Objectives: Substance use among young adult childhood cancer survivors (YACCSs) has been found to increase during survivorship, resulting in increased risk of developing long-term negative health outcomes. This investigation sought to determine various risk and protective factors of tobacco, alcohol, or marijuana use over time among a sample of YACCSs. Methods: 127 YACCSs (57% Hispanic, 55% female, average age at diagnosis 12.4 years) who were diagnosed with any cancer type (except Hodgkin lymphoma) at two large pediatric medical centers in Los Angeles County between 2000 and 2007 responded to two surveys separated by ∼5 years. Bivariate logistic regression models were used to assess independent clinical and psychosocial Time 1 variables associated with each substance use outcome at Time 2. Time 1 variables significant at p < .10 were included in multivariable logistic regression models for each Time 2 substance use variable. Results: Rates of 30-day use increased over time for binge drinking alcohol (from 25.6% to 37.7%), marijuana (from 10.6% to 22.1%), and cigarette/tobacco (from 8.9% to 12.2%). Of the following Time 1 variables, marijuana use, cigarette use, and binge drinking were associated with Time 2 marijuana, cigarette, and binge drinking, respectively. Of the following clinical factors, receipt of more intensive cancer treatment was associated with decreased tobacco use. All other psychosocial and clinical factors analyzed were not associated with any increase or decrease in substance use. Conclusions: A greater emphasis on early health education efforts regarding the health risks of tobacco, alcohol, and marijuana use is needed in this at-risk population.

目标：已发现年轻成人儿童癌症幸存者 (YACCSs) 的物质使用在幸存者期间增加，导致发生长期负面健康结果的风险增加。该调查旨在确定随时间推移在 YACCS 样本中使用烟草、酒精或大麻的各种风险和保护因素。方法：2000 年至 2007 年期间在洛杉矶县的两个大型儿科医疗中心被诊断出患有任何癌症类型（霍奇金淋巴瘤除外）的 127 名 YACCS（西班牙裔占 57%，女性占 55%，平均诊断年龄为 12.4 岁）对两项调查做出回应～5 年。双变量逻辑回归模型用于评估与时间 2 的每种物质使用结果相关的独立临床和社会心理时间 1 变量。时间 1 变量在p  < .10 时具有显着性，包括在每个时间 2 物质使用变量的多变量逻辑回归模型中。结果：随着时间的推移，暴饮暴食（从 25.6% 到 37.7%）、大麻（从 10.6% 到 22.1%）和香烟/烟草（从 8.9% 到 12.2%）的 30 天使用率随着时间的推移而增加。在以下时间 1 变量中，大麻使用、香烟使用和狂饮分别与时间 2 大麻、香烟和狂饮相关。在以下临床因素中，接受更强化的癌症治疗与减少烟草使用有关。分析的所有其他社会心理和临床因素都与物质使用的任何增加或减少无关。结论：在这个高危人群中，需要更加重视关于烟草、酒精和大麻使用的健康风险的早期健康教育工作。