***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Asthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children . Low rates of asthma preventer medication adherence is a major contributor to poor asthma control in these patients . Web-based methods have potential to improve patient knowledge and medication adherence by providing interactive patient education , monitoring of symptoms and medication use , and by facilitation of communication and teamwork among patients and health care providers . Few studies have evaluated web-based asthma support environments using all of these potentially beneficial interventions . The multidimensional website created for this study , BostonBreathes , was design ed to intervene on multiple levels , and was evaluated in a pilot trial . Methods An interactive , engaging website for children with asthma was developed to promote adherence to asthma medications , provide a platform for teamwork between caregivers and patients , and to provide primary care providers with up-to- date symptom information and data on medication use . Fifty-eight ( 58 ) children primarily from inner city Boston with persistent-level asthma were r and omised to either usual care or use of BostonBreathes . Subjects completed asthma education activities , and reported their symptoms and medication use . Primary care providers used a separate interface to monitor their patients ’ website use , their reported symptoms and medication use , and were able to communicate online via a discussion board with their patients and with an asthma specialist . Results After 6-months , reported wheezing improved significantly in both intervention and control groups , and there were significant improvements in the intervention group only in night-time awakening and parental loss of sleep , but there were no significant differences between intervention and control groups in these measures . Emergency room or acute visits to a physician for asthma did not significantly change in either group . Among the subgroup of subjects with low controller medication adherence at baseline , adherence improved significantly only in the intervention group . Knowledge of the purpose of controller medicine increased significantly in the intervention group , a statistically significant improvement over the control group . Conclusions This pilot study suggests that a multidimensional web-based educational , monitoring , and communication platform may have positive influences on pediatric patients ’ asthma-related knowledge and use of asthma preventer medications OBJECTIVE Determine whether Multisystemic Therapy-Health Care ( MST-HC ) improved asthma knowledge and controller device use skills among African-American youth with poorly controlled asthma and whether any improvements mediated changes in illness management . METHODS A r and omized controlled trial was conducted with 170 adolescents with moderate to severe asthma . Families were r and omized to MST-HC or attention control . Data were collected at baseline and 6 and 12 months after intervention completion . RESULTS In linear mixed models , adolescents in the MST-HC group had increases in asthma knowledge ; asthma knowledge was unchanged for attention control . Controller device use skills increased for adolescents in the MST-HC group , while skills declined for attention control . Both knowledge and skills mediated the relationship between intervention condition and changes in illness management . CONCLUSIONS Tailored , home-based interventions that include knowledge and skills building components are one means by which illness management in African-American youth with poorly controlled asthma can be improved Background . The ability to identify potentially resistant participants early in the course of an intervention could inform development of strategies for behavior change and improve program effectiveness . Objective . The objective of this analysis was to identify factors related to nonresponse ( i.e. , lack of behavior change ) to an  asthma management intervention  for urban teenagers . The intervention targeted several behaviors , including medication adherence , having a rescue inhaler nearby , and smoking . Methods . A discriminate analysis was conducted using data from a r and omized trial of the intervention . Included in this analysis are participants who reported a physician diagnosis of asthma , completed a baseline question naire , were r and omized to the treatment group , completed ≥2 of 4 educational sessions , and completed ≥2 of 3 follow-up question naires . Ninety students met criteria for inclusion in this subgroup analysis . Results . In logistic regression models for medication adherence , nonresponse was related to low baseline asthma self-regulation , odds ratio = 3.6 ( 95 % confidence interval = 1.3–9.5 ) . In models for having an inhaler nearby , nonresponse was related to low baseline self-regulation and to rebelliousness , OR = 4.7 ( 1.6–13.2 ) and 5.6 ( 1.7–18.0 ) , respectively . Nonresponse to smoking messages was related to rebelliousness , low emotional support , and low religiosity , ORs = 7.6 ( 1.8–32.3 ) , 9.5 ( 1.4–63.5 ) , and 6.6 ( 1.5–29.8 ) respectively . Conclusions . Certain variables had the ability to discriminate the likelihood of response from that of nonresponse to an asthma program for urban , African American adolescents with asthma . These variables can be used to identify resistant subgroups early in the intervention , allowing the application of specialized strategies through tailoring . These types of analyses can inform behavioral interventions BACKGROUND Accurate assessment of medication adherence has been difficult to achieve but is essential to drug evaluation in clinical trials and improved outcomes in clinical care . OBJECTIVE This study was conducted to compare four adherence assessment methods : child report , mother report , canister weight , and electronic measurements of metered dose inhaler ( MDI ) actuation . METHODS Participants included 27 children with mild-to-moderate asthma who were followed prospect ively for 6 months . All patients used an MDI equipped with an electronic Doser attached to their inhaled steroid . At each 2-month follow-up visit , Doser and canister weight data were recorded , while child and mother were interviewed separately regarding medication use . RESULTS Children and mothers reported , on average , over 80 % adherence with the prescribed inhaled steroid . Canister weight revealed , on average , adherence of 69 % , significantly lower than self-report . When adherence recorded by the electronic Doser was truncated to no more than 100 % of prescribed daily use , average adherence was 50 % . Older children and adolescents , nonwhite children , and those from poorer functioning families were least adherent . CONCLUSIONS Electronic adherence monitoring was significantly more accurate than self-report or canister weight measures . Such accuracy is an essential prerequisite to increasing underst and ing of the treatment , setting , and patient factors that influence adherence , and to the consequent design of effective intervention strategies OBJECTIVE To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma . METHODS We used a r and omized clinical trial with 48 youth ( aged 9 - 15 years ) assigned to 1 of 3 groups : Teamwork Intervention ( TI ) , Asthma Education ( AE ) , or St and ard Care ( SC ) . Treatment occurred across 2 months , with a 3-month follow-up assessment . Adherence to inhaled corticosteroids was assessed via the MDILog-II . Parent-adolescent conflict , asthma functional severity , and spirometry assessment s were obtained pre-treatment , post-treatment , and on follow-up . Mixed linear model analysis was used to evaluate group and time effects for outcome measures . RESULTS TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions , and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group . CONCLUSIONS Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management 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 r and omized 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 r and omized to each arm . At 10 weeks , no statistical difference in objective ly 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 objective ly measured adherence at week 10 ( P < .0001 ) . CONCLUSION 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 OBJECTIVE to develop and assess the feasibility of a motivational interviewing ( MI ) based asthma self-management program for inner-city , African-American , adolescents with asthma . METHODS 37 African-American adolescents ( age 10 - 15 years ) recently seen in an inner-city emergency department for asthma and prescribed an asthma controller medication participated in the newly developed program consisting of 5 home visits . Adolescents and their caregivers completed phone-based surveys before and after the intervention . RESULTS 95 % of the adolescents completed all 5 sessions ; 89 % of caregivers and 76 % of adolescents believed other families would benefit from the intervention . Caregivers were more likely to report 100 % adherence post-intervention compared to pre-intervention and reported a trend for adolescents taking greater responsibility for their asthma . There were no pre-post-differences in adolescent-reported medication adherence , but adolescents did reported increased motivation and readiness to adhere to treatment . Caregivers and adolescents each reported statistically significant increases in their asthma quality of life . CONCLUSIONS the findings from this pilot study suggest that MI is a feasible and promising approach for increasing medication adherence among inner-city adolescents with asthma and is worthy of further evaluation in a r and omized trial . PRACTICE IMPLICATION S incorporating MI into disease management programs may enhance their effectiveness OBJECTIVE To investigate the adherence behaviors ( MDI use , MDI/spacer technique , appointment attendance , smoking in the home ) of low-income , urban , primarily African American children with asthma . METHOD Participants were 55 children ages 6 to 17 with moderate to severe asthma . Adherence to MDI anti-inflammatory agents was estimated primarily from canister weight at the follow-up appointment . RESULTS The mean use of MDI medication was 44 % of prescribed use , with 27 % of subjects demonstrating MDI/spacer technique likely to prevent drug delivery . Almost half reported that household members smoked cigarettes , and 21 % missed scheduled follow-up appointments . CONCLUSIONS These findings have implication s for how clinicians should assess and improve adherence 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 prospect i ve 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 OBJECTIVE . We aim ed to determine the effectiveness of school-based supervised asthma therapy in improving asthma control . The primary hypothesis was that the supervised-therapy group would have a smaller proportion of children experiencing an episode of poor asthma control each month , compared with those in the usual-care group . METHODS . Children were eligible if they had physician-diagnosed persistent asthma , the need for daily controller medication , and the ability to use a dry-powder inhaler and a peak flowmeter . The trial used a 2-group , r and omized , longitudinal design with a 15-month follow-up period . A total of 290 children from 36 schools were assigned r and omly to either school-based , supervised therapy or usual care .  Ninety-one percent of the children were black , and 57 % were male . The mean age was 11 years ( SD : 2.1 years ) . An episode of poor asthma control was defined as ≥1 of the following each month : ( 1 ) an absence from school attributable to respiratory illness/asthma ; ( 2 ) average use of rescue medication > 2 times per week ( not including preexercise treatment ) ; 
    Output:
    
All Pediatric Self-Management Model domains were correlated with youth adherence , which suggests medication adherence is influenced across multiple systems ; however , most studies assessed adherence correlates within a single domain .