Purpose Asthma interventions targeting urban adolescents are rare, despite a great need. Motivating adolescents to achieve better self-management of asthma is challenging, and the literature suggests that certain subgroups are more resistant than others. We conducted a school-based, randomized controlled trial to evaluate Puff City, a web-based, tailored asthma intervention, which included a referral coordinator, and incorporated theory-based strategies to target urban teens with characteristics previously found to be associated with lack of behavior change. Methods To identify eligible teens, questionnaires on asthma diagnoses and symptoms were administered to 9–12th graders of participating schools during a scheduled English class. Eligible, consenting students were randomized to Puff City (treatment) or generic asthma education (control). Results 422 students were randomized (98% African-American, mean age=15.6 years). At 12 month follow-up, adjusted Odds Ratios (95% Confidence Intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) aOR=0.49 (0.24–0.79), p=0.006 and 0.53 (0.32–0.86), p=0.010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences and restricted activity days, aOR=0.30 (0.11–0.80), 0.29 (0.14–0.64), 0.40 (0.20–0.78), and 0.23 (0.10–0.55); all p<0.05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls, aOR=0.23 (0.06 – 0.88), p=0.031. Statistically significant differences in medical care use were not observed. Conclusions Results suggest a theory-based, tailored approach, with a referral coordinator, can improve asthma management in urban teens. Puff City represents a viable strategy for disseminating an effective intervention to high risk and hard-to-reach populations.

Despite medical and scientific advances, racial and ethnic disparities persist in US asthma morbidity and mortality rates. Progress in the elimination of these disparities will involve disentangling the contribution of social constructs, such as race, socioeconomic status, and culture, from that of the physical environment and genetic susceptibility. One approach to reducing asthma disparities is through the traditional disease prevention stages of intervention. As such, primary prevention targets reductions in asthma incidence; secondary prevention is the mitigation of established disease and involves disease detection, management, and control; and tertiary prevention is the reduction of complications caused by severe disease. Once causative factors at each level of disease prevention are understood, this knowledge can be translated into clinical practice and public health policy.

Background The ability to identify potentially resistant participants early in the course of an intervention could inform development of strategies for behavior change and improve program effectiveness. Objective The objective of this analysis was to identify factors related to nonresponse (i.e., lack of behavior change) to an asthma management intervention for urban teenagers. The intervention targeted several behaviors, including medication adherence, having a rescue inhaler nearby, and smoking. Methods A discriminate analysis was conducted using data from a randomized trial of the intervention. Included in this analysis are participants who reported a physician diagnosis of asthma, completed a baseline questionnaire, were randomized to the treatment group, completed ≥2 of 4 educational sessions, and completed ≥2 of 3 follow-up questionnaires. Ninety students met criteria for inclusion in this subgroup analysis. Results In logistic regression models for medication adherence, nonresponse was related to low baseline asthma self-regulation, odds ratio = 3.6 (95% confidence interval = 1.3–9.5). In models for having an inhaler nearby, nonresponse was related to low baseline self-regulation and to rebelliousness, OR = 4.7 (1.6–13.2) and 5.6 (1.7–18.0), respectively. Nonresponse to smoking messages was related to rebelliousness, low emotional support, and low religiosity, ORs = 7.6 (1.8–32.3), 9.5 (1.4–63.5), and 6.6 (1.5–29.8) respectively. Conclusions Certain variables had the ability to discriminate the likelihood of response from that of nonresponse to an asthma program for urban, African American adolescents with asthma. These variables can be used to identify resistant subgroups early in the intervention, allowing the application of specialized strategies through tailoring. These types of analyses can inform behavioral interventions.

Background Retention of study participants in randomized controlled trials (RCTs) is crucial to study validity. Purpose We analyzed the result of four retention strategies used to reconnect with urban teens enrolled in a school-based randomized controlled trial (RCT) and overdue for a 12-month follow-up survey. Methods Traditional retention strategies used to reconnect with teens categorized as “unable to contact” were weekly re-dials of non-working telephone numbers and mailings to the student’s home. Non-traditional retention strategies were obtaining assistance from school administration and communication through Facebook. Results Of the 422 students enrolled, 125 (29.5%) were overdue for a 12-month follow-up survey, but had no working telephone number (unable to contact). We made 196 attempts to contact these 125 students, of which 82 attempts (41.8%) were successful in “reconnecting,” defined as (1) a student contacting research staff as a result of a mailed notice; (2) a research staff member leaving a voicemail at a previously disconnected telephone number; (3) a student responding to Facebook outreach; or (4) research staff obtaining a new telephone number and talking to a person at the new telephone number. We used “ mailed reminder letters” as the referent category, in our analysis. Odds ratios (95% confidence intervals) for the association between the strategy used and success (“reconnecting”) for telephone number re-dials, Facebook, and school administration assistance were 4.60 (1.8–11.8), 1.94 (1.01–3.73), and 2.91 (0.58–14.50), respectively. Limitations Retention strategies were not applied hierarchically or systematically across students, and we were unable to ascertain student preference for a particular strategy. In addition, our findings may be applicable only to study populations with characteristics similar to those of students included in this study. Conclusion Overall, of the 422 students who enrolled in the study, 380 (90%), ultimately completed the 12-month follow-up survey. A mix of traditional retention strategies, such as telephone number re-dials, and more contemporary methods, such as use of Facebook, were effective in reconnecting with urban teenagers enrolled in a school-based RCT, and controlling attrition during the 12-month follow-up survey period.