An evaluation of asthma interventions for preteen students.
BACKGROUND
Asthma is a serious problem for low-income preteens living in disadvantaged communities. Among the chronic diseases of childhood and adolescence, asthma has the highest prevalence and related health care use. School-based asthma interventions have proven successful for older and younger students, but results have not been demonstrated for those in middle school.


METHODS
This randomized controlled study screened students 10-13 years of age in 19 middle schools in low-income communities in Detroit, Michigan. Of the 6,872 students who were screened, 1,292 students were identified with asthma. Schools were matched and randomly assigned to Program 1 or 2 or control. Baseline, 12, and 24 months data were collected by telephone (parents), at school (students) and from school system records. Measures were the students' asthma symptoms, quality of life, academic performance, self-regulation, and asthma management practices. Data were analyzed using multiple imputation with sequential regression analysis. Mixed models and Poisson regressions were used to develop final models.


RESULTS
Neither program produced significant change in asthma symptoms or quality of life. One produced improved school grades (p = .02). The other enhanced self-regulation (p = .01) at 24 months. Both slowed the decline in self-regulation in undiagnosed preteens at 12 months and increased self-regulation at 24 months (p = .04; p = .003).


CONCLUSIONS
Programs had effects on academic performance and self-regulation capacities of students. More developmentally focused interventions may be needed for students at this transitional stage. Disruptive factors in the schools may have reduced both program impact and the potential for outcome assessment.
Center for Managing Chronic Disease, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA. nmclark@umich.edu
Noreen M
NM
Clark
Smita
S
Shah
Julia A
JA
Dodge
Lara J
LJ
Thomas
Rebecca R
RR
Andridge
Roderick J A
RJ
Little
D001741:Black or African American; D001249:Asthma / Q000150:complications / Q000628:therapy*; D002648:Child; D003479:Curriculum; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008824:Michigan; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care / Q000379:methods; D012720:Severity of Illness Index; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population