A Pilot Stress Management Intervention for High Risk Children with Asthma

针对哮喘高危儿童的试点压力管理干预措施

• 批准号: 8242940
• 负责人: ANNA L MARSLAND
• 金额: $ 22.45万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8242940
• 关键词: 12 year old; Absenteeism; Accounting; Acute; Adherence; Affect; Anxiety; Asthma; Attention; Behavior; Biological; Child; Childhood; Childhood Asthma; Chronic; Chronic Disease; Chronic stress; Clinic; Clinical Trials; Clinical Trials Design; Cognitive Therapy; Coping Skills; Data; Development; Disadvantaged; Drops; Economically Deprived Population; Education; Effectiveness; Elements; Evaluation; Event; Exhalation; Exposure to; Future; Health; Health Benefit; Health behavior; Individual; Inflammatory; Inflammatory Response; Intervention; Intervention Trial; Knowledge; Learning; Life; Light; Link; Lung Inflammation; Measures; Mediating; Medical; Methods; Minority; Morbidity - disease rate; Nitric Oxide; Outcome; Outpatients; Participant; Pathway interactions; Pharmaceutical Preparations; Phase; Physicians; Physiological; Pilot Projects; Play; Prevalence; Problem Solving; Process; Psychological Stress; Psychosocial Assessment and Care; Psychosocial Factor; Psychosocial Stress; Public Health; Randomized; Recruitment Activity; Research; Respiratory physiology; Risk Factors; Role; Sampling; Schools; Self Efficacy; Self Management; Severities; Severity of illness; Social Environment; Socioeconomic Status; Spirometry; Stress; Stress and Coping; Symptoms; Training Programs; United States; Up-Regulation; Visit; Work; abstracting; airway inflammation; base; control trial; coping; cost effective; depressive symptoms; health belief; high risk; improved; low socioeconomic status; modifiable risk; mortality; novel; peer; physical conditioning; pilot trial; post intervention; primary outcome; programs; psychologic; psychosocial; pulmonary function; satisfaction; skills; skills training; socioeconomics; standard care; stress management; urban area

DESCRIPTION (provided by applicant): Asthma is the most common chronic illness among children in the United States, with disproportionately high morbidity and mortality among minority and socioeconomically disadvantaged children living in urban areas. These disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. Converging evidence suggests that psychosocial factors that accompany socioeconomic disadvantage contribute to the marked disparities in childhood asthma morbidity, with psychological stress predicting future asthma exacerbations in children. Chronic stress and lower socioeconomic status also are associated with the exacerbation of airway inflammatory responses to environmental triggers and the upregulation of inflammatory processes directly implicated in asthma exacerbation. Evidence that stress accentuates airway inflammation and predicts asthma morbidity raises the possibility that psychological interventions aimed at helping children manage stress could improve the physical health of high risk children with asthma. To date, studies of psychosocial interventions for pediatric asthma have been of poor general quality, highlighting a need for further more rigorous research. Accordingly, we have developed a stress management and coping skills training program based on the principles of cognitive behavioral therapy ("I Can Cope"). Preliminary trials provide initia support for the feasibility of offering this supplemental intervention to 8-12 year old asthmatics n urban schools and provide initial evidence for intervention-related decreases in perceived stress and improvements in lung function, as measured by spirometry. The primary objective of the proposed research is to conduct a critical randomized controlled pilot evaluation of the effectiveness of this school-based intervention to obtain data that is necessary to develop a full-scale clinical trial. For this purpose, we propose randomly assigning 108 economically disadvantaged urban 3rd through 6th graders with physician-confirmed asthma to the school-based intervention or an education only control condition. Primary outcomes will include (1) psychological function and (2) asthma health, as assessed at the end of the intervention period. If future work confirms our initial feasibility findings, this will be the first study to demonstrae the health benefit of a school-based asthma stress management intervention for high risk children living in urban settings, providing a novel means of intervening to reduce disparities in asthma morbidity. Furthermore, it will provide a more efficient and cost-effective means of accessing vulnerable children than individual clinic based intervention, which we have not found to be feasible. PUBLIC HEALTH RELEVANCE: Minority and socioeconomically disadvantaged children living in urban areas in the US are at disproportionately high risk for asthma morbidity, with disparities in asthma severity being larger than those in asthma prevalence. Growing evidence shows that psychosocial factors that accompany socioeconomic disadvantage may play a role in these disparities, with psychological stress predicting future asthma exacerbations in children. The current application proposes a pilot study examining the first school-based intervention to target this modifiable risk factor. Thus, the public health implications of the project are considerable and include the identification of a method of intervening to reduce disparities in asthma morbidity. In addition, we anticipate that the intervention will be cost effective, reducing medical visits, use of as needed medications, and school absenteeism. (End of Abstract)

描述（由申请人提供）： 哮喘是美国儿童中最常见的慢性疾病，在城市地区的少数民族和社会经济弱势儿童中发病率和死亡率高得不成比例。哮喘患病率的差异并不能完全解释这些差异，这突出表明需要针对与哮喘控制较差相关的因素进行干预。越来越多的证据表明，伴随社会经济劣势的心理社会因素导致儿童哮喘发病率的显著差异，心理压力可预测儿童未来的哮喘加重。慢性压力和较低的社会经济地位也与环境触发的气道炎症反应的恶化和直接参与哮喘恶化的炎症过程的上调有关。有证据表明，压力加重气道炎症和预测哮喘发病率提出了一种可能性，即旨在帮助儿童管理压力的心理干预措施可以改善哮喘高危儿童的身体健康。迄今为止，儿童哮喘的心理社会干预研究的总体质量较差，突出了进一步更严格的研究的必要性。因此，我们根据认知行为疗法（“我能科普”）的原则制定了一项压力管理和应对技能培训计划。初步试验为城市学校8-12岁哮喘患者提供这种补充干预的可行性提供了初步支持，并提供了与干预相关的感知压力降低和肺功能改善（通过肺量计测量）的初步证据。拟议研究的主要目标是对这种以学校为基础的干预措施的有效性进行关键的随机对照试点评估，以获得开发全面临床试验所需的数据。为此，我们建议随机分配108个经济困难的城市3 - 6年级的医生确诊的哮喘，以学校为基础的干预或教育的控制条件。主要结果将包括（1）心理功能和（2）哮喘健康，在干预期结束时进行评估。如果未来的工作证实了我们最初的可行性研究结果，这将是第一个证明以学校为基础的哮喘压力管理干预对生活在城市环境中的高危儿童的健康益处的研究，提供了一种新的干预手段，以减少哮喘发病率的差异。此外，它将提供一个更有效和更具成本效益的方式访问脆弱的儿童比个人诊所为基础的干预，我们还没有发现是可行的。 公共卫生关系： 生活在美国城市地区的少数民族和社会经济上处于不利地位的儿童患哮喘病的风险不成比例地高，哮喘严重程度的差异更大 比哮喘患病率高。越来越多的证据表明，伴随社会经济劣势的心理社会因素可能在这些差异中发挥作用，心理压力可预测儿童未来的哮喘加重。目前的申请提出了一项试点研究，审查第一个以学校为基础的干预措施，以针对这一可改变的风险因素。因此，该项目的公共卫生影响是相当大的，包括确定 一种减少哮喘发病率差异的干预方法。此外，我们预计，干预措施将具有成本效益，减少医疗访问，使用所需的药物，和学校缺勤。 (End摘要）