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Rhee H, Batek L, Rew L, Tumiel-Berhalter L. Parents' Experiences and Perceptions of Healthcare Transition in Adolescents with Asthma: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1510. [PMID: 37761471 PMCID: PMC10527731 DOI: 10.3390/children10091510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Adolescence marks a significant transition from pediatric to adult healthcare, and parents play critical roles in supporting their adolescents with chronic conditions through this process. However, little is known about parents' experiences, perceptions, and needs during this healthcare transition. This qualitative study explores the experiences and perceptions of parents regarding the care transition of their 16-17-year-old adolescents with asthma. Nineteen mothers participated in either a focus group or individual interviews, and a content analysis was conducted on the data. Parents expressed negative emotions and various concerns about their teens' transition readiness and asthma management. A need for early transition training for both adolescents and parents was discussed. Overall, the complexity and challenges associated with the healthcare transition of adolescents with asthma take a toll on parents, particularly when their teens are not adequately prepared to manage asthma independently. Parents need appropriate anticipatory guidance regarding the transition and skills to navigate changing roles and negotiate asthma care responsibilities with their teens. Timely interventions and support strategies for both adolescents and parents are needed to ensure the successful healthcare transition of adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Lynn Rew
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14203, USA;
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Isik E, Mack G, Sockrider MM, Fredland NM, Shegog R. Assessing Available Adolescent Self-Reported Measures for Asthma Management: A Systematic Literature Review. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:69-89. [PMID: 37669446 DOI: 10.1089/ped.2023.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Objective: Asthma is a common chronic disease and a substantial public health problem for children, adolescents, and adults. Adolescence, a period of increased independence and striving for autonomy, is an opportune time for youth transitioning to adulthood to assume more responsibility for their own asthma self-management. However, accurate measures of adolescent asthma outcomes are limited. The purpose of this systematic review is to identify self-reported asthma measures currently available in the empirical literature focused on adolescent populations. Methods: Search terms were based on the National Library of Medical Subject Headings and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases searched included CINAHL, Nursing Allied Health Prevention, Medline, ProQuest, and PubMed. Included studies were peer reviewed and published in English between 2010 and 2022. All studies reported on asthma measures for adolescents between 10 and 19 years old. Results: Nineteen studies were included, comprising 15 experimental and 4 quasi-experimental. This review revealed the following asthma measure domains: asthma knowledge, self-efficacy, attitudes, self-care, self-regulation, symptom prevention and management, medication adherence, asthma disease control, symptoms, and quality of life (QOL) for evaluating psychosocial, behavioral, clinical, and QOL outcomes. Conclusion: This review revealed the necessity of developing a comprehensive measure to assess the asthma self-management behaviors of adolescents. A comprehensive tool related to adolescent asthma self-management behavior would enhance the assessment and evaluation of adolescent asthma self-management behaviors and extend the science and clinical practice around adolescent self-management. Present measures for asthma self-management behavior for adolescents are limited; therefore, developing a valid and reliable measure is necessary not only to assess adolescents' asthma self-management behavior outcomes but also to identify and evaluate the essential components to include in educational interventions for adolescent self-management.
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Affiliation(s)
- Elif Isik
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Gardner Mack
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Marianna M Sockrider
- Pediatric Pulmonology, Texas Children's Hospital, Houston, Texas, USA
- Pediatric Pulmonology, Baylor College of Medicine, Houston, Texas, USA
| | - Nina M Fredland
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Ross Shegog
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas, Houston, Texas, USA
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MacDonell KK, Dailey R, Gibson-Scipio W, Wang B, Dinaj-Koci V, Bruzzese JM. Exploring Barriers to Medication Adherence Among African American Emerging Adults With Uncontrolled Asthma. HEALTH EDUCATION & BEHAVIOR 2023; 50:131-135. [PMID: 33813923 DOI: 10.1177/10901981211001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
African American emerging adults (age 18-29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.
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Affiliation(s)
| | | | | | - Bo Wang
- University of Massachusetts, Amherst, MA, USA
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Wallace-Farquharson T, Rhee H, Oguntoye AO, Elder JH, Ezenwa MO, Fedele D, Duckworth L, Wilkie DJ. Adolescents' practical knowledge of asthma self-management and experiences in the context of acute asthma: a qualitative content analysis. J Asthma 2023; 60:277-287. [PMID: 35195484 PMCID: PMC9470766 DOI: 10.1080/02770903.2022.2045309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/12/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To characterize adolescents' practical knowledge of asthma self-management and experiences during acute asthma episodes, and compare practical knowledge between minority and non-minority groups. METHODS We conducted a secondary analysis using a qualitative descriptive design of textual data collected from 126 adolescents that participated in a randomized controlled trial of an asthma self-management program. Directed content analysis was conducted using four constructs of asthma self-management including symptom prevention, symptom monitoring, acute symptom management, and symptom communication. RESULTS Most of the adolescents knew how to prevent exercised-induced bronchoconstriction, but had limited understanding about how to assess and monitor the severity of acute symptoms, appropriately use bronchodilators, seek timely medical help, and communicate acute symptoms to caregivers or healthcare providers during a slow-onset and rapid-onset asthma attack. More minority participants monitored asthma using peak expiratory flow than non-minority participants, who often relied on symptom-based monitoring. Minority adolescents more frequently mentioned bronchodilator use to manage asthma attacks, while non-minority adolescents often reported use of complementary and alternative approaches. Minority youth mentioned accessing healthcare services for acute episodes more often than their non-minority counterparts. Minority participants mentioned communicating acute symptoms to their providers, or family members less frequently than non-minority youth. CONCLUSIONS Adolescents have insufficient practical knowledge about ways to prevent and manage acute asthma. Periodic assessment of learning needs related to asthma attacks should be considered a routine part of clinical visits for adolescents to provide targeted information support to address their identified needs.
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Affiliation(s)
- Tanya Wallace-Farquharson
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Hyekyun Rhee
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Anne O. Oguntoye
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Miriam O. Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - David Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Laurie Duckworth
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Diana J. Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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George M, Camargo CA, Burnette A, Chen Y, Pawar A, Molony C, Auclair M, Wells MA, Ferro TJ. Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis. J Asthma Allergy 2023; 16:567-577. [PMID: 37200709 PMCID: PMC10187653 DOI: 10.2147/jaa.s383817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/31/2023] [Indexed: 05/20/2023] Open
Abstract
Purpose The identification of risk factors associated with uncontrolled moderate-to-severe asthma is important to improve asthma outcomes. Aim of this study was to identify risk factors for uncontrolled asthma in United States cohort using electronic health record (EHR)-derived data. Patients and Methods In this retrospective real-world study, de-identified data of adolescent and adult patients (≥12 years old) with moderate-to-severe asthma, based on asthma medications within 12 months prior to asthma-related visit (index date), were extracted from the Optum® Humedica EHR. The baseline period was 12 months prior to the index date. Uncontrolled asthma was defined as ≥2 outpatient oral corticosteroid bursts for asthma or ≥2 emergency department visits or ≥1 inpatient visit for asthma. A Cox proportional hazard model was applied. Results There were 402,403 patients in the EHR between January 1, 2012, and December 31, 2018, who met the inclusion criteria and were analyzed. African American (AA) race (hazard ratio [HR]: 2.08), Medicaid insurance (HR: 1.71), Hispanic ethnicity (HR: 1.34), age of 12 to <18 years (HR 1.20), body mass index of ≥35 kg/m2 (HR: 1.20), and female sex (HR 1.19) were identified as risk factors associated with uncontrolled asthma (P < 0.001). Comorbidities characterized by type 2 inflammation, including a blood eosinophil count of ≥300 cells/μL (as compared with eosinophil <150 cells/μL; HR: 1.40, P < 0.001) and food allergy (HR: 1.31), were associated with a significantly higher risk of uncontrolled asthma; pneumonia was also a comorbidity associated with an increased risk (HR: 1.35) of uncontrolled asthma. Conversely, allergic rhinitis (HR: 0.84) was associated with a significantly lower risk of uncontrolled asthma. Conclusion This large study demonstrates multiple risk factors for uncontrolled asthma. Of note, AA and Hispanic individuals with Medicaid insurance are at a significantly higher risk of uncontrolled asthma versus their White, non-Hispanic counterparts with commercial insurance.
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Affiliation(s)
- Maureen George
- Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, USA
- Correspondence: Maureen George, Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, 10032, USA, Tel +1 212-305-1175, Email
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Autumn Burnette
- Division of Allergy and Immunology, Howard University Hospital, Howard University College of Medicine, Washington, DC, USA
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AIM2ACT: Randomized controlled trial protocol for a mobile health intervention for early adolescents with asthma. Contemp Clin Trials 2022; 123:107011. [PMID: 36396068 PMCID: PMC10071332 DOI: 10.1016/j.cct.2022.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Early adolescents diagnosed with asthma have difficulties consistently performing disease self-management behaviors, placing them at-risk for poor asthma control, morbidity, and reduced quality of life. Helpful caregiver support is pivotal in determining whether early adolescents develop and master asthma self-management behaviors. We developed Applying Interactive Mobile health to Asthma Care in Teens (AIM2ACT), a mobile health intervention to facilitate helpful caregiver support in early adolescents (12-15 year-olds) with poorly controlled asthma. AIM2ACT is a dyadic smartphone intervention that contains three components: 1) ecological momentary assessment to identify personalized strengths and weaknesses in asthma self-management behaviors; 2) collaborative identification and tracking of goals that help early adolescents to become increasingly independent in managing their asthma; and 3) a suite of skills training videos. This paper describes our plans to test the efficacy of AIM2ACT and evaluate long-term maintenance of treatment effects in a fully powered randomized controlled trial with 160 early adolescents with poorly controlled persistent asthma, ages 12-15 years, and a caregiver. Families will be randomly assigned to receive AIM2ACT (n = 80) or a mHealth attention control condition (n = 80) that accounts for attention and novelty of a technology-based intervention for 6 months. Assessments will occur at baseline, post-intervention, and 3-, 6-, and 12-month follow-up time points. We will collect patient-reported and objectively monitored (e.g., spirometry, adherence) outcomes. Given the timing of the trial, a secondary exploratory goal is to evaluate the perceived impact of COVID-19 on family functioning and parental control of their adolescent's asthma in the context of our intervention.
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Rhee H, Batek L, Wallace-Farquharson T, Tumiel-Berhalter L. Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1573. [PMID: 36291509 PMCID: PMC9600616 DOI: 10.3390/children9101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16-20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents' asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA
| | | | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, 77 Goodell St., Buffalo, NY 14203, USA
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Leonard SI, Turi ER, Céspedes A, Liu J, Powell JS, Bruzzese JM. Asthma Knowledge, Self-Efficacy, and Self-Management Among Rural Adolescents with Poorly Controlled Asthma. J Sch Nurs 2022:10598405221116017. [PMID: 35880266 PMCID: PMC9873834 DOI: 10.1177/10598405221116017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Rural adolescents with asthma are a disparate group. Self-management is essential to asthma control. We describe asthma knowledge, self-efficacy, and self-management behaviors among 198 rural adolescents with poorly controlled asthma, exploring demographic differences; we also test the application of Social Cognitive Theory to asthma self-management examining if self-efficacy mediates associations between knowledge and self-management. Asthma knowledge and self-management were relatively poor in our sample, particularly among male and White adolescents; greater knowledge was significantly associated with better symptom prevention and management. Self-efficacy partially mediated the association between knowledge and symptom prevention, but not acute symptom management, suggesting that knowledge may not improve symptom prevention behaviors without confidence to implement such behaviors and that factors beyond knowledge and self-efficacy likely play a role in asthma self-management in this population. Addressing asthma knowledge and self-efficacy could improve self-management and, ultimately, enhance asthma control among rural adolescents with poorly controlled asthma.
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Affiliation(s)
| | | | | | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
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9
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Rhee H, Love T, Wicks MN, Tumiel-Berhalter L, Sloand E, Harrington D, Walters L. Long-term Effectiveness of a Peer-Led Asthma Self-management Program on Asthma Outcomes in Adolescents Living in Urban Areas: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2137492. [PMID: 34874404 PMCID: PMC8652603 DOI: 10.1001/jamanetworkopen.2021.37492] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Long-term effectiveness of a peer-led asthma self-management program in improving asthma outcomes in adolescents living in urban areas has not been established. OBJECTIVE To determine the long-term effects of a peer-led program on asthma control, quality of life, and asthma management among predominantly racial and ethnic minority adolescents living in urban areas. DESIGN, SETTING, AND PARTICIPANTS A parallel-group, randomized clinical trial was conducted in 2015 to 2019 in 3 metropolitan cities in the US: Buffalo, New York; Baltimore, Maryland; and Memphis, Tennessee. Adolescents aged 12 to 17 years old with persistent asthma were recruited mainly through clinical practices and schools. Participants were followed-up for 15 months after the intervention. Double-blinding was achieved for baseline. Data analysis was performed from June 2019 to June 2020. INTERVENTIONS The intervention group received a peer-led asthma self-management program; the control group received the identical program led by adult health care professionals. Peer leaders made follow-up contacts every other month for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was quality of life measured by the Pediatric Asthma Quality of Life Questionnaire, which consists of 3 subscales that measure symptoms (10 items), activity limitations (5 items), and emotional functioning (8 items) in the past 2 weeks. Each item was measured on a 7-point scale, with higher mean scores indicating better quality of life. Secondary measures included the Asthma Control Questionnaire and an asthma self-management index capturing steps to prevent and manage symptoms, self-efficacy, and lung function. RESULTS Of 395 eligible adolescents, 35 refused, 38 did not show or were lost to contact, and 2 withdrew before randomization; 320 adolescents participated (mean [SD] age, 14.3 [1.71] years), including 168 boys (52.5%), 251 Black or African American adolescents (78.4%), and 232 adolescents (72.5%) with public health insurance. Of 320 enrolled, 303 were included in the longitudinal analysis. Response rates were 80% or higher at all time points. The peer-led group had greater improvement in outcomes than the adult-led group, with adjusted mean differences (AMDs) between baseline and 15 months of 0.75 vs 0.37 for quality of life (between-group AMD, 0.38; 95% CI, 0.07 to 0.63) and -0.59 vs -0.31 for asthma control (between-group AMD, -0.28; 95% CI, -0.51 to -0.01). Outcomes were not affected by bimonthly contact doses. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, a peer-led asthma self-management education was more effective than an adult-led program in improving asthma outcomes, with the improvements sustained for up to 15 months. These findings suggest that a peer-led asthma self-management program should be considered in addressing the disproportionate asthma burden in racial and ethnic minority adolescents living in urban communities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02293499.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, New York
- Now with School of Nursing, University of Texas at Austin, Austin
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Mona N. Wicks
- College of Nursing, University of Tennessee Health Science Center, Memphis
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo
| | - Elizabeth Sloand
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Donald Harrington
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Leanne Walters
- Department of Social Work, Roberts Wesleyan College, Rochester, New York
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Using Mobile Health to Improve Asthma Self-Management in Early Adolescence: A Pilot Randomized Controlled Trial. J Adolesc Health 2021; 69:1032-1040. [PMID: 34274211 DOI: 10.1016/j.jadohealth.2021.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/11/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Early adolescence is an important developmental period where youth take primary responsibility for asthma self-management. Helpful caregiver support during this time is pivotal in determining whether early adolescents successfully develop asthma self-management behaviors. AIM2ACT is a dyadic mobile health intervention designed to increase helpful caregiver support as early adolescents engage in asthma self-management behaviors. We conducted a pilot randomized controlled trial to determine the feasibility and acceptability of AIM2ACT and conduct preliminary tests of efficacy. METHODS We randomized adolescents (12-15 years old) and a caregiver to receive AIM2ACT (n = 17) or a self-guided attention control condition (n = 16) for 20 weeks. We conducted assessment visits at baseline, postintervention, and 4-month follow-up. Outcomes included family asthma management (primary outcome), adolescent asthma control, lung function (forced expiratory volume in 1 second), asthma-related quality of life, asthma management self-efficacy, and family communication. RESULTS We randomized 33 dyads and had 100% retention in the trial among AIM2ACT participants. Dyads frequently engaged with AIM2ACT (M = 21 days for adolescents, 32.65 days for caregivers) and reported very high satisfaction with content, functionality, and helpfulness. Participants randomized to AIM2ACT had significant improvements in asthma control scores (p = .04) compared to control that surpassed the minimally clinically important difference threshold. Although not statistically significant, the magnitude of improvements in family asthma management, asthma-related quality of life, and family communication was larger in the AIM2ACT group. CONCLUSIONS AIM2ACT is a feasible and acceptable dyadic mobile health asthma self-management intervention that improves asthma control.
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11
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Turi ER, Reigada LC, Liu J, Leonard SI, Bruzzese JM. Associations among anxiety, self-efficacy, and self-care in rural adolescents with poorly controlled asthma. Ann Allergy Asthma Immunol 2021; 127:661-666.e1. [PMID: 34547441 PMCID: PMC8627490 DOI: 10.1016/j.anai.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rural adolescents are vulnerable to asthma; good self-care can reduce morbidity. The subtypes of anxiety (eg, asthma-related, generalized) may have differential associations with asthma self-care. Low self-efficacy, a determinant of behavior, is associated with increased anxiety. Little is known regarding these relationships in rural adolescents. OBJECTIVE To evaluate whether anxiety symptoms are associated with asthma symptom prevention and management among rural adolescents and whether self-efficacy mediates these relationships. METHODS We used baseline data from 197 rural adolescents (mean age = 16 years; 69% girls; 62% Black) who were part of a trial that tested the effectiveness of a school-based asthma intervention. Adolescents completed the Youth Asthma-Related Anxiety Scale, Screen for Child Anxiety and Emotional Disorders, Asthma Management Self-efficacy Index, and Asthma Prevention and Management Indices. Linear regression was performed to test whether: (1) asthma-related and generalized anxiety had curvilinear relationships with self-care; (2) social and separation anxiety had linear relationships with self-care; and (3) self-efficacy mediated relationships. RESULTS Asthma-related anxiety had a significant curvilinear relationship with prevention (P = 0.001) and a linear association with management (P = .01). Generalized anxiety had a significant curvilinear association with management (P = .03), whereas social anxiety had a significant linear relationship with prevention (P = .04). Self-efficacy partially or fully mediated these relationships. CONCLUSION Anxiety symptoms were associated with asthma self-care among this sample of rural adolescents, with differing roles for prevention and management. Self-efficacy may be a mechanism to improve asthma self-care among rural adolescents with anxiety. With a lack of self-efficacy, asthma-related, generalized, or social anxiety may motivate adolescents to take steps to care for their asthma.
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Affiliation(s)
- Eleanor R Turi
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Laura C Reigada
- Department of Psychology, Brooklyn College and The Graduate Center, The City University of New York, New York, New York
| | - Jianfang Liu
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Sarah I Leonard
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Jean-Marie Bruzzese
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York.
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12
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Mitchell SJ, Rangel A, Klein EJ, Stout JW, Lowry SJ, Wingfield E, Horn IB, Coker TR. Sociodemographic Differences in Asthma Self-Management Knowledge of Parents Seeking Asthma Care for their Children in Pediatric Emergency Departments. J Health Care Poor Underserved 2021; 32:2191-2201. [PMID: 34803068 DOI: 10.1353/hpu.2021.0191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To effectively support asthma self-management among children most at risk for poor outcomes, it is important to examine potential disparities in parents' asthma-related knowledge. This study draws on baseline data collected from a randomized controlled trial to analyze how knowledge of asthma self-management varies by sociodemographic characteristics in a racially and economically diverse sample of Medicaid-insured children seeking emergency asthma care (N=221). Multivariable linear regression revealed that parent race/ethnicity, preferred language, and education were independently associated with scores on the Asthma Self Management Knowledge Questionnaire, and there was a significant interaction between parent race/ethnicity and education. In analyses stratified by parent education level, Latinx race/ethnicity was associated with lower-self-management knowledge among parents with higher education level, but not among those with a lower level of education. Our findings call for further research to understand and address the unique barriers to improving asthma self-management knowledge among Latinx parents and parents with limited English proficiency.
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Ali NM, Combs RM, Kakar RM, Muvuka B, Porter J. Promoting Interdisciplinary, Participatory Approaches to Address Childhood Asthma Disparities in an Urban Black Community. FAMILY & COMMUNITY HEALTH 2021; 44:32-42. [PMID: 33055573 DOI: 10.1097/fch.0000000000000283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Black children are twice as likely as non-Hispanic white children to have asthma due to an interplay of socioeconomic, historical, and industrial factors. The underlying socio-economic and structural inequities result in poor adherence to recommended asthma management treatments. National guidelines suggest asthma action plans (AAPs) as a tool for patient self-management, yet they remain underutilized. Boot Camp Translation (BCT), rooted in community-based participatory research, provides a method for engaging communities to improve health literacy. This article describes the successful use of BCT to develop a culturally relevant AAP promotion campaign in West Louisville, a predominantly Black community that experiences social and health disparities.
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Affiliation(s)
- Nida M Ali
- University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky (Drs Ali, Combs, Kakar, and Muvuka); and Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Dr Porter)
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Rhee H, Love T, Harrington D, Walters L, Mammen J, Sloand E. Long-term effects of a peer-led asthma self-management program on asthma outcomes in adolescent peer leaders. PATIENT EDUCATION AND COUNSELING 2021; 104:1415-1422. [PMID: 33339656 PMCID: PMC8164959 DOI: 10.1016/j.pec.2020.11.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To examine the long-term effects of a peer-led asthma self-management program on urban adolescent peer leaders with asthma. METHODS This longitudinal study includes 51 adolescents (16-20 years) enrolled in an asthma self-management program implemented at a one-day camp as peer leaders. Study outcomes, including quality of life, asthma control, asthma knowledge, and attitudes toward asthma were collected for 15 months post-intervention. Mixed-effects models were conducted to estimate time effects, and effect sizes were calculated for each model. RESULTS Of 51 enrolled, 41 completed the training, of which 35 successfully participated in the camp program. A total of 17 peer leaders withdrew between enrollment and 15-months follow-up. Quality of life, asthma control, and knowledge significantly improved after peer leader training and remained elevated for 15 months, while significant improvement in attitudes emerged immediately after camp, in which they served as leaders, and sustained for 15 months. CONCLUSION This study demonstrates the long-term positive effects of a peer-led program on a wide range of asthma outcomes in urban adolescent peer leaders. PRACTICE IMPLICATIONS A peer-led approach to asthma education providing peer leaders with intense training and leadership experience can be effective and sustainable in improving asthma outcomes among urban adolescents.
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Affiliation(s)
- Hyekyun Rhee
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY, 14642, USA.
| | - Tanzy Love
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, 601 Elmwood Ave, Box 630, Rochester, NY, 14642, USA.
| | - Donald Harrington
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, 601 Elmwood Ave, Box 630, Rochester, NY, 14642, USA.
| | - Leanne Walters
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY, 14642, USA.
| | - Jennifer Mammen
- University of Rhode Island College of Nursing, 350 Eddy St., Providence, RI, 02905, USA.
| | - Elizabeth Sloand
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.
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Netz M, Fedele DA, Sweenie R, Baker D, Light M, McQuaid EL. Asthma Management Responsibility, Control, and Quality of Life Among Emerging Adolescents. J Pediatr Psychol 2020; 45:40-49. [PMID: 31579923 DOI: 10.1093/jpepsy/jsz069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine how asthma control is related to the association between the division of responsibility for asthma management and asthma-related quality of life among early adolescents. METHODS Forty-nine youth aged 10-15 years (Mage = 12.25, 57.1% female) with a physician-verified asthma diagnosis completed the Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and Asthma Control Test (ACT). Youth and their caregivers also completed the Asthma Responsibility Questionnaire (ARQ). Higher ACT scores indicate better asthma control. RESULTS There was a significant difference in ARQ scores between youth and caregivers (p < .001, d = .94). Youth reported sharing equal responsibility for asthma management with caregivers, while caregivers reported having more responsibility relative to youth. Greater youth-reported ARQ (p = .004) and greater ACT scores (p < .001) were associated with higher PAQLQ scores. ACT scores moderated the effect of youth-reported ARQ on PAQLQ scores (p = .043). For youth with lower ACT scores, higher youth-reported responsibility was associated with higher PAQLQ scores; while for youth with higher ACT scores, PAQLQ scores were high regardless of perceived responsibility. The interaction between caregiver ARQ scores and ACT scores was not significant. CONCLUSION This study suggests youth and caregivers report discrepant ARQ for asthma management tasks. Responsibility and level of asthma control are important factors for PAQLQ, with results indicating that fostering responsibility is an important factor, even among youth with poorly controlled asthma. Findings suggest that healthcare providers should assess family responsibility and help caregivers support adolescents in developing asthma management skills.
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Affiliation(s)
- Mallory Netz
- Department of Clinical and Health Psychology, University of Florida
| | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida
| | - Rachel Sweenie
- Department of Clinical and Health Psychology, University of Florida
| | - Dawn Baker
- Department of Pediatrics, University of Florida
| | | | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University and Rhode Island Hospital
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Roberts G, Vazquez‐Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Garriga‐Baraut T, Gore C, Gowland MH, Hox V, Jensen B, Mortz CG, Pfaar O, Pite H, Santos AF, Sanchez‐Garcia S, Timmermans F. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy 2020; 75:2734-2752. [PMID: 32558994 DOI: 10.1111/all.14459] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
Adolescent and young adult (AYA) patients need additional support, while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self-manage their allergies and/or asthma. Transitional care is a complex process, which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multidisciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include the following: (a) starting transition early (11-13 years), (b) using a structured, multidisciplinary approach, (c) ensuring AYA fully understand their condition and have resources they can access, (d) active monitoring of adherence and (e) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (a) simplifying medication regimes and using reminders; (b) focusing on areas where AYA are not confident and involving peers in training AYA patients; (c) identifying and managing psychological and socio-economic issues impacting disease control and quality of life; (d) enrolling the family in assisting AYA to undertake self-management; and (e) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.
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Affiliation(s)
- Graham Roberts
- Faculty of Medicine University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Marta Vazquez‐Ortiz
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | | | - Cherry Alviani
- Faculty of Medicine University of Southampton Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology, Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine Section of Paediatrics University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Teresa Garriga‐Baraut
- Unitat d'Allergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d'Investigació “Creixement i Desenvolupament” Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR) Barcelona Spain
| | - Claudia Gore
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | | | - Valérie Hox
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children's Health (Paediatric Allergy School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King's College London London UK
- Children's Allergy Service Guy's and St Thomas' Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | | | - Frans Timmermans
- Nederlands Anafylaxis Netwerk—European Anaphylaxis Taskforce Dordrecht The Netherlands
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Asthma Care Quality, Language, and Ethnicity in a Multi-State Network of Low-Income Children. J Am Board Fam Med 2020; 33:707-715. [PMID: 32989065 PMCID: PMC8682951 DOI: 10.3122/jabfm.2020.05.190468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Prior research has documented disparities in asthma outcomes between Latino children and non-Hispanic whites, but little research directly examines the care provided to Latino children over time in clinical settings. METHODS We utilized an electronic health record-based dataset to study basic asthma care utilization (timely diagnosis documentation and medication prescription) between Latino (Spanish preferring and English preferring) and Non-Hispanic white children over a 13-year study period. RESULTS In our study population (n = 37,614), Latino children were more likely to have Medicaid, be low income, and be obese than non-Hispanic white children. Latinos (Spanish preferring and English preferring) had lower odds than non-Hispanic whites of having their asthma recorded on their problem list on the first day the diagnosis was noted (odds ratio [OR] = 0.83; 95% CI, 0.77 to 0.89 Spanish preferring; OR = 0.93; 95% CI, 0.87 to 0.99 English preferring). Spanish-preferring Latinos had higher odds of ever receiving a prescription for albuterol (OR = 1.96; 95% CI, 1.52 to 2.52), inhaled corticosteroids (OR = 1.45; 95% CI, 1.01 to 2.09), or oral steroids (OR = 1.48; 95% CI, 1.07 to 2.04) than non-Hispanic whites. Among those with any prescription, Spanish-preferring Latinos had higher rates of albuterol prescriptions compared with non-Hispanic whites (adjusted rate ratio [aRR] = 1.0; 95% CI, 1.01 to 1.13). CONCLUSIONS In a multi-state network of clinics, Latino children were less likely to have their asthma entered on their problem list the first day it was noted than non-Hispanic white children, but otherwise did not receive inferior care to non-Hispanic white children in other measures. Further research can examine other parts of the asthma care continuum to better understand asthma disparities.
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Vazquez‐Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Gore C, Hox V, Jensen B, Pite H, Santos AF, Sanchez S, Alviani C, Garriga‐Baraut T, Knibb R, Mortz CG, Gowland MH, Timmermans F, Roberts G. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy 2020; 75:1850-1880. [PMID: 32141620 DOI: 10.1111/all.14258] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. METHODS A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. RESULTS A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. CONCLUSIONS We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.
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Affiliation(s)
- Marta Vazquez‐Ortiz
- Department of Paediatrics Faculty of Medicine Imperial College London London UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Department of Paediatrics Imperial College London London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Claudia Gore
- Department of Paediatrics Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Valérie Hox
- Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital Lisbon Portugal
- CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children’s Health (Paediatric Allergy) Faculty of Life Sciences and Medicine School of Life Course Sciences King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Silvia Sanchez
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
| | - Cherry Alviani
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Teresa Garriga‐Baraut
- Unitat d'Al.lergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d’Investigació “Creixement i Desenvolupament” Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR) Barcelona Spain
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | | | - Frans Timmermans
- Frans Timmermans: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce Dordrecht The Netherlands
| | - Graham Roberts
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
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Margolis R, Bellin MH, Bookman JRM, Collins KS, Bollinger ME, Lewis-Land C, Butz AM. Fostering Effective Asthma Self-Management Transfer in High-Risk Children: Gaps and Opportunities for Family Engagement. J Pediatr Health Care 2019; 33:684-693. [PMID: 31253454 PMCID: PMC6815689 DOI: 10.1016/j.pedhc.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The process of self-management knowledge, behavior, and skill development in children with asthma from families with low income is understudied. METHOD Fifteen mothers of children with uncontrolled asthma participated in semistructured interviews exploring the transfer of asthma self-management responsibilities from parent to child. Team members performed thematic analysis of written transcripts. RESULTS All participants were all the biological mothers and were impoverished, with most (73%) reporting an annual family income of less than $30,000. Their children ranged from 5 to 15 years old, were African American (100%), and had uncontrolled asthma based on national guidelines. Themes showed that child asthma self-management is difficult to achieve, that the transfer of asthma responsibility from mother to child is variable, and that mothers overestimate their child's developmental capacities for independent asthma self-management and have poor understanding of what well-controlled asthma means. DISCUSSION Ongoing assessment and tailored guidance from health care providers are critical to support the pivotal role of mothers in their child's self-management development process.
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Affiliation(s)
- Rachel Margolis
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | - Melissa H. Bellin
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | | | - Kathryn S. Collins
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | | | - Cassie Lewis-Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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Zheng K, Bruzzese JM, Smaldone A. Illness acceptance in adolescents: A concept analysis. Nurs Forum 2019; 54:545-552. [PMID: 31313315 DOI: 10.1111/nuf.12368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To strengthen the theoretical understanding of illness acceptance in adolescents and to inform healthcare strategies geared toward supporting adolescents with chronic illness. BACKGROUND Illness acceptance is associated with positive health outcomes. Though well understood in adults with chronic illness, less is known about how this phenomenon ensues in adolescents. Adolescents may have a difficult time accepting an illness due to their unique developmental needs. Consequently, they are vulnerable to poor health outcomes. DESIGN Concept analysis. DATA SOURCES A literature search through 2 databases (PubMed and PsycINFO) and a hand-search through Google were conducted to identify uses of the concept. REVIEW METHODS The Walker and Avant method of concept analysis. RESULTS Four attributes of illness acceptance were identified: understanding of illness, overcoming limitations, normalization, and readiness for responsibility. Antecedents that predisposed illness acceptance included peer and family support, disease management education, and developmental readiness. Positive consequences of illness acceptance included high self-esteem, improved quality of life, resilience, identity formation, and better disease control. CONCLUSIONS Establishing a standardized conceptual understanding of how illness acceptance ensues in adolescents can enable nurses and other health professionals to tailor developmentally appropriate care strategies and optimize the overall quality of life for this unique patient population.
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Affiliation(s)
| | | | - Arlene Smaldone
- Columbia University School of Nursing, New York, New York.,College of Dental Medicine, Columbia University, New York, New York
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Ansari R, Ahmadian L, Harandi NB. Developing and Evaluating Parents' Satisfaction with a Website to Manage Pediatric Asthma. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2019; 16:1a. [PMID: 31423118 PMCID: PMC6669365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Providing information in an accessible form is important for managing chronic diseases. OBJECTIVE To develop an interactive website regarding pediatric asthma and to evaluate the satisfaction with the website of parents of children with asthma. METHODS In this cross-sectional study, the user interface of the website was developed by examining experts' perspective. Then, the users used the website during a three-month period and completed an electronic questionnaire. RESULTS All parents reported that the entire website was informative. Of the participants, 98 percent reported that the medication section was the most useful, 93 percent considered the management and treatment section most useful, and 90 percent found the nutrition section most useful. The users had high satisfaction with the information content of the website. CONCLUSION By creating an interactive website, we provided an educational tool to help parents learn essential information about asthma treatment and prevention of disease progression. The users believed that the website could meet their information needs.
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Affiliation(s)
- Rezvan Ansari
- Institute for Future Studies in Health at Kerman University of Medical Sciences in Kerman, Iran
| | - Leila Ahmadian
- Institute for Future Studies in Health at Kerman University of Medical Sciences in Kerman, Iran
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Bellin MH, Newsome A, Lewis-Land C, Kub J, Mudd SS, Margolis R, Butz AM. Improving Care of Inner-City Children with Poorly Controlled Asthma: What Mothers Want You to Know. J Pediatr Health Care 2018; 32:387-398. [PMID: 29540280 PMCID: PMC6026044 DOI: 10.1016/j.pedhc.2017.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/06/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Low-income caregiver perspectives on asthma management are understudied but may illuminate strategies to improve care delivery and child outcomes. METHOD Purposive sampling methods were used to recruit 15 caregivers of children with frequent asthma emergency department visits. Interviews explored how poverty and stress affect asthma management. Grounded theory coding techniques were used to analyze the data. RESULTS Participants were the biological mother (100%) and were poor (75% had mean annual income ≤ $30,000). Their children (mean age = 6.9 years) were African American (100%), enrolled in Medicaid (100%), and averaged 1.5 emergency department visits over the prior 3 months. Four themes emerged: (a) Deplorable Housing Conditions, (b) Allies and Adversaries in School-Based Asthma Management, (c) Satisfaction With Asthma Health Care Delivery, and (d) Prevalent Psychological Distress. DISCUSSION Impoverished caregivers of children with frequent asthma emergency department visits describe stress that is multifaceted, overwhelming, and difficult to eradicate. Their experiences underscore the need for improved school-based asthma management and family-centered approaches to health care delivery.
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Affiliation(s)
| | | | - Cassie Lewis-Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Joan Kub
- University of Southern California School of Social Work-Department of Nursing
| | - Shawna S. Mudd
- Johns Hopkins University School of Nursing, Medicine and Public Health
| | | | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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MacDonell K, Naar S, Gibson-Scipio W, Bruzzese JM, Wang B, Brody A. The Detroit Young Adult Asthma Project: Proposal for a Multicomponent Technology Intervention for African American Emerging Adults With Asthma. JMIR Res Protoc 2018; 7:e98. [PMID: 29735474 PMCID: PMC5962828 DOI: 10.2196/resprot.8872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 12/31/2022] Open
Abstract
Background Racial and ethnic minority youth have poorer asthma status than white youth, even after controlling for socioeconomic variables. Proper use of asthma controller medications is critical in reducing asthma mortality and morbidity. The clinical consequences of poor asthma management include increased illness complications, excessive functional morbidity, and fatal asthma attacks. There are significant limitations in research on interventions to improve asthma management in racial minority populations, particularly minority adolescents and young adults, although illness management tends to deteriorate after adolescence during emerging adulthood, the unique developmental period beyond adolescence but before adulthood. Objective The objective of the pilot study was to test the feasibility, acceptability, and signals of efficacy of an intervention targeting adherence to controller medication in African American youth (ages 18-29) with asthma. All elements of the protocol were piloted in a National Heart, Lung, and Blood Institute (NHLBI)–funded pilot study (1R34HL107664 MacDonell). Results suggested feasibility and acceptability of the protocol as well as proof of concept. We are now ready to test the intervention in a larger randomized clinical trial. Methods The proposed study will include 192 African American emerging adults with moderate to severe persistent asthma and low controller medication adherence recruited from clinic, emergency department, and community settings. Half of the sample will be randomized to receive a multicomponent technology-based intervention targeting adherence to daily controller medication. The multicomponent technology-based intervention consists of 2 components: (1) 2 sessions of computer-delivered motivational interviewing targeting medication adherence and (2) individualized text messaging focused on medication adherence between the sessions. Text messages will be individualized based on ecological momentary assessment. The remaining participants will complete a series of computer-delivered asthma education modules matched for length, location, and method of delivery of the intervention session. Control participants will also receive text messages between intervention sessions. Message content will be the same for all control participants and contain general facts about asthma (not tailored). Results It is hypothesized that youth randomized to multicomponent technology-based intervention will show improvements in medication adherence (primary outcome) and asthma control (secondary outcome) compared with comparison condition at all postintervention follow-ups (3, 6, 9, and 12 months). The proposed study was funded by NHLBI from September 1, 2016 through August 31, 2021. Conclusions This project will test a brief, technology-based intervention specifically targeting adherence to asthma controller medications in an under-researched population, African American emerging adults. If successful, our multicomponent technology-based intervention aimed at improving adherence to asthma medications has the potential to improve quality of life of minority emerging adults with asthma at relatively low cost. It could eventually be integrated into clinical settings and practice to reach a large number of emerging adults with asthma. Trial Registration ClinicalTrials.gov NCT03121157; https://clinicaltrials.gov/ct2/show/NCT03121157 (Archived by WebCite at http://www.webcitation.org/6wq4yWHPv)
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Affiliation(s)
- Karen MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States
| | - Sylvie Naar
- Florida State University, Tallahassee, FL, United States
| | | | | | - Bo Wang
- Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts, Amherst, MA, United States
| | - Aaron Brody
- Department of Emergency Medicine, Wayne State University, Detroit, MI, United States
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24
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Gray WN, Netz M, McConville A, Fedele D, Wagoner ST, Schaefer MR. Medication adherence in pediatric asthma: A systematic review of the literature. Pediatr Pulmonol 2018; 53:668-684. [PMID: 29461017 DOI: 10.1002/ppul.23966] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains. METHODS Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality. RESULTS Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies. CONCLUSIONS All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.
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Affiliation(s)
- Wendy N Gray
- Department of Psychology, Auburn University, Auburn University, AL
| | - Mallory Netz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Andrew McConville
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - David Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Scott T Wagoner
- Department of Psychology, Auburn University, Auburn University, AL
| | - Megan R Schaefer
- Department of Psychology, Auburn University, Auburn University, AL
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Mammen JR, Rhee H, Atis S, Grape A. Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training. PATIENT EDUCATION AND COUNSELING 2018; 101:687-695. [PMID: 29129307 PMCID: PMC5878979 DOI: 10.1016/j.pec.2017.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate efficacy of a developmentally sensitive curriculum for improving asthma self-management knowledge, attitude, and self-efficacy in adolescents. METHODS Fourty-two inner-city adolescents (ages 16-20) participated in a 12hour asthma self-management training program. Self-management knowledge, attitude toward asthma, and asthma-related self-efficacy were measured using short-answer tests before and after training. T-Tests were used to evaluate impact and effect sizes were calculated. RESULTS Mean pretest knowledge was 21.37/46 points; mean posttest was 36.33/46 points. Change from pre- to posttest was highly significant (t=10.34; p<0.0001), with a large effect size (d=1.68). Females improved more than males (18.66±8.58 vs. 12.29±8.13, p=0.039). Greatest effects were seen in awareness of long-term consequences of uncontrolled asthma (d=2.04), ability to recognize symptoms of life-threatening asthma (d=1.61), correctly monitor symptoms (d=1.49), and tell if asthma was uncontrolled (d=1.39). Asthma self-efficacy also improved significantly (p=0.017), particularly confidence in ability to correctly manage asthma, however improvements in attitude did not achieve statistical significance. CONCLUSION Developmentally appropriate training is effective in increasing critical self-management knowledge and self-efficacy in inner city adolescents, particularly females. PRACTICE IMPLICATIONS Providers should screen carefully for symptoms and educate using developmentally appropriate training materials on ways to correctly monitor and manage symptom.
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Affiliation(s)
- Jennifer R Mammen
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States.
| | - Hyekyun Rhee
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
| | - Shannska Atis
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
| | - Annette Grape
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
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Gould CF, Perzanowski MS, Evans D, Bruzzese JM. Association of exercise-induced wheeze and other asthma symptoms with emergency department visits and hospitalizations in a large cohort of urban adolescents. Respir Med 2018; 135:42-50. [PMID: 29414452 PMCID: PMC5806151 DOI: 10.1016/j.rmed.2018.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/08/2017] [Accepted: 01/09/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Exercise-induced wheeze (EIW) has been found to be associated with asthma-related urgent care in school-aged children. Despite asthma's high prevalence and morbidity among adolescents, this association has not been examined in adolescents. We tested the association of EIW and other asthma symptoms to asthma-related ED visits and hospitalizations in urban adolescents with probable asthma. We hypothesized that EIW would be associated with urgent care. METHODS In this cross-sectional study 30,467 high school students (mean age = 16.0) from 49 NYC schools completed two brief validated measures, one assessing probable asthma and the other the frequency of six asthma symptoms over the past year. Adolescents also reported if in the past year they had an asthma-related ED visit or hospitalization. Analyses presented here included students with probable asthma (n = 9149). Using logistic regression, we modeled each asthma symptom as a function of ED visits and hospitalizations adjusting for sex, age, race/ethnicity and asthma severity. Multivariable models included all symptoms to account for the potential interaction between symptoms. RESULTS Among adolescents with probable asthma, EIW was associated with ED visits and hospitalizations. In multivariable models wheeze without a cold, chest tightness, night wakening, but not EIW, were significantly associated with both ED visits and hospitalizations. CONCLUSIONS Unlike findings with younger children, EIW does not appear to be associated with ED visits and hospitalizations among urban adolescents with probable asthma. Instead, symptoms, such as chest tightness and night wakening, appear to be important at identifying adolescents at risk for asthma-related urgent care.
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Affiliation(s)
- Carlos F Gould
- Columbia University, Mailman School of Public Health, Department of Environmental Health Sciences, 722 West 168th Street, New York, NY 10032, USA
| | - Matthew S Perzanowski
- Columbia University, Mailman School of Public Health, Department of Environmental Health Sciences, 722 West 168th Street, New York, NY 10032, USA
| | - David Evans
- Columbia University Medical Center, Pediatric Pulmonary Division, 3959 Broadway, Room CHC-745, New York, NY 10032, USA
| | - Jean-Marie Bruzzese
- Columbia University Medical Center, School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA.
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Fedele DA, McConville A, Graham Thomas J, McQuaid EL, Janicke DM, Turner EM, Moon J, Abu-Hasan M. Applying Interactive Mobile health to Asthma Care in Teens (AIM2ACT): Development and design of a randomized controlled trial. Contemp Clin Trials 2017; 64:230-237. [PMID: 28986245 DOI: 10.1016/j.cct.2017.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 01/01/2023]
Abstract
Early adolescents have difficulties performing asthma self-management behaviors, placing them at-risk for poor asthma control and reduced quality of life. This paper describes the development and plans for testing an interactive mobile health (mHealth) tool for early adolescents, ages 12-15years, and their caregivers to help improve asthma management. Applying Interactive Mobile health to Asthma Care in Teens (AIM2ACT) is informed by the Pediatric Self-management model, which posits that helpful caregiver support is facilitated by elucidating disease management behaviors and allocating treatment responsibility in the family system, and subsequently engaging in collaborative caregiver-adolescent asthma management. The AIM2ACT intervention was developed through iterative feedback from an advisory board composed of adolescent-caregiver dyads. A pilot randomized controlled trial of AIM2ACT will be conducted with 50 early adolescents with poorly controlled asthma and a caregiver. Adolescent-caregiver dyads will be randomized to receive the AIM2ACT smartphone application (AIM2ACT app) or a self-guided asthma control condition for a 4-month period. Feasibility and acceptability data will be collected throughout the trial. Efficacy outcomes, including family asthma management, lung function, adolescent asthma control, asthma-related quality of life, and self-efficacy for asthma management, will be collected at baseline, post-treatment, and 4-month follow-up. Results from the current study will inform the utility of mHealth to foster the development of asthma self-management skills among early adolescents.
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Affiliation(s)
- David A Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States.
| | - Andrew McConville
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Elise M Turner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Jon Moon
- MEI Research, Ltd, Edina, MN, United States
| | - Mutasim Abu-Hasan
- Pediatric Pulmonary Division, University of Florida, Gainesville, FL, United States
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Bellin MH, Newsome A, Land C, Kub J, Mudd SS, Bollinger ME, Butz AM. Asthma Home Management in the Inner-City: What can the Children Teach us? J Pediatr Health Care 2017; 31:362-371. [PMID: 27955875 PMCID: PMC6407130 DOI: 10.1016/j.pedhc.2016.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Knowledge of asthma home management from the perspective of poor, minority children with asthma is limited. METHOD Convenience sampling methods were used to recruit families of low-income children who are frequently in the emergency department for uncontrolled asthma. Thirteen youths participated in focus groups designed to elicit reflections on asthma home management. Data were analyzed using grounded theory coding techniques. RESULTS Participants (Mean age = 9.2 years) were African American (100%), enrolled in Medicaid (92.3%), averaged 1.4 (standard deviation = 0.7) emergency department visits over the prior 3 months, and resided in homes with at least 1 smoker (61.5%). Two themes reflecting multifaceted challenges to the development proper of self-management emerged in the analysis. DISCUSSION Findings reinforce the need to provide a multipronged approach to improve asthma control in this high-risk population including ongoing child and family education and self-management support, environmental control and housing resources, linkages to smoking cessation programs, and psychosocial support.
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29
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Mammen JR, Rhee H, Norton SA, Butz AM. Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma. J Asthma 2017; 54:143-152. [PMID: 27337035 PMCID: PMC5182183 DOI: 10.1080/02770903.2016.1201835] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Teens often have inadequate asthma self-management and control. However, little is known of their perceptions of or rationales for self-management behaviors. OBJECTIVES To explore how teens self-manage asthma, including experiences, perceptions, responses to and reporting of symptoms. METHODS A case-based, qualitative-descriptive design was used. Data were collected from minority and non-minority teens with controlled and uncontrolled asthma and their respective parents (N = 28). There were four data-collection points, including: (1) a primary teen interview; (2) parent interview; (3) 2-week self-management voice-diary; and (4) follow-up teen interview, incorporating symptom-response card-sorting to map symptoms and associated self-management responses. Seventy data sources were included in the analysis. RESULTS Teens thought of their asthma symptoms as normal or unusual relative to their personal baseline symptom pattern; Those with uncontrolled asthma normalized higher levels of asthma symptoms than their counterparts with controlled asthma. Second, teens' decisions to treat symptoms of asthma with rescue medication were based on perceived benefits, burdens and accessibility of treatment balanced against perceived normalcy of symptoms. Teens with uncontrolled asthma had substantially higher treatment thresholds and delayed responses to symptoms compared to controlled peers. Third, teens never reported perceived normal symptoms of asthma to parents or providers, who were thus only aware of unusual or visible/audible symptoms. CONCLUSIONS Teen's perceptions of symptoms and understanding of what is normal is the basis for self-management decisions. Improving self-management will likely entail modifying perceptions of symptoms and benefits/burdens of treatment to achieve healthier self-management patterns.
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Affiliation(s)
| | - Hyekyun Rhee
- a University of Rochester School of Nursing , Rochester , NY , USA
| | - Sally A Norton
- a University of Rochester School of Nursing , Rochester , NY , USA
| | - Arlene M Butz
- b Johns Hopkins University, School of Medicine , Baltimore , MD , USA
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30
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Bruzzese JM, Reigada LC, Lamm A, Wang J, Li M, Zandieh SO, Klein RG. Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents. Acad Pediatr 2016; 16:792-798. [PMID: 27049680 PMCID: PMC5047850 DOI: 10.1016/j.acap.2016.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/16/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the association of adolescent asthma-related anxiety, social anxiety, separation anxiety, and caregiver asthma-related anxiety with asthma care by urban adolescents. METHODS Participants were 386 ethnic minority adolescents (mean age 12.8 years) with persistent asthma and their caregivers. Adolescents reported what they do to prevent asthma symptoms and to manage acute symptoms, and if they or their caregiver is responsible for their asthma care. Adolescents completed the Youth Asthma-Related Anxiety Scale, and the social and separation anxiety subscales of the Screen for Child Anxiety and Emotional Disorders (SCARED); caregivers completed the Parent Asthma-Related Anxiety Scale. Linearity of the associations was assessed by generalized additive models. When there was no evidence for nonlinearity, linear mixed effects models were used to evaluate the effects of the predictors. RESULTS Adolescent asthma-related anxiety had a strong curvilinear relationship with symptom prevention (P < .001). Adolescents took more prevention steps as their anxiety increased, with a plateau at moderate anxiety. There was a linear relationship of adolescent asthma-related anxiety to symptom management (β = 0.03, P = .021) and to asthma responsibility (β = 0.11, P = .015), and of caregiver asthma-related anxiety to adolescent symptom prevention (β = 0.04, P = .001). Adolescent social and separation anxiety had weak to no relationship with asthma care. Results remained consistent when controlling for each of the other anxieties. CONCLUSIONS Asthma-related anxiety plays an important, independent role in asthma care. When low, adolescents may benefit from increased support from caregivers and awareness of the consequences of uncontrolled asthma. When elevated, health providers should ensure the adolescents are not assuming responsibility for asthma care prematurely.
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Affiliation(s)
- Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Laura C. Reigada
- Department of Psychology, Brooklyn College of the City University of New York, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Alexandra Lamm
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Jing Wang
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Meng Li
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Stephanie O. Zandieh
- Department of Pediatrics, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Rachel G. Klein
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
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Ellis DA, King P, Naar-King S. Mediators of Treatment Effects in a Randomized Clinical Trial of Multisystemic Therapy-Health Care in Adolescents With Poorly Controlled Asthma: Disease Knowledge and Device Use Skills. J Pediatr Psychol 2016; 41:522-30. [PMID: 26628249 PMCID: PMC4888112 DOI: 10.1093/jpepsy/jsv114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/29/2015] [Accepted: 11/01/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Determine whether Multisystemic Therapy-Health Care (MST-HC) improved asthma knowledge and controller device use skills among African-American youth with poorly controlled asthma and whether any improvements mediated changes in illness management. METHODS A randomized controlled trial was conducted with 170 adolescents with moderate to severe asthma. Families were randomized to MST-HC or attention control. Data were collected at baseline and 6 and 12 months after intervention completion. RESULTS In linear mixed models, adolescents in the MST-HC group had increases in asthma knowledge; asthma knowledge was unchanged for attention control. Controller device use skills increased for adolescents in the MST-HC group, while skills declined for attention control. Both knowledge and skills mediated the relationship between intervention condition and changes in illness management. CONCLUSIONS Tailored, home-based interventions that include knowledge and skills building components are one means by which illness management in African-American youth with poorly controlled asthma can be improved.
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Affiliation(s)
- Deborah A Ellis
- Carman and Ann Adams Department of Pediatrics, Wayne State University
| | - Pamela King
- Carman and Ann Adams Department of Pediatrics, Wayne State University
| | - Sylvie Naar-King
- Carman and Ann Adams Department of Pediatrics, Wayne State University
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32
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Gibson-Scipio W, Gourdin D, Krouse HJ. Asthma Self-Management Goals, Beliefs and Behaviors of Urban African American Adolescents Prior to Transitioning to Adult Health Care. J Pediatr Nurs 2015; 30:e53-61. [PMID: 26169338 DOI: 10.1016/j.pedn.2015.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/16/2015] [Accepted: 06/16/2015] [Indexed: 11/16/2022]
Abstract
UNLABELLED Adolescence is a unique time of development incorporating a transition from child centered to adult centered health care. This transition period can be particularly challenging for individuals with a chronic disease such as asthma. Inadequate transition planning during adolescence may place an already vulnerable population such as African American adolescents with known health disparities in asthma prevalence, morbidity and mortality at risk for a continuation of poor health outcomes across the lifespan. Central to transition planning for these youth is the core element of developing and prioritizing goals. The purpose of this qualitative study was to explore the asthma self-management goals, beliefs and behaviors of urban African American adolescents prior to transitioning from pediatric to adult health care. METHODS A focus group composed of 13 African American adolescents with asthma ages 14-18 years from an urban population was conducted. Responses from transcripts and field notes were reviewed using an iterative process to best characterize asthma self-management goals and beliefs that emerged. RESULTS Four core themes were identified: 1) medication self-management, 2) social support, 3) independence vs. interdependence, and 4) self-advocacy. Medication self-management included subthemes of rescue medications, controller medications and medication avoidance. The social support theme included three subthemes: peer support, caregiver support and healthcare provider support. CONCLUSION Findings suggest that adolescents with asthma form both short term and long term goals. Their goals indicated a need for guided support to facilitate a successful health care transition.
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Affiliation(s)
| | - Dustin Gourdin
- University of Chicago Department of Sociology, Chicago, IL
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Crowder SJ, Hanna KM, Carpenter JS, Broome ME. Factors Associated with Asthma Self-Management in African American Adolescents. J Pediatr Nurs 2015; 30:e35-43. [PMID: 25936998 PMCID: PMC4624611 DOI: 10.1016/j.pedn.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/29/2015] [Accepted: 03/30/2015] [Indexed: 01/03/2023]
Abstract
Few studies have focused on asthma self-management in African American adolescents, a group with high rates of the disease. This study examined factors associated with asthma self-management in 133 African Americans aged 14-16 years including gender, asthma impairment, prior asthma education, cognitive and emotional illness representations. Twenty-five percent of the variance in asthma self-management was explained by having attended an asthma education program, perceiving more asthma consequences (illness consequences), and reporting greater understanding of asthma as an illness (illness coherence). Findings suggest that these variables may be important targets of interventions to improve asthma self-management in African American middle adolescents.
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Affiliation(s)
- Sharron J Crowder
- Community and Health Systems Department, Indiana University School of Nursing, Indianapolis, IN.
| | - Kathleen M Hanna
- Carol M. Wilson Endowed Chair in Nursing, Nebraska Medical Center College of Nursing, Omaha, NE
| | - Janet S Carpenter
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN
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Rhee H, Belyea MJ, Sterling M, Bocko MF. Evaluating the Validity of an Automated Device for Asthma Monitoring for Adolescents: Correlational Design. J Med Internet Res 2015; 17:e234. [PMID: 26475634 PMCID: PMC4704980 DOI: 10.2196/jmir.4975] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Symptom monitoring is a cornerstone of asthma self-management. Conventional methods of symptom monitoring have fallen short in producing objective data and eliciting patients' consistent adherence, particularly in teen patients. We have recently developed an Automated Device for Asthma Monitoring (ADAM) using a consumer mobile device as a platform to facilitate continuous and objective symptom monitoring in adolescents in vivo. OBJECTIVE The objectives of the study were to evaluate the validity of the device using spirometer data, fractional exhaled nitric oxide (FeNO), existing measures of asthma symptoms/control and health care utilization data, and to examine the sensitivity and specificity of the device in discriminating asthma cases from nonasthma cases. METHODS A total of 84 teens (42 teens with a current asthma diagnosis; 42 without asthma) aged between 13 and 17 years participated in the study. All participants used ADAM for 7 consecutive days during which participants with asthma completed an asthma diary two times a day. ADAM recorded the frequency of coughing for 24 hours throughout the 7-day trial. Pearson correlation and multiple regression were used to examine the relationships between ADAM data and asthma control, quality of life, and health care utilization at the time of the 7-day trial and 3 months later. A receiver operating characteristic (ROC) curve analysis was conducted to examine sensitivity and specificity based on the area under the curve (AUC) as an indicator of the device's capacity to discriminate between asthma versus nonasthma cases. RESULTS ADAM data (cough counts) were negatively associated with forced expiratory volume in first second of expiration (FEV1) (r=-.26, P=.05), forced vital capacity (FVC) (r=-.31, P=.02), and overall asthma control (r=-.41, P=.009) and positively associated with daily activity limitation (r=.46, P=.01), nighttime (r=.40, P=.02) and daytime symptoms (r=.38, P=.02), and health care utilization (r=.61, P<.001). Device data were also a significant predictor of asthma control (β=-.48, P=.003), quality of life (β=-.55, P=.001), and health care utilization (β=.74, P=.004) after 3 months. The ROC curve analysis for the presence of asthma diagnosis had an AUC of 0.71 (95% CI 0.58-0.84), which was significantly different from chance (χ(2) 1=9.7, P=.002), indicating the device's discriminating capacity. The optimal cutoff value of the device was 0.56 with a sensitivity of 51.3% and a specificity of 72.7%. CONCLUSIONS This study demonstrates validity of ADAM as a symptom-monitoring device in teens with asthma. ADAM data reflect the current status of asthma control and predict asthma morbidity and quality of life for the near future. A monitoring device such as ADAM can increase patients' awareness of the patterns of cough for early detection of worsening asthma and has the potential for preventing serious and costly future consequences of asthma.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, NY, United States.
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Koinis Mitchell D, Kopel SJ, Williams B, Cespedes A, Bruzzese JM. The Association Between Asthma and Sleep in Urban Adolescents With Undiagnosed Asthma. THE JOURNAL OF SCHOOL HEALTH 2015; 85:519-526. [PMID: 26149307 PMCID: PMC4539959 DOI: 10.1111/josh.12277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 12/29/2014] [Accepted: 01/12/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND We examined associations between asthma and sleep in a sample of inner-city adolescents with asthma-like symptoms who are undiagnosed, and to assess the extent to which youth's report of perceived stress moderates this association. METHODS A total of 349 adolescents (83% girls), with a mean age of 15.8 years, and their primary caregivers participated. Large segments of the sample were Latinos (46%) or African Americans (37%). Adolescents reported on asthma-namely, rate of waking up at night due to asthma-like symptoms and perceived severity of breathing problems-and sleep, specifically sleep-wake behavior problems and daytime sleepiness during activities. Caregivers provided demographic information by telephone. RESULTS Night awakenings and perceived severity of breathing problems were each independently associated with sleep-wake behavior problems and daytime sleepiness during activities. Youth report of perceived stress moderated the association between perceived severity of breathing problems and sleep-wake behavior problems, and perceived severity of breathing problems and daytime sleepiness during activities. CONCLUSIONS Results suggest the importance of interventions that consider undiagnosed asthma and its effects on sleep indicators related to daytime functioning in this high risk group of youth. This study highlights the need for interventions that consider asthma severity, nocturnal asthma, and sleep problems among urban adolescents with no asthma diagnosis.
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Affiliation(s)
- Daphne Koinis Mitchell
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, 1 Hoppin Street, Providence, RI 02903.
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, 1 Hoppin Street, Providence, RI 02903.
| | - Brittney Williams
- Bradley/Hasbro Children's Research Center, Warren Alpert Medical School of Brown University, 1 Hoppin Street, Providence, RI 02903.
| | - Amarilis Cespedes
- Department of Child and Adolescent Psychiatry, Child Study Center, New York University School of Medicine, One Park Avenue 7th FL, New York, NY 10016.
| | - Jean-Marie Bruzzese
- New York University School of Medicine, Child Study Center, One Park Avenue 7th FL, New York, NY 10016.
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Wiecha JM, Adams WG, Rybin D, Rizzodepaoli M, Keller J, Clay JM. Evaluation of a web-based asthma self-management system: a randomised controlled pilot trial. BMC Pulm Med 2015; 15:17. [PMID: 25885418 PMCID: PMC4355974 DOI: 10.1186/s12890-015-0007-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/27/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Asthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children. Low rates of asthma preventer medication adherence is a major contributor to poor asthma control in these patients. Web-based methods have potential to improve patient knowledge and medication adherence by providing interactive patient education, monitoring of symptoms and medication use, and by facilitation of communication and teamwork among patients and health care providers. Few studies have evaluated web-based asthma support environments using all of these potentially beneficial interventions. The multidimensional website created for this study, BostonBreathes, was designed to intervene on multiple levels, and was evaluated in a pilot trial. METHODS An interactive, engaging website for children with asthma was developed to promote adherence to asthma medications, provide a platform for teamwork between caregivers and patients, and to provide primary care providers with up-to-date symptom information and data on medication use. Fifty-eight (58) children primarily from inner city Boston with persistent-level asthma were randomised to either usual care or use of BostonBreathes. Subjects completed asthma education activities, and reported their symptoms and medication use. Primary care providers used a separate interface to monitor their patients' website use, their reported symptoms and medication use, and were able to communicate online via a discussion board with their patients and with an asthma specialist. RESULTS After 6-months, reported wheezing improved significantly in both intervention and control groups, and there were significant improvements in the intervention group only in night-time awakening and parental loss of sleep, but there were no significant differences between intervention and control groups in these measures. Emergency room or acute visits to a physician for asthma did not significantly change in either group. Among the subgroup of subjects with low controller medication adherence at baseline, adherence improved significantly only in the intervention group. Knowledge of the purpose of controller medicine increased significantly in the intervention group, a statistically significant improvement over the control group. CONCLUSIONS This pilot study suggests that a multidimensional web-based educational, monitoring, and communication platform may have positive influences on pediatric patients' asthma-related knowledge and use of asthma preventer medications.
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Affiliation(s)
- John M Wiecha
- Boston University School of Medicine, 72 East Concord St., B2900, Boston, MA, 02118-2518, USA.
| | - William G Adams
- Department of Pediatrics, Boston Medical Center, 1 BMC Place, Boston, MA, 02118, USA.
| | - Denis Rybin
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Maria Rizzodepaoli
- Department of Family Medicine, Boston Medical Center, 1 BMC Place, Boston, MA, 02118, USA.
| | - Jeremy Keller
- Windsor Street Health Center/Cambridge Health Alliance, 119 Windsor Street, Cambridge, MA, 02139, USA.
| | - Jayanti M Clay
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA.
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Klok T, Lubbers S, Kaptein AA, Brand PL. Every parent tells a story: why non-adherence may persist in children receiving guideline-based comprehensive asthma care. J Asthma 2013; 51:106-12. [PMID: 24007568 DOI: 10.3109/02770903.2013.841191] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Effective self-management and adherence to inhaled corticosteroids are issues of particular interest in comprehensive asthma care. In spite of this care, however, a number of parents and children remain non-adherent. The reasons for this non-adherence have up till now been unknown, because previous adherence studies have based their findings either on populations with poor adherence or on unreliable self-reported adherence. This study was designed to explore factors that contribute to persistent non-adherence to inhaled corticosteroids in children ranging between 2 and 12 years of age receiving comprehensive asthma care, with adherence assessed objectively. METHODS This qualitative study was based on in-depth interviews which took place in the homes of parents whose children had completed a one-year follow-up of electronically measured adherence to inhaled corticosteroids. Rich and comprehensive descriptions of parents' own accounts of self-management behavior were obtained using active listening techniques. Each interview was recorded and transcribed verbatim followed by data analysis using standard methodology for qualitative studies. RESULTS Twenty children's parents (mean age 5.9 years) were interviewed. Distinctive patterns of modifiable barriers to adherence emerged, including a novel finding of parents misjudging their child's ability to manage the daily use of medication by him/herself. Persistent non-adherence appeared to be caused by a number of maintaining factors. Most noticeable factors were unawareness of non-adherence by both parents and health care providers, a lack of parental drive to achieve high adherence and ineffective parental problem-solving behaviour. CONCLUSIONS This study has identified modifiable barriers to adherence in families participating in a comprehensive asthma care programme. Future studies are needed to verify our novel findings and to investigate whether interventions around these barriers are needed to increase the effectiveness of asthma care programs.
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Affiliation(s)
- Ted Klok
- Princess Amalia Children's Clinic, Isala klinieken , Zwolle , the Netherlands
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Mammen J, Rhee H. Adolescent Asthma Self-Management: A Concept Analysis and Operational Definition. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012; 25:180-189. [PMID: 23285426 DOI: 10.1089/ped.2012.0150] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/15/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND: Adolescents with asthma have a higher risk of morbidity and mortality than other age groups. Asthma self-management has been shown to improve outcomes; however, the concept of asthma self-management is not explicitly defined. METHODS: We use the Norris method of concept clarification to delineate what constitutes the concept of asthma self-management in adolescents. Five databases were searched to identify components of the concept of adolescent asthma self-management, and lists of relevant subconcepts were compiled and categorized. RESULTS: Analysis revealed 4 specific domains of self-management behaviors: (1) symptom prevention; (2) symptom monitoring; (3) acute symptom management; and (4) communication with important others. These domains of self-management were mediated by intrapersonal/cognitive and interpersonal/contextual factors. CONCLUSIONS: Based on the analysis, we offer a research-based operational definition for adolescent asthma self-management and a preliminary model that can serve as a conceptual base for further research.
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Affiliation(s)
- Jennifer Mammen
- School of Nursing, University of Rochester , Rochester, New York
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Hayes SE, Huang KY, Evans D, Bruzzese JM. Minors' attitudes toward peers with asthma: a developmental study. J Asthma 2012; 50:90-6. [PMID: 23176168 DOI: 10.3109/02770903.2012.743153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Peers can play a critical role in asthma management, with attitudes toward friends with asthma hindering or supporting self-management. We explored minors' attitudes toward peers with asthma, testing if attitudes varied by grade, sex, asthma knowledge, and asthma status. METHODS Three hundred and eighty-one students in grades 5-11 (51% female; 51% White, non-Hispanic; 12% with asthma) read five vignettes about peers with asthma, and rated the characters on 10 adjective pairs (e.g., afraid/brave and sad/happy). Three vignettes portrayed an aspect of uncontrolled asthma (asthma-related school absence, asthma-related limited physical activity, and asthma-related school nurse visit). One vignette depicted controlled asthma; one described taking medication publically. We computed a total attitude score for each vignette and a mean attitude score across the three uncontrolled vignettes. Linear regression analyses tested the effect of each predictor (grade, sex, asthma knowledge, and asthma status) on attitudes, as well as the interaction of asthma status with the remaining three predictors. RESULTS Grade was the most robust predictor. Participants in higher grades tended to have more favorable attitudes toward peers with asthma, except for the controlled asthma vignette where participants in lower grades had more favorable attitudes. There were significant interactions between grade and asthma status for the stop-running-and-taking-medication-publically vignettes: among those with asthma, participants in higher grades had more favorable attitudes. Sex interacted with asthma status for the overall uncontrolled, absence, and stop-running vignettes; among those with asthma, girls had more favorable attitudes. CONCLUSION With increased grade, minors have better attitudes toward peers with asthma. Living with asthma may normalize asthma. Clinicians can use grade-specific findings to counsel patients.
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Affiliation(s)
- Sarah E Hayes
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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Jay M, Wijetunga NA, Stepney C, Dorsey K, Chua DM, Bruzzese JM. The Relationship between Asthma and Obesity in Urban Early Adolescents. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2012; 25:159-167. [PMID: 22970423 PMCID: PMC3429276 DOI: 10.1089/ped.2012.0145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/10/2012] [Indexed: 12/21/2022]
Abstract
Asthma and obesity, which have reached epidemic proportions, impact urban youth to a great extent. Findings are inconsistent regarding their relationship; no studies have considered asthma management. We explored the association of obesity and asthma-related morbidity, asthma-related health care utilization, and asthma management in urban adolescents with uncontrolled asthma. We classified 373 early adolescents (mean age=12.8 years; 82% Hispanic or Black) from New York City public middle schools into 4 weight categories: normal (body mass index [BMI]<85th percentile); overweight (85th percentile≤BMI<95th percentile); obese (95th percentile≤BMI<97th percentile); and very obese (BMI≥97th percentile). We compared sample obesity prevalence to national estimates, and tested whether weight categories predicted caregiver reported asthma outcomes, adjusting for age and race/ethnicity. Obesity prevalence was 37%, with 28% of the sample being very obese; both rates were significantly higher than national estimates. We found no significant differences in asthma-related health care utilization or asthma management between weight categories, and a few differences in asthma-related morbidity. Relative to normal weight and obese youth, overweight youth had higher odds of never having any days with asthma-related activity limitations. They also had higher odds of never having asthma-related school absences compared with obese youth. Overweight youth with asthma-related activity limitations had more days with limitations compared with normal weight youth. Overweight, but not obese youth, missed more school due to asthma than normal weight youth. Overweight and obesity prevalence was very high in urban, Hispanic, and Black adolescents with uncontrolled asthma, but not strongly associated with asthma-related morbidity, asthma-related health care utilization, or asthma management practices.
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Affiliation(s)
- Melanie Jay
- Division of General Internal Medicine, New York University School of Medicine, New York, New York
| | - N. Ari Wijetunga
- Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
| | - Cesalie Stepney
- Department of Psychology, Rutgers University, New Brunswick, New Jersey
| | - Karen Dorsey
- Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Danica Marie Chua
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York
| | - Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York
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