Inner-city Teens Get Asthma Messages by MP3

Ask a teenager what he or she did today, and you’ll probably get the universal adolescent answer: “Nothing.” Turns out that a whole lot of that “nothing” involves using electronic media. Some innovative pilot studies tapped into those habits to get inner-city teenagers to improve their use of asthma medications, Dr. Giselle Mosnaim reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI).

Image of iPod Shuffle by flickr user aliciat80 (Creative Commons license).

She became frustrated when she kept seeing the same teens in the emergency department in acute asthma crisis over and over again. The messages to use their asthma medications were not getting through to them, so she looked for potentially better ways to reach them.

In a large survey study by the Kaiser Family Foundation, youths aged 8-18 years reported that their use of media (TV, music, computer, video games, print, or movies) in 2009 increased to 10 hours and 45 minutes per day, up from 8.5 hours in 2004 and 7.5 hours in 1999. How is that even possible? They’re multitasking 29% of that time, compared with 26% of media time spent multitasking in 2004 and 16% in 1999. Even accounting for multitasking, they were exposed to media 7 hours and 38 minutes per day in 2009.

In that same time span, cellphone ownership increased in this age group from 39% to 66%. The proportion that owned an iPod or other MP3 player increased from 18% to 76%.

Dr. Mosnaim (Photo by Sherry Boschert)

So Dr. Mosnaim designed a pilot study in which 27 inner-city teenagers with asthma received free cellphones and could choose music to listen to via the phones, but they had to  hear messages from celebrities urging them to take their asthma meds before they could access the music. That study bombed. (Not as in, “You’re the bomb!” but as in, “Fail!”)  Medication adherence did not improve, and the teens found a way around safeguards on the cellphones to run up hundreds of dollars in calls that they weren’t supposed to be making, said Dr. Mosnaim of Rush University Medical Center, Chicago. Plus, they didn’t think much of the celebrity messages.

So she tried again, this time using iPod Shuffles. Four teens in the second pilot study were allowed to download 10 profanity-free MP3 songs per week. They met weekly in coping/peer-support groups, where they recorded their own take-your-asthma-meds messages, and those were mixed in with the tracks on the iPod Shuffle. I don’t have permission to post audio of some of those messages here, but suffice it to say that their creativity outshines most rappers and DJs. The investigators attached a device to each teen’s inhaler to objectively measure medication adherence.

Hearing their own voice on the “asthma track” proved to be a hit. And it seemed to work. Medication adherence increased to 70% in 8 weeks, a “clinically significant treatment target,” Dr. Hosnaim said.

The idea is now graduating from pilot studies to a randomized, controlled trial with 90 participants. The control group will get the iPod Shuffles and follow the same protocol as the intervention group, but the voice on the asthma messages will be Dr. Mosnaim.

Not too long ago, I might have ended this blog post by saying, “Stay tuned.” That’s so last century. When the study’s results drop, you’ll get them here first. Are you subscribed?

— Sherry Boschert (@SherryBoschert on Twitter)

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Filed under Allergy and Immunology, Emergency Medicine, Family Medicine, IMNG, Internal Medicine, Pediatrics, Primary care

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