Motivating Asthma Adherence in Urban Teens

低收入，少数民族青少年有不成比例的哮喘发病率高，包括过度 与白色人相比，急诊科（艾德）护理、住院和哮喘死亡的风险 青少年。这个小组和其他人的研究已经证明，不坚持哮喘治疗 方案是常见的高风险，内城家庭与哮喘，这种不良的依从性， 处方治疗在哮喘发病率中起重要作用。市中心的青少年 哮喘患者尤其有不依从的风险，但对这一人群的研究仍然不足。当哮喘自我- 管理培训已显示出在实现哮喘依从性的一些改善方面的希望， 很少有干预研究明确针对青少年，特别是那些在市中心。城市 儿童通常在儿童晚期/早期对哮喘管理进行主要控制 青春期与此同时，青少年为实现自主和同伴接受所做的努力可能会导致 增加健康风险行为，包括哮喘自我管理不良。适合发展 需要针对青少年独特挑战的哮喘自我管理干预措施。 动机性访谈（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，以增强改变健康行为的动机。ML技术在发展 符合早期青少年的需要。ML并不认为健康将是最重要的 激励青少年的因素，而是承认并纳入其他激励因素， 青少年的生活情境，因此这种干预策略具有适应青少年独特生活的灵活性 城市青少年面临的环境和压力。我们建议评估相对有效性 自我管理干预（MI+SM）与自我管理（SM）干预相比， 在226名10-15岁儿童中进行哮喘教育和自我监测策略 我们的主要假设是，与单独使用SM相比，MI+SM将导致 在随机化后3个月和6个月，通过以下指标测量， 电子药物监测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照顾者/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, non- directive approachfor 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.