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)

基本信息

批准号：
10274793
负责人：
Marina Reznik
金额：
$ 83.59万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-24 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10274793
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 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 Reach, Effectiveness, Adoption, Implementation, and Maintenance Schools Self Efficacy Self Management Severities Sports Strenuous Exercise Students Symptoms Testing Time Urban Community Urban Health Work aged asthma exacerbation base comparison group contextual factors demographics design disorder control effectiveness evaluation effectiveness outcome elementary school experience feasibility testing functional outcomes health care service utilization health disparity high risk implementation intervention 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 minority urban school

项目摘要

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.

项目概要/摘要纽约州布朗克斯学校的哮喘患病率为 20-25%。体力活动 (PA) 是哮喘的重要组成部分。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然而，患有哮喘的城市少数民族儿童面临障碍。在我们之前的工作 (K23HD065742) 中，我们发现了城市少数民族的 PA 的几个障碍。这些障碍包括：在学校无法获得哮喘急救药物，初级保健医生 (PCP) 的预防性哮喘治疗处方不理想，缺乏学校 PA 机会、与哮喘相关的耻辱、家长/孩子对 PA 哮喘发作的恐惧以及缺乏老师我们制定了一项新颖的哮喘管理计划来促进学生对帮助哮喘患者的信心。学校学生活动 (Asthma-PASS) 与利益相关者合作，解决这些关键障碍。我们对来自 4 所布朗克斯小学的 109 名哮喘学生及其家长进行了试点测试展示试点结果的概念证明和初步证据。研究表明，无症状天数 (SFD)（主要结果指标）显着增加，并且此外，初步调节分析表明，剧烈的 PA 和步数是调节因素。我们现在计划以这项工作为基础，并通过一项全面的随机试验来评估哮喘是否- PASS 干预可降低高危城市学童的哮喘发病率。随机对照试验，纳入 416 名 5-11 岁患有持续性或不受控制哮喘的儿童，年龄 26 岁布朗克斯学校将按规模分层，然后随机分配到 (1) 哮喘-PASS 学校。干预（PCP 合作，确保基于最佳指南的预防性哮喘护理和社区健康工作人员促进学校救援药物的供应，并提供哮喘意识和规划对儿童、家长和学校工作人员进行教育，以减少哮喘的耻辱感和 (2) 哮喘管理 (AM) 对照组（PCP 和家长通知儿童哮喘状况和一般哮喘教育）。两个小组都将参加现有的全区课堂日常活动计划（“移动”）。我们将评估 Asthma-PASS 在降低哮喘发病率方面的有效性（主要结果 - SFD），并改善 PA（次要结果）以及其他临床和功能结果。我们还将使用先前制定的程序通过加速度计测量 PA。我们将评估干预实施的过程。通过应用 RE-AIM 框架，该提案直接建立在我们之前在学校改善哮喘的工作的基础上。如果 Asthma-PASS 成功减少症状并改善健康状况，它将为全国学校和城市社区的政策变革提供有力的论据。