Project Overview +

This study builds on the success of Puff City 1 (PC1), an Internet-based, teen-focused asthma management program, and enhances the effects achieved in PC1 in several ways: 1) tests new theory- and empirically-based approaches to recruiting urban high school students, 2) enhances program content to address resistance to change and relapse, and 3) uses PC1 data to create participation and success profiles of the students who can then be differentially approached on the basis of these profiles in Puff City II.

Related Media +

Related Media:

Aims +

Aim 1. Develop and pilot culturally-tailored and theory-based methods for recruiting urban teenagers into a randomized trial to evaluate an asthma management program.

Aim 2. Identify factors predicting sustained improvement, relapse, and resistance to change in Puff City I to guide modifications in Puff City II.

Aim 3. Develop and add Motivational Interviewing techniques based on Self-Determination Theory and Attribution Theory to address resistance to change and relapse.

Aim 4. Evaluate the Puff City II program using a randomized trial to assess efficacy and program costs, deploying recruitment strategies resulting from specific aim 1.

Participants +

Five hundred high school students who have a diagnosis of asthma or asthma-like symptoms. Students from grades 9-11 will be recruited from six Detroit area high schools.

Intervention +

Students who participate (with parents' consent) complete all components of the program during school time on school computers. Students complete a baseline survey and are randomized to receive an individually tailored web-based tailored program (treatment) or existing generic asthma education web sites (control). Randomization occurs within each school and is based on gender, grade, and asthma diagnosis to assure a comparable distribution of these factors. Students have 180 days to complete four 20-30 minute educational sessions, with a minimum of 7 days between sessions to allow for behavior change. School staff help students with any technical issues that arise on the computers. An asthma counselor based at Henry Ford Health System is available by phone to all students enrolled in Puff City

The content of the Puff City computer program is based on recommendations for patient education made by the National Asthma Education and Prevention Program, and focuses on three core behaviors: controller medication adherence, rescue inhaler availability, and smoking cessation/reduction. The entire program is voiced over, to accommodate low literacy.

NEW elements in Puff City II:

  • Session 1 provides the opportunity for two additional submodules.
  • Students classified as having low social support receive a social support submodule.
  • Students with low motivation will receive a motivation submodule.
  • Sessions 2-4 submodules are values-based and focus on what students value in life. Students are placed into one of three categories to determine if they get a submodule:
  1. Successful - Making positive change or doing well. (do not get submodules)
  2. Resistant - Do not change for the better. Continue to do poorly. (receive submodules in sessions 2, 3 and 4)
  3. Relapsed - Appear to have success and then slip. (receive submodules in sessions 2, 3 and 4)
  • A fifth "booster" session is given to students who are categorized as Resistant or Relapsed immediately after their 6-month evaluation.
  • The baseline survey assesses if a student is "Rebellious" or "Non-Rebellious". Each submodule is written and voice recorded with rebellious and non-rebellious tones and all are tailored on gender. The goal of the two tones is to enhance potential connectedness to the Puff City characters and motivate the student to change.

Evaluations are completed at 6, 9 and 12 months after baseline.