Natalie Walders

The allocation of family responsibility for asthma management tasks in African-American adolescents

The allocation of responsibilities for asthma management within African-American families was examined in 60 adolescents and their primary caretakers. Separate structured interviews were conducted with adolescents and primary caretakers, and perceptions of family management, adherence to asthma treatment regimen, and functional morbidity were assessed. Support for the primary hypothesis that higher levels of nonadherence and functional morbidity would be observed in families where caretakers overestimated the level of adolescent involvement in asthma self-care was found. Implications for family-based asthma management in ethnic minority adolescents are discussed.

Environmental Tobacco Smoke Exposure in Pediatric Asthma: Overview and Recommendations for Practice

At sthma has become the most common pediatric chronic illness in the United States, affecting an estimated 4.8 million children and adolescents, and it has been identified as a priority for public health research and intervention. i Pediatric asthma is linked to extensive functional morbidity and is a leading cause of pediatric acute care visits, emergency department use, and hospital admissions.2 Management of the pediatric asthma patient can be challenging due to the multiple medical, behavioral, and environmental factors that contribute to asthma symptoms and exacerbations. Of these factors, exposure to environmental tobacco smoke (ETS) is a critical clinical problem for many children with asthma. ETS not only triggers asthma episodes, but also has deleterious effects on airway reactivity,3 which makes the airways more responsive to other irritants and allergens that affect asthma. Health

Understanding Cultural and Ethnic Influences in Research with Child Clinical and Pediatric Psychology Populations

It is becoming increasingly necessary for child clinical and pediatric psychologists to possess the skills and knowledge necessary to conduct research and clinical work with ethnically diverse populations (Hall, 1997). Despite increasing demographic diversity within the United States, psychological research has been largely restricted to mainstream, homogeneous samples (Foster & Martinez, 1995). Consequently, the knowledge base concerning both normative and problematic developmental processes within ethnic minority child clinical and pediatric populations remains limited. Graduate and professional level training opportunities for conducting ethnically diverse research are also limited in scope and availability (Ponterotto & Cases, 1987).

Ethical Issues in Conducting Research with Pediatric and Clinical Child Populations in Applied Settings

Over and beyond the general ethical principles with which all psychologists should be thoroughly familiar (American Psychological Assoication, 1992; Canter, Bennett, Jones, & Nagy, 1994), research with pediatric and clinical child populations raises special ethical problems that challenge investigators to develop special strategies in order to conduct their research in a responsible manner. The work described in this chapter, which is based on research experiences in hospital, school, and clinic settings, describes a number of knotty ethical problems that have not been well articulated in previous work. These issues include considerations in working with groups that are charged with the oversight of research ethics in clinical settings, problems related to confidentiality of data, obtaining appropriate consent, managing risk-related to psychological vulnerability, for example, depression in adolescents, and maintaining appropriate role boundaries as researchers in clinical settings. Using illustrations from research with varied populations of children and families, we describe a number of ethical issues that have arisen in data collection in clinical settings and consider strategies to manage them. Our aim is to help researchers to anticipate and prevent ethical problems wherever possible and to provide suggestions concerning how their impact on families can be minimized.

Conducting Research with Children and Adolescents in Clinical and Applied Settings

In order to successfully conduct research in clinical and other applied settings with children and adolescents, investigators need to learn to manage a number of logistic problems that can be difficult to anticipate (Drotar, 1989). These problems include developing collaborations with agency and hospital staff that are necessary to recruit subjects (Drotar, 1993), recruiting and maintaining research participants in studies, and managing problems in data collection, especially those that threaten the integrity of study design. Researchers who work with children and families need to anticipate as many of these problems as possible so that they can either implement strategies to prevent them, which is the preferable approach, or develop data analytic approaches to limit their influence on the quality of their data (see Chapter 4, this volume).

Patterns of quick-relief and long-term controller medication use in pediatric asthma

OBJECTIVES To simultaneously examine adherence to long-term controller and quick-relief medications and to contrast patterns of medication use in children with asthma. STUDY DESIGN Cross-sectional, 1-month follow-up study conducted with 75 children ages 8 to 16 years diagnosed with persistent asthma and prescribed quick-relief and long-term controller medications by metered dose inhaler. Participants were a subsample of a larger adherence study. The primary outcome measure was adherence to both medications as measured by electronic monitoring devices. A classification framework for contrasting adherence patterns between medication classes was developed to identify cases for individual analysis. RESULTS High levels of nonadherence to long-term controller medications (median = 46% of prescribed doses taken) and variable patterns of quick-relief medication use (range = 0 to 251 doses over the month) were documented, whereas consistent relationships between patterns of medication use across both classes were not found. Individual cases identified by the classification scheme illustrated the complexity and clinical utility of contrasting adherence patterns. CONCLUSIONS Monitoring long-term controller medication adherence may be more predictive of morbidity than quick-relief medication use, except in outlier cases in which monitoring both medication types may be valuable for clinical and empirical purposes.