Nonadherence to medical regimens is a pervasive and significant problem in chronic illness treatment affecting patient health and quality of life, clinical decisions, and health care costs. Approximately 50 percent of children and 65 to 75 percent of adolescent chronic illness patients are nonadherent. Studies have consistently shown that patient and family behavioral factors contribute to poorer adherence in children and adolescents. However, no standardized treatment protocol for nonadherence in adolescents exists. Multicomponent behavioral treatments that target patient and family factors have demonstrated significant improvements in adherence to medication in young children;however, research is needed to develop behavioral interventions targeting nonadherence in adolescents, particularly those with inflammatory bowel disease (IBD), as they are an understudied population with nonadherence rates as high as 62 percent. The long-term objective of this application is to provide a basis for continued development of effective treatments for nonadherence, particularly in pediatric IBD.
The specific aim of the proposed research plan is to design a behavioral group treatment targeting medication nonadherence, and test the efficacy of this treatment in adolescents with IBD via a randomized controlled clinical trial. The intervention will use a multimethod assessment approach and integrate quantitative and qualitative data to target educational, organizational, and behavioral factors. We will test the hypotheses that the intervention will be feasible and acceptable, and that patients in the treatment condition will demonstrate improvement in medication adherence, disease functioning, and quality of life compared to patients in a usual care control condition. This application will advance the development of Dr. Kevin Hommel, a pediatric psychologist, as an independent investigator through a career development plan that includes 1) focused mentorship and collaboration with senior investigators, 2) didactic training in treatment outcome research, pharmacology, data analysis, health economics, and bioethics, 3) clinical and research training seminars, and 4) professional development activities. Relevance: Results of this research will contribute to public health by providing a basis for continued development of behavioral treatments for adolescent medical nonadherence. These evidence-based interventions should ultimately improve the effectiveness of health care and patient quality of life.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHD1-DSR-M (HB))
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Podskalny, Judith M,
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Cincinnati Children's Hospital Medical Center
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Leonard, Mary B; Shults, Justine; Long, Jin et al. (2016) Effect of Low-Magnitude Mechanical Stimuli on Bone Density and Structure in Pediatric Crohn's Disease: A Randomized Placebo-Controlled Trial. J Bone Miner Res 31:1177-88
Gray, Wendy N; Boyle, Shana L; Graef, Danielle M et al. (2015) Health-related quality of life in youth with Crohn disease: role of disease activity and parenting stress. J Pediatr Gastroenterol Nutr 60:749-53
Pai, Ahna L H; Tackett, Alayna; Hente, Elizabeth A et al. (2014) Assessing psychosocial risk in pediatric inflammatory bowel disease: validation of the Psychosocial Assessment Tool 2.0_General. J Pediatr Gastroenterol Nutr 58:51-6
Guilfoyle, Shanna M; Gray, Wendy N; Herzer-Maddux, Michele et al. (2014) Parenting stress predicts depressive symptoms in adolescents with inflammatory bowel disease. Eur J Gastroenterol Hepatol 26:964-71
Mackner, Laura M; Greenley, Rachel Neff; Szigethy, Eva et al. (2013) Psychosocial issues in pediatric inflammatory bowel disease: report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 56:449-58
Wu, Yelena P; Pai, Ahna L H; Gray, Wendy N et al. (2013) Development and reliability of a correction factor for family-reported medication adherence: pediatric inflammatory bowel disease as an exemplar. J Pediatr Psychol 38:893-901
Gray, Wendy N; Graef, Danielle M; Schuman, Shana S et al. (2013) Parenting stress in pediatric IBD: relations with child psychopathology, family functioning, and disease severity. J Dev Behav Pediatr 34:237-44
Hommel, Kevin A; Hente, Elizabeth; Herzer, Michele et al. (2013) Telehealth behavioral treatment for medication nonadherence: a pilot and feasibility study. Eur J Gastroenterol Hepatol 25:469-73
Greenley, Rachel N; Kunz, Jennifer H; Walter, Jennifer et al. (2013) Practical strategies for enhancing adherence to treatment regimen in inflammatory bowel disease. Inflamm Bowel Dis 19:1534-45
Schuman, Shana L; Graef, Danielle M; Janicke, David M et al. (2013) An exploration of family problem-solving and affective involvement as moderators between disease severity and depressive symptoms in adolescents with inflammatory bowel disease. J Clin Psychol Med Settings 20:488-96

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