The Effects of Coping Skills Training in Low-Income Urban African-American

Adolescents with Asthma

State of the Science Congress on Nursing Research

September 14, 2012

The Effects of Coping Skills Training in Low-Income Urban African-American

Adolescents with Asthma

Principal InvestigatorBarbara Velsor-Friedrich PhD, RN

Co-PI’sMaryse Richards, PhD

Jerold Sterling MD, FAAPGary Sigman MDFred Bryant, PhD

Project ManagerLisa Militello MPH, MSN, CPNP

The Effects of Coping Skills Training in Low-Income Urban African-American

Adolescents with Asthma

Research AssistantsRegina Conway-Phillips

Israel GrossEdna Romero

Patrick HarrisonProvost Scholars

Lauren WedelMaria Smith

Undergraduate AssistantAmanda Stoltz

T.E.A.M.

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 7 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.

Approximately 14 million school days are lost per year.

Health care and lost productivity costs are estimated at $14.2 billion/year.

Significance

Asthma disproportionately effects minority populations.

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

Significance

Exacerbations of asthma can be affected by psychosocial stress that is often associated with social conditions of poverty and neighborhood stress.

Coping strategies may counteract some of the negative outcomes associated with stress.

Purpose

To evaluate the efficacy of a school-based program TEAM (Teen Educational Asthma Management) on asthma 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) Five Coping Skills Training Sessions + one

booster session (treatment group only). 4) Four Nurse Practitioner Follow-Up Visits Students in both groups were compared at three

posttest times: 2, 6, and 12 months.

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 restructuring, and conflict resolution.

Problem Solving

Alternative ways of dealing with situations and potential consequences of those alternatives; choose a method and evaluate outcomes.

Effective Communication

Help participants express themselves in ways that are clear, appropriate and constructive.

Review forms of communication.

Discuss guidelines for speaking and listening.

Managing Stress

Teach a variety of stress management techniques (deep breathing, muscle relaxation & guided imagery).

Cognitive Restructuring

Recognition of thoughts and feelings Changing negative thoughts into positive

thoughts (self-talk)

Conflict Resolution

Focuses on reassessing conflict situations with the goal of finding a “win-win” resolution.

Coping Skills Training

First the aspects of the skills are taught Then an asthma-health scenario is described where

the skill can be used Participants are asked to describe how the skill can

be implemented in the asthma scenario Participants are asked to practice the skill that week The next sessions starts with an update of their use

of the skill and any questions

Fliers were posted around the schools

School based NP assisted in recruitment

TEAM recruitment table during student orientation and report card pick up days

Recruitment

Sample

A total of 137 African-American low-income urban teens with intermittent or persistent asthma were enrolled in the study over a four year period.

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

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CPS Student Deaths

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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. 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

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Student Participants

Parent Asthma Questionnaire Asthma Self-Care Asthma Quality of Life Asthma Knowledge Asthma Self-Efficacy Kid Cope Asthma Health Outcomes (FEV1, PEFR, symptom

days, ED visits/hospitalizations & school absences)

Instruments

Baseline

Mean Age = 15.5 years. Range = 13 – 18 Gender = Females 65% and Males 35% Asthma QOL scores indicated a moderate level of

impairment for all students Only 53% of students were determined to be in

control of their asthma.

Analyses

Data was entered, checked and cleaned.

Missing data was imputed via the maximization likelihood method

Using an intent to treat approach, mixed model ANOVAs were used to analyze the data.

Findings

Both groups improved over time, with significant increases in: Asthma related-qol (p < .05) Asthma knowledge (p < .01) Asthma self-efficacy (p < .001)

Significant Decreases in: Symptom days (p < .001) School Absences (P < .001)

Findings

However, there were no significant differences between groups on any of the outcome variables.

In the intervention group, increased treatment dosage was significantly associated with decreased asthma symptoms (p = .05) and marginally associated with increased asthma self-care (p = .07).

The intervention was most effective among participants reporting poorer asthma control.

Limitations

Students with persistent asthma were more difficult to recruit as they often had other school issues that kept them out of school.

Level of attention control received by both groups may have impacted the findings.

Limitations

High mobility rates, competing academic or school-related events and violence often interfered with the routine delivery of the program.

75% of students attended 4/5 (80%) of the CST sessions.

T.E.A.M Student Letter

Implications

The findings of this study highlight the utilization of an innovative education program for vulnerable African-American teens with asthma. The use of a group-based intervention delivered in the school setting was beneficial for low-income minority teens with asthma.

Funding

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

What’s Next?

ICAN (I Can Control Asthma and Nutrition Now) pilot completed this past fall. Asthma Education Nutrition Education integrated with CST Parent Session Re-enforcement visits with the NP and Dietitic

Interns