Evaluation of the Asthma Management Program to Promote Activity for Students in Schools (Asthma-PASS)

项目摘要/摘要 纽约州布朗克斯市学校的哮喘患病率为20%-25%。体力活动(PA)是哮喘的重要组成部分 儿童的管理。研究表明，PA与哮喘症状的严重程度降低有关，因为 以及改善疾病控制和生活质量。然而，患有哮喘的城市少数民族儿童面临障碍 到PA的多个层面上。在我们之前的工作(K23HD065742)中，我们发现了城市少数民族中PA的几个障碍 患有哮喘的学童。这些障碍包括：在学校没有足够的机会获得哮喘救援药物， 初级保健医生(PCP)的预防性哮喘治疗处方不佳，缺乏学校PA 机会，与哮喘相关的耻辱，父母/孩子对PA哮喘发作的恐惧，以及缺乏教师 有信心帮助哮喘学生。我们开发了一种新的哮喘管理计划来促进 与利益攸关方合作，为在校学生开展活动(哮喘通行证)，以解决这些关键障碍。 我们对来自4所布朗克斯小学的109名哮喘学生及其家长进行了哮喘通行证的试点测试 展示干预有效性的概念证明和初步证据。试行结果 研究表明，无症状天数(SFDs)(主要结果衡量标准)和 PA水平。此外，初步的中介分析表明，积极的PA和步数是 SFDS。我们现在计划在这项工作的基础上，在一项全面的随机试验中评估哮喘- PASS干预降低了高危城市学龄儿童的哮喘发病率。我们提出了一个集群- 随机对照试验，对26名5-11岁持续或未控制哮喘的416名儿童进行研究 布朗克斯的学校。学校将按规模分层，然后随机分配到(1)哮喘通行证 干预(PCP协作以确保最佳的以指南为基础的预防性哮喘护理和社区卫生 工作人员促进在学校获得救援药物，并提供哮喘意识规划和 对儿童、家长和学校工作人员进行教育，以减少对哮喘和哮喘的耻辱)或(2)哮喘 管理(AM)对照组(PCP和父母通知儿童哮喘状况和一般哮喘 教育)。这两个小组都将参加现有的全区教室日常活动计划(MOVE 来改进‘)。我们将评估哮喘通行证在降低哮喘发病率方面的有效性(主要结果 -SFDs)，以及改善PA(次要结果)以及其他临床和功能结果。我们会 使用先前建立的程序，用加速度计测量PA。我们还将确定潜在的 干预效果的调解人和调解人。我们将对干预实施过程进行评估 通过应用RE-AIM框架。这项建议直接建立在我们之前在学校改善哮喘的工作基础上。 结果，减少健康差距。如果哮喘通行证成功地减轻了症状并改善了健康， 它将为全国学校和城市社区的政策变化提供强有力的论据。

PROJECT SUMMARY/ABSTRACT Asthma prevalence in Bronx, NY schools is 20-25%. Physical activity (PA) is an important component of asthma management in children. Studies show that PA is associated with decreased severity of asthma symptoms, as well as improved disease control and quality of life. However, urban minority children with asthma face barriers to PA on multiple levels. In our prior work (K23HD065742), we identified several barriers to PA in urban minority schoolchildren with asthma. These barriers include: inadequate access to asthma rescue medications in school, suboptimal prescribing of preventive asthma therapy by primary care physicians (PCPs), lack of school PA opportunities, stigma associated with asthma, parent/child fear of an asthma attack with PA, and lack of teacher confidence in assisting students with asthma. We developed a novel Asthma management program to Promote Activity for Students in Schools (Asthma-PASS) in collaboration with stakeholders to address these key barriers. We pilot tested Asthma-PASS with 109 students with asthma from 4 Bronx elementary schools and their parents to demonstrate proof of concept and preliminary evidence of intervention effectiveness. Results from the pilot study demonstrated significantly greater increase in symptom-free days (SFDs) (primary outcome measure) and PA levels. In addition, preliminary mediation analyses suggested vigorous PA and step counts are mediators of SFDs. We now plan to build upon this work and evaluate in a full-scale randomized trial whether the Asthma- PASS intervention reduces asthma morbidity among high-risk urban schoolchildren. We propose a cluster- randomized controlled trial with 416 children ages 5-11 years with persistent or uncontrolled asthma from 26 Bronx schools. Schools will be stratified by size and then randomly assigned to either (1) the Asthma-PASS intervention (PCP collaboration to ensure optimal guideline-based preventive asthma care and community health workers to facilitate rescue medication availability in school and provide asthma awareness programming and education for children, parents and school personnel to reduce stigma around asthma and PA) or (2) an asthma management (AM) comparison group (PCP and parent notification of child’s asthma status and general asthma education). Both groups will participate in an existing district-wide classroom-based daily activity program (‘Move to Improve’). We will assess the effectiveness of Asthma-PASS in reducing asthma morbidity (primary outcome - SFDs), and improving PA (secondary outcome) as well as additional clinical and functional outcomes. We will measure PA with accelerometers using previously established procedures. We will also identify potential mediators and moderators of the intervention effect. We will evaluate the process of intervention implementation by applying the RE-AIM framework. This proposal directly builds on our prior work in schools to improve asthma outcomes and reduce health disparities. If Asthma-PASS successfully reduces symptoms and improves health, it will provide a powerful argument for policy change in schools and urban communities nationwide.