Motivating Asthma Adherence in Urban Teens

低收入、少数族裔青少年的哮喘发病率高得不成比例，包括过度 与白人相比，急诊科(ED)护理、住院和哮喘死亡的风险 青少年。该研究小组和其他人的研究证明，不坚持哮喘治疗 这种疗法在患有哮喘的高危市中心家庭中很常见，而且这种疗法的依从性很差 处方疗法在哮喘发病率中起着重要作用。市中心的青少年有 哮喘特别有可能不遵守，但这一群体仍然没有得到充分的研究。而哮喘则是自我 在那里，管理培训在改善哮喘的依从性方面显示出了希望 很少有明确针对青少年的干预研究，特别是市中心的青少年。城市 儿童通常在儿童后期/早期对他们的哮喘管理采取主要控制 青春期。与此同时，青少年努力实现自主性和同龄人接受可能会导致 增加健康危险行为，包括哮喘自我管理不善。发展适宜性 需要针对青春期独特挑战的哮喘自我管理干预措施。 动机访谈(Ml)是一种很有前途的干预方法，它使用以客户为中心的、非 增强改变健康行为的动力的指导性方法。ML技术是发展中的 符合早期青少年的需求。ML并不认为健康将是最重要的 激励青少年的因素，但承认并结合了其他激励因素 青少年的生活背景，因此这种干预策略具有灵活性，以适应独特的生活 城市青少年面临的环境和压力源。我们建议对相对有效性进行评估。 重点自我管理干预(MI+SM)与自我管理(SM)干预的比较 对226名10-15岁儿童进行哮喘教育和自我监测 在急诊室接受哮喘治疗。我们的主要假设是，与单独的SM相比，MI+SM将导致 在随机化后3个月和6个月的服药依从性方面有更大的改善，通过 电子用药监测。次要结果包括自我报告的服药依从性， 无症状天数，哮喘的紧急医疗保健利用，以及照顾者/青少年的生活质量。

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.