2007APhA_Poster_B
1
Associations Between Asthma Outcomes and Coping Styles Among Elementary Students in Southwest Virginia David A. Gettman, R.Ph., M.B.A., Ph.D. University of Appalachia College of Pharmacy, Oakwood, Virginia Methods •The Kidcope (A. Spirito, L. J. Stark, & C. Williams, 1988) is a brief screening measure of coping strategies for children and adolescents. The twelve items are associated with the following: 1.) distraction, 2.) social withdrawal, 3.) cognitive restructuring, 4.) self-criticism, 5.) blaming others, 6.) problem solving, 7.) emotional regulation, 8.) wishful thinking, 9.) social support, and 10.) resignation. • On the basis of a factor analyses in another study, the authors created 2 composite scores, representing control-oriented and escape-oriented coping strategies. • Paired Samples Test for Responses to 13 Items (Pre- and Post-Program) The Kidcope was used here to help us try to understand and improve these preventive interventions. Purpose • Overall, educational sessions were effective for school nurse- identified needs; however, this focus may have contributed to the lack of impact on Items 9, 11, and 12. • There was no statistically significant improvement for Items: 6, 7, and 9. It could be argued that students indicated, pre-program, they could already do Items 6 & 7. This argument does not appear to hold for Items 9, 11, and 12. • Items 11 and 12 were only marginally significant. • Despite nurses identifying How to Take Medications as important, the current evaluation tool does not measure this parameter. • Future studies targeting teacher-education about asthma management, trigger identification, and exacerbation actions may improve scoring for Items 9 and 10. • Preliminary results with the Kidcope also suggest that our pharmacy students will have differential impact on elementary students with different coping styles. • Follow-up data may be pursued at six months for determining long-term impact of this educational program, both for the children as well as the pharmacy students. References • The primary objective of this study was to determine if an educational program conducted by pharmacy students, targeting schoolchildren in rural Virginia, would result in statistically significant differences in their responses to questions about their asthma. •The secondary objective of this study was to determine any associations between outcome differences and coping styles. Conclusions Asthma: • Asthma is now the most common chronic childhood disease in the United States, causing American schoolchildren to miss 10 million days of school each year. 1 • In Virginia, 13.7% of African Americans and 10.4% of whites have asthma. In 1999, more than 11,000 people were hospitalized and 108 died because of asthma. Children were hospitalized at rates nearly twice those of adults. 2 • Although it affects people of all ages, races, and income groups; the asthma epidemic has hit low-income children (like those in central Appalachia) the hardest. 3 CDC Recommendations for Asthma Management: • In March 2003, the CDC recommended ten key clinical activities for improved asthma management. 4 • Of these key activities, pharmacists are ideally situated to provide the following components of care: 4 1. Assessment and monitoring for routine medication use, care plan, and self-management skills 2. Trigger identification and management, including vaccination status assessment 3. Medication management and refill history review 4. Education for partnership in care: emphasizing therapeutic goals, daily treatment and monitoring, peak flow monitoring, and asthma exacerbation management Background Results ITEMS 1 = Can do it 2 = Might be able to do it 3 = Can’t do it PRE PRE PRE PRE- - -PROGRAM PROGRAM PROGRAM PROGRAM POST POST POST POST- - -PROGRAM PROGRAM PROGRAM PROGRAM Mean Mean Mean Mean Std. Dev. Std. Dev. Std. Dev. Std. Dev. Mean Mean Mean Mean Std. Std. Std. Std. Dev. Dev. Dev. Dev. 1. Can you tell when to take your asthma medicine? 1. Can you tell when to take your asthma medicine? 1. Can you tell when to take your asthma medicine? 1. Can you tell when to take your asthma medicine? 1.40 1.40 1.40 1.40 .660 .660 .660 .660 1.25 1.25 1.25 1.25 .533 .533 .533 .533 2. Can you tell how much asthma medicine to take 2. Can you tell how much asthma medicine to take 2. Can you tell how much asthma medicine to take 2. Can you tell how much asthma medicine to take when you start to wheeze or cough? when you start to wheeze or cough? when you start to wheeze or cough? when you start to wheeze or cough? 1.67 1.67 1.67 1.67 .758 .758 .758 .758 1.43 1.43 1.43 1.43 .635 .635 .635 .635 3. Can you tell ahead of time when you are going to 3. Can you tell ahead of time when you are going to 3. Can you tell ahead of time when you are going to 3. Can you tell ahead of time when you are going to wheeze or cough? wheeze or cough? wheeze or cough? wheeze or cough? 1.80 1.80 1.80 1.80 .818 .818 .818 .818 1.54 1.54 1.54 1.54 .710 .710 .710 .710 4. Can you tell what things make you wheeze or cough 4. Can you tell what things make you wheeze or cough 4. Can you tell what things make you wheeze or cough 4. Can you tell what things make you wheeze or cough in your own house? in your own house? in your own house? in your own house? 1.71 1.71 1.71 1.71 .794 .794 .794 .794 1.45 1.45 1.45 1.45 .674 .674 .674 .674 5. Can you tell what things make you wheeze or cough 5. Can you tell what things make you wheeze or cough 5. Can you tell what things make you wheeze or cough 5. Can you tell what things make you wheeze or cough in your school or classroom? in your school or classroom? in your school or classroom? in your school or classroom? 1.87 1.87 1.87 1.87 .790 .790 .790 .790 1.66 1.66 1.66 1.66 .798 .798 .798 .798 6. Can you remember what you are supposed to do 6. Can you remember what you are supposed to do 6. Can you remember what you are supposed to do 6. Can you remember what you are supposed to do when wheezing or coughing? when wheezing or coughing? when wheezing or coughing? when wheezing or coughing? 1.31 1.31 1.31 1.31 .581 .581 .581 .581 1.27 1.27 1.27 1.27 .533 .533 .533 .533 7. Can you tell an adult when you start to wheeze or 7. Can you tell an adult when you start to wheeze or 7. Can you tell an adult when you start to wheeze or 7. Can you tell an adult when you start to wheeze or cough? cough? cough? cough? 1.27 1.27 1.27 1.27 .555 .555 .555 .555 1.23 1.23 1.23 1.23 .500 .500 .500 .500 8. Can you relax and stay calm every time you start to 8. Can you relax and stay calm every time you start to 8. Can you relax and stay calm every time you start to 8. Can you relax and stay calm every time you start to wheeze or cough? wheeze or cough? wheeze or cough? wheeze or cough? 1.69 1.69 1.69 1.69 .836 .836 .836 .836 1.48 1.48 1.48 1.48 .694 .694 .694 .694 9. Can you talk to your teacher about your asthma? 9. Can you talk to your teacher about your asthma? 9. Can you talk to your teacher about your asthma? 9. Can you talk to your teacher about your asthma? 1.61 1.61 1.61 1.61 .752 .752 .752 .752 1.55 1.55 1.55 1.55 .751 .751 .751 .751 10. Can you talk to your teacher about taking things out 10. Can you talk to your teacher about taking things out 10. Can you talk to your teacher about taking things out 10. Can you talk to your teacher about taking things out of your classroom that make you wheeze or cough? of your classroom that make you wheeze or cough? of your classroom that make you wheeze or cough? of your classroom that make you wheeze or cough? 1.87 1.87 1.87 1.87 .798 .798 .798 .798 1.70 1.70 1.70 1.70 .774 .774 .774 .774 11. Can you tell if you should go to school when 11. Can you tell if you should go to school when 11. Can you tell if you should go to school when 11. Can you tell if you should go to school when wheezing in the morning? wheezing in the morning? wheezing in the morning? wheezing in the morning? 1.66 1.66 1.66 1.66 .776 .776 .776 .776 1.51 1.51 1.51 1.51 .720 .720 .720 .720 12. Can you tell when you have to go to the hospital or 12. Can you tell when you have to go to the hospital or 12. Can you tell when you have to go to the hospital or 12. Can you tell when you have to go to the hospital or doctor for help? doctor for help? doctor for help? doctor for help? 1.62 1.62 1.62 1.62 .743 .743 .743 .743 1.48 1.48 1.48 1.48 .703 .703 .703 .703 1=Very Happy 2=Happy 3=Sad 4=Very Sad 1=Very Happy 2=Happy 3=Sad 4=Very Sad 1=Very Happy 2=Happy 3=Sad 4=Very Sad 1=Very Happy 2=Happy 3=Sad 4=Very Sad *13. Circle the face that shows how you feel about *13. Circle the face that shows how you feel about *13. Circle the face that shows how you feel about *13. Circle the face that shows how you feel about having asthma: having asthma: having asthma: having asthma: 2.931 2.931 2.931 2.931 .9983 .9983 .9983 .9983 2.651 2.651 2.651 2.651 1.0808 1.0808 1.0808 1.0808 Question Question Question Question (Pre &Post) (Pre &Post) (Pre &Post) (Pre &Post) Paired Differences Paired Differences Paired Differences Paired Differences t t t Df Df Df Df Sig. Sig. Sig. Sig. (2 (2 (2 (2- - -tailed) tailed) tailed) tailed) Mean Mean Mean Mean Std Std Std Std Dev Dev Dev Dev Std. Error Std. Error Std. Error Std. Error Mean Mean Mean Mean 95% Confidence Interval 95% Confidence Interval 95% Confidence Interval 95% Confidence Interval of the Difference of the Difference of the Difference of the Difference Lower Lower Lower Lower Upper Upper Upper Upper 1 1 1 0.157 0.157 0.157 0.157 0.713 0.713 0.713 0.713 0.055 0.055 0.055 0.055 0.047 0.047 0.047 0.047 0.266 0.266 0.266 0.266 2.829 2.829 2.829 2.829 165 165 165 165 0.005 0.005 0.005 0.005 2 2 2 0.241 0.241 0.241 0.241 0.847 0.847 0.847 0.847 0.066 0.066 0.066 0.066 0.111 0.111 0.111 0.111 0.371 0.371 0.371 0.371 3.666 3.666 3.666 3.666 165 165 165 165 0.000 0.000 0.000 0.000 3 3 3 0.265 0.265 0.265 0.265 0.948 0.948 0.948 0.948 0.074 0.074 0.074 0.074 0.120 0.120 0.120 0.120 0.410 0.410 0.410 0.410 3.602 3.602 3.602 3.602 165 165 165 165 0.000 0.000 0.000 0.000 4 4 4 0.265 0.265 0.265 0.265 0.861 0.861 0.861 0.861 0.067 0.067 0.067 0.067 0.133 0.133 0.133 0.133 0.397 0.397 0.397 0.397 3.966 3.966 3.966 3.966 165 165 165 165 0.000 0.000 0.000 0.000 5 5 5 0.205 0.205 0.205 0.205 0.925 0.925 0.925 0.925 0.072 0.072 0.072 0.072 0.063 0.063 0.063 0.063 0.347 0.347 0.347 0.347 2.854 2.854 2.854 2.854 165 165 165 165 0.005 0.005 0.005 0.005 6 6 6 0.042 0.042 0.042 0.042 0.716 0.716 0.716 0.716 0.056 0.056 0.056 0.056 - - - 0.068 0.068 0.068 0.068 0.152 0.152 0.152 0.152 0.758 0.758 0.758 0.758 165 165 165 165 0.449 0.449 0.449 0.449 7 7 7 0.042 0.042 0.042 0.042 0.673 0.673 0.673 0.673 0.052 0.052 0.052 0.052 - - - 0.061 0.061 0.061 0.061 0.145 0.145 0.145 0.145 0.807 0.807 0.807 0.807 165 165 165 165 0.421 0.421 0.421 0.421 8 8 8 0.211 0.211 0.211 0.211 0.939 0.939 0.939 0.939 0.073 0.073 0.073 0.073 0.067 0.067 0.067 0.067 0.355 0.355 0.355 0.355 2.892 2.892 2.892 2.892 165 165 165 165 0.004 0.004 0.004 0.004 9 9 9 0.060 0.060 0.060 0.060 0.865 0.865 0.865 0.865 0.067 0.067 0.067 0.067 - - - 0.072 0.072 0.072 0.072 0.193 0.193 0.193 0.193 0.898 0.898 0.898 0.898 165 165 165 165 0.371 0.371 0.371 0.371 10 10 10 10 0.169 0.169 0.169 0.169 0.912 0.912 0.912 0.912 0.071 0.071 0.071 0.071 0.029 0.029 0.029 0.029 0.308 0.308 0.308 0.308 2.383 2.383 2.383 2.383 165 165 165 165 0.018 0.018 0.018 0.018 11 11 11 11 0.151 0.151 0.151 0.151 0.964 0.964 0.964 0.964 0.075 0.075 0.075 0.075 0.003 0.003 0.003 0.003 0.298 0.298 0.298 0.298 2.013 2.013 2.013 2.013 165 165 165 165 0.046 0.046 0.046 0.046 12 12 12 12 0.139 0.139 0.139 0.139 0.866 0.866 0.866 0.866 0.067 0.067 0.067 0.067 0.006 0.006 0.006 0.006 0.271 0.271 0.271 0.271 2.061 2.061 2.061 2.061 165 165 165 165 0.041 0.041 0.041 0.041 13 13 13 13 0.2801 0.2801 0.2801 0.2801 1.0695 1.0695 1.0695 1.0695 .0830 .0830 .0830 .0830 0.1162 0.1162 0.1162 0.1162 0.4440 0.4440 0.4440 0.4440 3.375 3.375 3.375 3.375 165 165 165 165 0.001 0.001 0.001 0.001 Blue = Pre-program / Red = Post-program •0 •0.5 •1 •1.5 •2 •2.5 •3 •3.5 •1 •2 •3 •4 •5 •6 •7 •8 •9 •10 •11 •12 •13 •Item Number •Mean Frequency Figure 1. Mean Frequencies of Responses to 13 Items Table 2. Paired Samples Test for Responses to 13 Items (Pre- and Post-Program) Table 1: Mean and Standard Deviation for Each Pre- Program and Post-Program Response to the 13 Items • Overall, the Open Airways Program shows statistically significant improvement on 10 of the 13 Items. • The largest improvement was seen in appropriate medication use for wheezing or coughing, predicting triggers for wheezing or coughing, and identifying triggers in the household (that is items 2, 3, and 4, respectively). • All the children most frequently used wishful thinking, social support and problem solving. Self-criticism and blaming others were used less often by both age-groups. No gender differences occurred. • All the children rated social support as the most efficient coping strategy. • These improvements were associated with the composite factor score on the Kidcope, representing control-oriented coping strategies, e.g., social support and problem-solving, as opposed to escape-oriented coping strategies, e.g., blaming others and resignation. 1. (2004, March) Early Release of Selected Estimates Based on Data From the January – September 2003 National Health Interview Survey. http://www.cdc.gov/nchs/data/nhis/earlyrelease/200403_15.pdf Accessed 6/14/04. 2. U.S. Department of Health and Human Services. Reducing the Burden of Disease: Asthma. http://www.healthierus.gov/steps/summit/prevportfolio/programs/asthma.htm 3. (2002, January) Agency for Health Care Administration State Center for Health Statistics Document. Health Outcome Series: Asthma Hospitalizations. http://www.floridahealthstat.com/publications/asthma_hosp.pdf Accessed 6/14/04. 4. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. (2003). Key Clinical Activities for Quality Asthma Care: Recommendations of the National Asthma Education and Prevention Program. March 28, 2003/Vol. 52/No. RR-6. http://www.cdc.gov/mmwr/PDF/rr/rr5206.pdf Accessed May 2003. 5. Spirto A, Stark LJ, and Williams C. Development of a Brief Coping Checklist for Use in Pediatric Populations. Journal of Pediatric Psychology. Vol 13. No. 4. 1988, pp. 555-574. • There were 126 useable paired (pre- and post-program) questionnaires. If questions were not answered, or a matching pre- or post-program questionnaire was missing, the subject’s responses were dropped from the data analysis. Letters were distributed to parents of 3 rd to 5 th grade children with asthma, requesting permission for their child to participate in the American Lung Association’s Open Airways for Schools. Six lessons were adapted from and based upon an educational program created and evaluated by Columbia University’s College of Physicians and Surgeons. 1 st year and 2 nd year students in an accelerated Doctor of Pharmacy program were to take part in PICS (Pharmacists in Community Service) taught the children lessons at six elementary schools in Buchanan County (Council, Hurley, Riverview, Russell Prater, J.M. Bevins & Twin Valley). Before the lessons began, the children were to administer the KIDCOPE (Spirito et al. 1988) which is designed to measure coping styles in relation to illness.
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Transcript of 2007APhA_Poster_B
Associations Between Asthma Outcomes and Coping Styles Among Elementary Students in Southwest Virginia
David A. Gettman, R.Ph., M.B.A., Ph.D.
University of Appalachia College of Pharmacy, Oakwood, Virginia
Methods
•The Kidcope (A. Spirito, L. J. Stark, & C. Williams, 1988) is a brief screening
measure of coping strategies for children and adolescents. The twelve items
are associated with the following: 1.) distraction, 2.) social withdrawal, 3.)
cognitive restructuring, 4.) self-criticism, 5.) blaming others, 6.) problem
solving, 7.) emotional regulation, 8.) wishful thinking, 9.) social support, and
10.) resignation.
• On the basis of a factor analyses in another study, the authors created 2
composite scores, representing control-oriented and escape-oriented coping
strategies.
• Paired Samples Test for Responses to
13 Items (Pre- and Post-Program)
The Kidcope was used here to help us try to understand and improve these
preventive interventions.
Purpose
• Overall, educational sessions were effective for school nurse-
identified needs; however, this focus may have contributed to
the lack of impact on Items 9, 11, and 12.
• There was no statistically significant improvement for
Items: 6, 7, and 9. It could be argued that students indicated,
pre-program, they could already do Items 6 & 7. This
argument does not appear to hold for Items 9, 11, and 12.
• Items 11 and 12 were only marginally significant.
• Despite nurses identifying How to Take Medications as
important, the current evaluation tool does not measure this
parameter.
• Future studies targeting teacher-education about asthma
management, trigger identification, and exacerbation actions
may improve scoring for Items 9 and 10.
• Preliminary results with the Kidcope also suggest that our
pharmacy students will have differential impact on elementary
students with different coping styles.
• Follow-up data may be pursued at six months for determining
long-term impact of this educational program, both for the
children as well as the pharmacy students.
References• The primary objective of this study was to determine if an educational
program conducted by pharmacy students, targeting schoolchildren in rural
Virginia, would result in statistically significant differences in their
responses to questions about their asthma.
•The secondary objective of this study was to determine any associations
between outcome differences and coping styles.
ConclusionsAsthma:
• Asthma is now the most common chronic childhood disease in the United
States, causing American schoolchildren to miss 10 million days of school
each year.1
• In Virginia, 13.7% of African Americans and 10.4% of whites have asthma. In
1999, more than 11,000 people were hospitalized and 108 died because of
asthma. Children were hospitalized at rates nearly twice those of adults.2
• Although it affects people of all ages, races, and income groups; the
asthma epidemic has hit low-income children (like those in central
Appalachia) the hardest.3
CDC Recommendations for Asthma Management:
• In March 2003, the CDC recommended ten key clinical activities for
improved asthma management.4
• Of these key activities, pharmacists are ideally situated to provide the
following components of care:4
1. Assessment and monitoring for routine medication
use, care plan, and self-management skills
2. Trigger identification and management, including
vaccination status assessment
3. Medication management and refill history review
4. Education for partnership in care: emphasizing
therapeutic goals, daily treatment and monitoring,
peak flow monitoring, and asthma exacerbation
management
Background
Results
ITEMS
1 = Can do it
2 = Might be able to do it
3 = Can’t do it
PREPREPREPRE----PROGRAMPROGRAMPROGRAMPROGRAM POSTPOSTPOSTPOST----PROGRAMPROGRAMPROGRAMPROGRAM
MeanMeanMeanMean Std. Dev.Std. Dev.Std. Dev.Std. Dev. MeanMeanMeanMean Std. Std. Std. Std. Dev.Dev.Dev.Dev.
1. Can you tell when to take your asthma medicine?1. Can you tell when to take your asthma medicine?1. Can you tell when to take your asthma medicine?1. Can you tell when to take your asthma medicine? 1.401.401.401.40 .660.660.660.660 1.251.251.251.25 .533.533.533.533
2. Can you tell how much asthma medicine to take2. Can you tell how much asthma medicine to take2. Can you tell how much asthma medicine to take2. Can you tell how much asthma medicine to takewhen you start to wheeze or cough?when you start to wheeze or cough?when you start to wheeze or cough?when you start to wheeze or cough? 1.671.671.671.67 .758.758.758.758 1.431.431.431.43 .635.635.635.635
3. Can you tell ahead of t ime when you are going to3. Can you tell ahead of t ime when you are going to3. Can you tell ahead of t ime when you are going to3. Can you tell ahead of t ime when you are going towheeze or cough?wheeze or cough?wheeze or cough?wheeze or cough? 1.801.801.801.80 .818.818.818.818 1.541.541.541.54 .710.710.710.710
4. Can you tell what things make you wheeze or cough 4. Can you tell what things make you wheeze or cough 4. Can you tell what things make you wheeze or cough 4. Can you tell what things make you wheeze or cough in your own house?in your own house?in your own house?in your own house? 1.711.711.711.71 .794.794.794.794 1.451.451.451.45 .674.674.674.674
5. Can you tell what things make you wheeze or cough 5. Can you tell what things make you wheeze or cough 5. Can you tell what things make you wheeze or cough 5. Can you tell what things make you wheeze or cough in your school or classroom?in your school or classroom?in your school or classroom?in your school or classroom? 1.871.871.871.87 .790.790.790.790 1.661.661.661.66 .798.798.798.798
6. Can you remember what you are supposed to do 6. Can you remember what you are supposed to do 6. Can you remember what you are supposed to do 6. Can you remember what you are supposed to do when wheezing or coughing?when wheezing or coughing?when wheezing or coughing?when wheezing or coughing? 1.311.311.311.31 .581.581.581.581 1.271.271.271.27 .533.533.533.533
7. Can you tell an adult when you start to wheeze or 7. Can you tell an adult when you start to wheeze or 7. Can you tell an adult when you start to wheeze or 7. Can you tell an adult when you start to wheeze or cough?cough?cough?cough? 1.271.271.271.27 .555.555.555.555 1.231.231.231.23 .500.500.500.500
8. Can you relax and stay calm every time you start to 8. Can you relax and stay calm every time you start to 8. Can you relax and stay calm every time you start to 8. Can you relax and stay calm every time you start to wheeze or cough?wheeze or cough?wheeze or cough?wheeze or cough? 1.691.691.691.69 .836.836.836.836 1.481.481.481.48 .694.694.694.694
9. Can you talk to your teacher about your asthma?9. Can you talk to your teacher about your asthma?9. Can you talk to your teacher about your asthma?9. Can you talk to your teacher about your asthma? 1.611.611.611.61 .752.752.752.752 1.551.551.551.55 .751.751.751.751
10. Can you talk to your teacher about taking things out 10. Can you talk to your teacher about taking things out 10. Can you talk to your teacher about taking things out 10. Can you talk to your teacher about taking things out of your classroom that make you wheeze or cough?of your classroom that make you wheeze or cough?of your classroom that make you wheeze or cough?of your classroom that make you wheeze or cough? 1.871.871.871.87 .798.798.798.798 1.701.701.701.70 .774.774.774.774
11. Can you tell if you should go to school when 11. Can you tell if you should go to school when 11. Can you tell if you should go to school when 11. Can you tell if you should go to school when wheezing in the morning?wheezing in the morning?wheezing in the morning?wheezing in the morning? 1.661.661.661.66 .776.776.776.776 1.511.511.511.51 .720.720.720.720
12. Can you tell when you have to go to the hospital or12. Can you tell when you have to go to the hospital or12. Can you tell when you have to go to the hospital or12. Can you tell when you have to go to the hospital ordoctor for help?doctor for help?doctor for help?doctor for help? 1.621.621.621.62 .743.743.743.743 1.481.481.481.48 .703.703.703.703
1=Very Happy 2=Happy 3=Sad 4=Very Sad1=Very Happy 2=Happy 3=Sad 4=Very Sad1=Very Happy 2=Happy 3=Sad 4=Very Sad1=Very Happy 2=Happy 3=Sad 4=Very Sad
*13. Circle the face that shows how you feel about *13. Circle the face that shows how you feel about *13. Circle the face that shows how you feel about *13. Circle the face that shows how you feel about having asthma:having asthma:having asthma:having asthma:
2.9312.9312.9312.931 .9983.9983.9983.9983 2.6512.6512.6512.651 1.08081.08081.08081.0808
QuestionQuestionQuestionQuestion(Pre &Post)(Pre &Post)(Pre &Post)(Pre &Post)
Paired DifferencesPaired DifferencesPaired DifferencesPaired Differences
tttt DfDfDfDf Sig. Sig. Sig. Sig. (2(2(2(2 ---- tailed)tailed)tailed)tailed)MeanMeanMeanMean StdStdStdStd
DevDevDevDevStd. Error Std. Error Std. Error Std. Error
MeanMeanMeanMean
95% Confidence Interval 95% Confidence Interval 95% Confidence Interval 95% Confidence Interval of the Differenceof the Differenceof the Differenceof the Difference
LowerLowerLowerLower UpperUpperUpperUpper
1111 0.1570.1570.1570.157 0.7130.7130.7130.713 0.0550.0550.0550.055 0.0470.0470.0470.047 0.2660.2660.2660.266 2.8292.8292.8292.829 165165165165 0.0050.0050.0050.005
2222 0.2410.2410.2410.241 0.8470.8470.8470.847 0.0660.0660.0660.066 0.1110.1110.1110.111 0.3710.3710.3710.371 3.6663.6663.6663.666 165165165165 0.0000.0000.0000.000
3333 0.2650.2650.2650.265 0.9480.9480.9480.948 0.0740.0740.0740.074 0.1200.1200.1200.120 0.4100.4100.4100.410 3.6023.6023.6023.602 165165165165 0.0000.0000.0000.000
4444 0.2650.2650.2650.265 0.8610.8610.8610.861 0.0670.0670.0670.067 0.1330.1330.1330.133 0.3970.3970.3970.397 3.9663.9663.9663.966 165165165165 0.0000.0000.0000.000
5555 0.2050.2050.2050.205 0.9250.9250.9250.925 0.0720.0720.0720.072 0.0630.0630.0630.063 0.3470.3470.3470.347 2.8542.8542.8542.854 165165165165 0.0050.0050.0050.005
6666 0.0420.0420.0420.042 0.7160.7160.7160.716 0.0560.0560.0560.056 ---- 0.0680.0680.0680.068 0.1520.1520.1520.152 0.7580.7580.7580.758 165165165165 0.4490.4490.4490.449
7777 0.0420.0420.0420.042 0.6730.6730.6730.673 0.0520.0520.0520.052 ---- 0.0610.0610.0610.061 0.1450.1450.1450.145 0.8070.8070.8070.807 165165165165 0.4210.4210.4210.421
8888 0.2110.2110.2110.211 0.9390.9390.9390.939 0.0730.0730.0730.073 0.0670.0670.0670.067 0.3550.3550.3550.355 2.8922.8922.8922.892 165165165165 0.0040.0040.0040.004
9999 0.0600.0600.0600.060 0.8650.8650.8650.865 0.0670.0670.0670.067 ---- 0.0720.0720.0720.072 0.1930.1930.1930.193 0.8980.8980.8980.898 165165165165 0.3710.3710.3710.371
10101010 0.1690.1690.1690.169 0.9120.9120.9120.912 0.0710.0710.0710.071 0.0290.0290.0290.029 0.3080.3080.3080.308 2.3832.3832.3832.383 165165165165 0.0180.0180.0180.018
11111111 0.1510.1510.1510.151 0.9640.9640.9640.964 0.0750.0750.0750.075 0.0030.0030.0030.003 0.2980.2980.2980.298 2.0132.0132.0132.013 165165165165 0.0460.0460.0460.046
12121212 0.1390.1390.1390.139 0.8660.8660.8660.866 0.0670.0670.0670.067 0.0060.0060.0060.006 0.2710.2710.2710.271 2.0612.0612.0612.061 165165165165 0.0410.0410.0410.041
13131313 0.28010.28010.28010.2801 1.06951.06951.06951.0695 .0830.0830.0830.0830 0.11620.11620.11620.1162 0.44400.44400.44400.4440 3.3753.3753.3753.375 165165165165 0.0010.0010.0010.001
Blue = Pre-program / Red = Post-program
•0
•0.5
•1
•1.5
•2
•2.5
•3
•3.5
•1 •2 •3 •4 •5 •6 •7 •8 •9 •10 •11 •12 •13
•Item Number
•Me
an
Fre
qu
en
cy
Figure 1. Mean Frequencies of Responses to 13 Items
Table 2. Paired Samples Test for Responses to
13 Items (Pre- and Post-Program)
Table 1: Mean and Standard Deviation for Each Pre-Program and Post-Program Response to the 13 Items
• Overall, the Open Airways Program shows statistically significant
improvement on 10 of the 13 Items.
• The largest improvement was seen in appropriate medication use
for wheezing or coughing, predicting triggers for wheezing or coughing, and identifying triggers in the household (that is items 2,
3, and 4, respectively).
• All the children most frequently used wishful thinking, social support and problem solving. Self-criticism and blaming others
were used less often by both age-groups. No gender differences occurred.
• All the children rated social support as the most efficient coping strategy.
• These improvements were associated with the composite factor
score on the Kidcope, representing control-oriented coping strategies, e.g., social support and problem-solving, as opposed to
escape-oriented coping strategies, e.g., blaming others and resignation.
1. (2004, March) Early Release of Selected Estimates Based on Data From the
January – September 2003 National Health Interview Survey.
http://www.cdc.gov/nchs/data/nhis/earlyrelease/200403_15.pdf Accessed
6/14/04.
2. U.S. Department of Health and Human Services. Reducing the Burden of
Disease: Asthma.
http://www.healthierus.gov/steps/summit/prevportfolio/programs/asthma.htm
3. (2002, January) Agency for Health Care Administration State Center for Health
Statistics Document. Health Outcome Series: Asthma Hospitalizations.
http://www.floridahealthstat.com/publications/asthma_hosp.pdf Accessed
6/14/04.
4. Centers for Disease Control and Prevention Morbidity and Mortality Weekly
Report. (2003). Key Clinical Activities for Quality Asthma Care:
Recommendations of the National Asthma Education and Prevention
Program. March 28, 2003/Vol. 52/No. RR-6.
http://www.cdc.gov/mmwr/PDF/rr/rr5206.pdf Accessed May 2003.
5. Spirto A, Stark LJ, and Williams C. Development of a Brief Coping Checklist
for Use in Pediatric Populations. Journal of Pediatric Psychology. Vol 13. No.
4. 1988, pp. 555-574.
• There were 126 useable paired (pre- and post-program)
questionnaires. If questions were not answered, or a matching
pre- or post-program questionnaire was missing, the subject’s
responses were dropped from the data analysis.
� Letters were distributed to parents of 3rd to 5th grade children with asthma,
requesting permission for their child to participate in the American Lung
Association’s Open Airways for Schools.
� Six lessons were adapted from and based upon an educational program created
and evaluated by Columbia University’s College of Physicians and Surgeons.
� 1st year and 2nd year students in an accelerated Doctor of Pharmacy program
were to take part in PICS (Pharmacists in Community Service) taught the children
lessons at six elementary schools in Buchanan County (Council, Hurley,
Riverview, Russell Prater, J.M. Bevins & Twin Valley).
� Before the lessons began, the children were to administer the KIDCOPE (Spirito
et al. 1988) which is designed to measure coping styles in relation to illness.
