Abstract Introduction Asthma is a leading cause of morbidity and absenteeism among U.S. K-12 students. National guidelines recommend immediate access to a bronchodilator, yet only 12-15% of children with asthma have access at school. Barriers such as limited specialty care and financial constraints prevent many families from providing an inhaler for school use. The Stock Albuterol for Every (SAFE) School Program was established to equip schools with a stock bronchodilator inhaler and supply of valved-holding chambers for any student experiencing respiratory distress. In 2025, the program received NHLBI R01HL174599 funding to evaluate three implementation strategies statewide. This abstract describes the SAFE study design and 2025-2026 school recruitment phase. Methods This five-year Hybrid Effectiveness-Implementation Type III study will enroll 400 Arizona K-12 schools using a two-stage adoption and randomization design. Using community engagement strategies, rural and under-resourced schools without prior stock bronchodilator programs will be targeted for enrollment. Once enrolled, schools are assigned to Strategy 1 (Toolkit only) and must complete three core adoption requirements: (1) certify two staff via web-based training, (2) obtain a standing medical order, and (3) request medication and supplies. Schools that do not complete these requirements within the adoption window are randomized to one of two enhanced strategies: Strategy 2 (Toolkit + Coaching) or Strategy 3 (Toolkit + Coaching + Registered Nurse Practice Facilitation). Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR) frameworks, we will compare strategy intensity and resource needs to assess adoption, implementation fidelity, student reach, effectiveness, maintenance, and cost-effectiveness. The RN Practice Facilitation arm applies nursing-based principles to strengthen integration and sustainment. Results As of November 2025, 14.27% (235/1,647) of eligible schools had been contacted through a community advisory group consisting of county and state health departments, the Arizona Department of Education, and the Arizona Asthma Coalition. Of these schools, 172 were public, 37 charter, and 7 private or parochial. Outreach activities also included presentations at statewide rural and school health conferences and direct engagement via e-mail and site visits. By November 2025, fifty-nine schools returned permission forms; including, 5 schools completed all three adoption requirements, 1 completed at least 2, and 0 completed only 1. Conclusions Early recruitment results demonstrate strong cross-sector collaboration and initial engagement among diverse schools, supporting the feasibility of statewide implementation. Ongoing evaluation will identify effective, sustainable strategies to expand equitable access to emergency asthma care in schools nationwide. This abstract is funded by: National Heart, Lung, and Blood Institute
Peterson et al. (Fri,) studied this question.