The goal of this project is to develop and evaluate a multimedia, tailored web-based asthma management program to specifically target urban high school students. The program uses tailoring, in conjunction with theory-based models, to alter behavior through individualized health messages based on the user's beliefs, attitudes, and personal barriers to change. 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.

asthma, medication compliance, disease management, smoking cessation, smoking reduction, youth, high school, students, school-based program, tailored, Internet, web

1. Develop a computer-based, tailored asthma management program for urban teenagers based on an existing model of a software system that corresponds to the core concepts of the transtheoretical model of change and the Health Belief model.
   
2. Implement an asthma intervention in urban high schools that will consist of access to the tailored software and the guidance of an asthma counselor for students with asthma.
3. Evaluate the asthma intervention program by conducting a randomized trial to assess selected effectiveness outcomes and program costs.

Three hundred fourteen urban high school students who have asthma-like symptoms. Students in grades 9-11will be recruited from six Detroit area high schools.

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.<br><br>

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.<br><br>

Evaluations were completed at 6, 9 and 12 months from baseline.

More than 98% of participants were African-American, and an average of 52% qualified for federal school lunch programs.

The Puff City users:

• Made 50% fewer visits to the emergency department.
• Required 50% fewer hospitalizations.
• Missed 60% fewer schools days.

Students in the treatment group reported significantly fewer symptom days in the past two weeks than did controls (3.0 vs 3.4, respectively).

Significant differences between the treatment and control groups were also observed in the number of symptom nights in the past two weeks (2.3 vs 2.5, respectively), and days of restricted activity in the past two weeks (2.2 vs 3.4)

As each school had existing computer resources, the estimated cost of the program was $6.66 per student -- which in large part was attributed to the cost of the asthma referral coordinator, a necessary component of the program.

A web-based, tailored approach to changing negative asthma management behaviors is economical, feasible, and effective in improving asthma outcomes in a traditionally hard-to-reach population.

Joseph CLM, Peterson EL, Havstad S, Johnson CC, Hoerauf S, Stringer S, Gibson-Scipio W, Ownby DR, Elston-Lafata J, Pallonen U, Strecher V. A Web-based, Tailored Asthma Management Program for Urban African-American High School Students. Am J Respir Crit Care Med 2007; 175(9): 888-895.<br><br>

Joseph CLM, Baptist AP, Stringer S, Havstad S, Ownby DR, Johnson CC, Williams LK, Peterson EL. Identifying students with self-report of asthma and respiratory symptoms in an urban, high school setting. Journal of Urban Health 2007; 84(1): 60-9.<br><br>

Joseph CLM, Williams LK, Ownby DR, Saltzgaber J, Johnson CC. Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma. Invited Review. J Allergy Clin Immunology 2006; 117(2): 233-240.