School-based Asthma Interventions Research Articles

Strategies to improve the recruitment and retention of underserved children and families in clinical trials: A case example of a school-supervised asthma therapy pilot

BackgroundDue to underrepresentation of racial/ethnic minority and low-income groups in clinical studies, there is a call to improve the recruitment and retention of these populations in research. Pilot studies can test recruitment and retention practices for better inclusion of medically underserved children and families in subsequent clinical trials. We examined this using a school-based asthma intervention, in preparation for a larger clinical trial in which our goal is to include an underserved study population. MethodsWe recruited children with poorly controlled asthma in a two-site pilot cluster randomized controlled trial of school-supervised asthma therapy versus enhanced usual care (receipt of an educational asthma workbook). We sought a study population with a high percentage of children and families from racial/ethnic minority and low-income groups. The primary outcome of the pilot trial was recruitment/retention over 12 months. Strategies used to facilitate recruitment/retention of this study population included engaging pre-trial multi-level stakeholders, selecting trial sites with high percentages of underserved children and families, training diverse medical providers to recruit participants, conducting remote trial assessments, and providing multi-lingual study materials. ResultsTwenty-six children [42.3% female, 11.5% Black, 30.8% Multiracial (Black & other), 76.9% Hispanic, and 92.3% with family income below $40,000] and their caregivers were enrolled in the study, which represents 55.3% of those initially referred by their provider, with 96.2%, 92.3%, and 96.2% retention at 3-, 6-, and 12-month follow-up, respectively. ConclusionTargeted strategies facilitated the inclusion of a medically underserved population of children and families in our pilot study, prior to expanding to a larger trial.

The Promise of School-Based Asthma Interventions.

The Promise of School-Based Asthma Interventions.

The Impact of Adherence and Health Literacy on Difficult-to-Control Asthma

Medication nonadherence and health literacy are key factors that influence the management of difficult-to-control asthma. Adherence, or the extent to which a patient follows a treatment plan, extends beyond asthma medication use and includes an appropriate inhaler technique. Assessment of adherence is critical before making a diagnosis of severe asthma and stepping up asthma therapy but is challenging in the clinical context. Health literacy, or the degree to which individuals can obtain, process, and understand health information and services needed to make health care decisions, is additionally important for asthma management and has been shown to impact medication adherence. Initiatives aiming to improve difficult-to-control asthma should address medication adherence and health literacy. Universal health literacy precautions are recommended while communicating with patients, in addition to the creation of low health literacy asthma action plans. To improve adherence, a comprehensive assessment of adherence should be conducted. Additional evidence-based interventions aiming to improve adherence focus on appropriate inhaler use, improved access to medications, the use of digital platforms, school-based asthma interventions, and the implementation of culturally tailoredinterventions. Data are limited regarding the use of these initiatives in patients with severe or difficult-to-control asthma.

Associations among anxiety, self-efficacy, and self-care in rural adolescents with poorly controlled asthma

BackgroundRural adolescents are vulnerable to asthma; good self-care can reduce morbidity. The subtypes of anxiety (eg, asthma-related, generalized) may have differential associations with asthma self-care. Low self-efficacy, a determinant of behavior, is associated with increased anxiety. Little is known regarding these relationships in rural adolescents. ObjectiveTo evaluate whether anxiety symptoms are associated with asthma symptom prevention and management among rural adolescents and whether self-efficacy mediates these relationships. MethodsWe used baseline data from 197 rural adolescents (mean age = 16 years; 69% girls; 62% Black) who were part of a trial that tested the effectiveness of a school-based asthma intervention. Adolescents completed the Youth Asthma-Related Anxiety Scale, Screen for Child Anxiety and Emotional Disorders, Asthma Management Self-efficacy Index, and Asthma Prevention and Management Indices. Linear regression was performed to test whether: (1) asthma-related and generalized anxiety had curvilinear relationships with self-care; (2) social and separation anxiety had linear relationships with self-care; and (3) self-efficacy mediated relationships. ResultsAsthma-related anxiety had a significant curvilinear relationship with prevention (P = 0.001) and a linear association with management (P = .01). Generalized anxiety had a significant curvilinear association with management (P = .03), whereas social anxiety had a significant linear relationship with prevention (P = .04). Self-efficacy partially or fully mediated these relationships. ConclusionAnxiety symptoms were associated with asthma self-care among this sample of rural adolescents, with differing roles for prevention and management. Self-efficacy may be a mechanism to improve asthma self-care among rural adolescents with anxiety. With a lack of self-efficacy, asthma-related, generalized, or social anxiety may motivate adolescents to take steps to care for their asthma.

School-based self-management interventions for asthma among primary school children: a systematic review

A Cochrane review of school-based asthma interventions (combining all ages) found improved health outcomes. Self-management skills, however, vary according to age. We assessed effectiveness of primary school-based self-management interventions and identified components associated with successful programmes in children aged 6–12 years. We updated the Cochrane search (March 2020) and included the Global Health database. Two reviewers screened, assessed risk-of-bias and extracted data. We included 23 studies (10,682 participants); four at low risk-of-bias. Twelve studies reported at least one positive result for an outcome of interest. All 12 positive studies reported parental involvement in the intervention, compared to two-thirds of ineffective studies. In 10 of the 12 positive studies, parental involvement was substantial (e.g. attending sessions; phone/video communication) rather than being provided with written information. School-based self-management intervention can improve health outcomes and substantial parental involvement in school-based programmes seemed important for positive outcomes among primary school children.

Pediatric Asthma Is Associated With Poorer 3-Year Academic Achievement in Urban Elementary and Middle-School Students.

Asthma has been associated with worse academic performance in a single school year, yet this association may be magnified over time as students with asthma continue to fall behind. This study examined the relationship between asthma and standardized test performance aggregated across 3 school years, including whether performance varied by likelihood of having significant asthma. Data were from students in grades K-8 at 2 urban public schools in the Northeastern United States (2015-2018). Asthma was based on parent- and self-report and school health center records. Standardized test performance was assessed using Measures of Academic Progress (MAP) and Partnership for Assessment of Readiness for College and Careers (PARCC). Mixed effects linear and logistic regression models were used to evaluate the relationship between asthma and performance during 3 school years. Any asthma was associated with worse MAP performance across the 3 academic years. Students with the most significant asthma demonstrated worse performance on MAP and PARCC. Aggregating across 3 school years, students scored 3.17 points worse on MAP reading (95% confidence interval [CI]: 0.7-5.63; P = .012) and 3.56 points worse on MAP mathematics (95% CI: 0.52-6.6; P=.022); they had 48.8% (95% CI: 1.9%-73.2%; P=.044) and 58.0% (95% CI: 21%-78%; P=.007) lower odds of proficiency on PARCC English/Language Arts and Mathematics, respectively compared to those without asthma. The relationship between asthma and poorer academic achievement in 1 school year may be magnified over multiple years, particularly among those with more significant asthma. School-based asthma interventions may support academic growth and more equitable health outcomes.

Excessive Absenteeism Due to Asthma in California Elementary Schoolchildren.

Previous studies of asthma-related school absenteeism have reported absenteeism dichotomously (ie, any school days missed vs none). However, schools use higher thresholds to identify and intervene for students at risk of chronic absenteeism (18 days or ≥10% schoolyear missed), which is associated with negative health and educational outcomes. We sought to identify factors associated with excessive absenteeism (EA) due to asthma (≥9 days missed), a threshold based on a convention defined by Attendance Works for absenteeism risk, and is linked to decreased academic performance and increased risk of chronic absenteeism. We examined responses for asthma-related absenteeism from the 2011 to 2014 California Health Interview Survey for children ages 5-11. Multivariate logistic regression modeled odds ratios of EA for demographic, healthcare utilization, and asthma-related factors. Sensitivity analysis was performed modeling a ≥1 threshold (any absenteeism). 715 respondents represent an estimated 314,200 California schoolchildren with asthma. 50.3% of students missed ≥1 day, and 11.7% missed ≥9 days of school due to asthma. Odds of EA were significantly higher for younger children, lower-income families, and rural students, but not significant for any absenteeism. Indicators of greater asthma severity and poorer control were significantly associated with both EA and any absenteeism. This study identified factors significantly associated with EA that were not significant for lower absence thresholds. This may help direct school-based asthma interventions for which limited resources must target students at higher risk of chronic absenteeism.

Validation of Asthma Control Assessment Among Urban Adolescents Using the Asthma Control and Communication Instrument

The National Institutes of Health guidelines recommend questionnaires to assess asthma control, but there are few self-reported asthma morbidity surveys validated among urban, African American, Hispanic, and/or poor adolescents. The Asthma Control and Communication Instrument (ACCI) is a 12-item self-reported questionnaire previously validated among a diverse adult population, but not among adolescents. To assess the ability of the ACCI to accurately describe asthma control in an urban adolescent population. Between November 13, 2014, and March 2, 2017, we collected information using the ACCI, the Asthma Control Test, the Pediatric Asthma Quality of Life Questionnaire, and lung function among adolescents enrolled in a school-based asthma intervention study. The ACCI measure of asthma control was validated by evaluating accuracy (on the basis of receiver operating characteristic curve), internal reliability, and concurrent and discriminative validity. We collected information on 280 adolescents (mean age, 13.4 years; 56% males; and 51% African American). ACCI control showed good internal reliability and strong concurrent and discriminative validity with the Asthma Control Test and the Pediatric Asthma Quality of Life Questionnaire. The accuracy of the ACCI in classifying adolescents with uncontrolled asthma was good (area under the curve, 0.83; 95% CI, 0.79-0.88). The ACCI, a clinical tool developed to assist communication about asthma control, has demonstrated strong construct validity as a self-reported questionnaire within an urban, African American, and Hispanic sample of adolescents. It has the potential to assist in the assessment of asthma control in urban, minority, and/or poor adolescents.

Recruitment and retention of the Hardest-to-Reach families in community-based asthma interventions.

Engaging underserved populations in research requires substantial effort for recruitment and retention. The objective of this study is to describe the effort needed to recruit and retain urban participants in pediatric asthma studies and to characterize the Hardest-to-Reach group by demographics and asthma severity. We included 311 children (3-10 years) with persistent asthma enrolled in two school-based asthma interventions in Rochester, NY. Contact logs were collected at four time points (baseline, 2 month, 4 month, 6 month). We defined "Hardest-to-Reach" (vs "Easier-to-Reach") as being unable to reach a family by telephone at any given contact attempt due to disconnected or wrong numbers. Chi-square and Mann-Whitney tests were used to compare groups. Overall, we enrolled 311 children (60% Black, 29% Hispanic, 70% Medicaid, response rate 70%). On average, 3.1 contact attempts were required for recruitment (range 1-15), and 35% required rescheduling at least once for the enrollment visit. All but 12 participants completed each follow-up (retention rate = 96%). Completion of follow-ups required an average of 7.6 attempts; we considered 38% of caregivers "Hardest-to-Reach." Caregivers in the Hardest-to-Reach group were slightly younger (33 vs 36 years, p = 0.007) with more depressive symptoms (41% vs 29%, p = 0.035) and smokers in the home (59% vs 48%, p = 0.048). Furthermore, more of the Hardest-to-Reach children had moderate-severe versus mild persistent asthma (64% vs 52%, p = 0.045). Importantly, even the Easier-to-Reach families required many contact attempts, with 52% having >5 attempts for at least one follow-up. In conclusion, we found that among an already vulnerable population, the Hardest-to-Reach families demonstrated higher risk and had children with significantly worse asthma. This study highlights the importance of persistence in reaching those in greatest need.

A systematic review of school-based interventions that include inhaler technique education

Proper use of inhaled medication is essential for the successful treatment of childhood asthma; yet, improper inhaler technique among school-aged children is common. There are many schoolbased asthma education programs, but the extent to which these programs teach inhaler technique is unknown. We systematically reviewed the literature to identify schoolbased asthma interventions that included inhaler technique instruction. We searched several databases, including PubMed, for relevant articles. Studies were included if they were asthma interventions of any type (programs, curriculums, education) conducted at kindergarten through twelfth grade schools that taught inhaler technique and included inhaler technique as an outcome measure. Of the 285 citations identified, the final nine studies (selected from 71 full-text articles) met the inclusion criteria. Findings from this systematic review identified a very small number of school-based interventions that evaluated improvements in students' inhaler technique. Two of the nine studies (22%) used a validated measure of inhaler technique. Inhaler technique instruction varied in length, from 15min to 1h and nurses implemented inhaler technique instruction in six of the nine (67%) interventions. Existing studies offer mixed evidence for sustained technique improvements up to a 12-month follow-up period. Evidence suggests that students benefit from school-based inhaler technique education; however, inconsistencies in how technique was measured limit our ability to draw firm conclusions regarding the effectiveness of inhaler technique education on student outcomes. Future studies are needed to identify the most appropriate and feasible inhaler technique education components for use in comprehensive asthma self management interventions.

Analyzing Who, When, and Where: Data for Better Targeting of Resources for School-Based Asthma Interventions.

Rates of uncontrolled asthma vary by demographics, space, and time. This article uses data on ambulance-treated asthma attacks in children to analyze these variations so that school districts can improve their asthma management interventions. Incidence rates of 1826 ambulance-treated asthma attacks for children aged 5-18 years were calculated for school zones for elementary, middle, and high schools in the Houston (Texas) Independent School District (HISD). Zones with rates in the upper quartile were identified as the highest rate zones and were compared with other school zones in the district by demographics, location, and timing of attacks. The ambulance-treated asthma rate was respectively 5, 3, and 2 times greater in the highest rate school zones compared with all other school zones for those school levels. Ambulance-treated asthma attacks in the high-rate school zones occurred most at midday and in the evening and high-rate zones were often geographically contiguous. Schools in the high-rate zones had a higher percent of socioeconomically disadvantaged students and were more often without a school nurse. Spatial and temporal analysis of ambulance data can be valuable tools for schools to focus policy and program interventions for the students in need of improved asthma management.

Leveraging Mobile Technology in a School-Based Participatory Asthma Intervention: Findings From the Student Media-Based Asthma Research Team (SMART) Study

Background: Asthma places a heavy burden on Chicago's schoolchildren, particularly in low-income, minority communities. Recently, our group developed a 10-week afterschool program, the Student Asthma Research Team (START), which successfully engaged high school youth in a Photovoice investigation of factors impacting their asthma at school and in their community. Purpose: The present Student Media-Based Asthma Research Team (SMART) intervention adapted START to target middle school students with asthma during the school day. The 13-week SMART intervention leverages recent trends in mobile technology and the power of participatory media to improve student asthma self-management and outcomes, while enhancing asthma knowledge and support at the school and community levels through a student-led participatory media-based campaign. Methods: To assess the effectiveness of SMART, pre/postintervention data were collected from student participants, their caregivers, and their classmates. Results: Pre/post assessments identified significant increases in participant asthma knowledge (z = − 2.83; P < .05), self-efficacy (z = 2.00; P < .05), control (z = 2.01; P < .05), lung function (z = − 3.41; P < .01), and empowerment (z = 2.00; P < .05). Participants also produced 4 educational videos. Through dissemination of these videos, peer (z = − 2.72; P < .01) and parental asthma knowledge (z = − 2.64; P < .05) increased. Parental asthma caregiver-related quality of life (z = 2.83; P < .01) also improved. Translation to Health Education Practice: Future health education work should consider leveraging ongoing advances in mobile technology and adopting a participatory media-based approach.

SMART (Student Media-based Asthma Research Team): Engaging Adolescents to Understand Asthma in Their Communities.

Asthma rates in Chicago exceed national averages and disproportionately affect minority adolescents. We collaborated with students in a neighborhood with high asthma prevalence to better understand community factors impacting asthma. To evaluate the impact of our Student Media-based Asthma Research Team (SMART) program on student, parent, and student-peer outcomes related to asthma. Students with asthma (n = 11), their parents (n = 9), and student-peers (n = 91) participated in a school-based asthma intervention grounded in community-based participatory research (CBPR) principles and completed multiple pre-/post-intervention questionnaires. After the program, participants significantly increased (p < 0.05) asthma-related quality of life (QOL), asthma control, emotional support, and empowerment. Parents significantly increased their QOL and student-peers showed significant improvements in asthma knowledge. This novel intervention-which used participatory media as a vehicle through which children learn about their own asthma and share their findings with parents and peers-was successful in engaging adolescents to improve asthma management and community support.

Developing and Optimising the Use of Logic Models in Systematic Reviews: Exploring Practice and Good Practice in the Use of Programme Theory in Reviews.

BackgroundLogic models are becoming an increasingly common feature of systematic reviews, as is the use of programme theory more generally in systematic reviewing. Logic models offer a framework to help reviewers to ‘think’ conceptually at various points during the review, and can be a useful tool in defining study inclusion and exclusion criteria, guiding the search strategy, identifying relevant outcomes, identifying mediating and moderating factors, and communicating review findings.Methods and FindingsIn this paper we critique the use of logic models in systematic reviews and protocols drawn from two databases representing reviews of health interventions and international development interventions. Programme theory featured only in a minority of the reviews and protocols included. Despite drawing from different disciplinary traditions, reviews and protocols from both sources shared several limitations in their use of logic models and theories of change, and these were used almost unanimously to solely depict pictorially the way in which the intervention worked. Logic models and theories of change were consequently rarely used to communicate the findings of the review.ConclusionsLogic models have the potential to be an aid integral throughout the systematic reviewing process. The absence of good practice around their use and development may be one reason for the apparent limited utility of logic models in many existing systematic reviews. These concerns are addressed in the second half of this paper, where we offer a set of principles in the use of logic models and an example of how we constructed a logic model for a review of school-based asthma interventions.

Roles of the State Asthma Program in Implementing Multicomponent, School‐Based Asthma Interventions

Asthma is a leading chronic childhood disease in the United States and a major contributor to school absenteeism. Evidence suggests that multicomponent, school-based asthma interventions are a strategic way to address asthma among school-aged children. The Centers for Disease Control and Prevention (CDC) encourages the 36 health departments (34 states, District of Columbia, and Puerto Rico) in the National Asthma Control Program (NACP) to implement multicomponent, school-based asthma interventions on a larger scale. To gain a better understanding of replicable best practices for state-coordinated asthma interventions in schools, an NACP evaluation team conducted evaluability assessments of promising interventions run by state asthma programs in Louisiana, Indiana, and Utah. The team found that state asthma programs play a critical role in implementing school-based asthma interventions due to their ability to (1) use statewide surveillance data to identify asthma trends and address disparities; (2) facilitate connections between schools, school systems, and school-related community stakeholders; (3) form state-level connections; (4) translate policies into action; (5) provide resources and public health practice information to schools and school systems; (6) monitor and evaluate implementation. This article presents evaluability assessment findings and illustrates state roles using examples from the 3 participating state asthma programs.

Perceived Parent Financial Burden and Asthma Outcomes in Low-Income, Urban Children

The purpose of this study was to describe the demographic characteristics of low-income parents who perceive financial burden in managing their child's asthma and related associations with their children's asthma outcomes and clinical characteristics. We hypothesized that (1) identifiable differences between parents who do and do not report burden; (2) regardless of access to care, asthma outcomes would be worse for children whose parents perceive financial burden in obtaining care for their child's condition. Baseline data from a randomized trial evaluating the effect of a school-based asthma intervention were analyzed for this research. Eight hundred thirty-five parents were interviewed by telephone regarding their child's asthma management. Associations between demographic and clinical factors and perception of financial burden were examined using bivariate analysis. Multivariate regression analyses were used to examine associations between perceptions of financial burden and asthma outcomes, including emergency department visits, hospitalizations, and missed school days. Perceived financial burden was evident in 10% (n = 79) of parents. Female heads of household (χ2 (3) = 7.41; p < 0.05), those at the lowest income levels (χ2 (3) = 12.14; p < 0.01), and those whose child's asthma was poorly controlled (χ2 (2) = 49.42; p < 0.001) were most likely to perceive financial burden. In models controlling for level of asthma control, income, and having a usual source of asthma care, parents who perceived financial burden were more likely to have children who had at least one emergency department visit (OR = 1.95; 95% CI = 1.15 to 3.29), hospitalization (OR = 3.99; 95% CI = 2.03 to 7.82), or missed school days due to asthma (OR = 3.26; 95% CI = 1.60 to 6.67) in the previous year. Our results supported our hypotheses. Among low-income parents of children with asthma, the majority do not perceive financial burden to obtaining care. However, among parents that do perceive burden, urgent care use and missed school days due to asthma for their child were significantly higher, regardless of family income and having a usual source of asthma care. Mothers and grandmothers heading families and those caring for children with uncontrolled asthma were most likely to report burden. These findings have implications for clinical practice in that health care providers may be able to take simple actions to determine patients' financial-related perceptions, correct misconceptions, and help patients consider their full range of options to manage their child's asthma.

Computer-Assisted School-Based Asthma Management: A Pilot Study

BackgroundThe high prevalence of asthma among children continues to be a major public health issue. In particular, low-income African-American and Hispanic children often receive asthma care in the emergency department and lack access to continuity of care.ObjectiveThe aim of the current study was to test the feasibility of implementing a computerized program for empowering low-income children with asthma to manage their own disease. This pilot program consisted of a guided, personalized, Web-based computer program as the main component of a school-based asthma intervention.MethodsThe Automated Live E-Health Response Tracking System (ALERTS), a computer-assisted, Web-based tracking program, was tested for implementation in a school in East Harlem, New York. The program required children with asthma, assisted by trained researchers, to routinely measure their peak flow meter readings and answer a symptom questionnaire. The program provided individualized feedback on their disease status based on peak flow meter input. The computer program sent reports to the child’s physician and the nurse practitioner at the on-site school health center. The children were also encouraged to bring the reports home to their parents. A pre/post study design was employed such that each participant acted as his/her own control. Comparisons of preintervention and postintervention outcomes were calculated using the paired t-test and the McNemar test for dichotomous data.ResultsTwenty-four children (6 to 12 years) participated in the program over 2 to 15 months. Improvements in health outcomes showed the greatest significance among the group of participants who were enrolled for 8 months or longer. Statistically significant improvements were seen in the average physical health score of the children (from 65.64 preintervention to 76.28 postintervention, P = .045). There was a significant decrease in the number of participants experiencing wheezing episodes (n = 9 to n = 2, P = .03), and in the average number of wheezing episodes per child (1.86 to 0.43, P = .02). Although not statistically significant, decreases were also seen in the number of children experiencing an asthma attack and in the average number of asthma attacks among participants. There was also a significant decrease in the average number of visits to doctors’ offices or clinics (1.23 to 0.38, P = .04). There were no overnight hospitalizations in the two-week period following the end of the pilot program, a nonsignificant reduction from an average of 0.21 per child.ConclusionThis individualized, computer-assisted intervention resulted in improvements in some health outcomes among low-income children in an urban, public school-based setting. Consistent peak flow meter self-measurements, management of medication usage, and a computerized approach to symptom tracking resulted in fewer asthma exacerbations and improved overall physical health among this pediatric population with asthma.

School-based Asthma Intervention for Urban Teens

School-based Asthma Intervention for Urban Teens

What About Your Friends? Exploring Asthma-Related Peer Interactions

Purpose. School-based asthma interventions have been shown to be effective, but many may not be sensitive to the influence of peer interactions in shaping asthma-related emotional experiences. This exploratory study describes associations between peer interactions and asthma-related emotional experiences, asthma control, and outcomes among elementary-aged children with asthma. Methods. Data come from the baseline assessment of a randomized trial evaluating the effect of a school-based asthma intervention. Univariate and multivariate statistics were completed to examine associations between peer interactions and asthma-related variables of interest. Results. Eight hundred and thirty-five caregiver and child interviews were used in the analysis. Both males and females were enrolled in this study, 31% had not well controlled or poorly controlled asthma and 44% reported taking asthma medications. Overall, 26% of children talked to friends about asthma. Females were significantly more likely to talk to friends about asthma (p < .05) and more likely to report that they were worried, concerned, or troubled about asthma (p < .01). Significant differences in emotional quality of life between males and females were also found. Children who reported talking to friends about asthma were more likely to report teasing about asthma (OR = 2.47; 95% CI 1.57, 3.89) and to report that friends help with their asthma (OR = 1.79; 95% CI 1.07, 3.01). Conclusions. School-based asthma interventions should be sensitive to emotional-related outcomes associated with asthma and the influence of asthma-related peer interactions. Providing children with communication strategies for disclosure of asthma status to peers that result in more supportive interactions may be needed.

An Evaluation of Asthma Interventions for Preteen Students

Asthma is a serious problem for low-income preteens living in disadvantaged communities. Among the chronic diseases of childhood and adolescence, asthma has the highest prevalence and related health care use. School-based asthma interventions have proven successful for older and younger students, but results have not been demonstrated for those in middle school. This randomized controlled study screened students 10-13 years of age in 19 middle schools in low-income communities in Detroit, Michigan. Of the 6,872 students who were screened, 1,292 students were identified with asthma. Schools were matched and randomly assigned to Program 1 or 2 or control. Baseline, 12, and 24 months data were collected by telephone (parents), at school (students) and from school system records. Measures were the students' asthma symptoms, quality of life, academic performance, self-regulation, and asthma management practices. Data were analyzed using multiple imputation with sequential regression analysis. Mixed models and Poisson regressions were used to develop final models. Neither program produced significant change in asthma symptoms or quality of life. One produced improved school grades (p = .02). The other enhanced self-regulation (p = .01) at 24 months. Both slowed the decline in self-regulation in undiagnosed preteens at 12 months and increased self-regulation at 24 months (p = .04; p = .003). Programs had effects on academic performance and self-regulation capacities of students. More developmentally focused interventions may be needed for students at this transitional stage. Disruptive factors in the schools may have reduced both program impact and the potential for outcome assessment.