Health disparities in pediatric asthma persist, with Latino children demonstrating increased asthma morbidity. Middle school children have greater morbidity than children from any other age group, yet there are no school- based asthma management programs developed for this group. To address these gaps, we have developed and piloted a novel group-based intervention: ASMAS (Asthma Self-MAnagement in Schools) in two geographic areas with a high proportion of urban, Latino children with asthma: Providence, Rhode Island, and San Juan, Puerto Rico. ASMAS is a 4-session, peer-facilitated asthma self-management intervention specific to the school setting for Latino middle school (6th-8th graders) children. It is delivered by trained Latino High School Juniors and Seniors with asthma, adapts guidelines-based self-management to the urban school setting, and is consistent with Latino children's cultural backgrounds. In our pilot RCT, ASMAS improved asthma outcomes and self-management for the targeted groups. Our proposed approach involves a hybrid design including a large-scale randomized, controlled trial investigating the effect of ASMAS, and an evaluation of the implementation process to inform future plans to test ASMAS in additional urban settings.
Our first aim i s to evaluate the effects of ASMAS on asthma health outcomes (e.g., control, symptom free days, absences, lung function) and asthma self-management (skills, knowledge and self-efficacy, availability of rescue inhaler and action plan at school) in a sample of 432 Latino middle school children with asthma in Providence, RI and San Juan, PR (216 per site; 72 per condition). 6th to 8th grade middle schoolers will be enrolled then randomly assigned to 1) ASMAS, or 2) Asthma Education plus Child Health control condition, or 3) a no treatment control condition (9 groups of each condition per site; 8 children per group). Student and primary caregiver assessments will occur at baseline, end of treatment (directly following the intervention), and at three, 4-month post intervention follow-ups.
Our second aim i s to conduct a mixed-methods, multi-stakeholder process evaluation using the RE-AIM framework,48-50 with students, caregivers, HS Peers, school administrators and additional community stakeholders invested in supporting students' asthma care. We will begin to develop implementation strategies with key stakeholders to better prepare for future large-scale evaluation of the effectiveness of ASMAS and its implementation in additional urban centers. Relative to controls, over 1 year, we expect that ASMAS participants will have improved asthma outcomes and self- management. We also expect treatment effects on asthma outcomes will be mediated through changes in self- management in all children, and moderated by acculturative stress and language proficiency in RI children. The proposed work offers a critical opportunity to evaluate ASMAS for improving asthma outcomes for children at high risk on a larger-scale and to develop avenues for sustainability and future dissemination with state and community stakeholders.
Health disparities in pediatric asthma persist, with Latino children demonstrating increased asthma morbidity. Middle school children with asthma have greater morbidity than children from any other age group and spend a majority of their day in school, where they must manage any asthma. We developed and piloted a novel group- based intervention - ASMAS (Asthma Self-MAnagement in Schools) in two geographic areas with a high prevalence of urban and Latino children with asthma: Providence, Rhode Island, and San Juan, Puerto Rico. ASMAS is a 4-session, peer-facilitated asthma self-management intervention specific to the school setting for Latino middle school (6th-8th graders) children. It is delivered by trained High School Juniors and Seniors of Latino descent with asthma. We demonstrated the preliminary effects of ASMAS for improving asthma outcomes and self-management relative to controls. In this proposal, we will evaluate ASMAS through a large- scaled Randomized Control Trial with urban middle school students who have persistent asthma in Providence, RI and San Juan, Puerto Rico and we will identify barriers and facilitators to the implementation of ASMAS. These results will allow us to prepare for future, large-scale dissemination in other urban school settings.
