Peer-Administered Asthma Self-Management Intervention in Urban Middle Schools

说明(申请人提供)：儿童哮喘方面存在健康差距，波多黎各裔拉美裔儿童的哮喘发病率和死亡率有所增加。中学生的患病率高于其他年龄段的儿童。此R21应用程序的目标是为城市公立学校环境中的拉丁裔初中生(6-8年级)开发和测试一种由同伴促进的4节课哮喘自我管理干预。我们的干预措施ASMAS(学校哮喘自我管理)将由受过培训和监督的拉丁裔哮喘高三学生和高年级学生向一群患有哮喘的年轻同龄人(11-13岁)进行管理。ASMAS干预措施将在两个城市和拉丁裔哮喘儿童发病率较高的地区实施：波多黎各的圣胡安和罗德岛州的普罗维登斯。该应用程序的第一个目的是开发哮喘自我管理干预和干预程序，使其在文化上与拉美裔学生的背景一致，并适用于RCT/R01的学校环境。将与两个地点的学生、HS同龄人和学校工作人员一起进行焦点小组，具有哮喘教育和自我管理、基于学校的干预和文化定制治疗方面专业知识的调查人员将提供意见。第二个目的是通过试点随机对照试验来测试干预措施，以提供效应大小的估计，该估计将用于RCT/R01的样本量(每个站点6组；每个站点3组条件)。我们将每个地点招募30名患有哮喘的拉丁裔儿童，并随机将他们分配到ASMAS干预或哮喘教育加儿童健康控制条件(每个地点3组)。我们期望ASMAS干预措施的参与者将比对照情况有更好的哮喘自我管理(提高自我管理技能、哮喘知识和自我效能、可用的救援吸入器和哮喘行动计划)。我们还预计，与对照条件相比，ASMAS干预的参与者将有更好的哮喘结果(症状更大程度地减少，与哮喘相关的缺席更少，哮喘控制和与哮喘相关的生活质量改善)。

DESCRIPTION (provided by applicant): Health disparities in pediatric asthma exist, with Latino children of Puerto Rican descent demonstrating increased asthma morbidity and mortality. The morbidity levels of middle school children are higher than children from any other age group. The goal of this R21 application is to develop and test a 4-session, peer- facilitated asthma self-management intervention for Latino, middle school-aged (6th-8th graders) children in urban public school settings. Our intervention, ASMAS (Asthma Self-Management in Schools) will be designed to be administered by trained and supervised High School juniors and seniors of Latino descent with asthma to a group of younger peers with asthma (11-13 years of age). The ASMAS intervention will be implemented in two areas that contain a high prevalence of urban and Latino children with asthma: San Juan, Puerto Rico and Providence, Rhode Island. The first AIM of this application is to develop the asthma self-management intervention and intervention procedures to make them culturally consistent with Latino students' background, and applicable to the school setting, for the RCT/R01. Focus groups will be conducted with students, HS Peers, and school personnel in both sites, and Investigators with expertise in asthma education and self- management, school-based interventions, and culturally tailored treatments, will provide input. The second AIM is to test the intervention through a Pilot Randomized Control Trial to provide estimates of effect size that will be used to inform the sample size for the RCT/R01 (6 groups per site; 3 groups of each condition, per site). We will recruit 30 Latino children with asthma per site, and randomly assign them to the ASMAS intervention or the Asthma Education plus Child Health control condition (3 groups of each condition, per site). We expect that participants in the ASMAS intervention will have improved asthma self-management (improved self- management skills, asthma knowledge and self-efficacy, available rescue inhaler and asthma action plan with school nurse), relative to the control condition. We also anticipate that participants in the ASMAS intervention will have improved asthma outcomes (greater reduction of symptoms, fewer asthma-related absences, improved asthma control and asthma-related quality of life), relative to the control condition.