Candidate's Plans/Training: I, Andrea J. Apter, MD, MSc, plan a change in career emphasis from clinician-educator to an independent investigator in asthma clinical research. I want to use my extensive clinical experience and recent prior training in clinical epidemiology to better understand how social setting with its barriers to treatment influences disease. The training is designed to fill my knowledge gaps and will be interdisciplinary. it will include advanced formal course work in epidemiology, biostatistics, behavioral science, and health services research along with structured mentoring as I conduct the proposed research project. Environment: The University of Pennsylvania is an environment uniquely suited for this training award. its Center for Clinical Epidemiology and Biostatistics will provide structured mentoring and formal coursework. The Leonard Davis institute is a renowned center for health services research and the Annenberg School is a center for behavioral science research. The Pulmonary, Allergy, Critical Care Division serves a large, diverse patient population and has a record of outstanding clinical research. Research: Given the substantial morbidity and mortality associated with asthma and the proven efficacy of inhaled steroids in reducing this morbidity and mortality, identifying solutions for the problem of poor adherence to inhaled steroid regimens takes on great urgency. Recent research indicates low socioeconomic status and inadequacy of physician-patient communication are predictors of poor adherence. The low-income inner city asthma population is at high risk for poor clinical outcome. This project identifies potentially modifiable sociobehavioral factors that impede adherence to inhaled steroid regimens with a focus on the inner city poor population. The central hypothesis is that mutable social and behavioral factors influence adherence and that adherence can be improved by modifying these factors. This project has two phases, an observational cohort study and a randomized intervention. Phase I has 2 aims. We will identify potentially modifiable sociobehavioral barriers associated with poor adherence using electronic monitoring and controlling for disease activity and socioeconomic status (Aim 1). A behavioral model of adherence will be employed to formulate and test hypotheses.
Aim 2 will examine how fluctuations in adherence influence asthma severity measured by electronic monitoring of nighttime use of a short-acting beta-agonist. In Phase II we will implement a randomized controlled pilot trial to improve adherence (Aim 3). Possible interventions that will be studied include the effect of enhanced patient-physician communication using electronic monitoring data and/or an educational program on improving adherence. This intervention will be designed taking into account the results of the cohort study performed in Phase I of this training program. Upon the foundation of my prior clinical experience and education, this training program is designed to equip me with the additional skills and research experience necessary to become a fully independent investigator.
| Guéant, Jean-Louis; Guéant-Rodriguez, Rosa-Maria; Cornejo-Garcia, Jose-Antonio et al. (2009) Gene variants of IL13, IL4, and IL4RA are predictors of beta-lactam allergy. J Allergy Clin Immunol 123:509; author reply 509-10 |
| Apter, Andrea J; Schelleman, Hedi; Walker, Amy et al. (2008) Clinical and genetic risk factors of self-reported penicillin allergy. J Allergy Clin Immunol 122:152-8 |
| Gergen, Peter J; Apter, Andrea J (2007) Unconventional risk factors: another pathway to understanding health disparities. J Allergy Clin Immunol 119:165-7 |
| Apter, Andrea J (2006) The influence of health disparities on individual patient outcomes: what is the link between genes and environment? J Allergy Clin Immunol 117:345-50 |
| Apter, Andrea J; Kinman, Judith L; Bilker, Warren B et al. (2006) Is there cross-reactivity between penicillins and cephalosporins? Am J Med 119:354.e11-9 |
| Kim, Clara; Feldman, Harold I; Joffe, Marshall et al. (2005) Influences of earlier adherence and symptoms on current symptoms: a marginal structural models analysis. J Allergy Clin Immunol 115:810-4 |
| Szefler, Stanley J; Apter, Andrea (2005) Advances in pediatric and adult asthma. J Allergy Clin Immunol 115:470-7 |
| Apter, Andrea J; Kinman, Judith L; Bilker, Warren B et al. (2004) Represcription of penicillin after allergic-like events. J Allergy Clin Immunol 113:764-70 |
| Bogen, Daniel; Apter, Andrea J (2004) Adherence logger for a dry powder inhaler: a new device for medical adherence research. J Allergy Clin Immunol 114:863-8 |
| Apter, Andrea J; Boston, Ray C; George, Maureen et al. (2003) Modifiable barriers to adherence to inhaled steroids among adults with asthma: it's not just black and white. J Allergy Clin Immunol 111:1219-26 |
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