Motivating Asthma Adherence in Urban Teens

与白人青少年相比，低收入、少数族裔青少年的哮喘发病率高得不成比例，包括急诊（ED）护理、住院和哮喘死亡的风险过高。该小组和其他研究人员的研究表明，不遵守哮喘治疗方案在高风险的市中心哮喘家庭中很常见，并且这种对处方治疗的不良依从性在哮喘发病率中起着重要作用。患有哮喘病的市中心青少年尤其有不遵医嘱的风险，但这一人群仍未得到充分研究。虽然哮喘自我管理培训已经显示出在哮喘依从性方面取得一些改善的希望，但很少有明确针对青少年的干预研究，特别是那些在市中心的青少年。城市儿童通常在儿童期晚期/青春期早期对其哮喘管理承担主要控制权。与此同时，青少年为实现自主性和同伴接纳所做的努力可能导致健康风险行为增加，包括哮喘自我管理不善。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。动机性访谈（Ml）是一种很有前途的介入方法，它采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技术与早期青少年的发展需求是一致的。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激励因素，因此这种干预策略具有灵活性，可以适应城市青少年面临的独特生活环境和压力源。在226名在ED接受哮喘治疗的10-15岁儿童样本中，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测策略的自我管理干预（SM）的相对有效性。我们的主要假设是，与单独的SM相比，MI+SM在随机化后3个月和6个月的药物依从性改善更大，这是通过电子药物监测来衡量的。次要结局包括自我报告的药物依从性、无症状天数、对哮喘的紧急医疗保健利用以及护理者/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.