1. Dr Smita Shah Director Primary Health Care Education & Research Unit Sydney West Area Health Service Senior Clinical Lecturer University of Sydney Australia Smita_shah@wsahs.nsw.gov.au Initiatives and Community Approaches

2. Asthma in a Small World

4. Adolescent Asthma 1 in 6 adolescents 43% had asthma attacks 22% had severe limitation 22% smoked 78% missed school PG Gibson et al, 1998

5. Triple A Program  Peer-led  Entrusts young people to take the health messages  Based on psycho-social theory  Structured program  Triple A Program Resource kit  Asthma Friendly Schools Program

6. Medical Students Train as AAA Educators

7. Step 1: Training Asthma Peer Leaders

8. Take your medication before exercise Step 2: Peer-led lessons “ Take that cancer stick away”

9. Step 3:Asthma Skits

10. Does it work? Program tested in a large randomised controlled trial ( n = 1379) Improvements in:  Quality of Life  School absenteeism  Asthma attacks at school  Participant satisfaction Shah et al., BMJ 2001, Boulet et al., Evidence Based Medicine 2001

14. Comments from Peer Leaders   Gained leadership skills and felt proud that I got the message across   Knowing what to do if an asthma attack occurs   How to help people with asthma   Don’t smoke if you have asthma   Organisational skills and the confidence to teach

15. Parents & School Staff Parents “It’s great to see teenagers taking responsibility for their health” “ …. has become better at managing her asthma” “ Should be a regular program in the school” Teachers “Students are no longer embarrassed to take their medications at school” “We no longer have emergencies at school” “ Benefits for the peer leaders were enormous” “ Reduction in smoking”

16. Summary Triple A Program  Improves QoL  Reduces asthma attacks and school absenteeism  Seen as beneficial by young people themselves  Sustainable  Currently being trialed in USA (and Jordan)  Resources soon available on Asthma Foundation of Victoria website (www.asthma.org)  Funding thanks to the Australian Government Department of Health and Ageing

17. Triple A and Aboriginal Children  Hard to reach population  Can reache large numbers  Empowering  Beneficial for all involved  Promotes local leadership  Better communication skills “We got so much out of this program - and now my daughter plays netball and athletics and state championships and won a bronze medal for 700 meters”

18. Works for us – works for you

19. Questions Sydney Opera House & Harbor Bridge