Evaluation of the Asthma Management Program to Promote Activity for Students in Schools (Asthma-PASS)

对促进学校学生活动的哮喘管理计划的评估 (Asthma-PASS)

• 批准号: 9974906
• 负责人: Marina Reznik
• 金额: $ 86.77万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-24 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9974906
• 关键词: Absenteeism; Accelerometer; Address; Adherence; Adoption; Affect; African American; Age; Asthma; Awareness; Caregivers; Caring; Child; Childhood Asthma; Clinical; Clinical Trials; Collaborations; Communities; Community Health Aides; Education; Effectiveness; Effectiveness of Interventions; Ensure; Evaluation; Exercise; Face; Family; Feedback; Fright; Guidelines; Health; Health system; Hispanics; Human Resources; Intervention; Low income; Maintenance; Measures; Mediating; Mediation; Mediator of activation protein; Minority; Modeling; Morbidity - disease rate; New York; Notification; Outcome; Outcome Measure; Parents; Pathway interactions; Pharmaceutical Preparations; Phase; Physical Education; Physical activity; Pilot Projects; Policies; Prevalence; Preventive; Primary Care Physician; Procedures; Process; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Schools; Self Efficacy; Self Management; Severities; Sports; Strenuous Exercise; Students; Symptoms; Testing; Time; Urban Health; Work; aged; asthma exacerbation; base; comparison group; contextual factors; demographics; design; disorder control; effectiveness evaluation; elementary school; experience; functional outcomes; health care service utilization; health disparity; high risk; improved; inner city; intervention effect; meetings; minority children; novel; physical inactivity; physical state; primary outcome; programs; pulmonary function; randomized trial; reduce symptoms; school health; secondary outcome; social factors; social stigma; teacher; treatment as usual; urban children; urban school

PROJECT SUMMARY/ABSTRACT Asthma prevalence in Bronx, NY schools is 20-25%. Physical activity (PA) is an important component of asthma management in children. Studies show that PA is associated with decreased severity of asthma symptoms, as well as improved disease control and quality of life. However, urban minority children with asthma face barriers to PA on multiple levels. In our prior work (K23HD065742), we identified several barriers to PA in urban minority schoolchildren with asthma. These barriers include: inadequate access to asthma rescue medications in school, suboptimal prescribing of preventive asthma therapy by primary care physicians (PCPs), lack of school PA opportunities, stigma associated with asthma, parent/child fear of an asthma attack with PA, and lack of teacher confidence in assisting students with asthma. We developed a novel Asthma management program to Promote Activity for Students in Schools (Asthma-PASS) in collaboration with stakeholders to address these key barriers. We pilot tested Asthma-PASS with 109 students with asthma from 4 Bronx elementary schools and their parents to demonstrate proof of concept and preliminary evidence of intervention effectiveness. Results from the pilot study demonstrated significantly greater increase in symptom-free days (SFDs) (primary outcome measure) and PA levels. In addition, preliminary mediation analyses suggested vigorous PA and step counts are mediators of SFDs. We now plan to build upon this work and evaluate in a full-scale randomized trial whether the Asthma- PASS intervention reduces asthma morbidity among high-risk urban schoolchildren. We propose a cluster- randomized controlled trial with 416 children ages 5-11 years with persistent or uncontrolled asthma from 26 Bronx schools. Schools will be stratified by size and then randomly assigned to either (1) the Asthma-PASS intervention (PCP collaboration to ensure optimal guideline-based preventive asthma care and community health workers to facilitate rescue medication availability in school and provide asthma awareness programming and education for children, parents and school personnel to reduce stigma around asthma and PA) or (2) an asthma management (AM) comparison group (PCP and parent notification of child’s asthma status and general asthma education). Both groups will participate in an existing district-wide classroom-based daily activity program (‘Move to Improve’). We will assess the effectiveness of Asthma-PASS in reducing asthma morbidity (primary outcome - SFDs), and improving PA (secondary outcome) as well as additional clinical and functional outcomes. We will measure PA with accelerometers using previously established procedures. We will also identify potential mediators and moderators of the intervention effect. We will evaluate the process of intervention implementation by applying the RE-AIM framework. This proposal directly builds on our prior work in schools to improve asthma outcomes and reduce health disparities. If Asthma-PASS successfully reduces symptoms and improves health, it will provide a powerful argument for policy change in schools and urban communities nationwide.

项目摘要/摘要 纽约州布朗克斯的哮喘患病率为20-25％。体育活动（PA）是哮喘的重要组成部分 儿童的管理。研究表明，PA与哮喘症状的严重程度降低有关 以及改善疾病控制和生活质量。但是，有哮喘面部障碍的城市少数民族儿童 在多个级别上进行PA。在我们的先前工作（K23HD065742）中，我们确定了城市少数派的PA障碍 学童患有哮喘。这些障碍包括：在学校接受哮喘救援药物不足， 初级保健医师（PCP）对预防哮喘治疗的次优处方，缺乏学校PA 机会，与哮喘有关的污名，父母/孩子担心对PA哮喘发作以及缺乏老师 有信心协助学生患哮喘。我们制定了一个新颖的哮喘管理计划来促进 与利益相关者合作解决这些关键障碍的学校学生（哮喘）的活动。 我们试行了109名布朗克斯小学及其父母的哮喘的学生进行了哮喘测试 展示概念证明和干预效率的初步证据。飞行员的结果 研究表明，无症状天数（SFD）（主要结局指标）和 PA水平。此外，初步调解分析表明，有力的PA和步骤计数是 SFD。现在，我们计划以这项工作为基础，并在全尺度随机试验中评估哮喘 - 是否是 通行干预降低了高风险城市学童的哮喘发病率。我们提出了一个集群 - 随机对照试验，有416名5-11岁儿童，持续或不受控制的哮喘从26岁起 布朗克斯学校。学校将按大小进行分层，然后随机分配给（1）哮喘 - 干预（PCP协作以确保基于指南的最佳预防哮喘护理和社区健康 工人支持学校的救援药物可用性，并提供哮喘意识计划和 儿童，父母和学校人员的教育，以减少哮喘和PA周围的污名）或（2）哮喘 管理（AM）比较组（PCP和父母的哮喘状况和一般哮喘的父母通知 教育）。这两个小组将参加现有的基于地区范围的课堂日常活动计划（'移动 改进’。我们将评估哮喘 - 哮喘在降低哮喘发病率方面的有效性（主要结果 -SFD），改善PA（次要结果）以及其他临床和功能结果。我们将 使用先前建立的程序用加速度计测量PA。我们还将确定潜力 干预效果的介体和主持人。我们将评估干预实施过程 通过应用Re-Aim框架。该提案直接建立在我们先前在学校改善哮喘的工作 结果并减少健康差异。如果哮喘 - 通子成功减轻症状并改善健康，则 它将为全国学校和城市社区的政策变革提供有力的论点。