ASTHMA SELF-MANAGEMENT FOR ADOLESCENTS

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DESCRIPTION (Applicant's Abstract) The goal of this research is to develop strategies to help 9th and 10th grade students with persistent asthma learn to control their asthma and live without restrictions in physical or social activity. Adolescents, particularly those from minority groups, have a higher risk for prevalence, morbidity, and mortality due to asthma than children aged 5-12 years, yet there has been little work to address these problems. Columbia University College of Physicians & Surgeons (CU), the New York City Board of Education (BOE), and the Medical and Health Research Association of New York City, Inc. (MHRA) propose a collaboration to test the hypothesis that an intensive school-based asthma education program for 9th and 10th grade students who have persistent asthma, coupled with intensive asthma education for their community physicians, can improve the students' health status, quality of life, and ability to self-regulate their health behavior. This study builds on our previous work in New York City schools, and has the enthusiastic support of the leadership of the Board of Education. Specific aims: Working with BOE staff we will test the effectiveness of the following program: (1) screening to identify 9th and 10th grade students with asthma and assess how well their asthma is controlled; (2) intensive asthma education for students with persistent asthma based on the Open Airways for Schools and Asthma Self- Regulation programs developed by the investigators; (3) continuing medical education for the community physicians who treat the students through the MD/Family Partnership program developed by the investigators, supplemented by an intensive academic detailing program based on NHLBI guidelines for asthma care; (4) development of a written asthma management plan for asthma for each student with the family and physician; and (5) referral of students who lack continuing, primary medical care to physicians who have received training in asthma management. Hypothesis: We hypothesize that students with asthma enrolled in this intervention will have, relative to students in the control group, significantly greater improvement on three primary outcome measures: (1.1) reduced asthma symptom frequency; (1.2) improved quality of life; and (1.3) greater capacity for self-regulation of asthma. We will also examine four secondary outcome measures: (2.1) days with activity restriction; (2.2) urgent or emergency use of health care services; (2.3) school attendance; (2.4) school performance; (2.5) the proportion of students with written asthma management plans provided by their physician;and (2.6) the proportion of students who have inhaled antiinflammatory medicine prescribed by their physician.