, et al
Evaluation of a web-based asthma management intervention program for urban teenagers: reaching the hard to reach [published online ahead of print September 27, 2012]
J Adolesc Health
; doi:

Investigators from multiple institutions in Michigan and Georgia sought to determine whether using Puff City, a web-based asthma intervention developed by the authors and aimed at African American teenagers, improves asthma outcomes. Students in grades 9 through 12 were recruited from 6 public high schools for the study if they had a diagnosis of asthma made by a health care provider, current symptoms, and use of asthma medications. Students without a formal asthma diagnosis were also included if they had symptoms consistent with a diagnosis of intermittent asthma or more severe asthma (based on the International Survey of Asthma and Allergies in Childhood questionnaire).

At enrollment, participants were randomized to the intervention (Puff City) or to the control group and researchers were blinded to treatment group assignment. The Puff City intervention group was given access (via home or school computers) to four 15- to 30-minute online asthma management sessions. The modules consisted of a radio disc jockey providing voice-overs of asthma advice related to usage of medications and devices, trigger avoidance, and physiology. Puff City focused on 3 behaviors: adherence to controller medication, ensuring that rescue inhalers were nearby, and tobacco cessation or decreased use. Computer algorithms used the participants’ responses to questions on attitudes and beliefs to provide tailored feedback. Additional modules were included in the version of Puff City used in the study to provide tailored feedback to participants classified as more resistant to change based on measures for low perceived emotional support, low motivation, or rebelliousness. The comparison group received access to generic asthma education websites. Participants and their caregivers completed surveys at baseline and 12 months following enrollment on asthma symptoms and treatment. In addition, based on participant responses to specific questions, a referral coordinator identified red flags (eg, depression, no medication or physician, severe or persistent symptoms) and referred students to appropriate resources. Primary study outcomes (number of symptom days and nights, restricted activity days, missed school days, and health care utilization) at 12 months were compared in the 2 treatment groups, controlling for baseline symptoms. Subgroup analyses were conducted on participants classified as resistant to change and those with moderate to severe asthma.

Ultimately, 422 participants who were predominantly African American (98%) with a mean age of 15.6 years were enrolled, randomized (204 assigned to the intervention and 218 randomized to the control group), and completed the study. After completing the intervention, participants in the intervention group had significantly fewer symptom days than those in the control group. Health care utilization did not differ significantly among those in the intervention and control groups. Among participants who met criteria for rebelliousness, teens in the intervention group reported significantly fewer restricted activity days, symptom days and nights, and absences from school. For...

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