title: Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review.
abstract: BACKGROUND
  Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes.
  
  
  OBJECTIVE
  This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents.
  
  
  METHODS
  A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000, through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (education OR self-management OR behavioral OR technology OR trigger reduction), and the mean and/or median age of participants was between 11 and 16 years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents.
  
  
  RESULTS
  Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include objective monitoring of inhaled corticosteroid adherence with allergist and/or immunologist feedback on medication-taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings.
  
  
  CONCLUSIONS
  Novel strategies to objectively increase controller medication adherence for adolescents include allergist and/or immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills.
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill. Electronic address: giselle_mosnaim@rush.edu.
authors.forename: Giselle S
authors.initials: GS
authors.lastname: Mosnaim
authors.affiliation: Asthma and Allergy Center, Bloomingdale, Ill.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Pappalardo
authors.affiliation: University of Illinois College of Medicine, Chicago, Ill.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Resnick
authors.affiliation: Department of Immunology/Microbiology, Rush University Medical Center, Chicago, Ill.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Codispoti
authors.affiliation: Department of Immunology/Microbiology, Rush University Medical Center, Chicago, Ill.
authors.forename: Sindhura
authors.initials: S
authors.lastname: Bandi
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill.
authors.forename: Lisa
authors.initials: L
authors.lastname: Nackers
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill.
authors.forename: Rabia N
authors.initials: RN
authors.lastname: Malik
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill.
authors.forename: Vimala
authors.initials: V
authors.lastname: Vijayaraghavan
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Lynch
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill.
authors.forename: Lynda H
authors.initials: LH
authors.lastname: Powell
mesh_terms: D000293:Adolescent; D000818:Animals; D001242:Assertiveness; D001249:Asthma / Q000628:therapy*; D001521:Behavior Therapy; D003156:Community Mental Health Services; D006801:Humans; D058996:Quality Improvement; D012648:Self Care; D016896:Treatment Outcome
keywords: Adolescents; Asthma; Childhood asthma; Outcome assessment (health care); Schools