Running Heading: CALM

Childhood Asthma Lifestyle Management

Asthma and Children

HSC: 405 Health Education Program Evaluation and Measurements

Chelsea Puma
California State University, Long Beach
Fall 2016

Table of Content

Specific Aims..2
CALM

Background and Significance..3

Importance of the Topic...3

Critical Review on Similar Programs..4
Program Components and Theoretical Framework.....7
Program Objectives and Hypothesis....9

Methods....9

Description of the Population and Method of Sample Selection.....9

Design of Experimental Methodology...11
Operationalization of Concepts..13
Formative Evaluation.....14
Process Evaluation.....15
Rationale for Statistical Techniques..16
Timeline.....17

References..18

Appendix....22

Appendix A....22

Appendix B....25

Specific Aims

Asthma cost the U.S. $56 billion each year. Indirect costs make up $5.9 billion, this

includes lost pay from sickness or death and lost work output from missed school or work days.

Children with asthma miss 2.48 more days of school each year than children without asthma. The

most important part of managing asthma is for the child and their caretaker to be very

knowledgeable about how and when asthma causes problems, how triggers can be avoided and

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how to use medications (American Academy of Allergy, 2016).

Childhood Asthma Lifestyle Management (CALM) program is an educational program

aim to educate children on trigger identification, control, and avoidance, and basic

pathophysiology; medications and the proper use of inhalers; symptom recognition and action

plan use; lifestyle, exercise, and managing an asthma episode. This program will be implemented

in several cities through out Los Angeles County. This is a school-based, for workshops will be

implemented after school on campus. The program will be interactive and age appropriate in

order to engage children in the workshops.

The target population for the CALM program is Black and Latino, low socioeconomic

children in grades 3 to 5 residing living in Los Angeles County. The children must have a

diagnosis of asthma, have been prescribed a daily controller medication, or had 1 or more acute

exacerbations that required an unscheduled office visit, an emergency room visit, or persistent

asthma symptoms. They will be recruited from public school that is eligible from Title I and free

lunch programs. Also the schools must be 1-5 miles from a free way, refinery, or port.

The programs objective is to increase knowledge of asthma and asthma management as

by 30 %, a 15% increase positive attitude toward their asthma and a 10% decrease in reported

asthma symptoms.

Background and Significances

a) Importance of Topic. Childhood asthma is not a different disease from asthma in

adults, but children face unique challenges. An estimate of 39.5 million people, 12.9% of the

United States (U.S.) population, has been diagnosed with asthma in their lifetime. Of the 39.5

million, 18.9 (8.2%) adults and 7.1 million (9.5%) children still have asthma (National Asthma

Control Program, 2013). Asthma deaths are a rare event, particularly among children and young

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adults, with majority of deaths occurring in individuals ages 65 years and older. Blacks (23.8

per million) were 2 to 3 times more likely to die due to asthma compared to whites (8.4 per

million) and Hispanics (9.8 per million) (National Asthma Control Program, 2013).

About 1 in 10 children (10%) and 1 in 12 adults (8%) had asthma in 2009 (American

Academy of Allergy, 2016). Currently asthma prevalence was higher among adults ages 18-24

(10.3%), while asthma prevalence for children are broken up as ages 0-4 years at 6.3%, 5-9 years

at 10.0%, 10-14 years at 9.4% and 15-17 years at 9.0%. Asthma prevalence is higher among

black children (14.0%) than white children (7.4%) (National Asthma Control Program, 2013).

According to the journal article Proximity of US schools to major roadways: a nationwide

assessment schools serving predominantly black students were 18% more likely to be located

within 250meters of a major roadway. Public schools eligible for Title I programs and those with

a majority of students eligible for free/reduced price meals were also more likely to be near

major roadways. In conclusion, 6.4 million US children attended schools within 250m of a

major roadway and were likely exposed to high levels of traffic pollution. Minority and

underprivileged children were disproportionately affected. According to the journal article

Childhood Incident Asthma and Traffic-Related Air Pollution at Home and School asthma risk

increased with modeled traffic-related pollution exposure from roadways near homes and near

schools. Long-term exposure to traffic pollution has been associated with adverse health

outcomes in children and adolescents. Individuals living near refineries are at significantly more

likely to go to hospitals for asthma than other residents (Environmental Health News, 2011).

Asthma cost the U.S. $56 billion each year. The direct costs make up almost $50.1 billion

with hospital stays are the largest part of that cost. Indirect costs make up $5.9 billion, this

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includes lost pay from sickness or death and lost work output from missed school or work days

(Cost of asthma on society, n.d.). More children missed one or more days of school (48.6%)

compared with adults who missed one or more days of work (32.9%) due to asthma (National

Asthma Control Program, 2013). In 2008, more than half of children and one-third of adults

missed school because of their asthma. Children with asthma miss 2.48 more days of school each

year than children without asthma. Children were more likely to report a little activity limitation

(46.5%) compared with adults (40.1%) (National Asthma Control Program, 2013).

Children see medical professionals for asthma care more often than adults; this includes

routine doctor visits, emergency department visits, and urgent care visits. Nearly 1 in 5 children

with asthma went to an emergency department for care in 2009. Black and Hispanic children

visit emergency departments for asthma care more often than white children (National Asthma

Control Program, 2013). Since 2009, the cost of inhaled asthma medicines has increase by an

average of 50 percent. In 2014, Medicaid spent about $67 per member each year on asthma

medicine, which is the third highest of any category (Cost of asthma on society, n.d.). 54.3% of

children are not committed to using the medications.

b) Critical Review on Similar Programs. Developing effective interventions for

childhood asthma can greatly impact childrens quality of life and education. This may not cure

the disease but in most cases its the best way to reduce asthma symptoms, increase self-efficacy

for managing asthma, decrease health care use, and decrease absenteeism. Educational-based

interventions can be implemented in several of settings. The PARTNER intervention was

developed for caretaker buy implementing telephone training in order to manage 3 targeted

asthma management behaviors (Garbutt, Yan, Highstein, & Strunk, 2015). Unlike the

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PARTNER intervention that used telephone training, the MCAN Care Coordination Programs

was implemented face-to-face interaction in 4 different urban community settings. These 4 sites

included intervention components in which an asthma care coordinator provided families with

asthma education, including use of an asthma action plan and trigger remediation. The Roaring

Adventures of Puff (RAP) is a six-week child-center, school-based, education program. Children

in the RAP intervention schools had statistically significant improvements in unscheduled doctor

visits, missed school days, limitations in the nature of play and correct use of medications

(McGhan et al., 2010). Even though all the programs interacted with participants in different

settings, there is effectiveness in focusing programs in education in order to improve childhood

asthma.

Instructors implementing educational asthma program vary from skills and backgrounds.

MCAN Care Coordination Programs hired nurses, health educators, and community health

workers, who were trained in delivering culturally relevant care, performed the asthma care

coordinator role (Janevic et al., 2016). Yang, Chen, Chiang, & Chang, 2005 utilized nurses for

their Effects of Nursing Instruction on Asthma Knowledge and Quality of Life in Schoolchildren

With Asthma program. The Problem-Solving Training (PST) program also incorporated a health

educator as an instructor for their program (Seid, Varni, Gidwani, Gelhard, & Slymen, 2010).

PARTNER intervention incorporated peer trainers who were recruited from the target population,

and had experiential knowledge of asthma care (Garbutt, Yan, Highstein, & Strunk, 2015). The

RAP program was used in two different programs, one in Alberta, Canada and another in

Toronto, Canada. In Alberta the RAP program used 4 respiratory therapists working in

community rehabilitation and one community health nurse (McGhan et al., 2010). While in

Toronto instructors were certified asthma educators (Nabors, Kockritz, Ludke, & Bernstein,

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2012).

Contact with participants varied by intervention. The Community Action Against Asthma

program had 12 minimum visits over a 2-year period by a Community Environmental

Specialist (Parker et al., 2003). Nabors, Kockritz, Ludke, & Bernstein, 2012, and McGhan et al.,

2010 and PST (Seid, Varni, Gidwani, Gelhard, & Slymen, 2010) programs consisted of six

sessions 50 to 60 min in lengths that are held once a week over six consecutive weeks with

children with asthma. On the other hand, the Parents and Child Asthma Education Program had

less meetings (2 sessions) but where longer in length (4 hours) (Butz et al., 2005).

The Social Cognitive Theory (SCT) and Transtheoretical Model (TTM) showed great

impact on controlling two interventions. The content and implementation of the peer-training

intervention used to inform parents used SCT and TTM (Garbutt, Yan, Highstein, & Strunk,

2015). The SCT was used to influence factors of children with asthma such as elf regulation,

observational learning, reinforcement, environmental influences and perceived self-efficacy in

the RAP intervention at Alberta (McGhan et al., 2010).

The PARTNER intervention was very thorough in their recruitment strategy. Eligible

practices were community-based primary care practices providing asthma care to 40 or more

children. Eligible families within study practices had a child between 3 and 12 years of age with

a physicians diagnosis of asthma and in the past year had been prescribed a daily controller

medication or had 1 or more acute exacerbations that required an unscheduled office visit, a

course of oral steroids, an ED visit or hospitalization, or persistent asthma symptoms (Garbutt,

Yan, Highstein, & Strunk, 2015). Shames et al., 2004 focused on low socioeconomic children. In

order to recruit that specific population the program chose children 5 to 12 receiving Medi-Cal or

Medi-Cal eligible that were diagnosed as having asthma at least 6 months before enrollment, had

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parental reports of significant asthma symptoms. PST intervention recruited low socioeconomic

families as well by recruiting at San Diego, California, from Federally Qualified Health Centers

(FQHC). FQHCs are federally subsidized community clinics that generally treat the uninsured or

underinsured on a sliding scale fee structure (Seid, Varni, Gidwani, Gelhard, & Slymen, 2010).

Pre and Post test varied among programs but, Pediatric Asthma Quality of Life

Questionaire (PAQLQ) appeared in multiple interventions. Krishna et al. 2003, and McGhan et

al. 2010 both used the PAQLQ in order to assess change. Other pre and post test include

Childhood Asthma Control Test (Janevic et al., 2016), and Juniper Pediatric Asthma Quality of

Life Questionnaire (Nabors, Kockritz, Ludke, & Bernstein, 2012).

c) Program Components and Theoretical Framework. The theoretical framework for

the proposed program Childhood Asthma Lifestyle Management (CALM) program will be the

Social Cognitive Theory (SCT). SCT is a comprehensive framework. Created by Albert Bandura,

this theory interpersonal level theory says, internal personal factors, behavior patterns, and

environmental influences all operate as interacting determinates for ones behavior (McKenzie,

Neiger, & Thackeray, 2016). Factors that influence these three interactions include self-

regulation, observational learning, reinforcement, social and physical environmental support, and

self-efficacy. Using SCT as the groundwork for CALM helps health educators understand the

intricate relationships between the participants and their environment, how actions and

conditions reinforce or discourage change, and the importance of having self-efficacy and

knowing how to change.

A national survey revealed that 60% of individuals with asthma have poorly controlled

disease (Nabors, Kockri tz, Ludke, & Bernstein, 2012). The most important part of managing

asthma is for the child and their caretaker to be very knowledgeable about how and when asthma

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causes problems (personal), how triggers can be avoided (environmental) and how to use

medications (behavior) (American Academy of Allergy, 2016). Complications with asthma could

also be influenced by non-compliance and negative attitude toward the illness and drugs

(personal factor and behavior) (Anwar, Hassan, Jaffer, & Al-Sadri, 2008). This lack of

knowledge and defiance can be corrected through health education efforts.

CALM aims to educate children with asthma on trigger identification, control, and

avoidance, and basic pathophysiology; medications and the proper use of inhalers; symptom

recognition and action plan use; lifestyle, exercise, and managing an asthma episode. Through

this, CALM hope that the participants initiative to be more proactive on managing their asthma.

Before the start of the program, CALM will administer all participants a pretest to assess

child baseline knowledge, attitudes, and beliefs on their asthma management. The provided

pretest will be administered in the form of a face-to-face interview. Educational workshops on

asthma management will take place in four weekly 2 hour after school sessions in school in cities

where their may be high levels of pollution aggravating childrens asthma. Respiratory therapists

working in community rehabilitation will teach each workshop.

The first workshop will teach symptom recognition, and basic pathophysiology of asthma

(personal factor). The second workshop will go over medications and the proper use of inhalers

(behavior factor). The third workshop will address trigger identification, control, and avoidance;

lifestyle, and exercise (environmental factor). The last workshop will wrap all they have learned

together and incorporate how to carry out an action plan and managing an asthma episode (self-

efficacy). Workshops will be interactive and age appropriate.

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d) Program Objectives and Hypothesis. CALM is an educational program with three

measurable impact objectives. These objectives are expectations from each participating student,

which will measure program efficiency and feasibility:

Objective 1: At the end of the program, participants of will demonstrate a 30%

increase in knowledge of asthma and asthma management as measured at posttest by

Q1-14.
Objective 2: At the end of the program, participants will demonstrate a 15% increase

in positive attitude toward their asthma as measured at posttest by Q15-24.

Objective 3: At the end of the program, 10% decrease in reported asthma symptoms

as measured at posttest by Q25-34.

Methods
a) Description of population and method of sample size
Participants for the CALM program will be made up of male and female children attend

grades 3 to 5. Blacks and Latinos will be the target ethnicity of the program. This intervention is

focused on underserved communities, therefore will be targeting children of low socioeconomic

status. The participants must have a physicians diagnosis of asthma. Other eligibility consist of

the individual have been prescribed a daily controller medication, or had 1 or more acute

exacerbations that required an unscheduled office visit, an emergency room visit, or persistent

asthma symptoms. Acute exacerbation is defined as episodes of progressively worsening

shortness of breath, coughing, wheezing, and chest tightness. They must not have another co-

morbid pulmonary disease such as cystic fibrosis, and bronchopulmonary dysplasia. Children

must live in Los Angeles (LA) county.

The cluster sample, a probability-based sampling technique, will be used to select a

representative sample. The CALM program will only be available for children attending public

kindergarten to 5th grade school. Free ways, refineries, or ports are area that produces high levels

of pollution. This pollution can exacerbate a childs asthma. School will be chosen for this

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program if they are within 1-5 miles from a free way, refinery, or port. Because minority and

underprivileged children are disproportionately affected by asthma, the schools must meet one of

the following criteria. The school is a recipient of the Title I program. Title I of the Elementary

and Secondary Education Act, provides financial assistance to schools with high numbers or

high percentages of children from low-income families to help ensure that all children meet

challenging state academic standards (U.S. Department of Education, 2011). In addition,

schools with 40% or more students enrolled in for free/ or subsidized school lunch program will

be eligible for the program.

Choosing the proper sample size is critical for implementing a successful program. It

requires a sample that is large enough to show statistical significance. It is also necessary to

ensure that the sample is small enough to ensure no resources are being wasted. Because cluster

sampling does not allow randomization it is important to ensure no cross contamination between

comparison and experimental group. There for participants will be recruited from several

different geographical region. These locations consist of Los Angeles, Long Beach, San Pedro,

Wilmington, and Carson. These cities all reside in the LA County and are near a major freeway,

refineries or ports.
A 0.8 power test, 0.2 for P1, and a 0.05 significance level for alpha will be used to

determine Type 1 and Type 2 error. The effect size will be determined by the 10% rate of change

measured by Objective 3 of the CALM program. Initial participant needed for the program

according to Table 5.3 is 438 for both comparison and environmental group. In addition, to

account for estimated percentages of individuals who cannot be located, who drop out during the

program, and for those individuals who refuse to participate, and extra 88 participants must be

recruited. Therefore, 526 students will be recruited for the program, 263 participants per group.
b) Design of experimental methodology

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The experimental design selected for the CALM will be the non-equivalent comparison

group. The non-equivalent comparison group controls for history, maturation, testing, and

instrumentation treats to internal validity by having two requirements. The program must have

two groups- an experimental group (receives the program) and a comparison group (receives

standard treatment). The program must implement a pre and posttest as a measure of comparison

to attribute a direct causal effect of the program on the experimental group. Both groups must

show no significant difference at pretest and show significance difference at posttest to control

for the 4 threats.

Regression to the mean, selection, attrition, and interaction (threats to internal validity)

cannot be accounted for because there is no randomization. In regards to regression to the mean

effect, sample size is large enough to account for this effect. Therefore if there are any outliers

they can be thrown out when conducting statistical test. Selection is accounted for because

groups are already preselected. Each city is assigned either comparison or experimental group so

participants can no choose whether they want to be in either group. Thirty percent of participants

will be recruited from the city of Los Angeles, 20% from Long Beach, 20% from Wilmington,

10% from Carson, and 10% from San Pedro. Participants from Los Angeles and Long Beach will

be assigned the experimental group, while participants in Wilmington, Carson, and San Pedro

will be assigned the comparison groups. Because the comparison group and experimental groups

are relatively in different geographical areas, participants wont self-select themselves between

groups.

Incorporating incentives and addressing any barriers that can cause the target population

to drop out at any time can account for attrition. Incentives for children to attend the program are

providing snacks at every workshop, giving goodie bags at the end of every workshop, and

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letting the children who attend all workshops enter a raffle for a considerable prize, such as a

bike. Because workshops are given after school, children are most likely to attend because they

are already required to attend school. Interaction can be controlled for if the individual threats are

being controlled to begin with, which they are in this case.

Diffusion, compensation, compensatory rivalry, and demoralization cannot be controlled

for by any design but actions can be taken place to prevent it from happening. Diffusion is

eliminated for by having the comparison and experimental group are geographically separated.

The comparison and experimental group are most likely are not going to interact with each other

because they are in separate cities, therefore information will not be passed on. Training staff in

the importance of not giving the comparison group anything more than standard treatment will

eliminate compensation, compensatory rivalry, and demoralization. It is important to remind the

staff that results may be skewed if the comparison group is given any more or less than standard

treatment. Monitoring the comparison group to ensure standard treatment is being implemented

can also eliminate this. Also allowing the comparison group to get the program once it shows

effectiveness can influence staff to only provide standard treatment.

c) Operationalization of Concepts. The questionnaire will be administered through

face-to-face interview to ensure understanding of all questions being asked. The pre and posttest

will be age appropriate and free of all jargon. Q1-14 of the pre/post-test will be knowledge-based

questions. These questions are derived from the journal article Development and validation of

an asthma knowledge test for children 810 years of age. This article found the questions to

provide a valid and reliable measure of asthma knowledge in children that can be used in a wide

range of childhood asthma studies. These questions consist of true or false question written at an

8-year-old reading level. These questions deliver ordinal level data. The questions will evaluate

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sound knowledge of the pathophysiology of the disease, symptoms and triggers, and know the

appropriate steps to take in managing their asthma. The knowledge based questions attempt to

promote greater asthma awareness, asthma knowledge and acceptance of children with asthma to

give positive influence on the health and wellbeing of the children.

Q15-24 will evaluate the attitudes the participants have towards their asthma. The

questions are a derivative of the Pediatric Asthma Quality of Life Questionnaire. The questions

give ordinal level data. These particular questions measure the attitudes towards asthma,

specifically worriedness. The type of questions being asked consists of: how often did your

asthma make you feel frustrated during the past week, how often did you feel uncomfortable

because of your asthma during the past week? These questions are measured in a scale of: (1) all

of the time, (2) most of the time, (3) some of the time, (4) a little of the time, (5) none of the

time.

Lastly, Q25-34 will evaluate the individuals symptoms. This measurement will test

whether or not the persons behavior and knowledge has change in regards to managing their

asthma, in return giving them less symptoms. Theses questions are derived from the Pediatric

Asthma Quality of Life Questionnaire and Asthma Control Questionnaire. There will be four

different types of answers to the questions, but all in a scale form. The first consist of questions

answered in (0) extremely bothered, (1) bothered, (2) somewhat bothered, (3) bothered a bit, and

(4) not bothered. Second type of questions consist of answers: (0) 4 or more times a night, (1) 2

to 3 nights, (2) once a week, (3) once or twice, or (4) not at all. Third type of questions consist of

answers: (0) 3 or more times per day, (1) 1 or 2 times per day, (2) 2 or 3 times per week, (3) once

a week times per day, or (4) not at all. Lastly, the type of question consists of answers: (0) not

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controlled, (1) poorly controlled, (2) somewhat controlled, (3) well controlled, and (4)

completely controlled.

d) Formative Evaluation Methods- Pilot Testing Procedures. CALM will be

conducting a pilot test by forming a key informant interview consisting of community leaders

and experts in the field of childhood asthma. Experts in the field consist of respiratory therapist,

school nurses, and an allergist. The respiratory therapist and allergist are chosen because they are

experts in the topic and can give valuable input about whether information is being taught

correctly. School nurses are chosen because they are the people who directly interact with the

children if they are experiencing an asthma attack at school.

Community leaders will consist of members from Long Beach Alliance for Children with

Asthma (LBACA), and Asthma Coalition of Los Angeles County (ACLAC). These community

activist groups were chosen because they are working with the specific community CALM is

targeting. LBACA focuses on changing the profile of childhood asthma in the most affected

areas of The City of Long Beach and surrounding communities (LBACA, 2016). ACLAC a

collective, powerful voice for policy and systems change to prevent, minimize and manage the

burden of asthma (County of Los Angeles Public Health, n.d.).

Program materials (PowerPoint slides, brochures, and handouts) and pre and posttest will

be under advisement during pilot testing. Materials will be under scrutiny of the respiratory

therapist and allergist to ensure correct information is being taught and sufficient information.

School nurses are knowledgeable in regards to what children face at school, how asthma attack

occurs and how they are able to alleviate the symptoms. These experts will also give input on

whether recruitment methods are feasible for the target population. Because LBACA is an

organization that incorporates provides asthma education for schools, after school programs,

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churches, parent groups, community clinics and many other community-wide events they will

be exceedingly knowledgeable on how to what is appropriate to reach the target population

(LBACA, 2016).

e) Process Evaluation- Monitoring of Program Implementation. To monitor the

CARE program, trained program staff will learn how to effectively deal with children grades 3 to

5. During program implementation, program staff will be come together for training workshop

three months before the program runs. Because the community respiratory therapists already are

knowledgeable on asthma, their training of the curriculum will run easier because of their

previous knowledge of the topic. On the other hand, they will need necessary training on how to

interact with children, how to build rapport with the age group, and how to be culturally

sensitive. This will also give the staff an opportunity to address any concerns or questions before

the program begins. It will also be emphasized that it is important to stick to the program, any

more or less being taught to the participants will skew the results.

The program staff will have briefing meetings every week in order to ensure that the

program is implemented the way it is supposed to. Because the program staff will have day-to-

day interactions with the participants, they can tell evaluators if the program is running

effectively. Program staff will be emphasized the importance of documenting everything

occurring in the program. If there is anything not working or things that need to be changed the

program staff will need to note this for future evaluation. If there are things that need to be

change it is important to let who ever is in charge of the program know in order to accommodate

as quick as possible. The briefings will also ensure that there are no resources going to waste.

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Retention rates will be continuously monitored in order to show effectiveness of the

program. If the program is starting to see a high percentage of dropout rates, more compelling

incentives will need to be implemented.

f) Rationale for Choice of Statistical Technique. Descriptive Statistics- Univariate

Analysis. A bar graph will be used to report nominal data, where the mode will be used.

Participants who answered Q-14 correctly and incorrectly will be reported on the graph using

percentages. A bar chart will also be use to report ordinal data. The chart will depict Q15-34,

with the percentage of people reporting the how they fit the scale. The mode will be use to report

the ordinal data.

Inferential Statistics- Bivariate Analysis. To determine whether the CARE program

objectives were met, data collected will be analyzed using inferential statistics at a 0.05 level of

significance. To measure a 30% increase in knowledge of asthma and asthma management at

posttest, a summative index will be created by assigning a score of 0 to incorrect answers and a

score of 1 to correct answers for each of Q1-14. The summative index ranges between [0;14] and

is considered an interval level variable. An independent sample t-test will be conducted using

group membership as the group interval and the summative index as the test variable. Test is

conducted at a significant level of alph =.05. The test will be conducted at the significance level

at alpha =.05. To measure a 15% positive attitude toward asthma as measured at posttest by Q15-

24, a summative index will be created by assigning the least desired response option a score of 0

and consecutively increasing the score by 1 until the highest score is assigned to the most

favorable answer for each. The summative index range [0; 40] and is an interval level variable.

To measure a 10% decrease in reported asthma symptoms as measured at posttest by Q25-34, a

summative index will be created by assigning the least desired response option a score of 0 and

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consecutively increasing the score by 1 until the highest score is assigned to the most favorable

answer for each. The summative index range [0; 40] and is an interval level variable.

g) Timeline

Month Month
Activity Month 1 Month 2 Month 3 Month 4 Month 5
6 7
Needs Assessment
Program development
Pilot testing
Sampling
Pretest
Program Implementation
Process Evaluation
Posttest
Data Analysis
Report Writing

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Appendix A

Pre/post test

This survey will assess what your knowledge, and will require you to answer personal

information about your asthma. Please answer to the best of your abilities.

Please state whether the statement is true or false:

1. People with asthma worry a lot

2. People with asthma can drink milk and eat yogurt
3. Having the flu can cause an asthma attack
4. Smoking is OK for people with asthma
5. An asthma attack is caused by redness in the lungs
6. Most children with asthma are smaller than other children
7. Medicines that keep asthma from happening should be taken every day.
8. A puffer (inhaler) should be used when a person has an asthma attack
9. Asthma happens more at night
10. Some asthma medicines can hurt the heart
11. Rest is needed to stop an asthma attack
12. An asthma attack can happen suddenly without warning
13. When asthma is OK, all medicines can be stopped
14. Children with asthma can play sport

Please answer the following questions with a:

0= all of the time, 1= most of the time, 2= some of the time, 3= hardly any of the time, 4=

none of the time

15. How often did your asthma make you feel FRUSTRATED during the past week?
16. How often did your asthma make you feel TIRED during the past week?
17. How often did you feel WORRIED, CONCERNED OR TROUBLED because of your

asthma during the past week?

18. How often did your asthma make you feel ANGRY during the past week?
19. How often did you feel IRRITABLE (cranky) during the past week?
20. How often did you feel FRUSTRATED BECAUSE YOU COULDNT KEEP UP WITH

OTHERS during the past week?

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21. How often did you feel UNCOMFORTABLE because of your asthma during the past week?
22. How often did you have trouble SLEEPING AT NIGHT because of your asthma during the

past week?
23. How often did you feel FRIGHTENED BY AN ASTHMA ATTACK during the past week?
24. How often did you have difficulty taking a DEEP BREATH during the past week?

Please answer the following questions with a:

0= extremely bothered, 1=bothered, 2= somewhat bothered, 3= bothered a bit, 4= not

bothered

25. How much have you been bothered by your asthma in during the past week?
26. How much did COUGHING bother you in the past week?
27. How much did ASTHMA ATTACKS bother you during the past week?
28. How much did TIGHTNESS IN YOUR CHEST bother you during the past week?
29. How often did you feel DIFFERENT or LEFT OUT because of your asthma during the past

week?
30. How much did SHORTNESS OF BREATH bother you during the past week?
31. Think about all the activities that you did during the past week. How much were you

bothered by your asthma doing these activities?

Please answer the following questions with a:

0= four or more times a night, 1= two to three nights, 2= once a week, 3= once or twice, 4=

not at all.

32. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing,

shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the

morning?

33. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer

medication (such as albuterol)?

Please answer the following question with a:

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0= not controlled, 1= poorly controlled, 2= somewhat controlled, 3= well controlled, and 4=

completely controlled.

34. How would you rate your asthma control during the past 4 weeks?

Appendix B

Consent Form

Your child has been selected to take part in the Childhood Asthma Lifestyle Management
(CALM) afterschool program. CALM is asking, you, the parent or guardian, permission to allow
your child to participate in this study. This study aims to collect research on managing asthma.

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With your consent, we can obtain further information on effective approaches to managing
asthma.

As the parent/ guardian, you have the right to withdraw your child at any time during the
program without repercussions. Participation in the CALM program is strictly voluntary. Any and
all personal information will be kept confidential and will only be used for analysis. You may
also refuse to answer any questions.

By signing below you give consent you are allowing your child to participate in the program and
giving consent for CALM to collect data on your child for research purposes.

Date:______________

Participants Name:_______________________________

Participants Signature:_____________________________

Parent or Guardian Name:_____________________________

Parent or Guardian Signature:__________________________

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For further inquires please contact us at:

CALMASTHMA@gmail.com

(562)222-3333

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