1. Promoting Self-Care in Urban African- American Teens with Asthma Barbara Velsor-Friedrich PhD, RN Maryse Richards PhD Lisa Militello MPH, MSN, CPNP, RN Regina Conway-Phillips Pedja Stevanovic Israel Gross Jamila Cunningham Kathryn Donley Steven Pearce

2. 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

3. Significance  There are approximately 9 million U.S. youth under the age of 17 years who have been diagnosed with asthma.

4. 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.

5. 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).

6. 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

7. 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.

8. 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. 9 TEAM Program Communities Median Household Income **Based on the 2000 Census

10. 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 http://www.chicagobreakingnews.com/2009/03/cps-ups-number-of-students-slain- to-27.html

11. A B C D Subject School’s Locations in Relation to Locations of CPS Violence

12. 12 Violence Chicago Teen Violence A 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)

13. CPS Public High School

14. 14 TEAM Program CPS Schools Number of Students Enrolled in 2008

15. 15 Student Participants

16. 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.

17. 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.

18. 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.

19. Preliminary Analyses  57 % of students have a diagnosis of intermittent asthma  43% of students have a diagnosis of persistent asthma

20. 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

21. CoMorbidity of Obesity

23. 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

24. 24 Student Letter about T.E.A.M Program

25. 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.

26. Funding  This study is funded by the National Institute of Nursing Research RO1 NR950202.