Published ahead of print on February 8, 2007, doi:10.1164/rccm.200608-1244OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200608-1244OC
A Web-based, Tailored Asthma Management Program for Urban African-American High School Students1 Department of Biostatistics and Research Epidemiology, and the Center for Health Services Research, Henry Ford Health System, Detroit, Michigan; 2 Center for Health Communications Research, University of Michigan, Ann Arbor, Michigan; 3 Oakland University, Rochester, Michigan; 4 Allergy–Immunology Section, Medical College of Georgia, Augusta, Georgia; and 5 Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas Correspondence and requests for reprints should be addressed to Christine L.M. Joseph, Ph.D., Senior Staff Epidemiologist, Henry Ford Health System, Department of Biostatistics & Research Epidemiology, 1 Ford Place, Suite 3E, Detroit, MI 48202. E-mail: cjoseph1{at}hfhs.org Rationale: Urban African-American youth, aged 15–19 years, have asthma fatality rates that are higher than in whites and younger children, yet few programs target this population. Traditionally, urban youth are believed to be difficult to engage in health-related programs, both in terms of connecting and convincing. Objectives: Develop and evaluate a multimedia, web-based asthma management program to specifically target urban high school students. The program uses "tailoring," in conjunction with theory-based models, to alter behavior through individualized health messages based on the user's beliefs, attitudes, and personal barriers to change. Methods: High school students reporting asthma symptoms were randomized to receive the tailored program (treatment) or to access generic asthma websites (control). The program was made available on school computers. Measurements and Main Results: Functional status and medical care use were measured at study initiation and 12 months postbaseline, as were selected management behaviors. The intervention period was 180 days (calculated from baseline). A total of 314 students were randomized (98% African American, 49% Medicaid enrollees; mean age, 15.2 yr). At 12 months, treatment students reported fewer symptom-days, symptom-nights, school days missed, restricted-activity days, and hospitalizations for asthma when compared with control students; adjusted relative risk and 95% confidence intervals were as follows: 0.5 (0.4–0.8), p = 0.003; 0.4 (0.2–0.8), p = 0.009; 0.3 (0.1–0.7), p = 0.006; 0.5 (0.3–0.8), p = 0.02; and 0.2 (0.2–0.9), p = 0.01, respectively. Positive behaviors were more frequently noted among treatment students compared with control students. Cost estimates for program delivery were $6.66 per participating treatment group student. Conclusions: A web-based, tailored approach to changing negative asthma management behaviors is economical, feasible, and effective in improving asthma outcomes in a traditionally hard-to-reach population.
Key Words: asthma • urban • adolescents • school-based • web-based
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