Effect of the School-Based Asthma Care for Teens (SB-ACT) Program on Asthma Morbidity: a 3-arm Randomized Controlled Trial

Urban adolescents with asthma often have inadequate preventive care. We tested the effectiveness of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity and preventive medication adherence.- 12-16yr olds with persistent asthma in Rochester, NY schools. - 3-group randomized trial (2014-2019). - Two core components: 1) Directly observed therapy (DOT) of preventive asthma medications, provided in school for at least 6-8 weeks for the teen to learn proper technique and experience the benefits of daily preventive therapy; 2) 4-6 weeks later, 3 sessions of motivational interviewing (MI) to discuss potential benefits from DOT and enhance motivation to take medication independently. We included 2 comparison groups: 1) DOT-only for 6-8wks, and 2) asthma education (AE) attention control. Masked follow-up assessments were conducted at 3, 5, and 7mos. - Mean number of symptom-free days (SFDs)/2 weeks and medication adherence. - Modified intention-to-treat repeated measures analysis. We enrolled 430 teens (56% Black, 32% Hispanic, 85% Medicaid). There were no group differences at baseline. We found no difference in SFDs at any follow-up timepoint. More teens in the SB-ACT and DOT-only groups reported having a preventive asthma medication at each follow-up (<.001), and almost daily adherence at 3 and 5-months (<.001, =.003) compared to AE. By 7 months there were no significant differences between groups in adherence (=.49). SB-ACT improved preventive medication availability and short-term adherence but did not impact asthma symptoms. Further work is needed to create developmentally appropriate and effective interventions for this group.