title: Evaluation of a web-based asthma management intervention program for urban teenagers: reaching the hard to reach.
abstract: OBJECTIVE
  Asthma interventions targeting urban adolescents are rare, despite a great need. Motivating adolescents to achieve better self-management of asthma is challenging, and the literature suggests that certain subgroups are more resistant than others. We conducted a school-based, randomized controlled trial (RCT) to evaluate Puff City, a Web-based, tailored asthma intervention, which included a referral coordinator, and incorporated theory-based strategies to target urban teens with characteristics previously found to be associated with lack of behavior change.
  
  
  METHODS
  To identify eligible teens, we administered questionnaires on asthma diagnoses and symptoms to ninth through 12th graders of participating schools during a scheduled English class. We randomized eligible, consenting students to Puff City (treatment) or generic asthma education (control).
  
  
  RESULTS
  We randomized 422 students (98% African-American, mean age = 15.6 years). At 12-month follow-up, adjusted odds ratios (aORs) (95% confidence intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) as aOR = .49 (.24-.79), p = .006 and .53 (.32-.86), p = .010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences, and restricted activity days: aOR = .30 (.11-.80), .29 (.14-.64), .40 (.20-.78), and .23 (.10-.55); all p < .05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls: aOR = .23 (.06-.88), p = .031. We did not observe statistically significant differences in medical care use.
  
  
  CONCLUSIONS
  Results suggest that a theory-based, tailored approach, with a referral coordinator, can improve asthma management in urban teens. Puff City represents a viable strategy for disseminating an effective intervention to high-risk and hard-to-reach populations.
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA. cjoseph1@hfhs.org
authors.forename: Christine L M
authors.initials: CL
authors.lastname: Joseph
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Ownby
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Havstad
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saltzgaber
authors.forename: Shannon
authors.initials: S
authors.lastname: Considine
authors.forename: Dayna
authors.initials: D
authors.lastname: Johnson
authors.forename: Ed
authors.initials: E
authors.lastname: Peterson
authors.forename: Gwen
authors.initials: G
authors.lastname: Alexander
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Wanda
authors.initials: W
authors.lastname: Gibson-Scipio
authors.forename: Christine Cole
authors.initials: CC
authors.lastname: Johnson
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D001741:Black or African American / Q000193:education* / Q000523:psychology*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D001294:Attitude to Health; D005260:Female; D006801:Humans; D007389:Internal-External Control; D020407:Internet; D008297:Male; D009042:Motivation; D062405:Motivational Interviewing; D010349:Patient Compliance / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology; D011795:Surveys and Questionnaires; D014505:Urban Population
chemical_list: D018927:Anti-Asthmatic Agents