School-Based Asthma Care for Teens (SB-ACT)

描述(申请人提供)：哮喘是儿童最常见的慢性疾病，尽管目前在治疗方面取得了进展，但发病率和死亡率仍在继续上升。与白人青少年相比，低收入的少数族裔青少年的哮喘发病率高得不成比例，包括急诊科护理、住院和哮喘死亡的风险过高。尽管城市儿童的哮喘负担最大，但他们是最不可能得到充分预防护理的群体，而遵从性差在哮喘发病率中起着重要作用。患有哮喘的市中心青少年特别容易出现不遵守规定的情况。因此，可能会有大量的痛苦 通过改善护理来预防。这一应用建立在我们为患有哮喘的城市儿童和青少年有效的校本计划方面的丰富经验基础上。总体目标是在整个城市学区广泛传播一种新的哮喘护理系统(‘以学校为基础的青少年哮喘护理’；SBACT)，并测试其在城市青少年中提高遵从性和降低发病率的有效性。SB-ACT干预包括两个核心组成部分。首先，青少年在新学年开始的6-8周内每天拜访学校护士，接受预防哮喘药物的直接观察疗法(DOT)试验。目标是让青少年与护士建立关系，学习适当的用药技巧，并体验日常预防性治疗的好处和价值。在DOT开始后4至6周，青少年将接受动机访谈(MI)咨询计划，旨在增强青少年过渡到独立、持续的预防性药物使用的动机。我们将培训附属于当地美国肺脏协会的社区护士，以提供MI部件。MI护士将在学校与青少年进行三次咨询会议，旨在利用青少年使用DOT的经验和他们所体验的潜在好处。鉴于哮喘护理在这一人群中的复杂性，我们计划使用3组设计来评估这项干预措施，其中430名青少年将被随机分配到以下任一组：1)SB-ACT计划(DOT试验6-8周，3 MI咨询课程)；2)仅DOT(仅DOT 6-8周)；或3)哮喘教育(AE)对照组(由训练有素的哮喘教育人员提供在校哮喘教育)。我们纳入了DOT-Only组，以评估这一成分是否足以在没有咨询的情况下促进持续的依从性。AE小组的目的是为了加强对MI咨询中受到的关注的哮喘的护理和控制。我们将评估SB-ACT干预措施在降低哮喘发病率方面的有效性，执行经济可持续性分析，并评估项目实施的每个组成部分，重点是可持续性和传播。在研究完成后，这一以学校为基础的哮喘护理系统的有效性将被更好地定义为改善青少年护理和减少健康差距的可持续手段。

DESCRIPTION (provided by applicant): Asthma is the most common chronic illness of childhood, and despite current advances in therapies, morbidity and mortality continue to increase. Low-income, minority teenagers have disproportionately high rates of asthma morbidity, including excess risk of emergency department care, hospitalization, and death from asthma, compared to white adolescents. Although urban children suffer the largest burden from asthma, they are the least likely group to receive adequate preventive care, and poor adherence plays a significant contributing role in asthma morbidity. Inner city adolescents with asthma are at particular risk of nonadherence. Thus, there is a substantial amount of suffering that could be prevented with improvements in care. This application builds on our extensive experience with efficacious school-based programs for urban children and teens with asthma. The overall goal is to broadly disseminate a novel system of asthma care throughout the entire city school district ('School Based Asthma Care for Teens'; SBACT), and test its effectiveness in improving adherence and reducing morbidity among urban teens. The SB-ACT intervention includes two core components. First, adolescents visit the school nurse daily for 6-8 weeks at the start of the school year to receive a trial of directly observed therapy (DOT) of preventive asthma medications. The goal is for the teen to establish a relationship with the nurse, learn proper medication technique, and experience the benefits and value of daily preventive therapy. Four to 6 weeks after the initiation of DOT, the teen will receive a motivational interviewing (MI) counseling program designed to enhance the teen's motivation to transition to independent, sustained preventive medication use. We will train community-based nurses affiliated with the local American Lung Association to deliver the MI component. The MI nurse will conduct three counseling sessions with the teen at school, which are designed to capitalize on the teen's experience with DOT and the potential benefits they experienced. Given the complex nature of asthma care in this population, we plan to evaluate this intervention using a 3-group design in which 430 teens will be randomly assigned to either; 1) the SB-ACT program (trial of DOT for 6-8 weeks + 3 MI counseling sessions); 2) DOT-only (DOT only for 6-8 weeks); or 3) an asthma education (AE) comparison group (in-school asthma education delivered by a trained asthma educator). We include the DOT-only group to evaluate whether this component alone is sufficient to promote sustained adherence without counseling. The AE group is designed to enhance asthma care and control for the attention received in MI counseling. We will assess the effectiveness of the SB-ACT intervention in reducing asthma morbidity, perform an economic sustainability analysis, and evaluate each component of program implementation with a focus on sustainability and dissemination. At the completion of the study, the effectiveness of this system of school-based asthma care will be better defined as a sustainable means to improve care for adolescents and reduce health disparities.