Promoting Asthma Wellness in Rural Communities

描述（由申请人提供）：哮喘是儿童时期最常见的慢性疾病，对非洲裔美国人（AAs）的影响不成比例，其发病率和死亡率都较高。AA男性青年患哮喘的死亡率是同龄白人男性青年的六倍。在哮喘的触发因素中，烟草使用和被动吸烟暴露被认为是最不利的。今天生活的近640万青年将过早死于烟草引起的疾病。嗜酒者青少年中较高的发病率和死亡率有时与烟草接触有关，这强调需要采取新的方法来接触这些青少年。在NHLBI的资助下（HL68971），基于动机理论、信息裁剪、基本哮喘管理技能和娱乐开发了一种具有文化敏感性的基于网络的干预措施，称为“Puff City”。当这个项目在中西部城市学校系统（底特律公立学校）的主要AA青年中进行评估时，发现了令人满意的结果（即急诊就诊次数减少，住院次数减少，生活质量得分提高，缺课天数减少）。提供该课程的成本为每位学生6.67美元。鉴于Puff City在底特律青年中取得的初步成功，一个重要的问题是，这种干预是否会对生活在南方农村的AA青年有效：一个不同的文化、社会和气候环境。本应用程序旨在评估泡芙城计划在南方农村9 -11年级青少年（N=300）中的有效性，采用随机、两组设计和重复测量。随机分配到治疗组的青少年将接受Puff City项目，而对照组的青少年将在提供哮喘和烟草风险教育的网站上接受相同的网络时间。Puff City干预包括四个30分钟的模块，针对三个关键的哮喘管理问题：减少烟草暴露（即吸烟和被动吸烟），控制者药物依从性和攻击准备（即随时携带救援吸入器）。行为改变将通过基线、治疗结束（短期）、6个月和12个月随访（长期）的自我报告，以及在同一时间点通过唾液可替宁和呼出的一氧化氮（eNO）来评估。Puff City项目预计将促进个人动机因素的发展，从而改善所有三个目标领域的哮喘管理。主要假设是：治疗组的青少年将有以下改善的行为结果：1)减少被动吸烟暴露；2)控制者更强的药物依从性；3)更强的攻击准备。第二种假设是，与对照组相比，接受治疗的年轻人的唾液可替宁和eNO水平也会降低，吸烟的活跃程度也会减少。还将在南部农村和中西部城市青年人口之间进行交叉研究比较分析。与NHLBI的使命一致，该应用程序的目标是促进社会文化行为治疗，以预防进一步的哮喘和烟草相关的发病率和死亡率，并消除少数民族aas中观察到的健康差异。如果有效，很有可能通过学校系统作为主要切入点来实施这种适合文化和成本效益高的方法。公共卫生相关性：本研究解决了两个重要的公共卫生问题，哮喘和烟草使用在很大程度上被忽视的人口，生活在农村地区的非洲裔美国青年。有证据表明，这两个健康问题都可以使用具有文化敏感性的、成本效益高的、基于网络的、自定义的计算机程序来有效解决。

DESCRIPTION (provided by applicant): Asthma, the most common chronic disorder in childhood, disproportionately affects African-Americans (AAs) with both greater morbidity and mortality. AA male youth suffer death rates from asthma that are six times greater than for white male youth of the same age. Among triggers for asthma, tobacco use and passive smoke exposure are considered among the most adverse. Nearly 6.4 million youth living today will die prematurely from tobacco attributable diseases. The higher level of morbidity and mortality among AA youth, at times related to tobacco exposure, emphasize the need for new methods for reaching these youth. With NHLBI funding (HL68971) a culturally sensitive, web-based intervention, termed "Puff City," was developed based on: Motivational Theory, tailoring of information, essential asthma management skills, and entertainment. When this program was evaluated among predominately AA youth attending a Midwestern, urban school system (Detroit Public Schools) promising results (i.e. fewer emergency department visits, fewer hospitalizations, improved quality of life scores, and reduced number of school days missed) were found. The cost of delivering the program was $6.67 per student. Given the initial success of Puff City among the Detroit youth, an important question is whether this intervention will be effective among AA youth living in the rural south: a different cultural, social, and climatic environment. This application seeks to evaluate the effectiveness of the Puff City program in 9th-11th grade, southern, rural youth (N=300) using a randomized, two-group design with repeated measures. Youth randomized to the treatment group will receive the Puff City program and those in the control group will receive equal web-based time on websites that provide education on asthma and tobacco risks. The Puff City intervention consists of four, 30 minute, modules that target three key asthma management issues: reduction of tobacco exposure (i.e. smoking and passive smoke exposure), controller medication adherence, and attack readiness (i.e. carrying a rescue inhaler at all times). Behavioral change will be evaluated by self-report at baseline, end of treatment (short-term), and at six and 12 months follow up (long-term) and also via salivary cotinine and exhaled nitric oxide (eNO) at the same time points. The Puff City program is expected to foster the development of personal motivational factors that will result in improved asthma management in all three target areas. The primary hypotheses are: Youth in the treatment arm will have improved behavioral outcomes of: 1) a decrease in passive smoke exposure; 2) greater controller medication adherence; and 3) greater attack readiness. The secondary hypotheses are that treated youth when compared to control youth will also have reduced levels of salivary cotinine and eNO, and a decrease in active smoking. Cross-study comparative analyses will also be performed between the rural South and urban Midwestern youth populations. Consistent with the mission of the NHLBI, this application targets the advancement of socio-cultural behavioral treatments for preventing further asthma and tobacco-related morbidity and mortality and the elimination of health disparities observed for an ethnic minority-AAs. If effective, implementation of this culturally tailored and cost effective approach via school systems as the primary point of entry is highly probable. PUBLIC HEALTH RELEVANCE: This research addresses two significant public health concerns, asthma and tobacco use in a largely neglected population, African American youth living in a rural area. There is evidence to suggest that both of these health issues can be effectively addressed using a culturally sensitive, cost effective, web-based, self-tailoring, computer program.