Asthma is the most common chronic illness among children in the United States, with disproportionately high morbidity and mortality among minority and socioeconomically disadvantaged children living in urban areas. These disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. Converging evidence suggests that psychosocial factors that accompany socioeconomic disadvantage contribute to the marked disparities in childhood asthma morbidity, with psychological stress predicting future asthma exacerbations in children. Chronic stress and lower socioeconomic status also are associated with the exacerbation of airway inflammatory responses to environmental triggers and the upregulation of inflammatory processes directly implicated in asthma exacerbation. Evidence that stress accentuates airway inflammation and predicts asthma morbidity raises the possibility that psychological interventions aimed at helping children manage stress could improve the physical health of high risk children with asthma. To date, studies of psychosocial interventions for pediatric asthma have been of poor general quality, highlighting a need for further more rigorous research. Accordingly, we have developed a stress management and coping skills training program based on the principles of cognitive behavioral therapy ("I Can Cope"). Preliminary trials provide initia support for the feasibility of offering this supplemental intervention to 8-12 year old asthmatics n urban schools and provide initial evidence for intervention-related decreases in perceived stress and improvements in lung function, as measured by spirometry. The primary objective of the proposed research is to conduct a critical randomized controlled pilot evaluation of the effectiveness of this school-based intervention to obtain data that is necessary to develop a full-scale clinical trial. For this purpose, we propose randomly assigning 108 economically disadvantaged urban 3rd through 6th graders with physician-confirmed asthma to the school-based intervention or an education only control condition. Primary outcomes will include (1) psychological function and (2) asthma health, as assessed at the end of the intervention period. If future work confirms our initial feasibility findings, this will be the first study to demonstrae the health benefit of a school-based asthma stress management intervention for high risk children living in urban settings, providing a novel means of intervening to reduce disparities in asthma morbidity. Furthermore, it will provide a more efficient and cost-effective means of accessing vulnerable children than individual clinic based intervention, which we have not found to be feasible.
Minority and socioeconomically disadvantaged children living in urban areas in the US are at disproportionately high risk for asthma morbidity, with disparities in asthma severity being larger than those in asthma prevalence. Growing evidence shows that psychosocial factors that accompany socioeconomic disadvantage may play a role in these disparities, with psychological stress predicting future asthma exacerbations in children. The current application proposes a pilot study examining the first school-based intervention to target this modifiable risk factor. Thus, the public health implications of the project are considerable and include the identification of a method of intervening to reduce disparities in asthma morbidity. In addition, we anticipate that the intervention will be cost effective, reducing medical visits, use of as needed medications, and school absenteeism.