Asthma is the most common cause of hospitalization in children other than infections. The Health People 2000 initiative to reduce asthma hospitalizations was NOT met. Minority, inner city children, particularly adolescents, appear to be most at risk for high morbidity and mortality. Poor illness management is thought to be a primary driver of asthma morbidity and mortality. Yet, there are very few randomized controlled trials with inner city adolescents with asthma. Because of the complexity of asthma management and the associated barriers, intensive, multi-component interventions are needed to improve outcomes among those at highest risk. The investigators have adapted Multisystemic Therapy (MST), an innovative home- and community-based psychotherapy, to successfully improve treatment adherence and outcomes in urban pediatric medical populations. The objective of the present study is to utilize MST to improve asthma management and to reduce health care utilization (emergency department visits and hospitalizations) among high risk African American adolescents (ages 12-16) with moderate to severe persistent asthma. High risk is defined as having >=2 emergency department visits or >= 1 hospitalizations in 12 months). Additional aims are to determine the stability of MST's effects over a 12 month interval and to determine cost-effectiveness of the intervention. Families will be recruited from the only university-affiliated medical center in Detroit, Michigan. Detroit has the highest percentage of African Americans of any major city in the United States. The experimental design for the proposed study is a randomized controlled trial with 170 high risk African American adolescents with moderate to severe persistent asthma, 85 of whom will receive standard multidisciplinary specialty care (control condition) and 85 of whom will receive this care plus MST. Families will complete an initial data collection session (baseline), a 7-month post-test designed to coincide with treatment completion, and a subsequent post-test at 12 months after baseline. If successful, this intervention will provide immediate assistance to a vulnerable population disproportionately affected by asthma and may reduce costs of care for this high risk population. While asthma is the second most common cause of hospitalization in children, minority, inner city teens are at increased risk for complications from the disease. We are testing the effectiveness of an intervention for inner city African American teens with asthma using Multisystemic Therapy an intensive, home- and community-based psychotherapy. If successful, this intervention will improve asthma management and overall health, as well as reduce healthcare costs for this vulnerable population disproportionately affected by asthma.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL087272-02
Application #
7664603
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Smith, Robert A
Project Start
2008-09-01
Project End
2013-06-30
Budget Start
2009-07-01
Budget End
2010-06-30
Support Year
2
Fiscal Year
2009
Total Cost
$745,029
Indirect Cost
Name
Wayne State University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
001962224
City
Detroit
State
MI
Country
United States
Zip Code
48202
Ellis, Deborah A; King, Pamela; Naar-King, Sylvie (2016) Mediators of Treatment Effects in a Randomized Clinical Trial of Multisystemic Therapy-Health Care in Adolescents With Poorly Controlled Asthma: Disease Knowledge and Device Use Skills. J Pediatr Psychol 41:522-30
Naar-King, Sylvie; Ellis, Deborah; King, Pamela S et al. (2014) Multisystemic therapy for high-risk African American adolescents with asthma: a randomized clinical trial. J Consult Clin Psychol 82:536-45
Bruzzese, Jean-Marie; Idalski Carcone, April; Lam, Phebe et al. (2014) Adherence to asthma medication regimens in urban African American adolescents: application of self-determination theory. Health Psychol 33:461-4
Ellis, Deborah A; King, Pamela; Naar-King, Sylvie et al. (2014) Effects of family treatment on parenting beliefs among caregivers of youth with poorly controlled asthma. J Dev Behav Pediatr 35:486-93
Naar-King, Sylvie; Lam, Phebe; Ellis, Deborah et al. (2013) Asthma medication device skills in high-risk African American adolescents. J Asthma 50:579-82