: Despite advances in asthma therapy, asthma morbidity has increased dramatically in the past decade, especially among inner-city minority populations. While epidemiological studies have highlighted the sociodemographic groups most at risk for illness and death, the underlying reasons for these disparities in health are not well understood. The overall objective of this project is to evaluate the factors contributing to asthma morbidity in inner-city minority populations.
The specific aims are to: (1) develop an instrument to measure patient adherence to asthma control medications; (2) determine the relative contribution of low adherence to medications, inadequate patient-provider communication, and poor access to care to poor asthma outcomes; (3) test if sensitization and indoor exposure to cockroach allergen result in increased asthma morbidity; and (4) develop the protocol and perform pilot testing of an intervention to improve the outcomes of adult inner-city asthmatics. The proposed study will enroll 420 adults with persistent asthma from the Primary Care Clinic of the Mount Sinai Hospital, located in East Harlem, a community in the epicenter of the asthma epidemic. The protocol will include a comprehensive baseline interview followed by telephone questionnaires at 4- and 12-weeks. The domains covered by the baseline interview will include sociodemographics, co-morbidities, access to care, past utilization, current medications, adherence, knowledge, beliefs, psychological symptoms, quality of patient-provider communication, environmental exposure to indoor allergens, and metered dose inhaler technique. Allergen specific IgE antibodies will be used to document allergic sensitization. At 4 and 12 weeks following the baseline assessment, telephone interviews will be conducted to obtain data on asthma symptoms, quality of life, peak flow measurements, hospitalizations, emergency department visits, and unscheduled outpatient visits. In the final 11/2 years of the project, the data collected from the initial phase of this proposal will be used to develop and pilot a self-management intervention to improve the outcome of inner-city asthmatics. During the five-year project, the candidate will pursue advanced graduate work in clinical epidemiology and health services research to further develop his scientific skills.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
1K08HS013312-01A1
Application #
6681390
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
Project Start
2003-09-01
Project End
2007-08-31
Budget Start
2003-09-01
Budget End
2004-08-31
Support Year
1
Fiscal Year
2003
Total Cost
Indirect Cost
Name
Mount Sinai School of Medicine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Lurslurchachai, Linda; Krauskopf, Katherine; Roy, Angkana et al. (2014) Metered dose inhaler technique among inner-city asthmatics and its association with asthma medication adherence. Clin Respir J 8:397-403
Roy, Angkana; Battle, Kayleigh; Lurslurchachai, Linda et al. (2011) Inhaler device, administration technique, and adherence to inhaled corticosteroids in patients with asthma. Prim Care Respir J 20:148-54
Mora, Pablo A; Berkowitz, Alayna; Contrada, Richard J et al. (2011) Factor structure and longitudinal invariance of the Medical Adherence Report Scale-Asthma. Psychol Health 26:713-27
Patil, Sangita P; Wisnivesky, Juan P; Busse, Paula J et al. (2011) Detection of immunological biomarkers correlated with asthma control and quality of life measurements in sera from chronic asthmatic patients. Ann Allergy Asthma Immunol 106:205-13
Roy, Angkana; Lurslurchachai, Linda; Halm, Ethan A et al. (2010) Use of herbal remedies and adherence to inhaled corticosteroids among inner-city asthmatic patients. Ann Allergy Asthma Immunol 104:132-8
Wisnivesky, Juan P; Lorenzo, Jessica; Feldman, Jonathan M et al. (2010) The relationship between perceived stress and morbidity among adult inner-city asthmatics. J Asthma 47:100-4
Cohen, Jessica L; Mann, Devin M; Wisnivesky, Juan P et al. (2009) Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma. Ann Allergy Asthma Immunol 103:325-31
Wisnivesky, Juan P; Kattan, Meyer; Evans, David et al. (2009) Assessing the relationship between language proficiency and asthma morbidity among inner-city asthmatics. Med Care 47:243-9
Mora, Pablo A; Contrada, Richard J; Berkowitz, Alayna et al. (2009) Measurement invariance of the Mini Asthma Quality of Life Questionnaire across African-American and Latino adult asthma patients. Qual Life Res 18:371-80
Wisnivesky, Juan P; Lorenzo, Jessica; Lyn-Cook, Richard et al. (2008) Barriers to adherence to asthma management guidelines among inner-city primary care providers. Ann Allergy Asthma Immunol 101:264-70

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