Treatment adherence among low-income, African American children with persistent asthma.

OBJECTIVE: The study aims to assess medication adherence and asthma management behaviors and their modifiable predictors in low-income children with persistent asthma. METHODS: The authors conducted a cohort study of 143 children ages 6 to 11 prescribed a daily inhaled controller medicine that could be electronically monitored. Children were recruited from clinics or the emergency department of an urban children's hospital. Data were collected at baseline (T1) and 1 year later (T2). Outcome measures were adherence to controller medications as measured by electronic monitoring devices, observed metered-dose inhaler and spacer technique, exposure to environmental tobacco smoke, and attendance at appointments with primary health care provider. RESULTS: Medication adherence rates varied across medications, with higher rates for montelukast than for fluticasone. Eleven percent to 15% of children demonstrated metered dose inhaler and spacer technique suggesting no drug delivery, and few (5% to 6%) evidenced significant exposure to environmental tobacco smoke. Less than half of recommended health care visits were attended over the study interval. Few psychosocial variables were associated with adherence at T1 or in the longitudinal analyses. Fluticasone adherence at T2 was predicted by caregiver asthma knowledge. CONCLUSIONS: A substantial number of low-income children with persistent asthma receive less than half of their prescribed inhaled controller agent. Patients without Medicaid, with low levels of caregiver asthma knowledge, or with caregivers who began childrearing at a young age may be at highest risk for poor medication adherence.

Patterns of decision making by wives of patients with life-threatening cardiac disease.

Implementation of the Patient Self-Determination Act (PSDA) in the United States has transferred decision making from the responsibility of health care professionals to the responsibility of family members. Dilemmas occurring as a result of this responsibility may cause stress and conflict among family members. The purpose of this study is to describe the patterns of decision making by family members of patients with life-threatening cardiac disease. Purposive sampling is used to select 10 wives of patients with life-threatening cardiovascular disease. Data are gathered through unstructured interviews and are analyzed using grounded theory and theory triangulation. Analysis of the data reveal three patterns of decision making: advocacy, acquiescence, and abdication.

Father and adolescent son variables related to son's HIV prevention.

The purpose of this study was to examine the relationship between fathers' influences and African American male adolescents' perceptions of self-efficacy to reduce high-risk sexual behavior. A convenience sample of 70 fathers was recruited from churches in a large metropolitan area in the South. Hierarchical multiple linear regression analysis indicated father-related factors and son-related factors were associated with 26.1% of the variance in son's self-efficacy to be abstinent. In the regression model greater son's perception of the communication of sexual standards and greater father's perception of his son's self-efficacy were significantly related to greater son's self-efficacy for abstinence. The second regression model with son's self-efficacy for safer sex as the criterion was not statistically significant. Data support the need for fathers to express confidence in their sons' ability to be abstinent or practice safer sex and to communicate with their sons regarding sexual issues and standards.

Predictors of father-son communication about sexuality.

Examining the factors that influence adolescents' sexual behaviors is crucial for understanding why they often engage in risky sexual behaviors. Using social cognitive theory, we examined predictors of father-son communication about sexuality. Fathers (N=155) of adolescent sons completed a survey measuring 12 variables, including self-efficacy and outcome expectations. We found that (a) son's pubertal development, father's sex-based values, father's education; father's communication with his father, outcome expectations, and general communication accounted for 36% of the variance in information sharing communication and (b) son's pubertal development, outcome expectations, general communication, and father-son contact accounted for 20% of the variance in values sharing communication. Study findings can aid professionals in designing guidelines for programs to promote father-son general communication and sex-based communication.

A home visiting asthma education program: challenges to program implementation.

This study describes the implementation of a nurse home visiting asthma education program for low-income African American families of young children with asthma. Of 55 families, 71% completed the program consisting of eight lessons. The achievement of learning objectives was predicted by caregiver factors, such as education, presence of father or surrogate father in the household, and safety of the neighborhood, but not by child factors, such as age or severity of asthma as implied by the prescribed asthma medication regimen. Incompatibility between the scheduling needs of the families and the nurse home visitors was a major obstacle in delivering the program on time, despite the flexibility of the nurse home visitors. The authors suggest that future home-based asthma education programs contain a more limited number of home visits but add telephone follow-ups and address the broader needs of low-income families that most likely function as barriers to program success.

The physical, behavioral, and psychosocial consequences of Internet use in college students.

The purposes of this study were to identify the physical, behavioral, and psychosocial consequences of Internet use in undergraduate college students; and to evaluate whether time, social norms, and adopter category predict the consequences of Internet use. Rogers' model for studying consequences of innovation was adapted for this study. A descriptive, correlational design was used. Convenience sampling yielded 293 undergraduate students who answered the online survey. Consequences of Internet use were assessed with the researcher-developed instrument, the Internet Consequences Scale (ICONS). Mean scores on the behavioral and psychosocial subscales of the ICONS indicated positive consequences of Internet use, while the physical consequences subscale revealed negative consequences. Multiple regression analyses revealed a small, but significant, amount of variance in consequences of Internet use that could be explained by time, social norms, and adopter category, thus supporting the adapted model for the study of consequences of Internet use in college students.

Buddy programs for people infected with HIV.

The purposes of this correlational study were to describe and compare clients' and volunteers' perceptions of a buddy program for people infected with HIV and to identify relationships between social support and clients' quality of life. Clients' social support was assessed with the Interpersonal Support Evaluation List(ISEL), and their quality of life was assessed with the Medical Outcomes Study-HIV (MOS-HIV) Scale. Clients' and volunteers' perceptions of satisfaction and assistance with activities were assessed with researcher-developed instruments. A convenience sample of 46 client-volunteer dyads was recruited from five AIDS service organizations. Clients perceived adequate levels of social support, moderate amounts of assistance, high levels of satisfaction with client-volunteer relationships, and moderate to low quality of life. A positive relationship was found between clients' and volunteers' perceptions of satisfaction. Relationships were found between ISEL subscales and the Health Transition and Mental Health subscales of the MOS-HIV and the MOS-HIV total scale scores. The findings of the study provide support for the continuation of buddy programs.

Home-based asthma education of young low-income children and their families.

OBJECTIVE: To conduct a controlled trial of a home-based education program for low-income caregivers of young children with asthma. METHODS: Participants were randomized to treatment-eight weekly asthma education sessions adapted from the Wee Wheezers program (n = 49)-or usual care (n = 46). Baseline and 3- and 12-month follow-up data were gathered from caregivers and from children's medical records. RESULTS: Treatment was associated with less bother from asthma symptoms, more symptom-free days, and better caregiver quality of life at follow-up for children 1-3, but not those 4-6, years of age. Treatment and control groups did not differ in caregiver asthma management behavior or children's acute care utilization. CONCLUSIONS: This home-based asthma education program was most effective with younger children; perhaps their caregivers were more motivated to learn about asthma management. Targeting psychosocial factors associated with asthma morbidity might also enhance the efficacy of asthma education for these families.