The Efficacy of CAMP Air, a Web-based Asthma Intervention, Among Urban Adolescents with Uncontrolled Asthma

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PROJECT SUMMARY / ABSTRACT Background and Rationale: Asthma has high prevalence and morbidity among minority adolescents. Yet, few interventions are tested in adolescents, with only one being web-based. Given asthma's significant impact on this group, and the important role technology plays in their lives, this oversight is a significant public health concern. There is a dearth of cost-effectiveness analyses and implementation studies in asthma intervention research. This study addresses these treatment and methodological gaps. We developed and established the preliminary impact of the Controlling Asthma Program for Adolescents (CAMP Air), a seven-module personalized, e-health intervention for adolescents with uncontrolled asthma. Objective: We aim to: (1) systematically evaluate CAMP Air's efficacy in 370 urban adolescents with uncontrolled asthma; (2) assess its cost-effectiveness; and (3) identify multi-level factors associated with successful implementation of CAMP Air to inform its future scale-up. Hypotheses: Relative to controls, over 1-year CAMP Air participants will have significantly better asthma control as indicated by (a) higher scores on the Asthma Control Test (ACT) and (b) fewer asthma-related urgent care visits (primary outcomes). CAMP Air participants will also have significantly better (a) asthma self-care skills, (b) controller medication use, (c) lung function (measured by spirometry), and (d) quality of life; and significantly lower rates of (e) steroid bursts, (f) symptoms days, (g) nights woken, (h) activity limitations, and (i) school absences. We hypothesize that compared to the control, CAMP Air will have favorable value (incremental cost-effectiveness ratio<$100,000/ quality adjusted life years [QALYs]). Methods: We will enroll 370 9th – 11th graders with uncontrolled asthma from up to 19 NYC high schools. We will randomize participants to CAMP Air or an asthma education control intervention and follow them for 12 months post-treatment. Using a decision-analytic Markov model, we will estimate CAMP Air's incremental cost per QALY gained and cost per symptom free days, from both the societal and payer perspectives. For the process evaluation, which is built on the RE-AIM and Consolidated Framework for Implementation Research (CFIR) models, we will collect qualitative and quantitative data from students, caregivers, and school administrators. Together with stakeholders we will develop strategies for widespread implementation of CAMP Air, informed by our clinical efficacy, cost-effectiveness, and implementation results. Significance: The study has high public health significance because it (1) targets an understudied population impacted greatly by asthma, (2) leverages technology in a health disparate population to promote self-care, (3) assesses CAMP Air's economic value using QALYs and symptom-free days, and (4) bridges a gap between research and practice by identifying implementation factors to inform strategies for widespread implementation of CAMP Air.