A School-based Approach to Helping Urban H.S. Students with Undiagnosed Asthma

以学校为基础的方法来帮助城市 H.S.

• 批准号: 8277955
• 负责人: Jean-Marie Bruzzese
• 金额: $ 76.29万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8277955
• 关键词: 18 year old; Abbreviations; Academic Detailing; Accounting; Address; Adolescent; Asthma; Breathing; Caregivers; Caring; Child; Chronic Disease; Clinical Treatment; Control Groups; Detection; Diagnosis; Education; Educational Intervention; Enrollment; Evaluation; Family; Goals; Health Personnel; Healthcare; Individual; Intervention; Knowledge; Logistic Regressions; Low income; Mails; Measures; Medical; Medical Students; Methods; Modeling; Morbidity - disease rate; Outcome; Pamphlets; Participant; Pharmaceutical Preparations; Policy Maker; Prevalence; Prevalence Study; Provider; Public Health; Quality of life; Randomized; Relative (related person); Reporting; Research; Research Personnel; Schools; Self Management; Severities; Stress; Students; Symptoms; Teenagers; Telephone; Testing; Universities; Vulnerable Populations; Writing; Youth; age group; base; control trial; design; efficacy testing; ethnic minority population; experience; follow-up; group intervention; health care service utilization; high school; improved; inner city; medical schools; meetings; post intervention; programs; public health relevance; research clinical testing; respiratory

DESCRIPTION (provided by applicant): Rationale: Recent studies consistently report substantial rates of youth with asthma-like symptoms that are undiagnosed. Undiagnosed symptomatic youth have appreciable morbidity and activity limitations. Despite successful school-based interventions for diagnosed youth, few programs have been implemented solely with undiagnosed adolescents. Asthma Self-Management for Adolescents with Undiagnosed Asthma (ASMA- Undx), an 8-week intensive school-based intervention that expands the caseworker model and has three complementary components designed to help families of adolescents with asthma-like symptoms obtain a clinical evaluation, obtain a diagnosis and manage their asthma-like symptoms: (1) student sessions group sessions, individual coaching sessions and referral to medical providers; (2) caregiver sessions referral to a medical provider, education via mailed booklets, telephone contacts, and a group session; and (3) academic detailing for students' medical providers. Specific Study Aim: This 5-year study addresses the unmet needs of adolescents who meet criteria for persistent asthma but who have yet to be diagnosed through the testing of ASMA-Undx compared to an information-and-referral control group. Hypotheses: Relative to controls, students in ASMA-Undx will show significant improvement over one year on: (1a) the proportion who see a medical provider for an evaluation, (1b) the proportion whose medical providers diagnose them with asthma, (1c) the proportion whose medical providers prescribe medication, (1d) the proportion who obtain medication if prescribed, (1e) rate of night wakening and (1f) rate of daily activity limitation due to asthma symptoms. They will also show greater improvement on: (2a) rate of day symptoms; (2b) asthma symptom severity; (2c) school absences due to asthma; (2d) asthma knowledge; (2e) asthma self-management; (2f) urgent health care utilization; (2g) quality of life; (2h) the proportion of students whose medical providers provide a written asthma management plan; and (2i) stress related to breathing problems. Methods: We will use a controlled trial with 400 9th through 11th grade undiagnosed students who report persistent asthma-like. Participants are randomly assigned to an intervention group or an information-and-referral control group. Students, who will primarily be from low-income, ethnic minority backgrounds, will be enrolled over four years from 16 NYC public high schools. All students will be followed for 12-months post-intervention. Outcomes will be analyzed according to the intent to treat (ITT) principle using a logistic regression model and a Poisson regression model that take into account the repeated measures post-intervention, covariates identified at baseline and school clustering effects. Significance: This study has high public health significance given: (1) the lack of interventions for undiagnosed youth despite the significant prevalence of undiagnosed asthma and the appreciable asthma morbidity and activity limitation suffered by these youth; (2) that it is delivered in the real-world setting of schools; and (3) that it targets under-served low-income, ethnic minority adolescents. PUBLIC HEALTH RELEVANCE: Targeting underserved inner-city, ethnic minority adolescents who meet criteria for persistent asthma but who have yet to be diagnosed, this study investigates whether a multi-component psycho-educational intervention (student, caregivers and medical providers) is efficacious at helping families obtain a diagnosis and treatment, and reduce asthma-like symptoms. This application has considerable public health relevance because it is delivered in high schools, and therefore will be informative for students with undiagnosed asthma from other age group and other SES backgrounds, and it will serve as a model for interventions in other chronic disease that also have high undiagnosed rates. Results also will be of significant use to health care providers, researchers, and policy makers, and will have significant public health implication for a highly vulnerable population of adolescents

描述（由申请人提供）：理由：最近的研究一致报告了未确诊的哮喘样症状的青年比例。未确诊的症状青年有明显的发病率和活动限制。尽管成功的以学校为基础的干预措施，确诊的青少年，很少有计划已实施单独与未确诊的青少年。未确诊哮喘的青少年的哮喘自我管理（ASMA- Undx），一项为期8周的强化校本干预，扩展了个案工作者模式，并有三个互补的组成部分，旨在帮助有哮喘样症状的青少年家庭获得临床评估，获得诊断和管理他们的哮喘样症状：（1）学生会议 小组会议、个人辅导会议和转诊医疗服务提供者;（2）照顾者会议 转诊到医疗提供者，通过邮寄小册子，电话联系和小组会议进行教育;（3）为学生的医疗提供者提供学术细节。具体研究目的：这项为期5年的研究解决了符合持续性哮喘标准但尚未通过ASMA-Undx测试进行诊断的青少年与信息和转诊对照组相比未满足的需求。假设条件：相对于对照组，ASMA-Undx的学生在一年内将在以下方面取得显着进步：（1a）看医疗提供者进行评估的比例，（1b）医疗提供者诊断他们患有哮喘的比例，（1c）医疗提供者开药的比例，（1d）如果开药，获得药物的比例，（1 e）夜间觉醒率和（1f）由于哮喘症状导致的日常活动受限率。他们还将在以下方面表现出更大的改善：（2a）日间症状发生率;（2b）哮喘症状严重程度;（2c）因哮喘而缺课;（2d）哮喘知识;（2 e）哮喘自我管理;（2f）紧急卫生保健利用;（2g）生活质量;（2 h）医疗提供者提供书面哮喘管理计划的学生比例;和（2 i）与呼吸问题有关的压力。方法：我们将使用一项对照试验，其中有400名9至11年级未确诊的学生报告持续性哮喘样。参与者被随机分配到干预组或信息和转诊对照组。学生将主要来自低收入，少数民族背景，将在四年内从16所纽约公立高中入学。所有学生将在干预后接受12个月的随访。将根据意向治疗（ITT）原则，使用logistic回归模型和Poisson回归模型分析结局，该模型考虑了干预后的重复测量、基线时确定的协变量和学校聚集效应。重要性：这项研究具有很高的公共卫生意义，因为：（1）尽管未确诊的哮喘患病率很高，而且这些青少年患有明显的哮喘发病率和活动受限，但缺乏对未确诊青少年的干预措施;（2）它是在现实世界的学校环境中进行的;（3）它针对服务不足的低收入少数民族青少年。 公共卫生相关性：针对服务不足的市中心，少数民族青少年谁符合持续性哮喘的标准，但尚未被诊断，本研究调查是否多成分的心理教育干预（学生，照顾者和医疗提供者）是有效的帮助家庭获得诊断和治疗，并减少哮喘样症状。该应用程序具有相当大的公共卫生相关性，因为它是在高中交付，因此将为其他年龄组和其他SES背景的未确诊哮喘的学生提供信息，它将作为其他慢性疾病干预的模型，也有很高的未确诊率。研究结果也将对卫生保健提供者、研究人员和政策制定者有重要意义，并将对高度脆弱的青少年群体产生重大的公共卫生影响。

项目成果

Asthma and subjective sleep disordered breathing in a large cohort of urban adolescents.

大量城市青少年的哮喘和主观睡眠呼吸障碍。

• DOI: 10.1080/02770903.2016.1188942
• 发表时间: 2017
• 期刊: The Journal of asthma : official journal of the Association for the Care of Asthma
• 作者: Zandieh,StephanieO;Cespedes,Amarilis;Ciarleglio,Adam;Bourgeois,Wallace;Rapoport,DavidM;Bruzzese,Jean-Marie
• 通讯作者: Bruzzese,Jean-Marie

Health literacy and asthma among Hispanic and African-American urban adolescents with undiagnosed asthma.

患有未确诊哮喘的西班牙裔和非裔美国城市青少年的健康素养和哮喘。

• DOI: 10.1016/j.anai.2018.06.022
• 发表时间: 2018
• 期刊: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
• 作者: Valerio,MelissaA;George,Maureen;Liu,Jianfang;Osakwe,ZainabT;Bruzzese,Jean-Marie
• 通讯作者: Bruzzese,Jean-Marie

Feasibility and preliminary outcomes of a school-based intervention for inner-city, ethnic minority adolescents with undiagnosed asthma.

对内城区未确诊哮喘的少数民族青少年进行学校干预的可行性和初步结果。

• DOI: 10.1016/j.pec.2010.09.019
• 发表时间: 2011
• 期刊: Patient education and counseling
• 影响因子: 3.5
• 作者: Bruzzese,Jean-Marie;Kingston,Sharon;Sheares,BeverleyJ;Cespedes,Amarilis;Sadeghi,Hossein;Evans,David
• 通讯作者: Evans,David

The Association Between Asthma and Sleep in Urban Adolescents With Undiagnosed Asthma.

• DOI: 10.1111/josh.12277
• 发表时间: 2015-08
• 期刊: The Journal of school health
• 作者: Koinis Mitchell D;Kopel SJ;Williams B;Cespedes A;Bruzzese JM
• 通讯作者: Bruzzese JM