Motivating Asthma Adherence in Urban Teens

与白色青少年相比，低收入少数民族青少年的哮喘发病率不成比例地高，包括急诊科（艾德）护理、住院和哮喘死亡的过度风险。这个小组和其他人的研究表明，不遵守哮喘治疗方案在高风险的内城哮喘家庭中很常见，这种对处方治疗的依从性差在哮喘发病率中起着重要作用。市中心的青少年哮喘患者尤其有不依从的风险，但这一人群的研究仍然不足。虽然哮喘自我管理训练在改善哮喘依从性方面显示出了希望，但很少有明确针对青少年的干预研究，特别是那些在市中心的青少年。城市儿童通常在儿童晚期/青春期早期承担对哮喘管理的主要控制。同时，青少年为获得自主权和同伴接纳所做的努力可能会导致健康风险行为的增加，包括哮喘自我管理不良。针对青少年的独特挑战，需要发展适当的哮喘自我管理干预措施。动机访谈（MI）是一种很有前途的干预方法，它使用以客户为中心的非指导性方法来增强改变健康行为的动机。ML技术在发育上符合早期青少年的需要。Ml并不假设健康是青少年最重要的动机因素，而是承认并整合了青少年生活背景下的其他动机，因此这种干预策略具有灵活性，以适应城市青少年所面临的独特生活环境和压力源。我们建议在ED中接受哮喘治疗的226名10-15岁儿童的样本中，评估以MI为中心的自我管理干预（MI+SM）与包含哮喘教育和自我监测策略的自我管理（SM）干预的相对有效性。我们的主要假设是，与单独使用SM相比，MI+SM，将导致随机化后3个月和6个月时的药物依从性得到更大改善（通过电子药物监测进行测量）。次要结局包括自我报告的药物依从性、无症状天数、哮喘的紧急卫生保健利用率和护理人员/青少年生活质量。

Low-income, minority teenagers have disproportionately high rates of asthma morbidity, including excess risk of emergency department (ED) care, hospitalization and death from asthma, compared to white adolescents. Research by this group and others has documented that non-adherence with asthma treatment regimens is common among high-risk, inner city families with asthma, and that this poor adherence with prescribed therapies plays a significant contributing role in asthma morbidity. Inner-city adolescents with asthma are at particular risk of non-adherence, yet this population remains understudied. While asthma self-management training has shown promise in achieving some improvement in adherence with asthma, there are few intervention studies explicitly targeting adolescents, particularly those in the inner-city. Urban children typically assume primary control over their asthma management during late childhood/early adolescence. At the same time, adolescents' efforts to achieve autonomy and peer-acceptance may result in increase health risk behaviors, including poor asthma self-management. Developmentally-appropriate asthma self-management interventions are needed that target the unique challenges of adolescence. Motivational Interviewing (Ml) is a promising interventional approach that uses a client-centered, nondirective approach for enhancing motivation to change health behaviors. Ml techniques are developmentally consistent with the needs of early adolescents. Ml does not assume that health will be the most important factor motivating the teen, but rather acknowledges and incorporates other motivators that are within the context of the teen's life, thus this intervention strategy has the flexibility to adapt to the unique life circumstances and stressors faced by urban adolescents. We propose to evaluate the relative effectiveness of a Mi-focused self-management intervention (MI+SM) compared to a self-management (SM) intervention containing asthma education and self-monitoring strategies in a sample of 226 children age 10-15 years treated for asthma in the ED. Our primary hypothesis is that the MI+SM, as compared to SM alone, will result in greater improvement in medication adherence at 3- and 6-months post-randomization, as measured by electronic medication monitoring. Secondary outcomes include self-reported medication adherence, symptoms free days, urgent health care utilization for asthma, and caregiver/adolescent quality of life.