Coping Peer Intervention for Adherence in Urban African American Adolescents with

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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.