Coping Peer Intervention for Adherence in Urban African American Adolescents with

描述(由申请人提供)：市中心非裔美国青少年的哮喘发病率和死亡率很高，需要紧急干预。与非西班牙裔和西班牙裔白人儿童相比，非西班牙裔黑人儿童的住院率和因哮喘而死亡的比例最高。为了解决这种差异，研究人员设计了一种文化敏感的干预措施，旨在提高对哮喘每日控制者药物的依从性，并最终降低哮喘恶化的风险，这很容易适应青少年混乱的生活方式。这项拟议的研究是一项行为随机对照试验，旨在测试应对同伴干预是否可以提高14至16岁的城市非裔美国青少年对哮喘控制器药物的依从性。为了确保项目的成功，首席研究员组建了一个多学科的研究团队，其中包括行为和社会科学专家以及一名社区哮喘负责人。具体目标是：(1)与注意力控制相比，评估3个月应对同伴支持干预对坚持和知识的影响；(2)评估与注意力控制相比，3个月和6个月应对同伴支持干预在坚持和知识方面实现持续改善的能力；以及(3)制定设计后续R01行为对照试验所需的估计，以测试这种干预措施降低哮喘恶化风险的有效性。这项研究的主要结果是坚持每天服用哮喘控制药物，使用客观的电子监测器进行测量。研究参与者将随机接受同等的医疗监督和音乐，外加以下任一项：(1)小组支持、应对同伴小组问题解决和同伴传递的哮喘信息(试验组)；或(2)医生开发并在便携式MP3播放器上记录的一般健康信息(注意控制组)。小组支持和应对同龄人小组问题解决包括：将受试者放在一个小组中，讨论坚持下去的障碍和克服这些障碍的方法；然后让小组成员相互录制关于克服障碍的信息，这些障碍将在他们的日常生活中在MP3播放器上、音乐曲目之间播放。这有效地将来自群体的应对同伴支持带入青少年的日常生活过程中。研究人员假设，MP3播放器促进持续的同伴支持的能力将是提高依从性的基础。长期目标是应用这项研究的数据提交R01拨款申请，以进行一项行为随机试验，评估这种应对同行干预在城市非裔美国青少年哮喘患者中改善依从性并最终减少哮喘恶化的有效性。 公共卫生相关性：市中心的非裔美国青少年因哮喘急性加重而遭受急诊室就诊和住院治疗的不成比例的高比率。这项研究建议使用应对同伴支持干预措施，并通过一个基于技术的平台将同伴支持注入青少年的日常生活中，以增加对每日控制者药物的依从性，并最终降低这一重要人群亚群中哮喘恶化的风险。这项研究的原则是，为了在目标人群中促进对适当药物的持续坚持，干预措施必须具有文化能力，并容易适应青少年的生活方式。

DESCRIPTION (provided by applicant): High rates of asthma morbidity and mortality among inner-city African American adolescents demand urgent intervention. Compared to white non-Hispanic and Hispanic children, black non-Hispanic children have the highest rates of hospitalizations and deaths due to asthma. To address this disparity, the investigators have designed a culturally sensitive intervention aimed at improving adherence to daily controller medications for asthma, and ultimately reduce asthma exacerbation risk, that fits easily into adolescents' chaotic lifestyles. The proposed study is a behavioral randomized controlled trial that tests if a coping peer intervention can increase adherence to asthma controller medications among urban African American adolescents 14 to 16 years of age. To ensure the project's success, the principal investigator has assembled a multi-disciplinary team of researchers, including behavioral and social science experts and a community asthma leader. The Specific Aims propose to: (1) evaluate the impact of a 3-month coping peer support intervention on adherence and knowledge, compared to an attention control; (2) evaluate the ability of a 3-month and a 6-month coping peer support intervention to achieve sustained post-treatment improvements in adherence and knowledge, compared to an attention control; and (3) to develop estimates needed for the design of a subsequent R01 behavioral controlled trial testing the efficacy of this intervention to decrease risk of asthma exacerbations. The study's primary outcome is adherence to daily asthma controller medications, measured using an objective electronic monitor. Study participants will be randomized to receive equal medical supervision and music tracks plus either: (1) group support, coping peer group problem solving, and peer delivered asthma messages (experimental group); or (2) physician developed and recorded general health messages (attention control group) on a portable MP3 player. The group support and coping peer group problem solving consists of: putting subjects together in a small group to discuss barriers to adherence and ways to overcome these barriers; then having group members record messages to each other about overcoming barriers that will be played on their MP3 player, between music tracks, during the course of their daily routines. This effectively brings the coping peer support from the group into the course of the adolescents' day-to-day lives. The investigators hypothesize that it is the ability of the MP3 player to facilitate ongoing peer support that will be the basis for improved adherence. The long term goal is to apply the data from this research to submit an R01 grant application to conduct a behavioral randomized trial evaluating the effectiveness of this coping peer intervention to improve adherence, and ultimately reduce asthma exacerbations, in urban African American adolescents with asthma. PUBLIC HEALTH RELEVANCE: Inner-city African American adolescents suffer from disproportionately high rates of emergency room visits and hospitalizations for acute exacerbations of asthma. This study proposes the use of a coping peer support intervention, enhanced by a technology-based platform that infuses the peer support throughout adolescents' daily routines, to increase adherence to daily controller medications and ultimately reduce asthma exacerbation risk in this important population subgroup. This research is based on the principle that, to promote sustained adherence to appropriate medications in this target population, interventions must be culturally competent and fit easily into adolescents' lifestyles.