B14-01 Reducing Asthma Disparities: Results of a Pilot Randomized Control Trial of Web-Based Asthma Intervention for Urban Adolescents

Rationale

Asthma has high prevalence and morbidity among adolescents and disproportionally affects minority youth. E-health interventions, which have demonstrated success, hold great promise to reduce disparities, especially among adolescents for whom technology is an integral part of their everyday lives. Yet only two asthma interventions have been tested rigorously in U.S. high schools; of these, only one is available online and it was developed for only Black youth. This study presents results of a randomized trial testing the initial impact of Controlling Asthma Program for Adolescents (CAMP Air), a theory-based, e-health intervention.

Methods

374 adolescents with poorly controlled asthma (mean age=15.6; Hispanic=63.8% Black=43.0%; female=79.6%) from 15 NYC high schools were randomized to treatment (n = 187) and attention-control (n = 187) groups. CAMP Air, which was co-developed with adolescents, incorporates behavior change mechanisms to foster self-care skills and asthma control. Skills taught over seven modules include the importance medication, the need to see a healthcare provider for an evaluation, how to talk with caregivers and healthcare providers regarding their asthma, and ways to manage triggers. CAMP Air utilizes interactive games for practice and personalized feedback. Control adolescents completed seven self-guided modules delivered via PowerPoint regarding asthma basics and other health challenges adolescents face that are related to asthma (e.g., stress, sleep); the control intervention lacked interactive games and personalization. Outcomes were assessed at baseline and immediate post-intervention. Primary outcomes were Asthma Control Questionnaire (ACQ) scores and number of asthma-related urgent care visits in prior 3 months (0, 1, 2+). Secondary outcomes were use of controller medication (yes/no), asthma self-efficacy and number of symptom days in past 2 weeks. Generalized linear mixed-effects models with cohort as a random effect controlling for sex and age tested effects on outcomes following the intent-to-treat principle.

Results

CAMP Air and control adolescents completed on average 6.60 (range=0-7) and 6.26 (range=0-7) modules, respectively. Table 1 details treatment results. Relative to controls, treatment adolescents had better asthma self-efficacy (β = 0.13, P = 0.03), higher odds of taking controller medication (OR = 1.87, P = 0.06), and fewer days with symptoms (RR = 0.78, P = 0.0001); there were no differences in ACQ scores or urgent care visits.

Conclusions

CAMP Air resulted in greater reported controller medication use, more confidence to manage asthma, and fewer days with symptoms. Additional time to practice the skills taught in CAMP Air are likely needed to impact other asthma outcomes. Future studies should consider the long-term impact of CAMP Air on asthma control and urgent health care utilization.

This abstract is funded by: NIH/NHLBI (R61-R33 HL151958; PI=Bruzzese)