Background/Rationale: Poor sleep quality, which is elevated in urban adolescents due to poor sleep hygiene, impairs functioning. Asthma, the most common pediatric illness, has high prevalence and morbidity among urban adolescents. Nocturnal symptoms contribute to poor sleep quality. Despite the success of asthma and of sleep hygiene in this population, no interventions concurrently address sleep hygiene and asthma control. This is of great concern given the high risk of poor sleep quality among urban adolescents. Process evaluations are often lacking during intervention development. We address these treatment and methodological gaps. Objectives: This pilot study will (1) develop an integrated, school-based intervention to improve asthma self- management and sleep hygiene in urban high school students; (2) evaluate the intervention's feasibility and acceptability; and (3) assess the preliminary evidence of intervention effects on improving sleep quality in urban high school students in NYC and Providence, RI. Hypotheses: (1) The intervention will be feasible and acceptable as evidenced by adolescents' high rates of adherence to the treatment protocol, and their high satisfaction ratings and positive responses to exit interviews; and (2) relative to controls, over 2-months post- intervention adolescents randomized to the intervention will have significant improvement on the following outcomes assessing sleep quality: (1) sleep efficiency; (2) night awakenings; and (3) sleep duration. Methods: In Year 1 we will adapt and integrate two efficacious school-based interventions for urban adolescents, our team's asthma and sleep hygiene interventions. We will retain components of each that are guideline-based and critical for asthma and sleep quality; expert feedback, as well as adolescent and caregiver input via focus groups at both sites, will also guide intervention development. In Year 2, we will conduct a randomized trial with 48 urban adolescents with persistent asthma and whose typical sleep duration is at/below what is recommended for this age group from 4 schools, 2 in NYC and 2 in RI. Students will be randomized within a school to the intervention and control, which consists of our asthma intervention in its original format, and will be followed for 2-months. University student interns will deliver both interventions. Process evaluation interviews with students, interns, and school personnel will be conducted to obtain feedback regarding intervention procedures. Significance: This study has high public health significance because it (1) targets a highly vulnerable population for poor sleep quality ? urban adolescents with persistent asthma; (2) adapts and integrates two efficacious interventions to develop a novel intervention that simultaneously targets asthma control and sleep hygiene, which has the potential to amplify intervention effects; and (3) includes a process evaluation, bridging the gap between science and practice, and aiding in the design of a full-scale RCT.
Sleep quality is greatly reduced in urban adolescents due, in part, to their poor sleep hygiene. Asthma, which is elevated in urban adolescents, is associated with poor sleep quality. A novel school-based intervention for use with urban adolescents with persistent asthma and whose typical sleep duration is at/below what is recommended for this age group that adapts and integrates two interventions with proven efficacy ? one targeting asthma management and the other sleep hygiene ? has the potential to greatly improve sleep quality in this high risk group.
