Motivating Asthma Adherence in Urban Teens

与白人青少年相比，低收入的少数族裔青少年哮喘发病率高得不成比例，包括急诊科(ED)护理、住院和哮喘死亡的风险过高。该小组和其他人的研究证明，不遵守哮喘治疗方案在患有哮喘的高危市中心家庭中很常见，这种对处方治疗的不良坚持对哮喘发病率起到了重要作用。市中心患有哮喘的青少年特别有可能不遵守，但这一群体仍然没有得到充分的研究。虽然哮喘自我管理训练在改善哮喘的依从性方面显示出了希望，但明确针对青少年的干预研究很少，特别是在市中心的青少年。城市儿童通常在儿童后期/青春期早期承担对其哮喘管理的主要控制。与此同时，青少年努力实现自主性和同龄人接受可能会导致健康危险行为的增加，包括糟糕的哮喘自我管理。需要针对青春期独特挑战的适合发育的哮喘自我管理干预措施。动机访谈(ML)是一种很有前途的干预方法，它使用以客户为中心的非指导性方法来增强改变健康行为的动机。ML技术在发育上符合早期青少年的需要。ML并不认为健康将是激励青少年的最重要因素，而是承认并纳入青少年生活背景下的其他动机，因此这种干预策略具有灵活性，以适应城市青少年面临的独特生活环境和压力源。我们建议评估以Mi为中心的自我管理干预(MI+SM)与包含哮喘教育和自我监控策略的自我管理(SM)干预的相对有效性，以226名在ED接受哮喘治疗的10-15岁儿童为样本。我们的主要假设是，与单独使用SM相比，MI+SM在随机后3个月和6个月的服药依从性方面将产生更大的改善，这是通过电子药物监测来衡量的。次要结果包括自我报告的服药依从性、无症状天数、哮喘的紧急卫生保健利用情况以及照顾者/青少年的生活质量。

Low-income, minority teenagers have disproportionately high rates of asthma morbidity, including excess risk of emergency department (ED) care, hospitalization and death from asthma, compared to white adolescents. Research by this group and others has documented that non-adherence with asthma treatment regimens is common among high-risk, inner city families with asthma, and that this poor adherence with prescribed therapies plays a significant contributing role in asthma morbidity. Inner-city adolescents with asthma are at particular risk of non-adherence, yet this population remains understudied. While asthma self-management training has shown promise in achieving some improvement in adherence with asthma, there are few intervention studies explicitly targeting adolescents, particularly those in the inner-city. Urban children typically assume primary control over their asthma management during late childhood/early adolescence. At the same time, adolescents' efforts to achieve autonomy and peer-acceptance may result in increase health risk behaviors, including poor asthma self-management. Developmentally-appropriate asthma self-management interventions are needed that target the unique challenges of adolescence. Motivational Interviewing (Ml) is a promising interventional approach that uses a client-centered, nondirective approach for enhancing motivation to change health behaviors. Ml techniques are developmentally consistent with the needs of early adolescents. Ml does not assume that health will be the most important factor motivating the teen, but rather acknowledges and incorporates other motivators that are within the context of the teen's life, thus this intervention strategy has the flexibility to adapt to the unique life circumstances and stressors faced by urban adolescents. We propose to evaluate the relative effectiveness of a Mi-focused self-management intervention (MI+SM) compared to a self-management (SM) intervention containing asthma education and self-monitoring strategies in a sample of 226 children age 10-15 years treated for asthma in the ED. Our primary hypothesis is that the MI+SM, as compared to SM alone, will result in greater improvement in medication adherence at 3- and 6-months post-randomization, as measured by electronic medication monitoring. Secondary outcomes include self-reported medication adherence, symptoms free days, urgent health care utilization for asthma, and caregiver/adolescent quality of life.