A Pilot Stress Management Intervention for High Risk Children with Asthma

针对哮喘高危儿童的试点压力管理干预措施

基本信息

批准号：
8242940
负责人：
ANNA L MARSLAND
金额：
$ 22.45万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-05-01 至 2015-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8242940
关键词：
12 year old Absenteeism Accounting Acute Adherence Affect Anxiety Asthma Attention Behavior Biological Child Childhood Childhood Asthma Chronic Chronic Disease Chronic stress Clinic Clinical Trials Clinical Trials Design Cognitive Therapy Coping Skills Data Development Disadvantaged Drops Economically Deprived Population Education Effectiveness Elements Evaluation Event Exhalation Exposure to Future Health Health Benefit Health behavior Individual Inflammatory Inflammatory Response Intervention Intervention Trial Knowledge Learning Life Light Link Lung Inflammation Measures Mediating Medical Methods Minority Morbidity - disease rate Nitric Oxide Outcome Outpatients Participant Pathway interactions Pharmaceutical Preparations Phase Physicians Physiological Pilot Projects Play Prevalence Problem Solving Process Psychological Stress Psychosocial Assessment and Care Psychosocial Factor Psychosocial Stress Public Health Randomized Recruitment Activity Research Respiratory physiology Risk Factors Role Sampling Schools Self Efficacy Self Management Severities Severity of illness Social Environment Socioeconomic Status Spirometry Stress Stress and Coping Symptoms Training Programs United States Up-Regulation Visit Work abstracting airway inflammation base control trial coping cost effective depressive symptoms health belief high risk improved low socioeconomic status modifiable risk mortality novel peer physical conditioning pilot trial post intervention primary outcome programs psychologic psychosocial pulmonary function satisfaction skills skills training socioeconomics standard care stress management urban area

项目摘要

DESCRIPTION (provided by applicant): Asthma is the most common chronic illness among children in the United States, with disproportionately high morbidity and mortality among minority and socioeconomically disadvantaged children living in urban areas. These disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. Converging evidence suggests that psychosocial factors that accompany socioeconomic disadvantage contribute to the marked disparities in childhood asthma morbidity, with psychological stress predicting future asthma exacerbations in children. Chronic stress and lower socioeconomic status also are associated with the exacerbation of airway inflammatory responses to environmental triggers and the upregulation of inflammatory processes directly implicated in asthma exacerbation. Evidence that stress accentuates airway inflammation and predicts asthma morbidity raises the possibility that psychological interventions aimed at helping children manage stress could improve the physical health of high risk children with asthma. To date, studies of psychosocial interventions for pediatric asthma have been of poor general quality, highlighting a need for further more rigorous research. Accordingly, we have developed a stress management and coping skills training program based on the principles of cognitive behavioral therapy ("I Can Cope"). Preliminary trials provide initia support for the feasibility of offering this supplemental intervention to 8-12 year old asthmatics n urban schools and provide initial evidence for intervention-related decreases in perceived stress and improvements in lung function, as measured by spirometry. The primary objective of the proposed research is to conduct a critical randomized controlled pilot evaluation of the effectiveness of this school-based intervention to obtain data that is necessary to develop a full-scale clinical trial. For this purpose, we propose randomly assigning 108 economically disadvantaged urban 3rd through 6th graders with physician-confirmed asthma to the school-based intervention or an education only control condition. Primary outcomes will include (1) psychological function and (2) asthma health, as assessed at the end of the intervention period. If future work confirms our initial feasibility findings, this will be the first study to demonstrae the health benefit of a school-based asthma stress management intervention for high risk children living in urban settings, providing a novel means of intervening to reduce disparities in asthma morbidity. Furthermore, it will provide a more efficient and cost-effective means of accessing vulnerable children than individual clinic based intervention, which we have not found to be feasible. PUBLIC HEALTH RELEVANCE: Minority and socioeconomically disadvantaged children living in urban areas in the US are at disproportionately high risk for asthma morbidity, with disparities in asthma severity being larger than those in asthma prevalence. Growing evidence shows that psychosocial factors that accompany socioeconomic disadvantage may play a role in these disparities, with psychological stress predicting future asthma exacerbations in children. The current application proposes a pilot study examining the first school-based intervention to target this modifiable risk factor. Thus, the public health implications of the project are considerable and include the identification of a method of intervening to reduce disparities in asthma morbidity. In addition, we anticipate that the intervention will be cost effective, reducing medical visits, use of as needed medications, and school absenteeism. (End of Abstract)

描述（由申请人提供）：哮喘是美国儿童中最常见的慢性疾病，居住在城市地区的少数族裔和社会经济弱势儿童的发病率和死亡率极高。这些差异并不能完全用哮喘患病率的差异来解释，这突出表明需要针对与哮喘控制较差相关的因素进行干预。一致的证据表明，伴随社会经济劣势而来的社会心理因素导致儿童哮喘发病率的显着差异，心理压力预示着儿童未来哮喘的恶化。慢性压力和较低的社会经济地位也与环境触发因素引起的气道炎症反应加剧以及直接与哮喘恶化有关的炎症过程上调有关。有证据表明，压力会加剧气道炎症并预测哮喘发病率，这表明旨在帮助儿童控制压力的心理干预措施可以改善患有哮喘的高危儿童的身体健康。迄今为止，针对小儿哮喘的心理社会干预研究总体质量较差，突出表明需要进一步进行更严格的研究。因此，我们根据认知行为疗法（“我可以应对”）的原则制定了压力管理和应对技能培训计划。初步试验为在城市学校向 8-12 岁哮喘患者提供这种补充干预的可行性提供了初步支持，并为干预相关的感知压力减少和肺功能改善（通过肺活量测定法测量）提供了初步证据。拟议研究的主要目标是对这种基于学校的干预措施的有效性进行关键的随机对照试点评估，以获得开展全面临床试验所需的数据。为此，我们建议将 108 名经医生确诊患有哮喘、经济困难的城市三年级至六年级学生随机分配到学校干预组或纯教育控制组。主要结局包括 (1) 心理功能和 (2) 哮喘健康状况（在干预期结束时进行评估）。如果未来的工作证实了我们最初的可行性研究结果，这将是第一项证明以学校为基础的哮喘压力管理干预措施对城市高危儿童健康益处的研究，为减少哮喘发病率差异提供了一种新的干预手段。此外，与基于个体诊所的干预措施相比，它将提供一种更有效、更具成本效益的方式来接触弱势儿童，而我们认为这种干预措施并不可行。公共卫生相关性：生活在美国城市地区的少数族裔和社会经济弱势儿童患哮喘的风险极高，而且哮喘严重程度的差异更大高于哮喘患病率。越来越多的证据表明，伴随社会经济劣势而来的社会心理因素可能在这些差异中发挥作用，心理压力预示着儿童未来哮喘的恶化。当前的申请提出了一项试点研究，检验第一个以学校为基础的干预措施，以针对这种可改变的风险因素。因此，该项目对公共卫生的影响是相当大的，包括确定减少哮喘发病率差异的干预方法。此外，我们预计干预措施将具有成本效益，减少就诊、按需药物的使用和缺课情况。（摘要完）