DESCRIPTION (provided by applicant): Pediatric asthma affects 9.6% of youth and is a leading cause of youth morbidity. Developing and mastering asthma self-management behaviors is imperative to control asthma and reduce morbidity among youth. Adolescents typically fail to perform the asthma self-management behaviors that prevent complications and enhance quality of life. Asthma self-management difficulties emerge in early adolescence as youth begin to transition towards taking more control of their treatment regimen, making it a critical intervention period. The presence or absence of helpful caregiver support often determines whether early adolescents ultimately develop and master asthma self-management behaviors. The aims of this application are to develop and test Team Speak, a mobile health (mHealth) tool, implemented via smartphones, that fosters helpful caregiver support as early adolescents with persistent asthma develop and master asthma self-management behaviors. To facilitate helpful caregiver support, Team Speak uses existing mHealth technology developed by the study team to elucidate tailored intervention targets for each family. Team Speak then facilitates collaborative caregiver/adolescent asthma management by automatically guiding dyads through a structured process that includes the supportive behavioral management strategies of goal setting, contingency management, and problem solving communication. Skills-training videos for adolescents and caregivers provide guidance on how to complete each collaborative asthma management component. We propose to develop Team Speak through iterative feedback from an advisory board composed of ten adolescent-caregiver dyads from the target user population and a pediatric pulmonologist. Following advisory board feedback, we will conduct a pilot randomized controlled trial of Team Speak with 50 early adolescents with poorly controlled asthma, ages 12-15 years, and a caregiver. Families will be randomly assigned to receive Team Speak or a self-guided control condition for a 4 month intervention period. Participants in the self-guided control condition will be given general information on supportive behavioral management techniques they can use to target improvement in asthma self-management behaviors. The control condition will serve as an attention control and is designed to optimize recruitment and sustain interest while concurrently having a minimal impact on asthma management. Feasibility, acceptability, and utilization data will be collected throughout the trial. Efficacy outcomes include changes in family asthma management (primary outcome), prescription refill history, lung function, asthma control, asthma-related quality of life, and sel-efficacy for asthma management. Data to evaluate efficacy outcomes will be collected at baseline, post-treatment, and 4 month follow-up time points. Feasibility, acceptability, and utilization of Team Speak will be determined by examining enrollment and attrition rates, usage statistics, and participant satisfaction with the Team Speak tool. If successful, this intervention offers excellent potential for wide spread dissemination to address a pressing public health problem.

PUBLIC HEALTH RELEVANCE: Early adolescents (ages 12-15) with persistent asthma typically have difficulties in performing disease self- management behaviors, placing them at high risk for experiencing significant health concerns including poor asthma control, higher risk of morbidity, and decreased quality of life. The proposed study will fill a critical gap in the literature by developing and testing a novel mobile-based intervention that aims to facilitate helpful family support as early adolescents develop and master asthma self-management behaviors. Successfully developing and mastering self-management behaviors during early adolescence will limit downstream health difficulties.