Does this project require contact of CCSS study subjects for...
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1 Received First Name Anne Last Name Lown Institution Alcohol Research Group Address Christie Street, Ste 400 Address 2 City Emeryville State CA Zip Phone ALown@arg.org Project Title Mental Health and Tobacco Use Among Childhood Cancer Survivors: A Longitudinal Analysis Planned research population (eligibility criteria) 18 years and older, enrolled in baseline, follow-up 2002 and follow-up 2007 Proposed specific aims Specific Aim 1. Describe longitudinal relationships between mental health distress (depression, anxiety, somaticization and fears about the cancer) and current and subsequent tobacco use (current smoking, higher quantity, maintenance of smoking and less quit attempts). Specific Aim 2. Describe the longitudinal relationship between posttraumatic stress (number of symptoms and posttraumatic stress disorder) and current and subsequent tobacco use. Will the project require non-ccss funding to complete? Yes If yes, what would be the anticipated source(s) and timeline(s) for securing funding? The project just recently got funded as a summer salary supplement to 1R01CA106914, A Web- Based Smoking Intervention for Cancer (Karen Emmons, P.I.). Does this project require contact of CCSS study subjects for... Additional self-reported information No Biological Samples No Medical record data No If yes to any of the above, please briefly describe. What CCSS Working Group(s) would likely be involved? (Check all that apply) Second Malignancy Chronic Disease Reproductive Neurologic Psychology / Neuropsychology Secondary - Yes Genetics
2 Cancer Control Primary - Yes Epidemiology / Biostatistics To describe the anticipated scope of the study, please indicate the specific CCSS data to be included as outcome (primary or secondary) or correlative factors. (Check all that apply) Late mortality Second Malignancy Health Behaviors Tobacco Primary - Yes Correlative Factors - No Alcohol Physical activity Medical screening Psychosocial Insurance Marriage Education Employment
3 Medical conditions Hearing/Vision/Speech Hormonal systems Heart and vascular Respiratory Digestive Surgical procedures Brain and nervous system overall health and health grade, activity limitations Medications Describe medications Pregnancy and offspring Family History Psychologic/Quality of Life BSI-18 Secondary - Yes Correlative Factors - No SF-36 Secondary - Yes Correlative Factors - No CCSS-NCQ PTS Secondary - Yes Correlative Factors - No PTG
4 Secondary - Yes Correlative Factors - No Chronic conditions (CTCAE v3) Health status Demographic Age Race Sex s If others, please specify Cancer treatment Chemotherapy Radiation therapy Surgery Anticipated sources of statistical support CCSS Statistical Center Local institutional statistician Yes If local, please provide the name(s) and contact information of the statistician(s) to be involved. Richard Harvey Will this project utilize CCSS biologic samples? No If yes, which of the following? Buccal cell DNA Peripheral blood
5 Lymphoblastoid cell lines Second malignancy pathology samples requiring collection of samples If other, please explain general comments
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