Rationale: Recent studies consistently report substantial rates of youth with asthma-like symptoms that are undiagnosed. Undiagnosed symptomatic youth have appreciable morbidity and activity limitations. Despite successful school-based interventions for diagnosed youth, few programs have been implemented solely with undiagnosed adolescents. Asthma Self-Management for Adolescents with Undiagnosed Asthma (ASMA- Undx), an 8-week intensive school-based intervention that expands the caseworker model and has three complementary components designed to help families of adolescents with asthma-like symptoms obtain a clinical evaluation, obtain a diagnosis and manage their asthma-like symptoms: (1) student sessions group sessions, individual coaching sessions and referral to medical providers;(2) caregiver sessions referral to a medical provider, education via mailed booklets, telephone contacts, and a group session;and (3) academic detailing for students'medical providers. Specific Study Aim: This 5-year study addresses the unmet needs of adolescents who meet criteria for persistent asthma but who have yet to be diagnosed through the testing of ASMA-Undx compared to an information-and-referral control group. Hypotheses: Relative to controls, students in ASMA-Undx will show significant improvement over one year on: (1a) the proportion who see a medical provider for an evaluation, (1b) the proportion whose medical providers diagnose them with asthma, (1c) the proportion whose medical providers prescribe medication, (1d) the proportion who obtain medication if prescribed, (1e) rate of night wakening and (1f) rate of daily activity limitation due to asthma symptoms. They will also show greater improvement on: (2a) rate of day symptoms;(2b) asthma symptom severity;(2c) school absences due to asthma;(2d) asthma knowledge;(2e) asthma self-management;(2f) urgent health care utilization;(2g) quality of life;(2h) the proportion of students whose medical providers provide a written asthma management plan;and (2i) stress related to breathing problems. Methods: We will use a controlled trial with 400 9th through 11th grade undiagnosed students who report persistent asthma-like. Participants are randomly assigned to an intervention group or an information-and-referral control group. Students, who will primarily be from low-income, ethnic minority backgrounds, will be enrolled over four years from 16 NYC public high schools. All students will be followed for 12-months post-intervention. Outcomes will be analyzed according to the intent to treat (ITT) principle using a logistic regression model and a Poisson regression model that take into account the repeated measures post-intervention, covariates identified at baseline and school clustering effects. Significance: This study has high public health significance given: (1) the lack of interventions for undiagnosed youth despite the significant prevalence of undiagnosed asthma and the appreciable asthma morbidity and activity limitation suffered by these youth;(2) that it is delivered in the real-world setting of schools;and (3) that it targets under-served low-income, ethnic minority adolescents.
Targeting underserved inner-city, ethnic minority adolescents who meet criteria for persistent asthma but who have yet to be diagnosed, this study investigates whether a multi-component psycho-educational intervention (student, caregivers and medical providers) is efficacious at helping families obtain a diagnosis and treatment, and reduce asthma-like symptoms. This application has considerable public health relevance because it is delivered in high schools, and therefore will be informative for students with undiagnosed asthma from other age group and other SES backgrounds, and it will serve as a model for interventions in other chronic disease that also have high undiagnosed rates. Results also will be of significant use to health care providers, researchers, and policy makers, and will have significant public health implication for a highly vulnerable population of adolescents
