A Coping Skills Intervention for Low-SES Latino Families of Children with Asthma

项目总结 拉美裔儿童在哮喘控制方面存在差异，与不良相关的功能结局更差 与非拉丁裔白人儿童相比，哮喘得到控制，包括更多的缺课、紧急情况 科室就诊和哮喘住院治疗。尽管哮喘本身有好处，但这些差距仍然存在 管理干预。越来越多的拉丁裔儿童生活在贫困中，这进一步 增加他们患上失控哮喘的风险。对于SES低的拉丁裔儿童来说，心理社会压力是一个未解决的问题 哮喘差异的因素。现有的干预措施很少针对心理社会过程来解决 哮喘控制中的压力。然而，对应对的研究提供了对潜在干预方法的洞察，这些方法 将缓冲压力的影响，并减少低SES拉丁裔儿童的哮喘差异。应对是一把钥匙 位于健康的上游社会决定因素和下游社会决定因素之间的“中游”因素 在健康结果方面的差异。特别是，二级控制应对(即努力适应/适应 应激源，如接受和认知结构调整)与儿童哮喘的更好控制有关 在低SES环境中。因此，目前R01提案的目的是测试有效性和 适应2哮喘的介体(A2A)，一种基于双语的家庭应对技能+哮喘管理干预 针对低SES拉丁裔家庭的压力源、优势和文化信仰而量身定做。280个低社会地位拉丁裔家庭 9-13岁的哮喘儿童将被识别并从社区初级保健诊所登记 并随机分配到A2A组或标准哮喘自我管理(AM)对照组。我们将评估 儿童哮喘控制、生活质量、肺功能、缺课和急诊科就诊 干预的结果。我们还将研究儿童调解途径(儿童应对和情绪以及 行为症状)和父母中介途径(父母应对和抑郁症状) 干预。将在干预前和干预后以及6个月和12个月的随访时间点进行评估 使用孩子和家长的报告、肺活量测定和学校记录。这条R01的成功完工将 为低SES拉丁裔儿童提供A2A的有效性和调节剂的证据 目前的干预方法没有提供足够的服务。我们的结果预计将导致随后的多站点 A2A在初级保健中的实施试验。这一系列研究的长期目标是缩小 哮喘控制及其对低社会地位拉丁裔儿童和类似服务不足青年的健康影响 人口。所获得的知识将改善低SES拉丁裔儿童的健康，并减少公众 健康负担与儿童哮喘有关，这是一种给社会带来巨大成本的疾病。

PROJECT SUMMARY Latino children experience disparities in asthma control and have worse functional outcomes related to poorly controlled asthma compared to non-Latino White children, including more school absences, emergency department visits, and hospitalizations for asthma. These disparities persist despite the benefits of asthma self- management interventions. A significant and growing percentage of Latino children live in poverty, which further increases their risk for uncontrolled asthma. For low-SES Latino children, psychosocial stress is an unaddressed factor in asthma disparities. Existing interventions rarely target psychosocial processes to address the role of stress in asthma control. However, research on coping offers insight into potential intervention approaches that would buffer the effects of stress and reduce asthma disparities for low-SES Latino children. Coping is a key modifiable factor that lies “midstream” between upstream social determinants of health and downstream disparities in health outcomes. In particular, secondary control coping (i.e., efforts to accommodate/adapt to stressors, such as acceptance and cognitive restructuring) has been linked to better asthma control for children in low-SES contexts. Therefore, the purpose of the current R01 proposal is to test the effectiveness and mediators of Adapt 2 Asthma (A2A), a bilingual family-based coping skills + asthma management intervention tailored to the stressors, strengths, and cultural beliefs of low-SES Latino families. 280 low-SES Latino families of children ages 9-13 years old with asthma will be identified and enrolled from community primary care clinics and randomly assigned to either A2A or a standard asthma self-management (AM) control arm. We will assess children’s asthma control, quality of life, lung function, school absences, and emergency department visits as the outcomes of the intervention. We will also examine child mediational pathways (child coping and mood and behavior symptoms) and parent mediational pathways (parent coping and depressive symptoms) of the intervention. Assessments will occur at pre- and post-intervention and at 6 and 12-month follow-up timepoints using child and parent report, spirometry, and school records. The successful completion of this R01 would provide evidence of the effectiveness and mediators of A2A for low-SES Latino children, a population underserved by current intervention approaches. Our results are expected to lead to a subsequent multi-site implementation trial of A2A in primary care. The long-term goal of this line of research is to reduce disparities in asthma control and its health consequences affecting low-SES Latino children and similar underserved youth populations. The knowledge gained would improve the health of low-SES Latino children and reduce the public health burden related to pediatric asthma, a condition with a significant cost to society.