Asthma death rates for teenagers 15-19 years of age are higher than that of younger children, despite a higher prevalence in the latter group. The small number of publications on urban adolescents suggests that inadequate asthma management plays a significant role in these grim statistics; however, this age group has been difficult to reach, in terms of both connecting and convincing. Consequently, there are few asthma management programs targeting urban, high school students with asthma. We have developed a unique, multi-media, web-based program (Puff City I) to motivate teens to change negative behaviors related to asthma management. Puff City I software uses """"""""tailoring"""""""" in conjunction with theoretical models of behavior change, to personalize health messages according to the beliefs, attitudes, and barriers of students with asthma. A school-based approach ensures accessibility. An asthma counselor responds to referrals generate by the software, providing assistance in addressing barriers to effective asthma management. A randomized trial to evaluate Puff City I in Detroit high schools (98% African American) is in its final stages. Results of initial analyses demonstrate short-term behavior changes, in addition to fewer Emergency Department (ED) visits (p=0.03) and hospitalizations (p=0.007), and higher scores for quality of life (p=0.02) when compared to controls. As with any research trial, not all students improved, some relapsed, and a substantial number did not participate. To maximize effectiveness of the program, we propose to use Puff City I data, including teen sociodemographics, motivation, and reported barriers, to make refinements that would target program failures resulting in a new version or Puff City II. In addition, we will test new theory- and empirically-based approaches to recruiting urban high school students into this and other randomized trials. Not only would the latter be useful to research, in terms of generalizability, but will also yield valuable information about attracting this population to health-related interventions. We will evaluate Puff City II in another randomized trial in 9 Detroit high schools. Dissemination of this unique tool will also be explored as part of this proposal. Our collaborators include the University of Michigan Center for Health Communications Research, Detroit Public Schools, and the Detroit Department of Health and Wellness Promotion (formerly Detroit Health Department). The result of this proposal will be a powerful tool for changing negative behaviors related to asthma management in a traditionally hard-to-reach population that experiences high asthma morbidity and mortality. ? ? ? ?
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