Evaluation of the Asthma Management Program to Promote Activity for Students in Schools (Asthma-PASS)

对促进学校学生活动的哮喘管理计划的评估 (Asthma-PASS)

• 批准号: 9974906
• 负责人: Marina Reznik
• 金额: $ 86.77万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-24 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9974906
• 关键词: Absenteeism; Accelerometer; Address; Adherence; Adoption; Affect; African American; Age; Asthma; Awareness; Caregivers; Caring; Child; Childhood Asthma; Clinical; Clinical Trials; Collaborations; Communities; Community Health Aides; Education; Effectiveness; Effectiveness of Interventions; Ensure; Evaluation; Exercise; Face; Family; Feedback; Fright; Guidelines; Health; Health system; Hispanics; Human Resources; Intervention; Low income; Maintenance; Measures; Mediating; Mediation; Mediator of activation protein; Minority; Modeling; Morbidity - disease rate; New York; Notification; Outcome; Outcome Measure; Parents; Pathway interactions; Pharmaceutical Preparations; Phase; Physical Education; Physical activity; Pilot Projects; Policies; Prevalence; Preventive; Primary Care Physician; Procedures; Process; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Schools; Self Efficacy; Self Management; Severities; Sports; Strenuous Exercise; Students; Symptoms; Testing; Time; Urban Health; Work; aged; asthma exacerbation; base; comparison group; contextual factors; demographics; design; disorder control; effectiveness evaluation; elementary school; experience; functional outcomes; health care service utilization; health disparity; high risk; improved; inner city; intervention effect; meetings; minority children; novel; physical inactivity; physical state; primary outcome; programs; pulmonary function; randomized trial; reduce symptoms; school health; secondary outcome; social factors; social stigma; teacher; treatment as usual; urban children; urban school

PROJECT SUMMARY/ABSTRACT Asthma prevalence in Bronx, NY schools is 20-25%. Physical activity (PA) is an important component of asthma management in children. Studies show that PA is associated with decreased severity of asthma symptoms, as well as improved disease control and quality of life. However, urban minority children with asthma face barriers to PA on multiple levels. In our prior work (K23HD065742), we identified several barriers to PA in urban minority schoolchildren with asthma. These barriers include: inadequate access to asthma rescue medications in school, suboptimal prescribing of preventive asthma therapy by primary care physicians (PCPs), lack of school PA opportunities, stigma associated with asthma, parent/child fear of an asthma attack with PA, and lack of teacher confidence in assisting students with asthma. We developed a novel Asthma management program to Promote Activity for Students in Schools (Asthma-PASS) in collaboration with stakeholders to address these key barriers. We pilot tested Asthma-PASS with 109 students with asthma from 4 Bronx elementary schools and their parents to demonstrate proof of concept and preliminary evidence of intervention effectiveness. Results from the pilot study demonstrated significantly greater increase in symptom-free days (SFDs) (primary outcome measure) and PA levels. In addition, preliminary mediation analyses suggested vigorous PA and step counts are mediators of SFDs. We now plan to build upon this work and evaluate in a full-scale randomized trial whether the Asthma- PASS intervention reduces asthma morbidity among high-risk urban schoolchildren. We propose a cluster- randomized controlled trial with 416 children ages 5-11 years with persistent or uncontrolled asthma from 26 Bronx schools. Schools will be stratified by size and then randomly assigned to either (1) the Asthma-PASS intervention (PCP collaboration to ensure optimal guideline-based preventive asthma care and community health workers to facilitate rescue medication availability in school and provide asthma awareness programming and education for children, parents and school personnel to reduce stigma around asthma and PA) or (2) an asthma management (AM) comparison group (PCP and parent notification of child’s asthma status and general asthma education). Both groups will participate in an existing district-wide classroom-based daily activity program (‘Move to Improve’). We will assess the effectiveness of Asthma-PASS in reducing asthma morbidity (primary outcome - SFDs), and improving PA (secondary outcome) as well as additional clinical and functional outcomes. We will measure PA with accelerometers using previously established procedures. We will also identify potential mediators and moderators of the intervention effect. We will evaluate the process of intervention implementation by applying the RE-AIM framework. This proposal directly builds on our prior work in schools to improve asthma outcomes and reduce health disparities. If Asthma-PASS successfully reduces symptoms and improves health, it will provide a powerful argument for policy change in schools and urban communities nationwide.

项目总结/摘要 纽约布朗克斯学校的哮喘患病率为20- 25%。体力活动（PA）是哮喘的重要组成部分 儿童管理。研究表明，PA与哮喘症状的严重程度降低有关， 以及改善疾病控制和生活质量。然而，患有哮喘的城市少数民族儿童面临障碍， 在多个层面上。在我们之前的工作（K23 HD 065742）中，我们确定了城市少数民族中PA的几个障碍 患有哮喘的学生这些障碍包括：在学校获得哮喘急救药物的机会不足， 初级保健医生（PCP）对预防性哮喘治疗的处方不理想，缺乏学校PA 机会，与哮喘相关的耻辱，父母/孩子对PA哮喘发作的恐惧，以及缺乏教师 有信心帮助患有哮喘的学生。我们开发了一种新颖的哮喘管理计划， 学校学生活动（哮喘-PASS）与利益相关者合作，以解决这些关键障碍。 我们对来自4所布朗克斯小学的109名哮喘学生及其家长进行了Asthma-PASS的初步测试 以证明概念证明和干预有效性的初步证据。试点结果 一项研究表明，无糖尿病天数（SFD）（主要结局指标）显著增加， PA水平。此外，初步的调解分析表明，积极的PA和步数是调解人， SFD。我们现在计划在这项工作的基础上，在一项全面的随机试验中评估哮喘- PASS干预降低了高危城市学龄儿童的哮喘发病率我们建议一个集群- 一项随机对照试验，纳入416名5-11岁的儿童，他们患有持续性或未控制的哮喘， 布朗克斯的学校。学校将按规模分层，然后随机分配到（1）哮喘-PASS 干预（PCP合作，以确保最佳的基于指南的预防性哮喘护理和社区健康 工作人员，以促进救援药物在学校的可用性，并提供哮喘意识规划， 对儿童、家长和学校工作人员进行教育，以减少哮喘和PA的耻辱感）或（2）哮喘 管理（AM）对照组（PCP和家长通知儿童哮喘状态和一般哮喘 教育）。这两个小组都将参加现有的全区范围内以课堂为基础的日常活动计划（“移动 改善”）。我们将评估Asthma-PASS在降低哮喘发病率方面的有效性（主要结局 - SFD）和改善PA（次要结局）以及其他临床和功能结局。我们将 使用先前建立的程序用加速度计测量PA。我们还将确定潜在的 中介者和调节者的干预效果。我们将评估干预实施的过程 通过使用RE-AIM框架。这项建议直接建立在我们先前在学校改善哮喘的工作基础上 减少健康差距。如果哮喘PASS成功地减少症状并改善健康， 它将为全国学校和城市社区的政策变革提供强有力的论据。