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Randomized Controlled Trial
. 2022 Mar;59(3):494-506.
doi: 10.1080/02770903.2020.1856869. Epub 2021 Jan 8.

Effect of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity: a 3-arm randomized controlled trial

Jill S Halterman  1 , Kristin A Riekert  2 , Maria Fagnano  1 , Paul J Tremblay  1 , Susan W Blaakman  3 , Reynaldo Tajon  1 , Hongyue Wang  4 , Belinda Borrelli  5
Affiliations
Randomized Controlled Trial

Effect of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity: a 3-arm randomized controlled trial

Jill S Halterman et al. J Asthma. 2022 Mar.

Abstract

Urban adolescents with asthma often have inadequate preventive care. We tested the effectiveness of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity and preventive medication adherence.Methods:Subjects/Setting- 12-16yr olds with persistent asthma in Rochester, NY schools. Design- 3-group randomized trial (2014-2019). SB-ACT Intervention- Two core components: 1) Directly observed therapy (DOT) of preventive asthma medications, provided in school for at least 6-8 weeks for the teen to learn proper technique and experience the benefits of daily preventive therapy; 2) 4-6 weeks later, 3 sessions of motivational interviewing (MI) to discuss potential benefits from DOT and enhance motivation to take medication independently. We included 2 comparison groups: 1) DOT-only for 6-8wks, and 2) asthma education (AE) attention control. Masked follow-up assessments were conducted at 3, 5, and 7mos. Outcomes- Mean number of symptom-free days (SFDs)/2 weeks and medication adherence. Analyses- Modified intention-to-treat repeated measures analysis.Results: We enrolled 430 teens (56% Black, 32% Hispanic, 85% Medicaid). There were no group differences at baseline. We found no difference in SFDs at any follow-up timepoint. More teens in the SB-ACT and DOT-only groups reported having a preventive asthma medication at each follow-up (p<.001), and almost daily adherence at 3 and 5-months (p<.001, p=.003) compared to AE. By 7 months there were no significant differences between groups in adherence (p=.49).Conclusion: SB-ACT improved preventive medication availability and short-term adherence but did not impact asthma symptoms. Further work is needed to create developmentally appropriate and effective interventions for this group.

Keywords: Adherence; adolescents; directly observed therapy; motivational interviewing; schools; symptoms; urban.

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Conflict of interest statement

Declaration of Interest Statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Figures

Figure 1:
Figure 1:
Consort Diagram
Figure 2a:
Figure 2a:. Symptom Free Days, Preventive Medication Prescription, and Adherence Over Time
Symptom Free Days
Figure 2b.
Figure 2b.. Symptom Free Days, Preventive Medication Prescription, and Adherence Over Time
Preventive Medication Prescription
Figure 2c.
Figure 2c.. Symptom Free Days, Preventive Medication Prescription, and Adherence Over Time
Medication Adherence
See this image and copyright information in PMC

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