Survivors of childhood cancer and comparison peers: the influence of peer factors on later externalizing behavior in emerging adulthood.

OBJECTIVE To examine group differences and predictors of externalizing behavior and substance use during the transition to emerging adulthood (i.e., ages 18-25) among survivors of childhood cancer and comparison peers. METHODS Peer acceptance and social behavior were assessed in classrooms of 55 children (ages 8-15) during cancer treatment. Children with cancer, comparison peers (n = 60), and parents completed measures of externalizing behavior and/or substance use during an initial home visit and soon after participants turned 18. RESULTS At follow-up, survivors and peers exhibited similar externalizing behaviors and substance use, except peers were more likely to use marijuana. Substance use was associated with earlier peer acceptance and social behavior. Survivors who were older at diagnosis were at greater risk for later externalizing behavior and substance use. CONCLUSIONS Mean externalizing behaviors and substance use generally fell within normative ranges for both survivors and peers. Some survivors may benefit from interventions to reduce risk behavior.