Multisystemic therapy for high-risk African American adolescents with asthma: a randomized clinical trial

Abstract

Objective: The primary purpose of the study was to determine whether Multisystemic Therapy adapted for health care settings (MST-HC) improved asthma management and health outcomes in high-risk African American adolescents with asthma.

Method: Eligibility included self-reported African American ethnicity, ages 12 to 16, moderate to severe asthma, and an inpatient hospitalization or at least 2 emergency department visits for asthma in the last 12 months. Adolescents and their families (N = 170) were randomized to MST-HC or in-home family support. Data were collected at baseline and posttreatment (7 months) based on an asthma management interview, medication adherence phone diary, and lung function biomarker (forced expiratory volume in 1 s [FEV1]). Analyses were conducted using linear mixed modeling for continuous outcomes and generalized linear mixed modeling for binary outcomes.

Results: In intent-to-treat analyses, adolescents randomized to MST-HC were more likely to improve on 2 of the measures of medication adherence and FEV1. Per-protocol analysis demonstrated that MST-HC had a medium effect on adherence measures and had a small to medium effect on lung function and the adolescent's response to asthma exacerbations.

Conclusion: There are few interventions that have been shown to successfully improve asthma management in minority youth at highest risk for poor morbidity and mortality. MST, a home-based psychotherapy originally developed to target behavior problems in youth, improved asthma management and lung function compared to a strong comparison condition. Further follow-up is necessary to determine whether MST-HC reduces health care utilization accounting for seasonal variability. A limitation to the study is that a greater number of participants in the control group came from single-parent families than in the MST group.

Figure 1.

Consort Diagram showing participant flow through the study.

Figure 2.

Difference between MST and Control Groups in Change in Lung Function (FEV1) from Baseline to the 7-Month Follow-Up.

Figure 3.

Difference between MST and Control Groups in Change in Adherence to Controller Medication from Baseline to the 7-Month Follow-Up, as reported on the Family Asthma Management System Scale (FAMSS).

Figure 4.

Difference between MST and Control Groups in Change in the Proportion of Participants Reporting Adherence to Controller Medication on the Daily Phone Diary (DPD) from Baseline to the 7-Month Follow-Up.