Evaluation of a web-based asthma management intervention program for urban teenagers: Reaching the hard to reach

Christine L.M. Joseph, Dennis R. Ownby, Suzanne L. Havstad, Jacqueline Saltzgaber, Shannon Considine, Dayna Johnson, Ed Peterson, Gwen Alexander, Mei Lu, Wanda Gibson-Scipio, Christine Cole Johnson

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


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 (RCT) 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, we administered questionnaires on asthma diagnoses and symptoms to ninth through 12th graders of participating schools during a scheduled English class. We randomized eligible, consenting students to Puff City (treatment) or generic asthma education (control). Results: We randomized 422 students (98% African-American, mean age = 15.6 years). At 12-month follow-up, adjusted odds ratios (aORs) (95% confidence intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) as aOR =.49 (.24-.79), p =.006 and.53 (.32-.86), p =.010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences, and restricted activity days: aOR =.30 (.11-.80),.29 (.14-.64),.40 (.20-.78), and.23 (.10-.55); all p <.05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls: aOR =.23 (.06-.88), p =.031. We did not observe statistically significant differences in medical care use. Conclusions: Results suggest that 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.

Original languageEnglish (US)
Pages (from-to)419-426
Number of pages8
JournalJournal of Adolescent Health
Issue number4
StatePublished - Apr 2013


  • Adolescents
  • African-American
  • Asthma
  • Behavioral intervention
  • Randomized controlled trial
  • Tailored intervention
  • Web-based intervention

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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