Promoting Asthma Wellness in Rural Communities

描述(由申请人提供)：哮喘是儿童时期最常见的慢性疾病，对非裔美国人的影响不成比例，发病率和死亡率都更高。AA男性青年患哮喘的死亡率是同龄白人男性青年的6倍。在哮喘的诱因中，吸烟和被动吸烟被认为是最有害的。今天生活的近640万青年将因烟草引起的疾病而过早死亡。再生障碍性贫血青年的发病率和死亡率较高，有时与烟草接触有关，这强调了接触这些青年需要新的方法。在NHLBI的资助下(HL68971)，开发了一种文化敏感的、基于网络的干预措施，名为“泡芙城市”，其基础是：激励理论、信息定制、基本哮喘管理技能和娱乐。当在中西部城市学校系统(底特律公立学校)对以AA为主的年轻人评估这一计划时，发现了有希望的结果(即急诊科就诊次数减少，住院人数减少，生活质量得分提高，缺课天数减少)。该项目的费用为每个学生6.67美元。鉴于帕夫市在底特律青年中取得的初步成功，一个重要的问题是，这种干预措施是否会对生活在南部农村的AA青年有效：一个不同的文化、社会和气候环境。这项申请旨在评估泡芙城市计划在9-11年级南部农村青少年(N=300)中的有效性，采用重复测量的随机两组设计。被随机分配到治疗组的年轻人将接受Puff City计划，而对照组的年轻人将在提供哮喘和烟草风险教育的网站上获得同等的网络时间。帕夫市干预措施由四个30分钟的单元组成，针对三个关键的哮喘管理问题：减少烟草暴露(即吸烟和被动吸烟暴露)、控制员服药依从性和攻击准备(即始终携带救援吸入器)。行为变化将在基线、治疗结束(短期)、6个月和12个月随访(长期)时通过自我报告进行评估，并通过唾液可替宁和呼出的一氧化氮(ENO)在相同时间点进行评估。帕夫市项目预计将促进个人激励因素的发展，从而改善所有三个目标地区的哮喘管理。主要假设是：接受治疗的青少年将改善以下行为结果：1)被动吸烟暴露的减少；2)更严格的控制者用药依从性；以及3)更好的攻击准备。第二个假设是，与对照青年相比，接受治疗的青年唾液可替宁和eNO水平也会降低，主动吸烟也会减少。还将对南部农村和中西部城市青年人口进行交叉研究比较分析。与NHLBI的使命一致，这项申请的目标是推进社会文化行为治疗，以防止进一步的哮喘和烟草相关的发病率和死亡率，并消除观察到的少数民族--AA的健康差距。如果有效，通过学校系统作为主要切入点实施这一文化定制和成本效益高的方法的可能性很高。公共卫生相关性：这项研究解决了两个重大的公共卫生问题，哮喘和烟草使用在一个很大程度上被忽视的人群中，非裔美国青年生活在农村地区。有证据表明，这两个健康问题都可以通过使用一个文化敏感、成本效益高、基于网络、自我定制的计算机程序来有效地解决。

DESCRIPTION (provided by applicant): Asthma, the most common chronic disorder in childhood, disproportionately affects African-Americans (AAs) with both greater morbidity and mortality. AA male youth suffer death rates from asthma that are six times greater than for white male youth of the same age. Among triggers for asthma, tobacco use and passive smoke exposure are considered among the most adverse. Nearly 6.4 million youth living today will die prematurely from tobacco attributable diseases. The higher level of morbidity and mortality among AA youth, at times related to tobacco exposure, emphasize the need for new methods for reaching these youth. With NHLBI funding (HL68971) a culturally sensitive, web-based intervention, termed "Puff City," was developed based on: Motivational Theory, tailoring of information, essential asthma management skills, and entertainment. When this program was evaluated among predominately AA youth attending a Midwestern, urban school system (Detroit Public Schools) promising results (i.e. fewer emergency department visits, fewer hospitalizations, improved quality of life scores, and reduced number of school days missed) were found. The cost of delivering the program was $6.67 per student. Given the initial success of Puff City among the Detroit youth, an important question is whether this intervention will be effective among AA youth living in the rural south: a different cultural, social, and climatic environment. This application seeks to evaluate the effectiveness of the Puff City program in 9th-11th grade, southern, rural youth (N=300) using a randomized, two-group design with repeated measures. Youth randomized to the treatment group will receive the Puff City program and those in the control group will receive equal web-based time on websites that provide education on asthma and tobacco risks. The Puff City intervention consists of four, 30 minute, modules that target three key asthma management issues: reduction of tobacco exposure (i.e. smoking and passive smoke exposure), controller medication adherence, and attack readiness (i.e. carrying a rescue inhaler at all times). Behavioral change will be evaluated by self-report at baseline, end of treatment (short-term), and at six and 12 months follow up (long-term) and also via salivary cotinine and exhaled nitric oxide (eNO) at the same time points. The Puff City program is expected to foster the development of personal motivational factors that will result in improved asthma management in all three target areas. The primary hypotheses are: Youth in the treatment arm will have improved behavioral outcomes of: 1) a decrease in passive smoke exposure; 2) greater controller medication adherence; and 3) greater attack readiness. The secondary hypotheses are that treated youth when compared to control youth will also have reduced levels of salivary cotinine and eNO, and a decrease in active smoking. Cross-study comparative analyses will also be performed between the rural South and urban Midwestern youth populations. Consistent with the mission of the NHLBI, this application targets the advancement of socio-cultural behavioral treatments for preventing further asthma and tobacco-related morbidity and mortality and the elimination of health disparities observed for an ethnic minority-AAs. If effective, implementation of this culturally tailored and cost effective approach via school systems as the primary point of entry is highly probable. PUBLIC HEALTH RELEVANCE: This research addresses two significant public health concerns, asthma and tobacco use in a largely neglected population, African American youth living in a rural area. There is evidence to suggest that both of these health issues can be effectively addressed using a culturally sensitive, cost effective, web-based, self-tailoring, computer program.