# Translating an Evidence-based Urban Asthma Program for Rural Adolescents:  Testing Effectiveness & Cost-effectiveness and Understanding Factors Associated with Implementation

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2021 · $622,410

## Abstract

PROJECT SUMMARY / ABSTRACT
Background and Rationale: Asthma, the most common pediatric chronic illness, has high prevalence and
morbidity among adolescents. Few interventions are tested in high schools; none when delivered by
Community Health Workers (CHWs), despite this model's success in clinic- and home-based interventions.
Further, rural adolescents, who represent a very large population, are overlooked in asthma intervention
research. Given the high prevalence of asthma in this group, this oversight is a significant public health
concern. Cost effectiveness analyses and implementation research are also lacking in asthma intervention
research. This study addresses these treatment and methodological gaps. We developed and established the
efficacy of Asthma Self-Management for Adolescents (ASMA), an 8-week, high school-based intervention, in
urban Hispanic and African American adolescents. Objective: Using an effectiveness-implementation hybrid
design, we: (1) evaluate systematically the effectiveness of ASMA when delivered under real world conditions
by CHWs to rural adolescents with uncontrolled asthma; (2) assess the cost-effectiveness of ASMA; and (3)
conduct a theory-based, mixed-methods, multi-stakeholder process evaluation of the barriers and facilitators of
ASMA's widespread implementation. Hypotheses: Over 1 year, relative to controls, ASMA students will have
significantly fewer (1) night awakenings due to asthma symptoms, and (2) days with asthma-related activity
limitations (primary outcomes). Secondary outcomes include other measures of morbidity (e.g., ED visits,
hospitalizations, quality of life) and care-process outcomes. We also hypothesize that ASMA will have
favorable value (ICER < 100,000/QALY) compared to alternative uses of health care resources over 1 and 5
years. Methods: We will enroll over 3 years, 400 9th through 11th grade students with uncontrolled asthma from
9 high schools in rural communities in South Carolina; we will randomize students within a school to ASMA and
to an attention control condition. CHWs will deliver both interventions. Students and caregivers will be followed
for 12-months post-treatment. The intention-to-treat (ITT) principle will be applied using linear and general
linear mixed effects models. The cost-effective analysis will rely on a decision-analytic Markov model. The
process evaluation is built on the RE-AIM model; we collect qualitative and quantitative data from students,
caregivers, CHWs and school administrators. Together with key stakeholders from a variety of settings, we will
develop models to widely disseminate and implement ASMA. Significance: The study has high public health
significance because (1) it targets an understudied population, (2) it relies on existing community resources for
intervention implementation, (3) it assesses ASMA's value through cost-effectiveness analyses, and (4) it
bridges the gap between research and practice by identifying factors associated with implem...

## Key facts

- **NIH application ID:** 10226972
- **Project number:** 5R01HL136753-04
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Jean-Marie Bruzzese
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $622,410
- **Award type:** 5
- **Project period:** 2017-07-05 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10226972

## Citation

> US National Institutes of Health, RePORTER application 10226972, Translating an Evidence-based Urban Asthma Program for Rural Adolescents:  Testing Effectiveness & Cost-effectiveness and Understanding Factors Associated with Implementation (5R01HL136753-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10226972. Licensed CC0.

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