TY - JOUR
T1 - Evaluation of a web-based asthma management intervention program for urban teenagers
T2 - Reaching the hard to reach
AU - Joseph, Christine L.M.
AU - Ownby, Dennis R.
AU - Havstad, Suzanne L.
AU - Saltzgaber, Jacqueline
AU - Considine, Shannon
AU - Johnson, Dayna
AU - Peterson, Ed
AU - Alexander, Gwen
AU - Lu, Mei
AU - Gibson-Scipio, Wanda
AU - Johnson, Christine Cole
N1 - Funding Information:
The authors thank the Detroit Public Schools Office of Research, Evaluation, and Assessment; and Anntinette McCain, Director of the Coordinated School Health Council. They also acknowledge the expert advice and consult of Sarah Lyon Callo, M.A., M.S., and Ericka Garcia, M.A., of the Michigan Department of Community Health. This research was funded by National Institutes of Health , National Heart, Lung, and Blood Institute Grant R01 HL67462-01 , ClinicalTrials.gov Id: NCT00201058 .
PY - 2013/4
Y1 - 2013/4
N2 - Purpose: Asthma interventions targeting urban adolescents are rare, despite a great need. Motivating adolescents to achieve better self-management of asthma is challenging, and the literature suggests that certain subgroups are more resistant than others. We conducted a school-based, randomized controlled trial (RCT) to evaluate Puff City, a Web-based, tailored asthma intervention, which included a referral coordinator, and incorporated theory-based strategies to target urban teens with characteristics previously found to be associated with lack of behavior change. Methods: To identify eligible teens, we administered questionnaires on asthma diagnoses and symptoms to ninth through 12th graders of participating schools during a scheduled English class. We randomized eligible, consenting students to Puff City (treatment) or generic asthma education (control). Results: We randomized 422 students (98% African-American, mean age = 15.6 years). At 12-month follow-up, adjusted odds ratios (aORs) (95% confidence intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) as aOR =.49 (.24-.79), p =.006 and.53 (.32-.86), p =.010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences, and restricted activity days: aOR =.30 (.11-.80),.29 (.14-.64),.40 (.20-.78), and.23 (.10-.55); all p <.05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls: aOR =.23 (.06-.88), p =.031. We did not observe statistically significant differences in medical care use. Conclusions: Results suggest that a theory-based, tailored approach, with a referral coordinator, can improve asthma management in urban teens. Puff City represents a viable strategy for disseminating an effective intervention to high-risk and hard-to-reach populations.
AB - Purpose: Asthma interventions targeting urban adolescents are rare, despite a great need. Motivating adolescents to achieve better self-management of asthma is challenging, and the literature suggests that certain subgroups are more resistant than others. We conducted a school-based, randomized controlled trial (RCT) to evaluate Puff City, a Web-based, tailored asthma intervention, which included a referral coordinator, and incorporated theory-based strategies to target urban teens with characteristics previously found to be associated with lack of behavior change. Methods: To identify eligible teens, we administered questionnaires on asthma diagnoses and symptoms to ninth through 12th graders of participating schools during a scheduled English class. We randomized eligible, consenting students to Puff City (treatment) or generic asthma education (control). Results: We randomized 422 students (98% African-American, mean age = 15.6 years). At 12-month follow-up, adjusted odds ratios (aORs) (95% confidence intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) as aOR =.49 (.24-.79), p =.006 and.53 (.32-.86), p =.010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences, and restricted activity days: aOR =.30 (.11-.80),.29 (.14-.64),.40 (.20-.78), and.23 (.10-.55); all p <.05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls: aOR =.23 (.06-.88), p =.031. We did not observe statistically significant differences in medical care use. Conclusions: Results suggest that a theory-based, tailored approach, with a referral coordinator, can improve asthma management in urban teens. Puff City represents a viable strategy for disseminating an effective intervention to high-risk and hard-to-reach populations.
KW - Adolescents
KW - African-American
KW - Asthma
KW - Behavioral intervention
KW - Randomized controlled trial
KW - Tailored intervention
KW - Web-based intervention
UR - http://www.scopus.com/inward/record.url?scp=84875371599&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84875371599&partnerID=8YFLogxK
U2 - 10.1016/j.jadohealth.2012.07.009
DO - 10.1016/j.jadohealth.2012.07.009
M3 - Article
C2 - 23299008
AN - SCOPUS:84875371599
SN - 1054-139X
VL - 52
SP - 419
EP - 426
JO - Journal of Adolescent Health
JF - Journal of Adolescent Health
IS - 4
ER -