Promoting SelfCare in Urban AfricanAmerican Teens with Asthma

1
Promoting Self-Care in Urban African-American
Teens with Asthma

• Barbara Velsor-Friedrich PhD, RN
• Maryse Richards PhD
• Lisa Militello MPH, MSN, CPNP, RN
• Regina Conway-Phillips
• Pedja Stevanovic
• Israel Gross
• Jamila Cunningham
• Kathryn Donley
• Steven Pearce

2
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

3
Significance

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

4
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.

5
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).

6
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

7
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.

8
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
Based on the 2000 Census
Median Household Income
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
11
A
Subject Schools Locations in Relation to
Locations of CPS Violence
B
C
D
12
Violence
Chicago Teen Violence
A 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)
13
CPS Public High School
14
TEAM Program CPS Schools
Number of Students Enrolled in 2008
15
Student Participants
16
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.

17
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.

18
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.

19
Preliminary Analyses

• 57 of students have a diagnosis of intermittent
  asthma
• 43 of students have a diagnosis of persistent
  asthma

20
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

21
CoMorbidity of Obesity
22
CoMorbidity of Obesity
23
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
25
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.

26
Funding

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