Introduction: Asthma, a leading cause of childhood chronic disease, affects over 2.4 million adolescents and their families in the United States (National Center for Health Statistics [NCHS], 2015). Non-Hispanic black adolescents have disproportionately higher asthma prevalence rates and worse asthma morbidity and mortality rates compared with adolescents of other races and ethnicities (Akinbami, Moorman, Simon, & Schoendorf, 2014). While asthma is currently an incurable disease, asthma symptoms can be controlled, asthma-related morbidity and mortality reduced, and quality of life improved by following current asthma care guidelines. These guidelines include recommendations for individual, family, and provider collaboration as well as effective self-management support (National Heart, Lung, and Blood Institute [NHLBI], 2007; Szefler, Gergen, Mitchell, & Morgan, 2010). Effective asthma self-management is essential for the health, quality of life, and economic well-being of adolescents with asthma and their families. Most studies about adolescents with asthma have focused on medication adherence, a concept related to self-management, rather than on the specific preventive and relief behaviors involved in asthma self-management (Bruzzese et al., 2012; Holley et al., 2016). Many factors have been identified as correlates of adolescent asthma self-management behaviors and medication adherence (Gray et al., 2018; Holley et al., 2016). Consistent with Bandura’s Social Cognitive Theory, these correlates reflect two categories: personal factors of the adolescent (hereafter referred to as adolescent personal factors) and environmental influences within the family (hereafter referred to as family environmental influences) of adolescents with asthma. Social Cognitive Theory provides a useful framework for understanding, explaining, predicting, and controlling factors influencing adolescent asthma self-management (Bandura, 1997). Adolescent personal factors reported to significantly predict adolescent asthma self-management behaviors include age, sex, and self-efficacy (Bruzzese et al., 2012; Gray et al., 2018; Mosnaim et al., 2014; Sleath et al., 2012). Family environmental influences that have been significantly associated with adolescent asthma self-management behaviors include family history of asthma, family socioeconomic status, and perceived family support (Gray et al., 2018; Sheikh, Pitts, Ryan-Wenger, McCoy, & Hayes, 2016; Yang, Sylva, & Lunt, 2010). While these adolescent personal factors and family environmental influences have been examined separately, adolescents’ sex, self-efficacy, family history of asthma, family socioeconomic status, and perceived family support have not been examined together as predictors of adolescent asthma self-management preventive and relief behaviors. Further, no published studies were found comparing adolescent asthma self-management preventive and relief behaviors across age subgroups (i.e., early, middle, and late adolescence). Moreover, no studies were found examining the potential differential influence of adolescent personal factors and family environmental influences on adolescent asthma self-management preventive and relief behaviors across stages of adolescence. Studies of adolescents with diabetes and their families have indicated that relationships among adolescent personal factors, family environmental influences, and adolescent diabetes self-management behaviors evolve as adolescents mature (Keough, Sullivan-Bolyai, Crawford, Schilling, & Dixon, 2011; King, Berg, Butner, Butler, & Wiebe, 2014; Markowitz, Garvey, & Laffel, 2015; Wiebe et al., 2014). Additionally, findings in the chronic disease self-management literature have suggested that adolescents and their families share common experiences, concerns, developmental considerations, and behavioral patterns across chronic diseases such as diabetes and persistent asthma (Hanghoj & Boisen, 2014; Heath, Farre, & Shaw, 2017; Martire & Helgeson, 2017). Given the commonalities between diabetes and persistent asthma for adolescents and their families and the dramatic developmental changes that occur during adolescence, asthma self-management preventive and relief behaviors likely vary across age subgroups. Moreover, similar to the findings from studies of adolescents with diabetes and their families, an evolving interplay of adolescent personal factors, family environmental influences, and asthma self-management preventive and relief behaviors is likely to be found for adolescents with asthma and their families.
Aims: The specific aims of this study of adolescents with persistent asthma are (a) to determine how asthma self-management preventive and relief behaviors differ by age subgroups (i.e., early, middle, and late adolescence); and (b) to determine the extent to which adolescent personal factors (e.g., sex and asthma self-management self-efficacy) and family environmental influences (e.g., family history of asthma, family socioeconomic status, and perceived family support) predict asthma self-management preventive and relief behaviors across age subgroups.
Methods: The proposed study is a secondary analysis of data using a descriptive-correlational design to characterize the study sample of 373 predominately non-Hispanic black adolescents (ages 12 – 20 years) with persistent asthma and address the study aims. Specifically, we will examine baseline survey data for associations among adolescent personal factors (e.g., sex and asthma self-management self-efficacy), family environmental influences (e.g., family history of asthma, family socioeconomic status, and perceived family support), and asthma self-management preventive and relief behaviors. Data were derived from participants previously enrolled in an adolescent asthma self-management intervention trial conducted in three large metropolitan cities. Adolescent age and sex, and family socioeconomic status (e.g., parent education level, parent relationship status, estimated annual household income, number of people living in the home with the teen, and health insurance type) were assessed using parent responses on a Demographic Information Form. Family history of asthma was assessed using parent self-report data from an Asthma Information Form. Asthma self-management self-efficacy, asthma self-management preventive behaviors, and asthma self-management relief behaviors were measured in the intervention trial using scores calculated from adolescent responses on each of the three scales of the Asthma Self-management Indices, respectively. The Asthma Self-management Indices is a self-report instrument comprised of three subscales, the 11-item Asthma Prevention Index, the 9-item Asthma Management Index, and the 14-item Asthma Management Self-efficacy Index (Bruzzese, Evans, and Mellins, 2011). Perceived family support was measured by adolescent self-report using the 20-item Perceived Social Support-Family Measure (Procidano & Heller, 1983). We will also estimate associations among adolescent personal factors (e.g., sex and asthma self-management self-efficacy), family environmental influences (e.g., family history of asthma, family socioeconomic status, and perceived family support), and asthma self-management preventive and relief behaviors for the entire sample and by age subgroups (i.e., early, middle, and late adolescence). Descriptive statistics will be used to summarize demographic data, asthma self-management self-efficacy, family history of asthma, family socioeconomic status, perceived family support, asthma self-management preventive behaviors, and asthma self-management relief behaviors. We will estimate Cronbach alpha coefficients for each study instrument as appropriate. Associations between variables will be examined by estimating Pearson’s or Spearman’s correlation coefficients. Multiple linear regression will be used to determine the extent to which adolescent personal factors and family environmental influences predict asthma self-management preventive and relief behaviors. Further, we will determine the extent to which these predictive relationships differ across age subgroups. An a priori alpha significance level of p ≤ .05 will be used for all statistical tests.
Results/Discussion: Study findings could inform clinical practice and the care of adolescents with asthma and their families. Findings could also be used to design more tailored and developmentally-appropriate asthma self-management interventions for adolescents and their families. Because 97% of the participants included in this sample are non-Hispanic black adolescents, this theory-guided study could better inform the care of an understudied population disproportionately affected by asthma and adverse health outcomes. Thus, findings could also determine the utility of Social Cognitive Theory in explaining outcomes and informing solutions in this population experiencing significant health disparities.
