Respiratory Disease

The relationship between air pollution and asthma outcomes among students will be studied by deploying personal monitoring and novel wearable technologies. Outdoor and indoor low-cost sensor networks will be established throughout Tucson schools to characterize spatiotemporal patterns of air pollution and develop machine learning-based prediction models. This project was funded by the University of Arizona.

This study will evaluate the impact of a multi-site green playground renovation program on academic performance (test scores, absenteeism, graduation rate) and health outcomes (respiratory health, physical activity, body mass index) in New York City (NYC) students employing a quasi-experimental study design. This project was funded by the Robert Wood Johnson Foundation. 

This a pilot clinical trial that seeks to determine the feasibility of dispensing inhaled corticosteroids in the emergency department and supervising their use in the school setting among children with asthma. The trial will be conducted at three clinical sites of the Pediatric Emergency Care Applied Research Network (PECARN). If this trial is successful, we plan to conduct a larger multi center trial to determine whether the intervention cost-effectively reduces exacerbation risk among elementary-age children with mild-to-moderate asthma. This project was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. 

Asthma prevalence among Navajo children is 2 times that of the general population and is fueled by disparities including poverty, environmental pollutants, and minimally accessible healthcare. This project on the Navajo Nation will address these disparities using a community-based intervention targeting healthcare providers, schools, parents, children, and community members. This project was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. 

This is a clinical trial pilot study to examine the feasibility of conducting a large multicenter trial of dispensing inhaled corticosteroids in the emergency department (ED) and supervising their use in the school setting in children with asthma. Kurt Denninghoff is co-principal investigator for this project. 

Abstract not available. 

While inhaled corticosteroids (ICS) are recommended for children with asthma, our experience suggests that Hispanic patients, particularly those of Mexican-origin, may be less responsive to ICS than non-Hispanic whites. To investigate this question, we used data from three Childhood Asthma Research and Education Network (CARE) multi-center trials that used ICS as a primary intervention, enrolled pre-school children with asthma-like symptoms, particularly severe wheeze, and whose Hispanic population was predominately of Mexican-origin. We harmonized data from three clinical trials by using the original data to construct comparable variables across the 3 studies. Data were available from 332 non-Hispanic white and 136 Hispanic white children. Our primary outcome variable, obtained from study diaries, was the fraction of asthma episode days.  The results of this analysis will help inform the treatment of pre-school children with asthma-like symptoms. This project was sponsored by the University of Arizona Health Sciences Health Data and Analytics Program. 

Located in the Mel and Enid Zuckerman College of Public Health at the University of Arizona and funded by the state tax on tobacco products, The Arizona Smokers’ Helpline (ASHLine) is one of over 50 quitlines across the United States. Established in 1995, it is also one of the oldest and most seasoned quit lines in existence.  As a member of the North American Quitline Consortium, ASHLine is actively engaged in collaborations, research, evaluation and quality improvement to assure all Arizonans have access to high quality, evidence-based tobacco cessation services and support. Nationally, quit rates reported among North American quit lines vary, averaging around 30%.  The Arizona Smokers’ Helpline (ASHLine) has been helping people quit tobacco since its inception in 1995. We are a comprehensive quitline, offering free telephone (both reactive and proactive) and web-based quit services and four to twelve weeks Nicotine Replacement Therapy (NRT). In addition, we have fax and electronic provider referral program and provide free training and technical assistance to healthcare providers and community partners statewide. The Arizona Smokers’ Helpline (ASHLine) is a service entity well-positioned to contribute to ongoing tobacco control efforts by providing effective, evidence-based support to individuals in their effort to end tobacco use.

More than four million people with asthma live outside of urban areas, and most are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Rural health disparities for children with asthma include poverty, limited access to care, and environmental challenges including high levels of outdoor and indoor particulate exposure. The Asthma Toolkit program has translated evidence-based asthma care into both rural and urban primary care practices. Although this program has produced evidence of increased guidelines-concordant care, much room exists for improvement. We believe that by deploying Asthma Toolkit training in a larger program that includes community, school, and family engagement, quality of care and health outcomes can be improved for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage three communities on the Navajo Nation to build a successful collaboration (U34); and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program (U01). During the initial empowerment phase, we will solidify relationships with community stakeholders including patients, parents, community leaders, hospital administrators, schools, and providers. A group of stakeholder advisors will be created to inform and guide the subsequent study.  In the second (U01) phase, we will employ a step wedge, randomized trial design to test the capacity of the Community Asthma Toolkit program to improve care and outcomes.  The provider component will include comprehensive training in evidence-based pediatric asthma care. The school component will work to improve capacity to identify pediatric asthma and facilitate communication between school, family, and provider. The hospital component will help provide structured communication between hospital clinicians and primary care providers to improve outpatient management and prevent unnecessary urgent care utilization. Finally, the air quality component will assess community and provider concerns about indoor and outdoor air quality and determine potential methods to measure and reduce environmental risks to children with asthma. The final trial will be modified in accord with stakeholder input during the engagement phase. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care in rural children.

The American Lung Association Airways Clinical Research Centers (ACRC) network is a network of asthma and airways experts with access to a nationwide and demographically representative study population, for the purpose of decreasing the prevalence, morbidity and mortality of asthma and COPD. The basic activities of the network and its data coordinating center include:  Developing a collective data base of well characterized patients with asthma and COPD who can serve as potential research participants;  Collecting core data from recruited participants;  Communicating information gained from network activities to local Lung Associations and the populations they serve;  Participating interactively in developing grant and contract proposals. Such proposals may be extensions of initial projects proposed in the applications of individual centers, or may involve emerging new priorities that arise as a consequence of developments within the field.  Participate in development of presentations and publications based on network research.

Asthma is a common chronic condition among children that is associated with significant morbidity. Because medication non-adherence is an important cause of excess morbidity, the National Asthma Education and Prevention Program guidelines have called for the development of more effective adherence programs.  Schools represent a logical setting where adherence programs could reach the inner-city, low-income, and ethnically diverse populations that have the highest morbidity and lowest adherence.  A recent clinical trial demonstrated that supervised therapy of daily controller medication at school increased medication adherence and asthma control among primarily African-American students in urban, low-income elementary schools.  This study aims to evaluate:  (1) the effectiveness of supervised therapy when administered by the community under real world conditions via a randomized controlled trial of 500 children with asthma in a large urban, predominantly Hispanic school system;  (2) the cost-effectiveness of supervised therapy from the societal perspective using dollars per quality-adjusted life year (QALY) gained; and 3) the program’s implementation fidelity, optimal delivery mechanisms, and construct validity via a comprehensive process evaluation.  Supervised therapy is hypothesized to be both an effective and cost-effective mechanism to improve population-level asthma control among students with asthma.  This project will provide critical information regarding the program’s value, feasibility, and sustainability within communities with large asthma burden.  In addition, it will provide important recommendations to accelerate the adoption of guideline-based care for students with asthma in urban, low-income, and ethnically diverse populations.  With this information, policymakers can optimize the use of scarce public health resources by adopting programs that efficiently maximize child health. Funding for this study came from the National Heart, Lung, and Blood Institute. Also, this study is supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp and product donation from Thayer Medical Corporation.

The goal of this project is to 1) to demonstrate utility and feasibility of detection of LTBI among migrant farmworkers, and to compare outcomes in the US and Mexico and; 2)To assess follow-up of workers detected with LTBI and ability to link individuals to care. Through additional funding, we have been able to expand the work to include further care for participating migrant farmworkers in conjunction with the Migrant clinicians Network.

The goal of this project is to examine the association between stress and asthma morbidity, using our preliminary work from the Children’s Respiratory Study, and within the context of an ongoing school-base randomized clinical trial, to determine to what degree variations in asthma control and morbidity are associated with chronic school stressors. Eyal Oren was a contributor on this project but has since left the University of Arizona. 

The goal of this project is to determine whether texting can serve as a low cost technology for improving low LTBI adherence rates. This work is being completed in partnership with the Pima County Health Department TB Clinic in Tucson, AZ. Specifically, the project will focus on these aims: Aim 1. To determine the effectiveness of text reminders for improving adherence in latent TB patients using a randomized controlled single blinded trial. Aim 2. To establish the costs associated with text messaging. Aim 3. To determine patient experiences with the texting intervention. You can learn more about TXT4MED and its progress at http://txt4med.arl.arizona.edu  

Abstract not available.  Eric Lutz was a contributor on this project but has since left the University of Arizona. 

Investigating Respiratory Protection for Firefighters Assessment of CBRN Canisters during Firefighter Overhaul in live fire exposure assessment in partnership with Northwest Fire Department.

  This is a K25 application for a mentored quantitative research scientist. Much of my research effort this year was focused on developing the preliminary data, and working with my mentoring team which includes: Fernando Martinez, Duane Sherrill, Lynn Gerald, Eric Betterton, Anne Wright, and Andrew Comrie. We have submitted one paper and one abstract. Research: Epidemiological analyses of respiratory outcomes and traffic pollutant exposures. Training: This grant provide training for Dr. Beamer. She has been accepted to the AzCRTP program. I completed 5 courses last year. For this project I will serve as Ms. Sugeng's primary sponsor. The main objectives of this project is to quantify pesticides in farmworker homes, understand how they are getting into the home and what are important characteristics of the pesticides and the homes to assess in future studies. RESEARCH: Ms. Sugeng has collected samples from 21 farmworker homes. They have been analyzed by Battelle Laboratories and we are currently in the process of assessing which factors were most important to their detection in the homes. SERVICE: We collaborated with Campesinos sin Fronteras to recruit participants. Each household will also receive the results of the analyses in their homes. TRAINING: This grant is primarily a training grant for Ms. Sugeng as it is her MS and dissertation work.   This is a K25 application for a mentored quantitative research scientist. Much of my research effort this year was focused on developing the preliminary data, and working with my mentoring team which includes: Fernando Martinez, Duane Sherrill, Lynn Gerald, Eric Betterton, Anne Wright, and Andrew Comrie. We have submitted one paper and one abstract. Research: Epidemiological analyses of respiratory outcomes and traffic pollutant exposures. Training: This grant provide training for Dr. Beamer. She has been accepted to the AzCRTP program. I completed 5 courses last year. For this project I will serve as Ms. Sugeng's primary sponsor. The main objectives of this project is to quantify pesticides in farmworker homes, understand how they are getting into the home and what are important characteristics of the pesticides and the homes to assess in future studies. RESEARCH: Ms. Sugeng has collected samples from 21 farmworker homes. They have been analyzed by Battelle Laboratories and we are currently in the process of assessing which factors were most important to their detection in the homes. SERVICE: We collaborated with Campesinos sin Fronteras to recruit participants. Each household will also receive the results of the analyses in their homes. TRAINING: This grant is primarily a training grant for Ms. Sugeng as it is her MS and dissertation work.

The ALA‑ACRC consists of 18 clinical centers and a data coordinating center who have the mission of improving asthma care through clinical research in diverse populations. The ALA‑ACRC conducts various clinical studies related to asthma. Core funding was provided by the American Lung Association and funding for individual protocols was provided by NIH, industry partners, and foundations.

This study is an NIH/NHLBI funded project that is examining the effectiveness of a school based hand sanitizer program on asthma exacerbations in elementary school children.