The K24 candidate is a general internist with a trajectory of peer-reviewed clinical research in asthma and extensive experience in mentoring fellows and junior faculty in clinical research through a formal Masters Degree Program in Clinical Epidemiology and Health Services Research. Supported by an RWJ Faculty Scholars Award, an NHLBI K23 award, and an NHLBI Translational Behavioral Science contract, the candidate has successfully completed a series of trials assessing interventions to improve self-management and to reduce cardiovascular risk in primary care asthma patients. An extension of this work is in progress in an NHLBI R01 trial to improve self-management in patients presenting to the emergency room for asthma. Throughout this work, the recurring theme of depressive symptoms as a risk for poor asthma outcomes has emerged. The objectives of this K24 award are to build on prior work and implement a new educational intervention targeted specifically at asthma patients with depressive symptoms. The K24 RCT will teach patients performance-based skills and use an innovative method to increase self-efficacy. The outcomes after 1 year will be quality of life, emergency resource utilization, work absenteeism, and the need for rescue medications. This trial will be the first to focus on asthma patients with depressive symptoms, a high risk population whose needs regarding education about self-management have been largely overlooked. An additional objective is for the candidate to develop expertise in diagnosing depressive disorders according to strict criteria using the standard Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). The candidate's short-term goals are to focus on asthma patients with depressive symptoms, to optimize their instruction in self-management, and to diagnose their spectrum of depressive disorders according to formal psychiatric criteria. The candidate's long-term goals are to develop interventions to simultaneously treat asthma and depression. Short-term goals in other related areas are to build on a recently completed RCT in physical activity in asthma patients by implementing a behavioral intervention to increase exercise among asthma patients, and to build on the findings of an ongoing emergency room RCT by implementing an intervention to decrease urgent resource utilization for asthma. Both goals will be addressed in R01 applications. As co-Director of the Masters Degree Program and AHRQ T32 Fellowship in Clinical Epidemiology and Health Services Research at the Weill Cornell Graduate School of Medical Sciences, the K24 candidate has been instrumental in developing a rigorous training program in clinical research and in mentoring fellows and junior faculty. The candidate has a successful track record of training physicians who become independent clinical investigators with peer-reviewed funding and academic appointments. During the K24 award, the candidate will increase her role as a primary mentor by decreasing her growing administrative responsibilities to the Masters Program. The award also will provide time for the candidate to extend her role to mentor medical residents. A rich research environment with experts and collaborators is available at Cornell for the K24 candidate. In particular, the candidate is an active member of the Research Methodology Core, a 'think tank'of established multi-disciplinary clinical researchers focusing on challenges in research methodology and the design and conduct of clinical trials. The Core has been extremely successful in supporting research initiatives of mid-career and senior investigators. In addition, the K24 candidate has established research relationships with experts in pulmonary medicine and psychiatry, and will continue to draw on their knowledge to meet the objectives of this multi-disciplinary K24 trial. In summary, the K24 award would advance the candidate's research career by permitting her to conduct an RCT targeted at asthma patients at high risk for poor outcomes. The award also would permit her to acquire expertise in diagnosing depressive disorders using the SCID and to develop co- interventions for asthma and depression. These are necessary steps to advance her research career. The K24 award also would grant the candidate dedicated time to provide one-on-one mentoring, to recruit mentees interested in research in pulmonary medicine, to establish a core of clinical asthma research in the Masters Program, and to establish a mentoring role for medical residents. Mentees will be able to participate in new asthma RCTs as well as the RCT proposed as part of this application. More time for mentoring will be derived by decreasing time spent in current and expanding administrative responsibilities to the Masters Program.

Public Health Relevance

Asthma affects 22 million Americans of all ages and is associated with significant adverse outcomes ranging from disruption of daily activities to emergency room visits and hospitalizations. Many asthma patients also have marked depressive symptoms, which make asthma management more difficult and lead to worse outcomes. The purpose of this study is to help asthma patients who have depressive symptoms better manage asthma and have improved outcomes, particularly better quality of life and less need for emergency treatment.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Special Emphasis Panel (ZHL1-CSR-R (M1))
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Tigno, Xenia
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Hospital for Special Surgery
New York
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