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Background Lower socioeconomic status (SES) has consistently been associated with poorer outcomes in individuals with cystic fibrosis (CF). Previous studies have compared outcomes for children with and without private insurance coverage, however the potential role of changes in insurance status on early health outcomes in children with CF remains unknown. Objectives To describe the variability in insurance status in early childhood and to evaluate whether insurance variability was associated with poorer outcomes at age 6. Methods Retrospective observational study using the Cystic Fibrosis Foundation Patient Registry. Insurance status was defined as: always private (including Tricare), exclusively public, or intermittent private insurance (private insurance and exclusively public insurance in separate years) during the first 6 years of life. Outcomes at age 6 included body mass index (BMI) and FEV1 percent predicted (maxFEV1pp). Results From a 2000–2011 birth cohort (n = 8,109), 42.3% always had private insurance, 30.0% had exclusively public insurance, and 27.6% had intermittent private insurance. BMI percentiles did not differ between groups; however, children with intermittent private insurance and exclusively public insurance had a 3.3% and 6.6% lower maxFEV1pp at age 6, respectively, compared to those with always private insurance. Conclusions A substantial proportion of young children in a modern CF cohort have public or intermittent private insurance coverage. While public insurance has been associated with poorer health outcomes in CF, variability in health insurance coverage may also be associated with an intermediate risk of disparities in lung function as early as age 6.

Background Adherence to CF treatments is poor, which can lead to negative health outcomes. The objective of our study was to qualitatively investigate the barriers and facilitators of self-management among older adolescents and adults with CF. Methods Individual semi-structured interviews were conducted, audio-taped, transcribed verbatim and coded to identify common themes. Results Twenty-five patients were interviewed. Four broad themes were identified: Barriers to Self-Management (e.g., treatment burden (identified by 64% of patients), accidental or purposeful forgetting (60%), no perceived benefit (56%)), Facilitators of Self-Management (e.g., CF clinic visits (76%), social support (68%), perceived benefit (68%)), Substitution of Alternative Approaches to Conventional Management (36%) and Planned Non-adherence (32%). Conclusions Older adolescents and adults with CF identified many barriers and facilitators of adherence that may be amenable to self-management counseling strategies, particularly the use of health feedback.

Objectives: Treatment fidelity, defined as implementation of interventions as intended, positively affects efficacy. To improve fidelity to behavioral interventions, providers require supervision and feedback. In iCARE (I Change Adherence and Raise Expectations), we examined the effects of supervision on fidelity over time. Methods: iCARE is a multisite, randomized trial, which includes Problem-Solving (PS). Behavioral Interventionists (BIs) from multidisciplinary teams conduct PS sessions with a teen and parent to identify adherence barriers and generate solutions. Sessions are videotaped and reviewed by a supervisor who provides feedback. Treatment fidelity is rated independently on a scale of 0−35. Results: Preliminary data on 242 sessions by 28 BIs (12 CF centers) were analyzed. Significant improvements in fidelity were noted after each supervision session, with the greatest magnitude of change occurring within 3 supervisions (Baseline M = 21.02; M post Supervision 1 = 23.01; Supervision 2 = 23.61; Supervision 3 = 26.09). Baseline fidelity predicted fidelity after Supervisions #1 (r = 0.76, p< 0.01) and #2, but not Supervision #3 (r = 0.31, ns). Repeated measures analyses confirmed that supervision leads to better treatment fidelity (t =−2.25, df = 15, p< 0.05). Conclusions: Supervision significantly improved BIs’ fidelity to PS steps. A minimum of 3 supervisions optimizes fidelity; however, ongoing supervision is ideal. Supervision is central to successful delivery of behavioral interventions in clinic settings. Future analyses will examine data from a larger sample. Funding provided by Novartis Pharmaceuticals Corporation, Genentech, Inc., & Cystic Fibrosis Foundation.

329 Paternity in men with cystic fibrosis: an observational study in Italy B. Messore1, A. Grande1, S. Cristadoro2, G. Pizzamiglio3, S. Ballarin4, V. Carnovale5, S. Carletto6, C. Braggion7, R. Casciaro8, M.L. Furnari9, B. Grosso1, V. Lucidi10, A. Manca11, D. Salvatore12, C. Castellani13. 1Adult CF Centre, Orbassano (TO), Italy; 2CF Centre, Messina, Italy; 3Adult CF Center, Milano, Italy; 4Gynaecology Dept, Verona, Italy; 5Adult CF Center, Napoli, Italy; 6University of Turin, Torino, Italy; 7CF Centre, Firenze, Italy; 8CF Centre, Genova, Italy; 9CF Centre, Palermo, Italy; 10CF Centre Bambin Gesu, Roma, Italy; 11CF Centre, Bari, Italy; 12CF Centre, Potenza, Italy; 13CF Center, Verona, Italy

Background The purpose of this study was to identify the extent to which pediatric and adult cystic fibrosis (CF) care teams implement best practices in adherence assessment and counseling. Methods All US CF Foundation accredited programs were invited to participate in a web-based survey; 80% (92/115) of pediatric and 40% (38/95) of adult centers participated. Health care providers reported on current approaches and barriers to implementing adherence promotion practices. Results 64% discussed adherence at every clinic visit while only 8% used an objective assessment of adherence. Most centers reported frequent use of strategies to increase knowledge; behavioral and support strategies were used less regularly. Several barriers to adherence promotion were reported. Conclusions Many opportunities exist for care teams to improve consistency in adherence practices and integrate a greater repertoire of effective counseling strategies into clinic visits. Adherence promotion practices should be considered for quality improvement (QI) projects.

Objectives: Knowledge of disease management and treatment skills are necessary, but not sufficient, to improve adherence. This study examined: 1. gaps in knowledge of disease management, 2. deficits in treatment skills, 3. impact of age and gender, and 4. convergence between teen and parent knowledge. Methods: Knowledge of Disease Management (KDM-CF) in four domains, General Health, Lung Health, Nutrition, and Treatments, and the Skills Checklist (scored as percent correct) were administered to 571 teens (M = 14.6 years, SD = 2.6; 307 girls) and 249 parents in iCARE at 18 CF centers in the US. Results: Significant gaps in knowledge were observed, with lowest scores on the Nutrition Scale (M = 68.9 [15.4]). Skills were best for enzymes (M = 94.5 [12.00]) and worst for MDIs (M = 68.8 [18.8]) and acapella (M = 69.9 [23.1]). Age was positively correlated with Knowledge Scores (r = 0.46, p< 0.001) but not Skills. Older teens had higher KDM-CF Total Scores (M = 82.4 [9.5]) than younger teens (M = 71.8 [13.4], p< 0.001). Knowledge scores did not differ by gender, but girls (M = 82.8 [17.7]) had significantly higher Nebulizer Skills than boys (M = 79.4 [19.2], p< 0.05). Parents had higher KDM-CF Total Scores (M = 84.7 [7.5]) than adolescents (M = 75.1 [14.2]), and paired t-tests revealed significant differences in KDM scores by dyads (p< 0.001). Conclusions: Remediating gaps in knowledge of disease management and skill deficits are critical targets for intervention and should be assessed annually. These measures provide individual teen and parent data to focus teaching and retraining. Acknowledgements: Novartis Pharmaceuticals, Genentech, Inc. & Cystic Fibrosis Foundation. WS4.6 The psychometric properties of CF-specific measures of health beliefs and motivation to adhere K.A. Riekert1, D. Rand-Giovannetti1, B. Borrelli2, A. Green1, M.N. Eakin1. 1Johns Hopkins University, Medicine, Baltimore, United States; 2Brown University, Psychiatry & Human Behavior, Providence, United States