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 = 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 self-management, 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 self-management and reducing asthma morbidity and urgent health care use in low-income urban minority adolescents.

Figure 1.

Flowchart of participants through the study.

Figure 2.

Descriptive data for significant health outcomes by assessment time point and treatment group. (A) Number of nights wakened in previous 2 weeks. (B) Number of days activity limitation in previous 2 weeks. (C) Number of school absences displayed as annualized rates at each time point. Top two lines show Department of Education de-identified data of all students for the baseline and follow-up years. Bottom two lines show bimonthly self-report data for absences due to asthma over the last 2 weeks, converted to annualized rates (mean 2-wk values at each time point × 18, the number of 2-week periods in a school year. Diamonds, dotted lines: control; circles, solid lines: intervention. *Corresponds roughly to immediate postintervention; **August, no school.