title: The impact of peer support and mp3 messaging on adherence to inhaled corticosteroids in minority adolescents with asthma: a randomized, controlled trial.
abstract: BACKGROUND
  Poor adherence to inhaled corticosteroids (ICS) is a critical risk factor contributing to asthma morbidity among low-income minority adolescents.
  
  
  OBJECTIVE
  This trial tested whether peer support group meetings and peer asthma messages delivered via mp3 players improved adherence to ICS.
  
  
  METHODS
  Low-income African American and/or Hispanic adolescents, ages 11-16 years old, with persistent asthma, and poor (≤ 48%) adherence to prescription ICS during the 3-week run-in were randomized to intervention or attention control groups (ATG) for the 10-week treatment. During treatment, the intervention arm subjects participated in weekly coping peer group support sessions and received mp3 peer-recorded asthma messages that promoted adherence. The ATG participated in weekly meetings with a research assistant and received an equivalent number of mp3 physician-recorded asthma messages. Adherence was measured by using self-report and the Doser CT, an electronic dose counter. The primary outcome was the difference in adherence at 10 weeks between the 2 arms.
  
  
  RESULTS
  Thirty-four subjects were randomized to each arm. At 10 weeks, no statistical difference in objectively measured adherence could be detected between the 2 arms when adjusting for baseline adherence (P = .929). Adherence declined in both groups over the course of the active treatment period. In both study arms, self-reported adherence by participants was significantly higher than their objectively measured adherence at week 10 (P < .0001).
  
  
  CONCLUSIONS
  Improving medication adherence in longitudinal studies is challenging. Peer support and mp3-delivered peer asthma messages may not be of sufficient dose to improve outcomes.
authors.affiliation: Department of Preventive Medicine, Rush Medical College, Chicago, Ill. Electronic address: giselle_mosnaim@rush.edu.
authors.forename: Giselle
authors.initials: G
authors.lastname: Mosnaim
authors.affiliation: Department of Preventive Medicine, Rush Medical College, Chicago, Ill.
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Preventive Medicine, Rush Medical College, Chicago, Ill.
authors.forename: Molly
authors.initials: M
authors.lastname: Martin
authors.affiliation: Department of Preventive Medicine, Rush Medical College, Chicago, Ill; Department of Mathematics and Computer Studies, Lake Forest College, Lake Forest, Ill.
authors.forename: DeJuran
authors.initials: D
authors.lastname: Richardson
authors.affiliation: Department of Preventive Medicine, Rush Medical College, Chicago, Ill.
authors.forename: Paula Jo
authors.initials: PJ
authors.lastname: Belice
authors.affiliation: Department of Preventive Medicine, Rush Medical College, Chicago, Ill.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Avery
authors.affiliation: Department of Family Practice, Rush Medical College, Chicago, Ill.
authors.forename: Norman
authors.initials: N
authors.lastname: Ryan
authors.affiliation: Department of Pediatrics, National Jewish Health, Denver, Colo.
authors.forename: Bruce
authors.initials: B
authors.lastname: Bender
authors.affiliation: Department of Preventive Medicine, Rush Medical College, Chicago, Ill.
authors.forename: Lynda
authors.initials: L
authors.lastname: Powell
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D055539:MP3-Player; D008297:Male; D055118:Medication Adherence; D008913:Minority Groups; D010379:Peer Group; D012944:Social Support
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Adolescents; Asthma knowledge; Childhood asthma; Health status disparities; Inner city; Medication adherence; Outcome assessment (health care)