DESCRIPTION (provided by applicant): Asthma, the most common chronic disorder in childhood, disproportionately affects African-Americans (AAs) with both greater morbidity and mortality. AA male youth suffer death rates from asthma that are six times greater than for white male youth of the same age. Among triggers for asthma, tobacco use and passive smoke exposure are considered among the most adverse. Nearly 6.4 million youth living today will die prematurely from tobacco attributable diseases. The higher level of morbidity and mortality among AA youth, at times related to tobacco exposure, emphasize the need for new methods for reaching these youth. With NHLBI funding (HL68971) a culturally sensitive, web-based intervention, termed "Puff City," was developed based on: Motivational Theory, tailoring of information, essential asthma management skills, and entertainment. When this program was evaluated among predominately AA youth attending a Midwestern, urban school system (Detroit Public Schools) promising results (i.e. fewer emergency department visits, fewer hospitalizations, improved quality of life scores, and reduced number of school days missed) were found. The cost of delivering the program was $6.67 per student. Given the initial success of Puff City among the Detroit youth, an important question is whether this intervention will be effective among AA youth living in the rural south: a different cultural, social, and climatic environment. This application seeks to evaluate the effectiveness of the Puff City program in 9th-11th grade, southern, rural youth (N=300) using a randomized, two-group design with repeated measures. Youth randomized to the treatment group will receive the Puff City program and those in the control group will receive equal web-based time on websites that provide education on asthma and tobacco risks. The Puff City intervention consists of four, 30 minute, modules that target three key asthma management issues: reduction of tobacco exposure (i.e. smoking and passive smoke exposure), controller medication adherence, and attack readiness (i.e. carrying a rescue inhaler at all times). Behavioral change will be evaluated by self-report at baseline, end of treatment (short-term), and at six and 12 months follow up (long-term) and also via salivary cotinine and exhaled nitric oxide (eNO) at the same time points. The Puff City program is expected to foster the development of personal motivational factors that will result in improved asthma management in all three target areas. The primary hypotheses are: Youth in the treatment arm will have improved behavioral outcomes of: 1) a decrease in passive smoke exposure;2) greater controller medication adherence;and 3) greater attack readiness. The secondary hypotheses are that treated youth when compared to control youth will also have reduced levels of salivary cotinine and eNO, and a decrease in active smoking. Cross-study comparative analyses will also be performed between the rural South and urban Midwestern youth populations. Consistent with the mission of the NHLBI, this application targets the advancement of socio-cultural behavioral treatments for preventing further asthma and tobacco-related morbidity and mortality and the elimination of health disparities observed for an ethnic minority-AAs. If effective, implementation of this culturally tailored and cost effective approach via school systems as the primary point of entry is highly probable. PUBLIC HEALTH RELEVANCE: This research addresses two significant public health concerns, asthma and tobacco use in a largely neglected population, African American youth living in a rural area. There is evidence to suggest that both of these health issues can be effectively addressed using a culturally sensitive, cost effective, web-based, self-tailoring, computer program.
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