promoting self-care in urban african- american teens with asthma barbara velsor-friedrich phd, rn...

Promoting Self-Care in Urban African-American Teens with Asthma

Barbara Velsor-Friedrich PhD, RNMaryse Richards PhD

Lisa Militello MPH, MSN, CPNP, RNRegina Conway-Phillips

Pedja StevanovicIsrael Gross

Jamila CunninghamKathryn DonleySteven Pearce

Conflict of Interest

This educational activity is presented without the provision of commercial support and without bias or conflict of interest from the planners and presenters

Significance

There are approximately 9 million U.S. youth under the age of 17 years who have been diagnosed with asthma.

Significance

Approximately 19% of all U.S. high school students have been diagnosed with asthma at some point in their lives.

Asthma disproportionately effects minority populations.

Adolescents are particularly at risk for poor control of this life-threatening disease.

Purpose

To evaluate the efficacy of a school-based program TEAM (Teen Educational Asthma Management) on self-care, asthma related quality of life, asthma knowledge, asthma self-efficacy, coping and asthma health outcomes (FEV1, mean peak flow reading, symptom days, asthma related ED visits, hospitalizations, school absences).

TEAM Program

1) Baseline Physical with a Nurse Practitioner & Development of Individual Asthma Action Plan

2) Two Asthma Education Sessions 3) Six Coping Skills Training Sessions

(treatment group only). 4) Four Nurse Practitioner Follow-Up Visits

Coping Skills Training

A cognitive behavior strategy that teaches students personal and social coping skills to assist in making health related decisions.

Skills taught include: problem-solving, effective communication, stress management, cognitive-behavior modification, and conflict resolution.

Sample

A total of 134 African-American low-income urban teens with intermittent or persistent asthma will be enrolled in the study over a four year period.

All students attend urban high schools with school-based health centers (SBHC).

9

TEAM Program Communities

Median Household Income

**Based on the 2000 Census

10

CPS Student Deaths

*C. Sadovi - Chicago Tribune, March 12, 2009 http://www.chicagobreakingnews.com/2009/03/cps-ups-number-of-students-slain-to-27.html

A

BC

D

Subject School’s Locations

in Relation to Locations

of CPS Violence

12

Violence

Chicago Teen ViolenceA High School student wears a jacket with a long list of names of people who have died, as he heads into school Monday, March 24, 2008, in Chicago. Following the slaying of a student earlier this month, community leaders, parents and police gathered for "Operation Safe Passage," an effort to encourage school attendance by acting as escorts for the students as they travel to and from school. (AP Photo/The Tribune, Nancy Stone)

CPS Public High School

14

TEAM Program CPS Schools

Number of Students Enrolled in 2008

15

Student Participants

Methods

The school-based NP identifies and recruits students.

All students complete baseline instruments and health outcome measures.

A baseline physical exam is conducted by the TEAM NP and an asthma action plan is developed for each student in the program.

Randomization then occurs by school.

Methods

All students attend two asthma ed sessions. Students in the treatment group attend six coping

skills training session. All students are seen by the TEAM NP for four

monthly follow-up and reinforcement visits. Students in both groups will be compared at three

posttest times: 2, 6, and 12 months.

Currently

After year one, there are 51 students from four urban high schools enrolled in the study.

Mean Age = 15.5 years. Range = 14 – 18 Gender = Females 65% and Males 35% Treatment Group = 22 Control Group = 29 One cohort has completed the 12 month posttest

and a second cohort is at the intervention phase.

Preliminary Analyses

57 % of students have a diagnosis of intermittent asthma

43% of students have a diagnosis of persistent asthma

Preliminary Analyses

African Americans are diagnosed with obesity at disproportionately higher rates than their Caucasian counterparts

An alarming number of T.E.A.M program participants have a comorbidity of obesity Fifty-four percent (54%) of students from year

one are Obese An additional 10% are Overweight

Per NHANES/CDC Guidelines

CoMorbidity of Obesity

CoMorbidity of Obesity

TEAM Participants BMI Stratified by Adult Classification

7%

33%

18%

13%

9%

20%

underweight normal overweight

obese 1 obese 2 obese 3

Currently

One cohort has completed the 12 month posttest and a second cohort is at the intervention phase.

Treatment group showing positive trends in mean scores in asthma quality of life coping with asthma self-efficacy

24

Student Letter about T.E.A.M Program

Implications

The findings of this study will improve care to an under served population of African-American teens with asthma and will have significant implications for health care providers, researchers, and policy makers.

Funding

This study is funded by the National Institute of Nursing Research RO1 NR950202.