Improving Asthma Research in an Inner-City Latino Neighborhood with Community Health Workers

This study tests the feasibility of a partnership between an academic medical center and community health workers to perform mutually beneficial research investigating asthma in an urban Latino neighborhood. Community heath workers participated in the study design, instrument development, implementation, and analysis. The 103 participants recruited by the community health workers were primarily Mexican with very low education and acculturation levels. After the 1-year enrollment period, the community health workers described the challenges of data collection and gave explanations for the access to care outcomes. This academic-community partnership showed that community health workers can be effective research partners.     

Improving Asthma Research in an Inner-City Latino Neighborhood with Community Health Workers

This study tests the feasibility of a partnership between an academic medical center and community health workers to perform mutually beneficial research investigating asthma in an urban Latino neighborhood. Community heath workers participated in the study design, instrument development, implementation, and analysis. The 103 participants recruited by the community health workers were primarily Mexican with very low education and acculturation levels. After the 1-year enrollment period, the community health workers described the challenges of data collection and gave explanations for the access to care outcomes. This academic-community partnership showed that community health workers can be effective research partners.     

Efficacy of Integrated Pest Management in Reducing Cockroach Allergen Concentrations in Urban Public Housing

The efficacy of residential interventions to reduce cockroach allergens in public housing developments was evaluated over months of follow-up. Repeated measurements were collected from 39 apartments, with longitudinal analyses used to evaluate changes over time. Bla g 1 kitchen concentrations were reduced 71% and bed concentrations 53% (86% and 70% for Bla g 2, respectively) by 6 months post-intervention, after which concentrations began to increase. Apartments with higher concentrations were usually in poorer condition and benefited most from pest management efforts. Intensive interventions can significantly reduce the allergen burden in public housing apartments, but intervention efforts must be sustained.     

Efficacy of Integrated Pest Management in Reducing Cockroach Allergen Concentrations in Urban Public Housing

The efficacy of residential interventions to reduce cockroach allergens in public housing developments was evaluated over months of follow-up. Repeated measurements were collected from 39 apartments, with longitudinal analyses used to evaluate changes over time. Bla g 1 kitchen concentrations were reduced 71% and bed concentrations 53% (86% and 70% for Bla g 2, respectively) by 6 months post-intervention, after which concentrations began to increase. Apartments with higher concentrations were usually in poorer condition and benefited most from pest management efforts. Intensive interventions can significantly reduce the allergen burden in public housing apartments, but intervention efforts must be sustained.     

Policy,Community and Kin: Interventions That Support Rural Healthy Aging

This study examines the interventions that enable rural seniors to remain within their homes and communities as they age. Through semi-structured interviews with 40 rural seniors, the findings reveal a number of actions that facilitate rural aging. This study has important implications for a range of stakeholders from policy makers to community leaders by identifying policy, community, and kin-level interventions that support rural healthy aging in place. In identifying interventions that support rural seniors’ needs, this study provides a fundamental basis to better allocate resources, plan programs, and develop policies that reflect the needs of an aging population.     

Academic incentives for faculty participation in community-based participatory research

Recognizing the need to overcome the obstacles of traditional university- and discipline-oriented research approaches, a variety of incentives to promote community-based participatory research (CBPR) are presented. Experiences of existing CBPR researchers are used in outlining how this methodological approach can appeal to faculty: the common ground shared by faculty and community leaders in challenging the status quo; opportunities to have an impact on local, regional, and national policy; and opening doors for new research and funding opportunities. Strategies for promoting CBPR in universities are provided in getting CBPR started, changing institutional practices currently inhibiting CBPR, and institutionalizing CBPR. Among the specific strategies are: development of faculty research networks; team approaches to CBPR; mentoring faculty and students; using existing national CBPR networks; modifying tenure and promotion guidelines; development of appropriate measures of CBPR scholarship; earmarking university resources to support CBPR; using Institutional Review Boards to promote CBPR; making CBPR-oriented faculty appointments; and creating CBPR centers.     

Community Partnership to Affect Substance Abuse among Native American Adolescents

Background: Substance abuse is one of the nation’s primary health concerns. Native American youth experience higher rates of substance abuse than other youth. There is little empirical evidence that exists concerning the use of culturally-based interventions among Native American adolescents. Objectives: This study used a community-based participatory research approach to develop and evaluate an innovative school-based cultural intervention targeting substance abuse among a Native American adolescent population. Methods: A two-condition quasi-experimental study design was used to compare the Cherokee Talking Circle (CTC) culturally-based intervention condition (n = 92) with the Be A Winner Standard Education (SE) condition (n = 87). Data were collected at pre-intervention, immediate post-intervention, and 90-day post-intervention using the Cherokee Self-Reliance Questionnaire, Global Assessment of Individual Needs – Quick, and Written Stories of Stress measures. Results: Significant improvements were found among all measurement outcomes for the CTC culturally-based intervention. Conclusions: The data provide evidence that a Native American adolescent culturally-based intervention was significantly more effective for the reduction of substance abuse and related problems than a noncultural-based intervention. Scientific Significance: This study suggests that cultural considerations may enhance the degree to which specific interventions address substance abuse problems among Native American adolescents.     

The Child Asthma Link Line: A Coalition-initiated,Telephone-based,Care Coordination Intervention for Childhood Asthma

Background. Childhood asthma is a complex chronic disease that poses significant challenges regarding management, and there is evidence of disparities in care. Many medical, psychosocial, and health system factors contribute to recognized poor control of this most prevalent illness among children, with resultant excessive use of emergency departments and hospitalizations for care. Recent national guidelines emphasize the need for community-based initiatives to address these critical issues. To address health system fragmentation and impact asthma outcomes, the Philadelphia Allies Against Asthma coalition developed and implemented the Child Asthma Link Line, a telephone-based care coordination and system integration program, which has been in operation since 2001. This study evaluates the effectiveness of the Child Asthma Link Line integration model to improve asthma management by measuring utilization markers of morbidity. Methods. Medicaid Managed Care Organization claims data for 59 children who received the Link Line intervention in 2003 are compared to a matched sample of 236 children who did not receive the Link Line intervention. Children in the two study groups are ages 3 through 12 years and matched on 2003 emergency department visits, age, gender, and race/ethnicity. Primary outcome variables analyzed in this study are emergency department visits, hospitalizations, and office visit claims from the follow-up year (2004). Results. Link Line intervention children were significantly less likely to have follow-up hospitalizations than matched sample children (p = .02). Children enrolled in the Link Line were also more likely to attend outpatient office visits in the follow-up year (p = .045). In addition, Link Line children with multiple emergency department visits in 2003 were significantly less likely to have an emergency department visit in 2004 (p = .046). Conclusion. This coalition-developed, telephone-based, system-level intervention had a significant impact on childhood asthma morbidity as measured by utilization endpoints of follow-up hospitalizations and emergency department visits. Telephone-based care coordination and service integration may be a viable and economic way to impact childhood asthma and other chronic diseases.     

Mobile-based asthma action plans for adolescents

Purpose: To examine feasibility and utilization of a mobile asthma action plan (AAP) among adolescents. Methods: Adolescents (aged 12–17 years) with persistent asthma had their personalized AAP downloaded to a smartphone application. Teens were prompted by the mobile application to record either daily symptoms or peak flow measurements and to record medications. Once data were entered, the application provided immediate feedback based on the teen’s AAP instructions. Asthma Control Test (ACT®) and child asthma self-efficacy scores were examined pre- and post-intervention. Results: Adolescents utilized the mobile AAP a median 4.3 days/week. Participant satisfaction was high with 93% stating that they were better able to control asthma by utilizing the mobile AAP. For participants with uncontrolled asthma at baseline, median (interquartile range) ACT scores improved significantly from 16 (5) to 18 (8) [p?=?0.03]. Median asthma attack prevention self-efficacy scores improved from 34 (3.5) to 36 (5.3) [p?=?0.04]. Conclusions: Results suggest that personalized mobile-based AAPs are a feasible method to communicate AAP instructions to teens.     

Management of Asthma Among Community-Based Primary Care Physicians

Background. Despite significant improvements in asthma treatment and the dissemination of national and international guidelines for asthma management, there are ongoing concerns that suboptimal care is being provided for patients with asthma. Objective. To determine the current practice patterns of asthma care among primary care physicians. Design. A cross-sectional study. Setting. Province of Alberta, Canada (population: 3 million people). Participants. Patients, 5 years of age or older, who had a physician's diagnosis of asthma, and had at least two visits for asthma between 1996 and 2001. Measurement and Results. Charts of 3072 distinct patients (from 45 unique primary care physicians) were reviewed. Previous emergency department visits or hospitalizations were experienced by 20% of the sample. A total of 25% of patients had documented evidence that they had performed spirometry. More than half of the patients had no documented evidence that they had received any form of asthma education; only 2% of the charts indicated that patients received a written action plan. Two thirds of the patients were prescribed an inhaled steroid within 6 months of the last clinic visit. Conclusions. Our study indicates a gap in the provision of asthma education, written action plans, and spirometric testing for patients diagnosed with asthma among primary care physicians.     

“Where people are safe in their own homes:” The interplay of community factors and health among people living with HIV in the Deep South

Abstract

Our aim was to explore the role of community factors in HIV health within the Deep South. We utilized community-based participatory research to qualitatively explore experiences and perceptions of 40 persons living with HIV (age ≥18) regarding their communities and HIV health. Participants identified community factors that were important for their health (e.g. social involvement) and those that were detrimental to their health (e.g. crime). It is important for HIV providers to be aware of the factors that may affect patients’ ability to remain engaged in care. Policymakers should consider the impact that community-level factors have on population health.     

Severe asthma in children: Evaluation and management

Severe asthma in children is associated with significant morbidity. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. It is important to differentiate between severe therapy resistant asthma and difficult-to-treat asthma due to comorbidities. The most common problems that need to be excluded before a diagnosis of severe asthma can be made are poor medication adherence, poor medication technique or incorrect diagnosis of asthma. Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities are clearly addressed. Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard Step 4 asthma therapies according to the guidelines^1,2, should be referred to an asthma specialist with expertise in severe asthma.     

Evaluating a community-based participatory research project for elderly mental healthcare in rural America

The purpose of this evaluation was to explore the collaborative nature of partners in a rural mental health program for the elderly, and to test an adapted method of assessing the collaborative process. Sixteen collaborative partners were interviewed to explore ratings of collaboration across 6 domains identified as critical to participatory research. Results indicate that the context of rural Missouri and uniqueness of the program necessitated an approach to collaboration that began with a top-down approach, but greater community responsibility developed over time. Partners recognized the efforts of the program’s directors to seek input. Most were satisfied with their roles and the degree of success achieved by the program, although several wanted to have more input in the future in some domains, but not in others. Interviews revealed numerous barriers to achieving sustainability. Methods to improve the assessment of collaboration are discussed and areas for improvement are offered.     

Children with asthma and their caregivers help improve written asthma action plans: A pilot mixed-method study

Objective: The objectives of this study were to (a) qualitatively examine caregiver and child feedback about a gold standard written asthma action plan (WAAP), and (b) determine whether having an asthma action plan was associated with child and caregiver self-efficacy in managing an exacerbation. Methods: This was a cross-sectional analysis of structured interviews with 22 children with persistent asthma that collected feedback about the WAAP as well as self-efficacy. An analysis of interviews used the constant comparative method to identify themes of child and caregiver statements. Caregivers completed a questionnaire that measured asthma management self-efficacy, barriers to managing asthma, and belief in the treatment efficacy using validated scales. Results: Approximately 36% of the caregivers reported having a WAAP for their child from their child's pediatrician. Most caregivers stated that having pictures would improve the WAAP, while most children stated that the layout needed to be improved by adding more space between the sections. Caregivers who reported knowing what the asthma action plan was had greater self-efficacy than caregivers who did not (z = ?1.99, p = 0.047). Conclusions: Re-designing the current WAAP layout and including pictures of inhalers may promote patient understanding. Future research needs to examine if a re-designed WAAP improves asthma management of children with asthma and their caregivers.     

肌松剂在危重哮喘抢救中的应用价值

目的探讨肌松剂在危重哮喘抢救中的应用价值。方法面罩充分给氧同时,异丙酚 维库溴铵诱导下经鼻或经口气管插管,然后用咪唑安定30~120mg/d或异丙酚600~2000mg/d和维库溴铵4~20mg/d微量泵维持,用药量及用药时间视病情而定,配合使用抗生素,静脉应用糖皮质激素,适当水化治疗及静脉营养。结果全部病例在给予肌松剂10~15min后,气道压显著下降,双肺喘鸣音明显减少。经5h~7d机械通气,哮喘完全缓解,治疗前后血气指标显著改善(P<0.01)。结论肌松剂在危重哮喘抢救中有显著疗效,应推广应用。     

Religious involvement,social support,and health among African-American women on the east side of detroit

BACKGROUND: A significant body of research suggests that religious involvement is related to better mental and physical health. Religion or spirituality was identified as an important health protective factor by women participating in the East Side Village Health Worker Partnership (ESVHWP), a community-based participatory research initiative on Detroit's east side. However, relatively little research to date has examined the mechanisms through which religion may exert a positive effect on health. OBJECTIVE: The research presented here examines the direct effects of different forms of religious involvement on health, and the mediating effects of social support received in the church as a potential mechanism that may account for observed relationships between church attendance and health. DESIGN: This study involved a random sample household survey of 679 African-American women living on the east side of Detroit, conducted as part of the ESVHWP. MAIN RESULTS: Results of multivariate analyses show that respondents who pray less often report a greater number of depressive symptoms, and that faith, as an important source of strength in one's daily life, is positively associated with chronic conditions such as asthma or arthritis. Tests of the mediating effect of social support in the church indicated that social support received from church members mediates the positive relationship between church attendance and specific indicators of health. CONCLUSIONS: These findings are consistent with the hypothesis that one of the major ways religious involvement benefits health is through expanding an individual's social connections. The implications of these findings for research and practice are discussed.     

Improving the nutritional resource environment for healthy living through community-based participatory research

OBJECTIVES: To build health promotion capacity among community residents through a community-based participatory model, and to apply this model to study the nutritional environment of an urban area to better understand the role of such resources in residents' efforts to live a healthy life. DESIGN: A multiphase collaborative study that inventoried selected markets in targeted areas of high African-American concentration in comparison with markets in a contrasting wealthier area with fewer African Americans. SETTING: A community study set in the Los Angeles metropolitan area. PARTICIPANTS: African-American community organizations and community residents in the target areas. INTERVENTIONS: Two surveys of market inventories were conducted. The first was a single-sheet form profiling store conditions and the availability of a small selection of healthy foods. The second provided detailed information on whether the store offered fruit, vegetables, low-fat dairy products, dried goods and other items necessary for residents to consume a nutritious diet. RESULTS: The targeted areas were significantly less likely to have important items for living a healthier life. The variety and quality of fresh fruit and vegetable produce was significantly lower in the target areas. Such products as 1% milk, skim milk, low-fat and nonfat cheese, soy milk, tofu, whole grain pasta and breads, and low-fat meat and poultry items were significantly less available. CONCLUSIONS: Healthy food products were significantly less available in the target areas. The authors conclude from these results that the health disparities experienced by African-American communities have origins that extend beyond the health delivery system and individual behaviors inasmuch as adherence to the healthy lifestyle associated with low chronic disease risk is more difficult in resource-poor neighborhoods than in resource-rich ones.     

Evaluation of daily home spirometry for school children with asthma: new insights

Home spirometers are useful for monitoring asthma therapy and for research, but the validity of maneuvers in children is in question. We evaluated the quality of PEF, FEV(1), and FVC data obtained from 67 children with persistent asthma who self-administered spirometry at home using the hand-held ndd EasyOne Frontline Spirometer with full expiratory curve data, electronic measurements of maneuver quality, and on-screen incentives. Half were studied in 2003 in one region, and half in 2004 in another region of Southern California. Subjects were followed at home weekly over 2 months and daily over 10 consecutive days. We retained completed spirometry sessions (9,916) consisting of three of six best maneuvers in the morning, afternoon, and evening. Percent compliance, software assessed repeatability and acceptability modified from American Thoracic Society criteria, and visually assessed quality of maneuvers, were compared across daily and weekly follow-up, study regions, and subject characteristics. Compliance was higher for daily (>90%) than for weekly follow-up (>84%), but not significantly different, and was consistent across subject characteristics. The number with two reproducible and acceptable maneuvers was significantly lower in the first than second region for daily (70 vs. 90%) and weekly follow-up (66 vs. 87%). Of 22,926 software accepted maneuvers, 1,944 (8.5%) were visually rejected (variable effort, cough, glottic closure). Maneuver quality was significantly lower for subjects age 9-12 versus 13-18 years, for subjects not taking anti-inflammatory medications, and for subjects with <80% predicted FEV(1). Longitudinal data collection is possible in children with asthma by employing repeated home training and follow-up, and using spirometers with built in quality assurance and incentive software. Region, age, and multiple indicators of persistent asthma, predict ability to perform reliable and accurate lung function maneuvers.