A web-based, tailored asthma management program for urban African-American high school students

Abstract

Rationale: Urban African-American youth, aged 15-19 years, have asthma fatality rates that are higher than in whites and younger children, yet few programs target this population. Traditionally, urban youth are believed to be difficult to engage in health-related programs, both in terms of connecting and convincing.

Objectives: Develop and evaluate a multimedia, web-based asthma management program to specifically target urban high school students. The program uses "tailoring," in conjunction with theory-based models, to alter behavior through individualized health messages based on the user's beliefs, attitudes, and personal barriers to change.

Methods: High school students reporting asthma symptoms were randomized to receive the tailored program (treatment) or to access generic asthma websites (control). The program was made available on school computers.

Measurements and main results: Functional status and medical care use were measured at study initiation and 12 months postbaseline, as were selected management behaviors. The intervention period was 180 days (calculated from baseline). A total of 314 students were randomized (98% African American, 49% Medicaid enrollees; mean age, 15.2 yr). At 12 months, treatment students reported fewer symptom-days, symptom-nights, school days missed, restricted-activity days, and hospitalizations for asthma when compared with control students; adjusted relative risk and 95% confidence intervals were as follows: 0.5 (0.4-0.8), p = 0.003; 0.4 (0.2-0.8), p = 0.009; 0.3 (0.1-0.7), p = 0.006; 0.5 (0.3-0.8), p = 0.02; and 0.2 (0.2-0.9), p = 0.01, respectively. Positive behaviors were more frequently noted among treatment students compared with control students. Cost estimates for program delivery were $6.66 per participating treatment group student.

Conclusions: A web-based, tailored approach to changing negative asthma management behaviors is economical, feasible, and effective in improving asthma outcomes in a traditionally hard-to-reach population.

Figure 1.

Study definitions and inclusion criteria for randomized trial of Puff City Asthma Management Program for urban adolescents. *Last 12 months. ED = emergency department.

Figure 2.

Flowchart of study participation and randomization. ¹Categorization of four students for whom Lung Health Survey forms are missing was achieved using baseline responses.