Promoting Risk Reduction Among Young Adults With Asthma During Wildfire Smoke Events (TRAK)
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      This research will contribute to fundamental knowledge about how young adults with asthma
      perceive their personal health risks to wildfire smoke, minimize their risk, and improve
      their health. The investigators will compare young adults who use 'Smoke Sense,' an
      EPA-developed smart phone application (app), with young adults who use the app plus engage in
      preventive activities, with young adults who do not use the app. Study aims are to:

        1. Establish the feasibility (recruitment, enrollment, retention rates), acceptability
           (intervention engagement, fidelity, usability, attitude) and barriers and facilitators
           of adopting the technology of the Smoke Sense interventions and use of portable devices
           in young adults with asthma;

        2. Explore the preliminary impact of the Smoke Sense interventions on lung function and
           asthma control. These primary outcomes will be assessed using objective measures
           (spirometry) and validated, self-report tools.

           Secondary outcomes will be anxiety, exposure reduction behaviors (e.g. stayed indoors,
           wore a mask), and symptom mitigating behaviors (use of medication, unscheduled health
           care appointments), measured via self-report and a Global Positioning System device.
           Outcome by group will be summarized. Preliminary evidence of treatment effect and its
           variance will be examined for a future clinical trial;

        3. Explore potential mediators (medication adherence, self-management skills, stress) and
           moderators (asthma severity/control) of the interventions to asthma outcomes. The
           long-term goal is to minimize asthma exacerbations from exposure to wildfire smoke.

      The long-term goal of the study is to minimize asthma exacerbations from exposure to wildfire
      smoke.
    

Detailed description: 
      Exposure to unprecedented levels of wildfire smoke is increasing cardiopulmonary mortality
      and is especially catastrophic in people with asthma. Little evidence exists on the
      effectiveness of air quality (AQ) alerts on objective measures of risk reduction behavior and
      health outcomes. Evidence shows that young adults are less likely to adhere to AQ alerts than
      older adults, yet young adulthood is a time when habits are formed in chronic illness
      management. The Environmental Protection Agency's (EPA) Smoke Sense smart phone application
      (app) is an innovative risk reduction intervention based on the health belief model and
      theory of planned behavior. The app invites users to record their smoke observations and
      health symptoms, play educational trivia games, earn badges, and explore what other users are
      reporting. Smoke Sense connects AQ exposure data with users' symptoms, thus framing risk
      reduction messages as personally relevant. Although Smoke Sense has almost 25,000 users, its
      impact on health outcomes has not been tested. Preliminary data suggests that users'
      engagement in health protective behaviors was driven in response to symptoms rather than as
      preventive courses of action. In a high-risk asthma population, prevention is paramount.
      Smoke Sense Plus is an intervention that builds on the Smoke Sense app, with value-added
      activities, such as notifying participants to review their asthma action plan, monitoring
      lung function weekly via mobile spirometry and subscribing to a social network to share
      strategies to minimize exposure. The purpose of this study is to assess the feasibility of
      the Smoke Sense interventions among young adults with asthma and pilot test the interventions
      compared to a control group. Sixty young adults aged 18-26 with asthma will be recruited
      through local universities. They will be randomized to 1 of 3 groups for a 2-month study
      period during wildfire season. Study aims are to:

        1. Establish the feasibility (recruitment, enrollment, retention rates), acceptability
           (intervention engagement, fidelity, usability, attitude) and barriers and facilitators
           of adopting the technology of the Smoke Sense interventions and use of portable devices
           in young adults with asthma;51

        2. Explore the preliminary impact of the Smoke Sense interventions on lung function,20 and
           asthma control, These primary outcomes will be assessed using objective measures
           (spirometry) and validated, self-report tools. Secondary outcomes will be anxiety,23
           exposure reduction behaviors (e.g. stayed indoors, wore a mask),24 and symptom
           mitigating behaviors (use of medication, unscheduled health care appointments), measured
           via self-report and a Global Positioning System device. Outcome by group will be
           summarized. Preliminary evidence of treatment effect and its variance will be examined
           for a future clinical trial;

        3. Explore potential mediators (medication adherence, self-management skills, stress) and
           moderators (asthma severity/control) of the interventions to asthma outcomes. The
           long-term goal is to minimize asthma exacerbations from exposure to wildfire smoke.

      The long-term goal of the study is to minimize asthma exacerbations from exposure to wildfire
      smoke.
    

Intervention name(s): Smoke Sense; Smoke Sense Plus
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Smoke Sense is a smartphone application (app). Smoke Sense participants will be asked to establish a profile which includes demographics, baseline health information and current beliefs about smoke and air pollution. In the Symptoms & Smoke Observations tab, participants are asked to report their weekly observations of smoke, health symptoms, and exposure reduction behaviors. In the Fire & Smoke Near Me tab, participants review the most recent AQ data measured at an AQ monitoring sites. Participants are asked to complete the AQ 101 module which test knowledge of AQ facts and provides correct answers. Badges are awarded for accomplishments within the app to promote certain desired behaviors: completing a user profile, launching the app weekly to check local AQ, reporting smoke and symptom observations, expanding AQ knowledge with AQ lessons, and exploring the map. Finally, participants can engage with other users by viewing cumulative statistics of symptoms and smoke observations.; Participants randomized to the Smoke Sense Plus intervention will be asked to do everything that the Smoke Sense intervention group does on a weekly basis, as well as: 1) Receive weekly push notifications that remind them to, for example, review their asthma action plan, refill any expired medications, take their daily controller medication, identify a clean air space in their home and community, 2) Monitor their lung function weekly via mobile spirometry, and 3) Subscribe to a social network to share strategies to minimize exposure.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be randomized with equal probability to 1 of 3 study groups in blocks of 2, 4 and 5. Random assignment of the participants will be determined using a randomization software. Random group assignment and a corresponding unique study identification (ID) number will be placed in sealed envelopes that are numbered sequentially. After the consent is signed, research personnel will open the envelope to reveal the participant's group assignment. Research personnel will record the participant's name, study ID and group assignment in a password-protected spreadsheet stored on a secure server at WSU. As part of (virtual) study visit 1, intervention participants will download the app to their smartphones. A set-up macro will ask the participant to enter their study ID which can be associated with all data captured by the app.
Masking: Single (Investigator)
Primary purpose: Prevention
Keywords: Young adult; quality of life; wildfires; risk reduction behavior; smartphone