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）：市中心非裔美国青少年的哮喘发病率和死亡率很高，需要紧急干预。与非西班牙裔白人和西班牙裔儿童相比，非西班牙裔黑人儿童因哮喘住院和死亡的比例最高。为了解决这种差异，研究人员设计了一种文化敏感的干预措施，旨在提高对哮喘日常控制药物的依从性，并最终降低哮喘恶化的风险，这很容易适应青少年混乱的生活方式。拟议的研究是一项行为随机对照试验，旨在测试应对同伴干预是否可以提高 14 至 16 岁城市非裔美国青少年对哮喘控制药物的依从性。为了确保该项目的成功，首席研究员组建了一个多学科研究团队，其中包括行为和社会科学专家以及社区哮喘领导者。具体目标建议：(1) 与注意力控制相比，评估为期 3 个月的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的能力，以实现治疗后依从性和知识的持续改善； (3) 制定设计后续 R01 行为对照试验所需的估计，以测试该干预措施降低哮喘恶化风险的功效。该研究的主要结果是使用客观电子监测仪测量每日哮喘控制药物的依从性。研究参与者将被随机分配接受平等的医疗监督和音乐曲目，以及：（1）小组支持、应对同伴小组问题解决以及同伴传递的哮喘信息（实验组）； (2) 医生在便携式 MP3 播放器上制定并记录一般健康信息（注意对照组）。小组支持和应对同伴小组问题解决包括： 将受试者聚集在一个小组中，讨论坚持的障碍以及克服这些障碍的方法；然后让小组成员互相录制关于克服障碍的信息，这些信息将在他们的 MP3 播放器上、在他们的日常生活过程中的音乐曲目之间播放。这有效地将来自团体的应对同伴支持带入青少年的日常生活中。研究人员推测，MP3 播放器能够促进持续的同伴支持，这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来提交 R01 拨款申请，以进行一项行为随机试验，评估这种应对同伴干预的有效性，以提高患有哮喘的城市非裔美国青少年的依从性，并最终减少哮喘发作。 公共卫生相关性：内城区非裔美国青少年因哮喘急性发作而去急诊室和住院的比例极高。本研究建议使用应对同伴支持干预措施，并通过基于技术的平台加强，将同伴支持融入到青少年的日常生活中，以提高对日常控制药物的依从性，并最终降低这一重要人群亚组的哮喘恶化风险。这项研究的原则是，为了促进目标人群持续坚持适当的药物治疗，干预措施必须在文化上具有竞争力并易于适应青少年的生活方式。