It is essential to know what motivates people to engage in health behaviors, especially when risks are great. Risks are great for children with asthma. Asthma is a chronic, debilitating, life-threatening, and costly disorder that disproportionately affects young, poor, and minority children, who must also rely on caregivers to meet their health care needs. The National Heart, Lung and Blood Institute (NHLBI) has created a strategic plan to address health disparities for asthma. In addition, the NHBLI coordinated an expert panel to develop national clinical guidelines for the diagnosis and management of asthma. Despite these guidelines and advances in treatment, morbidity and mortality rates of pediatric asthma are not improving. Caregiver behavior may be a factor, particularly as it pertains to the control of asthma triggers like environmental tobacco smoke (ETS). Self-determination theory (SDT) has been useful in predicting health behaviors in many contexts. According to SDT, persons persist in behaviors when they feel autonomously motivated (AM) for and perceive themselves to be competent (PC) about engaging in a particular behavior. Investigators have demonstrated that when clinicians support patients'autonomy and competence (are autonomy supportive;AS), behavior change is facilitated and health outcomes improved. SDT research to date, however, has focused on health behavior change for one's own sake (e.g. stopping smoking) while altruistic behavior change, for the primary benefit of others, has not been studied. Research to examine SDT as a theoretical framework consistent with the technique of motivational interviewing (Ml) is also new. Ml holds promise in assisting caregivers to adopt altruistic behaviors such as ETS control and is an intervention component of the larger randomized clinical trial (RCT) in which this cross-sectional, correlational study is nested. A sample of 304 caregivers of children with persistent asthma enrolled in a school-based medication program will be surveyed to address these specific aims: 1. To determine the role of AM and PC in predicting altruistic ETS control via caregiver smoking bans;2. To describe the influence of autonomy support (AS) on SDT variables of behavior change for caregivers in the Ml intervention group;and 3. To determine the indirect relationships between AS, through AM and PC, and ETS control behavior among caregivers receiving Ml, if direct relationships are supported. Study findings will improve understanding of what motivates caregivers to keep smoke away from their children with asthma. This information will help to guide future research and interventions to reduce asthma burden, especially for families at greatest risk.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of Rochester
Schools of Nursing
United States
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