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

针对低社会经济地位拉丁裔哮喘儿童家庭的应对技巧干预

• 批准号: 10399650
• 负责人: Erin M. Rodriguez
• 金额: $ 66.76万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-18 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10399650
• 关键词: 13 year old; Address; Affect; Age; Asthma; Behavior; Belief; Buffers; Child; Childhood Asthma; Clinic; Cognitive; Communities; Control Groups; Coping Skills; Educational Curriculum; Effectiveness; Elements; Emergency department visit; Empirical Research; Enrollment; Family; Financial Hardship; Goals; Health; Hospitalization; Household; Immigration; Intervention; Knowledge; Latino; Lead; Link; Mediating; Mediator of activation protein; Moods; Outcome; Parents; Pathway interactions; Patients; Pilot Projects; Population; Populations at Risk; Poverty; Primary Health Care; Problem behavior; Process; Psychosocial Stress; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Records; Reporting; Research; Risk; Role; Sampling; School-Age Population; Schools; Self Management; Site; Societies; Spirometry; Stress; Stress and Coping; Symptoms; Testing; Underserved Population; Work; Youth; arm; base; bilingualism; clinical decision-making; compare effectiveness; coping; cost; cost effective; depressive symptoms; disparity reduction; effective therapy; effectiveness testing; evidence base; experience; follow-up; functional outcomes; health disparity; implementation trial; improved; insight; low socioeconomic status; post intervention; programs; psychobiologic; psychosocial; pulmonary function; recruit; social health determinants; stressor; translational research program

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.

项目摘要 拉丁裔儿童在哮喘控制方面经历分布，并且与较差有关的功能结果较差 与非拉丁裔白人儿童相比，受控哮喘受控哮喘，包括更多的学校缺勤，紧急情况 哮喘的部门访问和住院治疗。尽管哮喘自我受益，但这些差异仍然存在 管理干预措施。贫困中有很大一部分的拉丁裔儿童生活在贫困中 增加了他们不受控制的哮喘的风险。对于低矮的拉丁裔儿童，心理压力是未解决的 哮喘分布的因素。现有的干预措施很少针对社会心理过程来解决 哮喘控制的压力。但是，应对研究提供了对潜在干预方法的见解 将缓解压力的影响并减少低SES拉丁裔儿童的哮喘分布。应对是关键 可修改的因素，位于上游社会决定者和下游之间的“中游” 健康结果的差异。特别是，次级控制应对（即，适应/适应的努力 压力源（例如接受和认知尚）已与儿童更好的哮喘控制联系在一起 在低调环境中。因此，当前R01提案的目的是测试有效性和 Adapt 2哮喘（A2A）的调解人，这是一种双语家庭应对技能 +哮喘管理干预措施 量身定制为低调拉丁裔家庭的压力源，优势和文化信念。 280个低名拉丁裔家庭 在9-13岁的患有哮喘的儿童中，将被确定并从社区初级保健诊所入学 并随机分配给A2A或标准的哮喘自我管理（AM）控制组。我们将评估 儿童的哮喘控制，生活质量，肺功能，学校缺勤和急诊科的访问 干预的结果。我们还将检查儿童中介途径（儿童应对和心情和 行为症状）和父母中介途径（父母应对和抑郁症状） 干涉。评估将在干预前和后期进行，在6个月和12个月的随访时间点处进行 使用子女报告，肺活量测定法和学校记录。这个R01的成功完成将 提供低SES拉丁裔儿童A2A的有效性和介体的证据，人口 通过当前干预方法的服务不足。我们的结果有望导致随后的多站点 A2A在初级保健中的实施试验。这一研究的长期目标是减少分布 哮喘控制及其健康后果影响了低调的拉丁裔儿童和类似服务的年轻人 人群。获得的知识将改善低调拉丁裔儿童的健康并减少公众 健康伯恩与儿科哮喘有关，这种疾病对社会的成本很高。