Coping Peer Intervention for Adherence in Urban African American Adolescents with

应对城市非裔美国青少年依从性的同伴干预

• 批准号: 8099537
• 负责人: Giselle Sarah Mosnaim
• 金额: $ 19.4万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8099537
• 关键词: 16 year old; Accident and Emergency department; Acute; Address; Adherence; Admission activity; Adolescent; African American; Aftercare; Applications Grants; Asthma; Attention; Behavior Control; Behavioral; Cessation of life; Child; Clinical; Communities; Control Groups; Data; Disease; Drops; Effectiveness; Electronics; Enrollment; Ensure; Event; Frequencies; Goals; Health; Hispanics; Hospitalization; Intensive Care Units; Intervention; Intubation; Knowledge; Life Style; Low income; Measures; Medical; Mental Depression; Methodology; Monitor; Morbidity - disease rate; Music; Not Hispanic or Latino; Oral; Outcome; Participant; Peer Group; Pharmaceutical Preparations; Physicians; Pilot Projects; Play; Population; Population Intervention; Prednisone; Principal Investigator; Problem Solving; Randomized; Randomized Controlled Trials; Research; Research Personnel; Risk; Sampling; Schools; Scientist; Screening procedure; Severities; Subgroup; Supervision; Support Groups; Target Populations; Technology; Testing; Treatment Efficacy; Visit; asthma inhaler; base; behavioral/social science; control trial; coping; design; efficacy testing; empowerment; group support; improved; inner city; innovative technologies; member; mortality; peer; primary outcome; programs; public health relevance; randomized trial; social; success; treatment effect

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.

描述（申请人提供）：市中心非裔美国青少年哮喘发病率和死亡率高，需要紧急干预。与白色非西班牙裔和西班牙裔儿童相比，黑人非西班牙裔儿童因哮喘住院和死亡的比例最高。为了解决这一差异，研究人员设计了一种文化敏感的干预措施，旨在提高对哮喘日常控制药物的依从性，并最终降低哮喘急性发作的风险，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增加14至16岁的城市非洲裔美国青少年对哮喘控制药物的依从性。为了确保该项目的成功，主要研究者组建了一个多学科的研究团队，包括行为和社会科学专家以及社区哮喘领导人。具体目标建议：（1）评估3个月应对同伴支持干预与注意力控制相比对依从性和知识的影响;（2）评估3个月和6个月应对同伴支持干预与注意力控制相比在依从性和知识方面实现持续治疗后改善的能力;以及（3）为随后的R 01行为对照试验设计提供所需的评估，以测试这种干预措施降低哮喘急性发作风险的有效性。这项研究的主要结果是坚持每日哮喘控制药物，使用客观的电子监测器测量。研究参与者将随机接受同等的医疗监督和音乐曲目，外加：（1）小组支持、应对同伴群体问题解决和同伴传递的哮喘信息（实验组）;或（2）医生在便携式MP3播放器上开发和记录的一般健康信息（注意力控制组）。小组支持和应对同伴小组问题解决包括：把受试者放在一个小组中，讨论坚持的障碍和克服这些障碍的方法;然后让小组成员记录彼此关于克服障碍的信息，这些信息将在他们的MP3播放器上播放，在音乐曲目之间，在他们的日常生活中。这有效地将来自团体的应对同伴支持带入青少年的日常生活。研究人员假设，MP3播放器促进持续同伴支持的能力将是提高依从性的基础。长期目标是应用本研究的数据提交R 01资助申请，以进行行为随机试验，评估这种应对同伴干预的有效性，以提高依从性，并最终减少哮喘急性发作，在城市非洲裔美国青少年哮喘。 公共卫生相关性：城市内部的非洲裔美国青少年患有哮喘急性加重的急诊室就诊率和住院率不成比例地高。本研究提出使用应对同伴支持干预，通过基于技术的平台增强，在青少年的日常生活中注入同伴支持，以增加对日常控制药物的依从性，并最终降低这一重要人群亚组的哮喘急性发作风险。这项研究所依据的原则是，为了促进这一目标人群持续坚持适当的药物治疗，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。