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

描述（由申请人提供）：理由：最近的研究一致报告了大量未被诊断的青少年哮喘样症状。未确诊的症状青年有明显的发病率和活动限制。尽管针对确诊青少年的学校干预措施取得了成功，但很少有方案仅针对未确诊青少年实施。未确诊哮喘青少年哮喘自我管理（ASMA- Undx）是一项为期8周的以学校为基础的强化干预，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、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给医疗提供者；(2)护理人员会议，转介给医疗提供者，通过邮寄小册子、电话联系和小组会议进行教育；(3)为学生的医疗服务提供者提供学术细节。具体研究目的：与信息和转诊对照组相比，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测试诊断的青少年的未满足需求。假设：与对照组相比，ASMA-Undx的学生在一年内将在以下方面表现出显著改善：（1a）看医疗服务提供者进行评估的比例，（1b）医疗服务提供者诊断为哮喘的比例，（1c）医疗服务提供者开处方的比例，（1d）在处方下获得药物的比例，（1e）夜间醒来率和（1f）哮喘症状导致的日常活动限制率。他们还将在以下方面表现出更大的改善：（2a）日常症状的发生率；（2b）哮喘症状严重程度；（2c）因哮喘缺课；（2d）哮喘知识；（2e）哮喘自我管理；（2f）紧急医疗保健利用；（2g）生活质素；（2h）医疗服务提供者提供书面哮喘管理计划的学生比例；(2)与呼吸问题有关的压力。方法：我们将对400名9年级至11年级未确诊的报告持续性哮喘样学生进行对照试验。参与者被随机分配到干预组或信息和转诊对照组。这些学生将主要来自低收入和少数族裔背景，他们将在纽约市16所公立高中就读四年。所有学生将在干预后随访12个月。结果将根据治疗意图（ITT）原则进行分析，使用逻辑回归模型和泊松回归模型，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类效应。意义：本研究具有高度的公共卫生意义，因为：(1)尽管未确诊的青少年有显著的未确诊哮喘患病率，并且这些青少年有明显的哮喘发病率和活动限制，但缺乏对这些青少年的干预；(2)在学校的现实环境中进行；(3)它针对的是服务不足的低收入、少数族裔青少年。

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