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