Effects of a school-based intervention for urban adolescents with asthma a controlled trial

Abstract

Rationale: Asthma prevalence and morbidity are especially elevated in adolescents, yet few interventions target this population. Objectives: To test the efficacy of Asthma Self-Management for Adolescents (ASMA), a school-based intervention for adolescents and medical providers. Methods: Three hundred forty-five primarily Latino/a (46%) and African American (31%) high school students (mean age 5 15.1 yr; 70% female) reporting an asthma diagnosis, symptoms of moderate to severe persistent asthma, and asthma medication use in the last 12 months were randomized to ASMA, an 8-week school-based intervention, or a wait-list control group. They were followed for 12 months. Measurements and Main Results: Students completed bimonthly assessments. Baseline, 6-month, and 12-month assessments were comprehensive; the others assessed interim health outcomes and urgent health care use. Primary outcomes were asthma selfmanagement, symptom frequency, and quality of life (QOL); secondary outcomes were asthma medical management, school absences, days with activity limitations, and urgent health care use. Relative to control subjects, ASMA students reported significantly: more confidence to manage their asthma; taking more steps to prevent symptoms; greater use of controller medication and written treatment plans; fewer night awakenings, days with activity limitation, and school absences due to asthma; improved QOL; and fewer acute care visits, emergency department visits, and hospitalizations. In contrast, steps to manage asthma episodes, daytime symptom frequency, and school-reported absences did not differentiate the two groups. Most results were sustained over the 12 months. Conclusions: ASMA is efficacious in improving asthma selfmanagement and reducing asthma morbidity and urgent health care use in low-income urban minority adolescents.