About Sign Up Asthma History For Organizations Awards Staff Publications Frequently Asked Questions
What is Puff City?
Puff City is a online asthma management program for teenagers! The goal of the program is to help teens better manage their asthma.
Program Benefits
In one study, Puff City participants reported fewer symptoms during both days and nights, less restricted activities, made 50 percent fewer visits to the emergency department, required 50 percent fewer hospitalizations and missed 60 percent fewer school days.
Why should teens with asthma participate?
Participating in Puff City can help teens learn more about their asthma and how to better manage asthma symptoms. With fewer asthma symptoms you can:
• Be more active and perform better in school and sports
• Have fewer emergency department visits and hospitalizations
• Feel healthier and more confident
What exactly will teens do?
Each computer session asks a series of questions relating to asthma management and control. The program is tailored to the participant’s needs and characteristics and gives feedback.
How do I Sign Up?
To enroll in Puff City you must contact an organization in your region that is a registered site. The organization will give you an access code to use Puff City. This is applicable ONLY to HFHS patients. You can also sign up for Puff City at your next doctor's visit. Ask your doctor to give you an access code to use Puff City.
What is Asthma?
Asthma is a chronic disease that affects your airways. Airways are the tubes that carry air in and out of your lungs.
During an asthma attack…
  • Airway becomes swollen and inflamed
  • Muscles tighten around airways
  • Mucus blocks airways
Asthma can make you feel short of breath, tight in your chest, or cause you to wheeze. If an asthma episode is severe, you may need emergency treatment to get back to normal breathing.
How is Asthma Treated?
There is no cure for asthma. Prevention and appropriate use of prescribed medication can help manage symptoms. Avoiding known triggers, such as certain allergens or situations, can help prevent attacks. Using prescribed medication in a timely manner and as directed by a physician can greatly improve asthma control.
Asthma can look like this inside your lungs:

Asthma deaths, asthma related hospitalizations and asthma attacks are higher among African American and Latino/a adolescents than most other groups. This high-risk population is also the least likely to have access to proper medication, education about appropriate management, and support. Puff city was developed by Henry Ford Hospital in collaboration with the University of Michigan. The intention of Puff City is to help teenagers manage their asthma symptoms better in order to avoid symptoms and asthma attacks and to improve quality of life of teens with asthma.

In 2001, the Puff City program began enrolling teenagers in Detroit public high schools, 15-19 years of age. After its positive response in the school environment, Puff City expanded to emergency departments and outpatient clinics. Puff City enrolls anyone that can benefit from the program. Participants are from all different ethnicities and range from ages 13-19 years old.

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Organizations that can use Puff City include healthcare organizations, schools, youth organizations, community clinics, insurance providers, youth clinics and any organization involved with teens who have asthma.
NOVA Award July 2012: Puff City I
Puff City was recipient of the American Hospital Association (AHA) NOVA Award, presented in July 2012. The AHA honors leadership by its member hospitals and health care systems by presenting AHA NOVA Awards annually to the bright stars of the hospital field that: Improve community health status--whether through health care, economic or social initiatives, and are collaborative efforts among health care systems or hospitals, or among hospitals and other community leaders and organizations. The NOVA Award was presented to Henry Ford Hospital for Puff City at the AHA-Health Forum Leadership Summit.
FREDDIE Award November 2008: Puff City II
Puff City was awarded the FREDDIE Award in November of 2008 for the category of inflammatory diseases and was nominated for the category of Allergies & Asthma. Sponsored by the MediMedia Foundation, the preeminent International Health & Medical Media Awards (FREDDIE ) holds 35 annual competitions (1974-2009) to encourage and recognize excellence in health-related media. FREDDIE’s founder, Dr. Fredrick Gottlieb, brought the worlds of medical science, education and the arts together in what has become the preeminent international media competition devoted to educational health and medical productions. Each year, the competition attracts hundreds of submissions from around the world—documentaries, series, shortvideos, web sites, and CD-ROMs—in 31 categories. Puff City was presented with the FREDDIE in November of 2008 at the International Health and Medical Media Awards Ceremony in Philadelphia, Pennsylvania.
Christine LM Joseph, Ph.D, MPH
Dr. Joseph is a Senior Epidemiologist in the Department of Public Health Sciences at Henry Ford Health System. Her research interests include racial/ethnic health disparities, adolescent health, asthma and allergic disease, adherence, and school-based health management.

Dennis Ownby, MD
Dennis R. Ownby, MD, is Professor of Pediatrics and Internal Medicine and was Head of the Section of Allergy and Immunology at the Medical College of Georgia in Augusta, Georgia. He is a fellow of the American Academy of Pediatrics, the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. His primary research interest is environmental factors affecting the development of asthma in children.
Christine Cole Johnson, PhD, MPH
Christine Cole Johnson, PhD, MPH, is an epidemiologist and the Chair of Public Sciences at Henry Ford Health System. She is an elected member of the American Epidemiological Society and a fellow of the American Academy of Allergy, Asthma and Immunology. Her primary research interest is prevention of disease and how environmental and social factors influence health in children and adults.
Reconnecting with urban youth enrolled in a randomized controlled trial and overdue for a 12-month follow-up survey.
By Ezell JM, Saltzgaber J, Peterson E, Joseph CLM

Clinical Trials 2013; 10(5): 775-781

Evaluation of a web-based asthma management intervention program for urban teenagers: Reaching the hard to reach.
By Joseph CLM, Ownby DR, Havstad SL, Saltzgaber J, Considine S, Johnson D, Peterson E, Alexander G, Lu M, Gibson-Scipio W, Johnson CC

Journal of Adolescent Health 2013; 52(4): 419-426

Effect of depressive symptoms on asthma intervention in urban teens.
By Guglani L, Havstad S, Johnson CC, Ownby DR, Joseph CLM

Annals of Allergy, Asthma & Immunology. 2012; 109(4):237–242.e2

Comparison of early-, late-, and non-participants in a school-based asthma management program for urban high school students.
By Joseph CLM, Saltzgaber J, Havstad SL, Johnson CC, Johnson D, Peterson EL, Alexander G, Couper M, Ownby DR

Trials 2011; 12:141

Factors associated with non-response to a computer tailored asthma management program for urban adolescents with asthma.
By Joseph CLM, Havstad SL, Johnson D, Saltzgaber J, Peterson EL, Resnicow K, Ownby DR, Baptist A, Johnson CC, Strecher V

J Asthma. 2010 Aug; 47(6):667-673

Gender differences in the association of overweight and asthma morbidity among urban adolescents with asthma.
By Joseph CLM, Havstad SL, Ownby DR, Zoratti E, Peterson EL, Stringer S, Johnson CC

Pediatr Allergy Immunol. 2009 Jun;20(4):362-369

A web-based, tailored asthma management program for urban, African-American high school students.
By Joseph CLM, Peterson E, Havstad S, Johnson CC, Hoerauf S, Stringer S, Gibson-Scipio W, Ownby DR, Elston-Lafata J, Pallonen U, Strecher V, on behalf of research team members

American Journal of Respiratory Disease and Critical Care Medicine 2007 May; 175(9): 888-895

Identifying students with self-report of asthma and respiratory symptoms in an urban, high school setting.
By Joseph CLM, Baptist AP, Stringer S, Havstad S, Ownby DR, Johnson CC, Williams LK, Peterson EL

Journal of Urban Health. 2007 84(1):60-69

Agreement between teenager and caregiver responses to questions about teenager’s asthma.
By Joseph CLM, Havstad SL, Johnson CC, Vinuya R, Ownby DR

Journal of Asthma 2006; 43(2):119-124

The effect of an asthma intervention on children with undiagnosed asthma.
By Joseph CLM, Havstad SL, Anderson L, Brown R, Clark NM

Journal of Pediatrics, 2005. 146(1):96-104

Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren.
By Joseph CLM, Foxman B, Leickly FE, Peterson E, Ownby D

Journal of Pediatrics 1996; 129(5): 735-742

1.Who can I contact if I need any additional information or materials?
You can email us at info@puffcitymobile.org
2. What is a Puff City Access Code?
The Access Code is the code provided to organizations that are registered to use Puff City Mobile. Organization can give this code to youth and community members that want to use Puff City Mobile.
3. Why do I need an organization to sign up?
We want to make sure that youth with asthma have assistance beyond what Puff City can provide. Organizations can also make communities aware of Puff City Mobile.
4. Are there any membership fees?
No. Puff City is free to non-profit organizations.
5.What is expected of youth that use the program?
There are surveys in the Puff City Mobile that capture the information needed to develop the personalized messages users will receive. Users should complete the surveys in order to get the full Puff City Mobile experience.
6. What is expected of me as an organization?
Make Puff City Mobile available to youth with asthma in the communities you serve, and continue to support persons living with asthma.
7. Where can I go to find more resources about asthma?
Resources for asthma are listed on the website or you can email us at info@puffcitymobile.org
8. Where can I go to find out more about Puff City Mobile?
Please go to are on the website for resources, links, and publications.
In Memory:
Puff City Mobile is dedicated to Anntinette McCain, former Chair of the Detroit Coordinated School Health Council for Detroit Public Schools. She worked tirelessly to build healthy environments for Detroit youth. Anntinette worked closely with Puff City staff, always advocating for youth with asthma. Without Anntinette, Puff City Mobile would not exist. We miss her.