Evaluation of a Web-Based Asthma Management Intervention Program for Urban Teenagers: Reaching the Hard to Reach

• Published in: Journal of adolescent health Vol. 52; no. 4; pp. 419 - 426
• Main Authors: Joseph, Christine L.M., Ph.D, Ownby, Dennis R., M.D, Havstad, Suzanne L., M.S, Saltzgaber, Jacqueline, M.S, Considine, Shannon, M.P.H, Johnson, Dayna, M.P.H., M.S.W, Peterson, Ed, Ph.D, Alexander, Gwen, Ph.D, Lu, Mei, Ph.D, Gibson-Scipio, Wanda, R.N., Ph.D, Johnson, Christine Cole, Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2013; Elsevier
• Subjects: Administration, Inhalation; Adolescent; Adolescents; African-American; Anti-Asthmatic Agents - administration & dosage; Asthma; Asthma - ethnology; Asthma - psychology; Asthma - therapy; Attitude to Health; Behavior therapy. Cognitive therapy; Behavioral intervention; Biological and medical sciences; Black or African American - education; Black or African American - psychology; Chronic obstructive pulmonary disease, asthma; Computer based; Coordinators; Female; Humans; Internal-External Control; Internet; Male; Medical sciences; Motivation; Motivational Interviewing; Patient Compliance - psychology; Patient Education as Topic - methods; Pediatrics; Pneumology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Randomized controlled trial; Referrals; Self Care - psychology; Smoking Cessation - methods; Smoking Cessation - psychology; Surveys and Questionnaires; Tailored intervention; Treatments; Urban Population; Web-based intervention; Web-based intervention; African-American; Behavioral intervention; Tailored intervention; Adolescents; Randomized controlled trial; Asthma; Social environment; Selfcare; Behavior therapy; Obstructive pulmonary disease; Public health; Human; Sanitary program; Urban environment; Respiratory disease; Treatment efficiency; Controlled therapeutic trial; Motor control; Ethnic group; School environment; Treatment; Adolescent; Internet; African American
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2012.07.009

Abstract 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.