comparison of two cohorts of medically at-risk adolescents engaging in substance use (cancer survivors and asthmatics)

Clinical predictors for monitoring care

Hollen, Patricia J. PhD, RN, PNP, FAAN (Professor)1; O'Laughlen, Mary C. PhD, RN, FNP-BC, FAAAAI (Assistant Professor)1; Hellems, Martha A. MS, MD (Pediatrician and Associate Professor)2; Hinton, Ivora D. PhD (Coordinator)3; Xin, Wenjun MS (Statistician)4; Patrie, James T. MS (Lead Statistician)4

Journal of the American Association of Nurse Practitioners: September 2019 - Volume 31 - Issue 9 - p 513–521
doi: 10.1097/JXX.0000000000000171
Research - Quantitative

Background and purpose: Medically at-risk adolescents differ in their perception of severity and are vulnerable to substance use because of effects on their medical regimen. The intent in comparing two cohorts, adolescent survivors of cancer and teens with asthma, is to provide clinical predictors to help in monitoring those needing help with substance use decision making.

Methods: Baseline data were obtained from two randomized controlled trials for a decision-making program of research for medically at-risk adolescents. Multivariate analyses were used to identify clinical predictors for poor decision making as well as lifetime and current substance use (smoking, alcohol use, and marijuana use).

Conclusions: Predictors for both cohorts for lifetime and current substance use were increasing age and risk motivation. A significant predictor for both cohorts for poor decision making related to substance use was risk motivation, measured as a more positive attitude for engaging in substance use. Negative modeling by peers and family members had an impact on teen survivors' decision making; but, this was not clear for teens with asthma.

Implications for practice: Research is needed comparing other medically at-risk adolescents to determine which cohorts on the substance use spectrum are less resilient to peer and parent modeling, have unrealistic views of their decision-making skills, and need close monitoring and guidance.

1School of Nursing, University of Virginia, Charlottesville, Virginia,

2School of Medicine, University of Virginia,

3Data Analyses and Interpretation, School of Nursing, University of Virginia,

4Department of Public Health Sciences, University of Virginia

Correspondence: Patricia J. Hollen, PhD, RN, PNP, FAAN; P.O. Box 800782, McLeod Hall, University of Virginia School of Nursing, Charlottesville, VA 22908-0782; E-mail:

Competing interests: The authors report no conflicts of interest.

Authors' contributions: P. J. Hollen: Writing - original draft, review and editing; M. C. O'Laughlen: Writing - original draft; M. A. Hellems: Project administration, Writing - review and editing; I. D. Hinton: Data curation; W. Xin: Formal analysis; J. T. Patrie: Formal analysis.

Received August 15, 2018

Accepted October 17, 2018

© 2019 American Association of Nurse Practitioners
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