Health disparities in pediatric asthma exist, with Latino children of Puerto Rican descent demonstrating increased asthma morbidity and mortality. The morbidity levels of middle school children are higher than children from any other age group. The goal of this R21 application is to develop and test a 4-session, peer- facilitated asthma self-management intervention for Latino, middle school-aged (6th-8th graders) children in urban public school settings. Our intervention, ASMAS (Asthma Self-Management in Schools) will be designed to be administered by trained and supervised High School juniors and seniors of Latino descent with asthma to a group of younger peers with asthma (11-13 years of age). The ASMAS intervention will be implemented in two areas that contain a high prevalence of urban and Latino children with asthma: San Juan, Puerto Rico and Providence, Rhode Island.
The first AIM of this application is to develop the asthma self-management intervention and intervention procedures to make them culturally consistent with Latino students'background, and applicable to the school setting, for the RCT/R01. Focus groups will be conducted with students, HS Peers, and school personnel in both sites, and Investigators with expertise in asthma education and self- management, school-based interventions, and culturally tailored treatments, will provide input.
The second AIM i s to test the intervention through a Pilot Randomized Control Trial to provide estimates of effect size that will be used to inform the sample size for the RCT/R01 (6 groups per site;3 groups of each condition, per site). We will recruit 30 Latino children with asthma per site, and randomly assign them to the ASMAS intervention or the Asthma Education plus Child Health control condition (3 groups of each condition, per site). We expect that participants in the ASMAS intervention will have improved asthma self-management (improved self- management skills, asthma knowledge and self-efficacy, available rescue inhaler and asthma action plan with school nurse), relative to the control condition. We also anticipate that participants in the ASMAS intervention will have improved asthma outcomes (greater reduction of symptoms, fewer asthma-related absences, improved asthma control and asthma-related quality of life), relative to the control condition.
Asthma is a common chronic illness in which urban Latino children are disproportionately affected. A novel intervention that tailors school-based asthma self-management for use with Latino children in urban public school settings and is facilitated by a Latino, High School Peer with Asthma has the potential to improve asthma management and outcomes for children who are at significant risk for morbidity.