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Journal of Pediatric Psychology Advance Access published online on August 26, 2009
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsp074
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© The Author 2009. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Adherence to Pediatric Asthma Treatment in Economically Disadvantaged African-American Children and Adolescents: An Application of Growth Curve Analysis

Jennifer Rohan, MA1, Dennis Drotar, PhD1, Kelly McNally, MA2, Mark Schluchter, PhD3, Kristin Riekert, PhD4, Pamela Vavrek, RN5, Amy Schmidt, MPH5, Susan Redline, MD, MPH6 and Carolyn Kercsmar, MD1

1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 2Department of Psychology, University of Cincinnati, 3Department of Epidemiology and Biostatistics, Case Western Reserve University, 4Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 5University Hospitals Health System and 6Case Western Reserve University Center for Clinical Investigation

All correspondence concerning this article should be addressed to Jennifer M. Rohan, MA, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 7039, Cincinnati, OH 45229, USA. E-mail: jennifer.rohan{at}cchmc.org


  Abstract

Objectives The primary aims of the study were to: (a) describe the trajectories of adherence to daily inhaled corticosteroid (ICS) medication for a year in economically disadvantaged, African-American youth with asthma based on growth curve modeling; and (b) test the relationship of treatment adherence to symptom control, quick-relief medication, and healthcare utilization. Methods This prospective study measured adherence to daily ICS treatment using electronic monitoring in 92 children and adolescents with moderate to severe asthma for 9–12 months and assessed clinical outcomes, including asthma-related symptoms, quick-relief medication, and healthcare utilization. Results Youth showed a decrement in treatment adherence to less than half of prescribed corticosteroid treatment over the course of the study, which related to increased healthcare utilization (p < .04), but not to asthma symptoms or albuterol use. Conclusion Economically disadvantaged youth with asthma demonstrate high rates of chronic nonadherence that warrant identification and intervention to reduce asthma-related healthcare utilization.

Key words: health care utilization; pediatric asthma; treatment adherence..

Received February 25, 2009; revision received July 18, 2009; accepted July 26, 2009


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