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

描述(由申请人提供)：理由：最近的研究一直报告说，有相当比例的年轻人有哮喘样症状，但没有得到诊断。未确诊的有症状的青少年有明显的发病率和活动受限。尽管对确诊的青少年进行了成功的学校干预，但很少有方案仅针对未确诊的青少年实施。针对患有未确诊哮喘的青少年的哮喘自我管理(ASMA-UNDX)是一个为期8周的以学校为基础的强化干预措施，它扩展了个案工作者模式，包括三个相辅相成的部分，旨在帮助有哮喘样症状的青少年家庭获得临床评估、获得诊断和管理其哮喘样症状：(1)学生会议、小组辅导和转诊至医疗提供者；(2)转诊至医疗提供者的照顾者会议、通过邮寄小册子、电话联系和小组会议进行教育；以及(3)为学生的医疗提供者提供学术详细信息。具体研究目的：这项为期5年的研究针对的是符合持续性哮喘标准但尚未通过Asma-Undx测试得到诊断的青少年的需求，与信息和转诊对照组相比。假设：与对照组相比，Asma-Undx的学生将在一年内表现出显著的改善：(1a)去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)医生开药的比例，(1d)如果开了药就获得药物的比例，(1e)夜间觉醒的比例和(1f)因哮喘症状而限制日常活动的比例。他们还将在以下方面表现出更大的改善：(2a)日间症状率；(2b)哮喘症状严重程度；(2c)哮喘缺课；(2d)哮喘知识；(2e)哮喘自我管理；(2f)紧急医疗保健利用；(2g)生活质量；(2h)其医疗提供者提供书面哮喘管理计划的学生比例；以及(2i)与呼吸问题有关的压力。方法：我们将对400名9至11年级的未确诊学生进行对照试验，这些学生报告了持续性哮喘样症状。参与者被随机分配到干预组或信息转介控制组。学生将主要来自低收入、少数民族背景，将在四年内从纽约市16所公立高中入学。所有学生将在干预后接受为期12个月的跟踪调查。结果将根据意向治疗(ITT)原则，使用Logistic回归模型和泊松回归模型进行分析，该模型考虑了干预后的重复测量、基线确定的协变量和学校集群效应。意义：这项研究具有很高的公共卫生意义，因为：(1)尽管未确诊哮喘的发病率很高，而且这些青年的哮喘发病率和活动受限，但缺乏针对未确诊青年的干预措施；(2)这项研究是在现实世界的学校环境中进行的；(3)它针对的是未得到充分服务的低收入少数民族青少年。 公共卫生相关性：这项研究以符合持续性哮喘标准但尚未确诊的服务不足的市中心少数民族青少年为目标，调查多成分心理教育干预(学生、照顾者和医疗提供者)是否有效地帮助家庭获得诊断和治疗，并减少哮喘样症状。这一应用具有相当大的公共卫生相关性，因为它是在高中提供的，因此将为来自其他年龄段和其他SES背景的患有未诊断哮喘的学生提供信息，并将作为其他慢性病干预的典范，这些慢性病的未诊断率也很高。研究结果还将对卫生保健提供者、研究人员和政策制定者产生重大作用，并将对高度脆弱的青少年群体产生重大的公共卫生影响

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