Web-Based Asthma Education Helps African-American Youths

Key Point

African-American adolescents, a high-risk group among asthma patients, can experience improvement in daily symptoms through use of a tailored, Web-based education program.

The rate of asthma deaths among African-Americans ages 15 to 24 is the highest in the nation. The death rate from asthma in this group is 75% higher than that of white persons of the same age; compared with rates among African-American and white children ages 5 to 14, it is 25% and 80% higher, respectively. These statistics provide evidence that the former group would be ideally suited for intervention—specifically, a comprehensive asthma education program, said Christine L. M. Joseph, PhD, and colleagues in the May 1 American Journal of Respiratory and Critical Care Medicine.

Toward that end, Dr. Joseph and colleagues developed Puff City, a first-of-its-kind, tailored Web-based multimedia asthma program for urban high school students evaluated in a non–clinic-based community setting. Past efforts at developing multimedia asthma education programs by other researchers have targeted children and adolescents, but not those living in urban environments.

The content of the Puff City computer program was based on recommendations for patient education made by the National Asthma Education and Prevention Program. Controller medication adherence, rescue inhaler availability, and smoking cessation/reduction were the core behaviors the program focused on. Messages providing information on such topics as asthma pathophysiology, trigger avoidance, and the correct use of inhalers and other devices—were voiced over, to accommodate low literacy.

USER FEEDBACK

Using information gleaned at baseline and during four consecutive computer sessions, the program provided assessment and feedback on how users compared with other users and how their responses compared with those of their last session. For this study, 314 students in grades 9 through 11 from six Detroit high schools were randomized to participate in the Web-based tailored program (treatment) or existing generic asthma education Web sites (control). All had doctor-diagnosed asthma or had reported frequent symptoms consistent with mild, intermittent asthma. More than 98% of participants were African-American, and an average of 52% qualified for federal school lunch programs.

Students accessed the program using computers at school and were given 180 days to complete the four sessions. Core behaviors—assessed at baseline and at 12 months postbaseline—were described as positive behavior or maintenance of positive behavior, no change in negative behavior, or evidence of change from a positive behavior to a negative one. The primary outcome was number of symptom days in the preceding two weeks.

With both groups having similar eligibility criteria and demographic characteristics, students who used the Puff City program were more likely than controls to complete all four sessions. In addition, at session 1, students in the treatment group were less likely than controls to use a controller or rescue medication.

BETTER SYMPTOM CONTROL

“Overall, treatment students showed more positive change and less negative change than control students,” the researchers noted, although the differences in positive changes were of borderline significance. These results confirm prior research that “it is difficult to change health behavior, especially in adolescents,” the authors acknowledged. With regard to the primary outcome, however, 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), school days missed in the past 30 days (1.2 vs 3.3), days of restricted activity in the past two weeks (2.2 vs 3.4), and asthma hospitalizations in the past year (0.6 vs 2.0). 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 referral coordinator, a necessary component of the program, the authors stressed.

“The approach and framework used in this program can be applied to other health conditions, such as diabetes, and other high-risk populations, such as rural or Latino youth,” the authors suggested. “More research is needed on the types of interventions that can successfully engage urban adolescents with chronic disease, and the enhancement of participation in such programs.”           

—Adriene Marshall

Reference
Centers for Disease Control and Prevention, National Center for Health Statistics, Health E-Stats: asthma prevalence, health care use, and mortality, 2002. Hyattsville, MD: US Department of Health and Human Services, National Center for Health Statistics; 2003.
Joseph CLM, Peterson E, Havstad S, et al. A Web-based, tailored asthma management program for urban African-American high school students. Am J Respir Crit Care Med. 2007;175:888-895.

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