A Coping Skills Intervention for Low-SES Latino Families of Children with Asthma

针对低社会经济地位拉丁裔哮喘儿童家庭的应对技巧干预

• 批准号: 10610909
• 负责人: Erin M. Rodriguez
• 金额: $ 65.37万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-18 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610909
• 关键词: 13 year old; 2 arm randomized control trial; Address; Affect; Age; Asthma; Behavior; Belief; Buffers; Child; Childhood Asthma; Cognitive; Communities; Control Groups; Coping Skills; Disparity; Education; Educational Curriculum; Effectiveness; Elements; Emergency department visit; Empirical Research; Enrollment; Family; Financial Hardship; Goals; Health; Hospitalization; Household; Immigration; Intervention; Knowledge; Latino; Link; Mediating; Mediator; Moods; Outcome; Parents; Pathway interactions; Patients; Pharmaceutical Preparations; Pilot Projects; Population; Populations at Risk; Poverty; Primary Care; Problem behavior; Process; Psychosocial Stress; Public Health; Quality of life; Randomized; Records; Reporting; Research; Risk; Risk Reduction; Role; Sampling; School-Age Population; Schools; Self Management; Site; Societies; Spirometry; Stress; Stress and Coping; Symptoms; Testing; Underserved Population; Work; Youth; acceptability and feasibility; arm; asthma exacerbation; bilingualism; clinical decision-making; compare effectiveness; coping; cost; cost effective; depressive symptoms; disparity reduction; effective therapy; effectiveness testing; evidence base; experience; follow-up; functional outcomes; health disparity; implementation trial; improved; insight; low socioeconomic status; post intervention; primary care clinic; programs; psychobiologic; psychosocial; pulmonary function; recruit; social health determinants; stressor; translational research program

PROJECT SUMMARY Latino children experience disparities in asthma control and have worse functional outcomes related to poorly controlled asthma compared to non-Latino White children, including more school absences, emergency department visits, and hospitalizations for asthma. These disparities persist despite the benefits of asthma self- management interventions. A significant and growing percentage of Latino children live in poverty, which further increases their risk for uncontrolled asthma. For low-SES Latino children, psychosocial stress is an unaddressed factor in asthma disparities. Existing interventions rarely target psychosocial processes to address the role of stress in asthma control. However, research on coping offers insight into potential intervention approaches that would buffer the effects of stress and reduce asthma disparities for low-SES Latino children. Coping is a key modifiable factor that lies “midstream” between upstream social determinants of health and downstream disparities in health outcomes. In particular, secondary control coping (i.e., efforts to accommodate/adapt to stressors, such as acceptance and cognitive restructuring) has been linked to better asthma control for children in low-SES contexts. Therefore, the purpose of the current R01 proposal is to test the effectiveness and mediators of Adapt 2 Asthma (A2A), a bilingual family-based coping skills + asthma management intervention tailored to the stressors, strengths, and cultural beliefs of low-SES Latino families. 280 low-SES Latino families of children ages 9-13 years old with asthma will be identified and enrolled from community primary care clinics and randomly assigned to either A2A or a standard asthma self-management (AM) control arm. We will assess children’s asthma control, quality of life, lung function, school absences, and emergency department visits as the outcomes of the intervention. We will also examine child mediational pathways (child coping and mood and behavior symptoms) and parent mediational pathways (parent coping and depressive symptoms) of the intervention. Assessments will occur at pre- and post-intervention and at 6 and 12-month follow-up timepoints using child and parent report, spirometry, and school records. The successful completion of this R01 would provide evidence of the effectiveness and mediators of A2A for low-SES Latino children, a population underserved by current intervention approaches. Our results are expected to lead to a subsequent multi-site implementation trial of A2A in primary care. The long-term goal of this line of research is to reduce disparities in asthma control and its health consequences affecting low-SES Latino children and similar underserved youth populations. The knowledge gained would improve the health of low-SES Latino children and reduce the public health burden related to pediatric asthma, a condition with a significant cost to society.

项目摘要 拉丁裔儿童在哮喘控制方面存在差异，并且与不良哮喘相关的功能结果更差。 与非拉丁裔白色儿童相比，哮喘得到控制，包括更多的缺课、急诊 部门访问和哮喘住院治疗。尽管哮喘自身的好处，这些差异仍然存在， 管理干预。越来越多的拉美裔儿童生活在贫困中，这进一步加剧了 会增加他们患哮喘的风险对于低社会经济地位的拉丁裔儿童来说，心理社会压力是一个无法解决的问题 哮喘差异的因素。现有的干预措施很少针对心理社会过程， 哮喘控制中的压力然而，关于应对的研究提供了对潜在干预方法的深入了解， 将缓冲压力的影响，减少低社会经济地位拉丁裔儿童的哮喘差异。应对是关键 位于上游健康社会决定因素和下游健康社会决定因素之间的“中游”可改变因素 健康结果的差异。特别是，二级控制顶盖（即，努力适应 压力源，如接受和认知重建）与更好地控制儿童哮喘有关 在低社会经济地位的情况下。因此，当前R 01提案的目的是测试有效性， Adapt 2哮喘（A2 A）的调解人，双语家庭为基础的应对技能+哮喘管理干预 针对低社会经济地位拉丁裔家庭的压力源，优势和文化信仰。280个低社会经济地位的拉丁裔家庭 的9-13岁哮喘儿童将被识别并从社区初级保健诊所登记 并随机分配到A2 A或标准哮喘自我管理（AM）对照组。 儿童哮喘控制、生活质量、肺功能、缺课和急诊就诊率 干预的结果。我们还将研究儿童中介途径（儿童应对和情绪， 行为症状）和父母中介途径（父母应对和抑郁症状）的影响。 干预将在干预前和干预后以及6个月和12个月随访时间点进行评估 使用儿童和家长报告、肺量测定和学校记录。R 01的成功完成将 提供A2 A对低社会经济地位拉丁裔儿童群体的有效性和介导因素的证据 目前的干预措施不足。我们的研究结果有望导致随后的多站点 A2 A在初级保健中实施试验。这项研究的长期目标是减少 哮喘控制及其对低SES拉丁裔儿童和类似服务不足青年的健康影响 人口。所获得的知识将改善低社会经济地位的拉丁裔儿童的健康，并减少公众对他们的关注。 与儿童哮喘相关的健康负担，这是一种给社会带来巨大成本的疾病。