A Comprehensive Intervention in Asthma Management in a Population of Black and Hispanic Pregnant Women and its Effects on Asthma Control, and Maternal and Prenatal Morbidity

Principal Investigator:             Dr. Darryl Jordan

Co-Investigators:                     Dr. Gwinnett Ladson
                                                     Dr. Tina Hartert
Racial disparities in asthma care and outcomes have been widely reported, with minority populations (e.g. blacks and Hispanics) being unfavorably affected. Many factors, believed to be important contributors, include lower socioeconomic and educational status, cultural barriers, and decreased access to medical care, environmental factors, and genetic differences. Women of childbearing age and, more specifically pregnant women, represent an important subgroup within minority populations, because of their biological role, their place in society, and their vulnerability to engage in high-risk behaviors (e.g. smoking). During pregnancy, both uncontrolled asthma and smoking can have deleterious effects in the newborn. Women during pregnancy may be more interested in their health state and that of their newborn, and this may be an ideal time in which to target intensive asthma care and smoking cessation programs.  Additionally, pregnant women have a high frequency of health provider visits during pregnancy, allowing for opportunities to intervene in chronic health issues. Hence, the study of the relative effectiveness of interventions aimed at this patient population would be of great benefit for mothers. In addition, as genetic factors play a major role in the development of asthma, targeting pregnant women may have a positive indirect effect on asthma recognition and care in their offspring. We hypothesize that an intense, comprehensive, and culturally appropriate intervention in African American and Hispanic pregnant women with asthma compared with a less intense intervention will improve asthma-specific outcome measures during pregnancy and the postpartum period for both the mother and potentially the newborn.

 Disparities in Symptom Perception and Assessment in African American Asthmatics

Principle Investigator:              D. Scott Trochtenberg, M.D.

African Americans suffer disproportionately from asthma and have more severe asthma and worse asthma outcomes relative to other races. Additionally, asthma hospitalization, emergency department (ED) visits and mortality among African Americans are 1.4 to 4.0 times more likely, respectively than in whites.  Several studies have identified predictors of asthma related emergency department use.  Among these predictors are medication adherence and asthma self-efficacy. Other factors such as low income, greater asthma severity, living alone or having resided at current residence for less than one year have also been shown to predict ED usage and hospitalization in under served asthmatic populations.  However, in this study we focus on amenable factors so that the results of this study can be used to implement future educational and clinical management interventions. Medication adherence can be defined as the patient’s ability to adhere to a prescribed medication regimen. Self-efficacy can be defined as the degree of confidence that a person has that they can successfully execute behaviors to produce a certain outcome. Asthma self-efficacy can therefore be defined as one’s confidence to execute behaviors related to the management of one’s own asthma. Our overall hypothesis is that self-assessment of asthma severity, and perception of dyspnea caused by airflow obstruction, are disparately impaired in African Americans. Moreover, we hypothesize that the ability to correctly assess overall asthma severity and dyspnea relate to medication compliance and self-efficacy. Patients who are unable to correctly perceive their overall severity of asthma or perceptions of dyspnea may be unable to accurately assess the need for asthma medication. Similarly, patients may have low self-efficacy for asthma care because the discordance between perceptions of severity and dyspnea and actual asthma severity and degree of airflow obstruction may impede them from identifying the proper course of action regarding their asthma care. Therefore, we hypothesize that discordance in perceived versus actual asthma severity and airflow obstruction plays an intermediary role in disparities in Emergency Department (ED) use.

Training and Education in Asthma Disparities

Principle Investigator            D. Scott Trochtenberg, M.D.
Co-Investigators:                   John J. Murray, MD, PhD
                                                  James Sheller, M.D.
Specific Aims

1. To enhance awareness of asthma disparities
2. To provide research support for medical students at Meharry and Vanderbilt University to develop research skills relevant to the investigation of the causes and treatments of asthma disparities
3. To provide training and mentorship in research techniques directed toward asthma disparities
4. To expand the cadre of scientific investigators dedicated to research on asthma in minority populations

Students interested in learning research techniques into the causes of racial disparities in disease and their outcomes are invited to apply for summer positions in this training program. All of the summer projects will deal with an aspect of asthma, ranging from diagnosis, symptom perception, relationship to smoking and pregnancy, and various biochemical and physiological aspects of the disease. The summer program typically runs for seven weeks. Students receive a stipend for their efforts. Each student will have a faculty mentor to help them learn about asthma, as well as research techniques. There is a series of orientation lectures, and students will meet periodically to exchange ideas about their research projects. At the end of the program, each student (or team of students) will give a 10 to 15 minute Power Point summary of their research. The ideal applicant is in college or graduate school, or is in a special training program (such as respiratory therapy or nursing). Prior research experience is preferred, but not necessary. Each applicant will need to submit a curriculum vita and a brief essay explaining what they hope to gain by being a part of the asthma disparities project, as well as a description of their research interests. This summer training program promises to be an exciting introduction into the study of a very common disease that affects a disproportionate number of African Americans.