Coping Peer Intervention for Adherence in Urban African American Adolescents with

应对城市非裔美国青少年依从性的同伴干预

• 批准号: 7989800
• 负责人: Giselle Sarah Mosnaim
• 金额: $ 23.21万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7989800
• 关键词: 16 year old; Accident and Emergency department; Acute; Address; Adherence; Admission activity; Adolescent; African American; Aftercare; Applications Grants; Asthma; Attention; Base Ratios; Behavior Control; Behavioral; Cessation of life; Child; Clinical; Communities; Control Groups; Data; Disease; Drops; Effectiveness; Electronics; Enrollment; Ensure; Event; Frequencies; Goals; Health; Hispanics; Hospitalization; Intensive Care Units; Intervention; Intubation; Knowledge; Life; Life Style; Low income; Measures; Medical; Mental Depression; Methodology; Monitor; Morbidity - disease rate; Music; Not Hispanic or Latino; Oral; Outcome; Participant; Peer Group; Pharmaceutical Preparations; Physicians; Pilot Projects; Play; Population; Population Intervention; Prednisone; Principal Investigator; Problem Solving; Randomized; Randomized Controlled Trials; Research; Research Personnel; Risk; Sampling; Schools; Scientist; Screening procedure; Severities; Subgroup; Supervision; Support Groups; Target Populations; Technology; Testing; Treatment Efficacy; Visit; asthma inhaler; base; behavioral/social science; control trial; coping; design; efficacy testing; empowerment; group support; improved; inner city; innovative technologies; member; mortality; peer; primary outcome; programs; public health relevance; randomized trial; social; success; treatment effect

DESCRIPTION (provided by applicant): High rates of asthma morbidity and mortality among inner-city African American adolescents demand urgent intervention. Compared to white non-Hispanic and Hispanic children, black non-Hispanic children have the highest rates of hospitalizations and deaths due to asthma. To address this disparity, the investigators have designed a culturally sensitive intervention aimed at improving adherence to daily controller medications for asthma, and ultimately reduce asthma exacerbation risk, that fits easily into adolescents' chaotic lifestyles. The proposed study is a behavioral randomized controlled trial that tests if a coping peer intervention can increase adherence to asthma controller medications among urban African American adolescents 14 to 16 years of age. To ensure the project's success, the principal investigator has assembled a multi-disciplinary team of researchers, including behavioral and social science experts and a community asthma leader. The Specific Aims propose to: (1) evaluate the impact of a 3-month coping peer support intervention on adherence and knowledge, compared to an attention control; (2) evaluate the ability of a 3-month and a 6-month coping peer support intervention to achieve sustained post-treatment improvements in adherence and knowledge, compared to an attention control; and (3) to develop estimates needed for the design of a subsequent R01 behavioral controlled trial testing the efficacy of this intervention to decrease risk of asthma exacerbations. The study's primary outcome is adherence to daily asthma controller medications, measured using an objective electronic monitor. Study participants will be randomized to receive equal medical supervision and music tracks plus either: (1) group support, coping peer group problem solving, and peer delivered asthma messages (experimental group); or (2) physician developed and recorded general health messages (attention control group) on a portable MP3 player. The group support and coping peer group problem solving consists of: putting subjects together in a small group to discuss barriers to adherence and ways to overcome these barriers; then having group members record messages to each other about overcoming barriers that will be played on their MP3 player, between music tracks, during the course of their daily routines. This effectively brings the coping peer support from the group into the course of the adolescents' day-to-day lives. The investigators hypothesize that it is the ability of the MP3 player to facilitate ongoing peer support that will be the basis for improved adherence. The long term goal is to apply the data from this research to submit an R01 grant application to conduct a behavioral randomized trial evaluating the effectiveness of this coping peer intervention to improve adherence, and ultimately reduce asthma exacerbations, in urban African American adolescents with asthma. PUBLIC HEALTH RELEVANCE: Inner-city African American adolescents suffer from disproportionately high rates of emergency room visits and hospitalizations for acute exacerbations of asthma. This study proposes the use of a coping peer support intervention, enhanced by a technology-based platform that infuses the peer support throughout adolescents' daily routines, to increase adherence to daily controller medications and ultimately reduce asthma exacerbation risk in this important population subgroup. This research is based on the principle that, to promote sustained adherence to appropriate medications in this target population, interventions must be culturally competent and fit easily into adolescents' lifestyles.

描述（由申请人提供）：非裔美国人青少年中城市中的哮喘发病率和死亡率的高率要求紧急干预。与白人非西班牙裔和西班牙裔儿童相比，黑人非西班牙裔儿童的住院和死亡率最高。为了解决这一差异，研究人员设计了一种具有文化敏感的干预措施，旨在改善对哮喘的每日控制器药物的依从性，并最终降低哮喘加重风险，可轻松适应青少年的混乱生活方式。拟议的研究是一项行为随机对照试验，该试验是否可以测试应对同伴干预是否可以增加14至16岁的城市非裔美国青少年中哮喘控制器药物的依从性。为了确保项目的成功，首席研究人员组建了一个多学科研究人员，包括行为和社会科学专家以及社区哮喘领导者。具体目的建议：（1）评估3个月应对同伴支持干预对依从性和知识的影响； （2）与注意力控制相比，评估3个月和6个月的应对同伴支持干预措施的能力，以实现依从性和知识的持续治疗后改善； （3）开发设计随后的R01行为对照试验所需的估计值，以测试这种干预措施的疗效，以减少哮喘患者的风险。该研究的主要结果是使用客观电子监测仪测量的每日哮喘控制器药物。研究参与者将被随机地接受平等的医疗监督和音乐轨道，加上：（1）组支持，应对同伴小组解决问题以及同伴传达的哮喘信息（实验组）；或（2）医师在便携式MP3播放器上开发并记录了一般健康消息（注意控制组）。小组的支持和应对同伴小组问题解决包括：将主题放在一个小组中，讨论遵守障碍以及克服这些障碍的方式；然后，让小组成员互相记录有关克服障碍的信息，这些障碍将在他们的MP3播放器，在音乐曲目之间，日常工作过程中进行。这有效地将小组的应对同伴支持带入了青少年日常生活的过程。调查人员假设MP3播放器促进持续的同伴支持的能力将成为提高依从性的基础。长期目标是应用这项研究的数据提交R01赠款应用程序，以进行行为随机试验，以评估这种应对同伴干预的有效性，以提高依从性，并最终减少非裔美国非裔美国青少年患有哮喘的哮喘患者的依从性。 公共卫生相关性：非裔美国人青少年遭受急诊室就诊和住院率较高的急性加重哮喘。这项研究提出了使用应对同伴支持干预措施的使用，这是通过基于技术的平台增强的，该平台在整个青少年的日常工作中注入同伴支持，以增加对每日控制器药物的依从性，并最终在这个重要的人群亚组中降低哮喘加剧风险。这项研究基于这样的原则，即为了促进该目标人群中适当的药物的持续遵守，干预措施必须具有文化胜任，并轻松适应青少年的生活方式。