Identifying phenotypes and factors impacting outcomes in older adults with asthma: A research protocol and recruitment results.

Success in testing research outcomes requires identification of effective recruitment strategies in the targeted population. In this paper, we present the protocol for our NIH-funded study as well as success rates for the various recruitment strategies employed. This longitudinal observational study is: developing a phenotyping algorithm for asthma in older adults, exploring the effects of the asthma phenotype and of volatile organic compounds on asthma control, and developing a predictive model of asthma quality of life. A sub-aim is to characterize barriers to successful medication management in older adults with asthma. Individuals are eligible if they are ≥60 years, have a positive response to at least 1 of 6 asthma screening questions, are non-smokers, and demonstrate bronchodilator reversibility or a positive bronchial challenge test with methacholine. Exclusion criteria are smokers who quit <5 years ago or with a >20 pack year smoking history, and those having other chronic pulmonary diseases. Participants (N = 190) complete baseline pulmonary function testing, questionnaires, sputum induction, skin prick testing, and have blood drawn for Vitamin D and Immunoglobulin E. Home environmental assessments are completed including 24-hr particulate and volatile organic compound measurements. At 9-months post-baseline, home spirometry, medication assessment, and assessment of asthma quality of life and asthma control are assessed. At 18-months post-baseline, home spirometry, completion of baseline questionnaires, and a home environmental assessment are completed. We have employed multiple recruitment efforts including referrals from clinical offices, no-cost media events, flyers, and ads. The most successful efforts have been referrals from clinical offices and media events.

Predicting asthma in older adults on the basis of clinical history.

BACKGROUND: The diagnosis of asthma is not always straightforward and can be even more challenging in older adults. Asthma is ideally confirmed by demonstration of variable expiratory airflow limitation. However, many patients with asthma do not demonstrate airflow obstruction nor show bronchodilator reversibility. We aimed to investigate predictors for a positive bronchial challenge test with methacholine in older adults being evaluated for asthma. METHODS: This is a diagnostic accuracy study with a cross-sectional design. Participants ≥60 years with suspected asthma and a negative postbronchodilator response on spirometry were included. All participants underwent a methacholine challenge test (MCT). We assessed the value of standard asthma screening questions and additional clinical questions to predict the MCT results. A multivariable logistic regression model was developed to assess the variables independently impacting the odds of a positive MCT result. RESULTS: Our study included 71 participants. The majority were female (n = 52, 73.2%) and the average age was 67.0 years. Those with a positive MCT (n = 55, 77.5%) were more likely to have wheezing or coughing due to allergens (n = 51, 92.7% vs. n = 12, 75.0%; P = 0.004) and difficulty walking several blocks (n = 14, 25.5% vs. n = 1, 6.3%, P = 0.009). After adjustment, having wheezing or coughing due to allergens (OR = 4.2, 95% CI 1.7-7.8, P = 0.012) remained the only significant independent predictor of a positive MCT. CONCLUSIONS: In older adults with suspected asthma, questioning about wheezing or coughing due to allergens provides a modest independent value to predict a MCT result in those who previously had a negative postbronchodilator response on spirometry.

A novel text message-based motivational interviewing intervention for college students who smoke cigarettes.

INTRODUCTION: Tobacco use disorder is critical among people aged 16 to 25 years. College campuses are prime locations for smoking cessation interventions for young adults. The vast majority of the smoking research with college students has been epidemiological in nature. This study examined a novel motivational interviewing intervention designed for college students, and explored predictors of smoking behavior change. METHODS: A quasi-experimental one group pretest-posttest design with repeated measures was used to evaluate a novel text message-based brief motivational interviewing intervention. The data were collected from undergraduate students (N=33) who smoked cigarettes in Fall 2015. RESULTS: Students' level of autonomy and relatedness needs satisfaction, autonomous motivation, and smoking cessation self-efficacy increased (p < 0.05), and their rate of daily smoking declined (p <0 .05) over time. However, competence need satisfaction, readiness to quit smoking and severity of nicotine addiction remained unchanged. Smoking cessation self-efficacy was the strongest predictor of smoking behavior change in college students. CONCLUSIONS: This study adds to the knowledge on smoking behavior among college students. Preliminary evidence indicates that text message-based motivational interviewing and smoking cessation self-efficacy may help guide successful smoking behavior interventions for college students.

The Relationships of Demographic Characteristics with Diabetes Biomarkers and Physical Activity Adherence in African American Adults.

OBJECTIVE: The objective of this study was to examine the relationships of demographic characteristics with diabetes biomarkers and physical activity adherence in African American adults with type 2 diabetes mellitus. METHODS: Data for this secondary analysis were collected in a controlled trial conducted at an ambulatory internal medicine clinic located in a mid-sized metropolitan area in the southeastern USA. Demographic information was obtained at baseline for all participants receiving a motivational interviewing intervention. Diabetes biomarkers and physical activity adherence were measured at baseline and 3-month follow-up. RESULTS: Being female, older, and having a higher education significantly predicted a decrease in serum glucose over time. Being female and older significantly predicted a slower decrease in body mass index over time. Being younger and more educated significantly predicted probability of improved physical activity adherence. CONCLUSION: Although older African American women had a significant decrease in serum glucose over time, they experienced a slower decrease in their body mass indices and were less likely to adhere to physical activity recommendations. Specific attention should be paid to the demographic characteristics of African Americans with type 2 diabetes mellitus in order to promote optimal clinical outcomes in this vulnerable population. This approach to treatment planning opens a window into the micro-level processes by which social determinants lead to a better response to treatment.

Using motivational interviewing for smoking cessation in primary care.

OBJECTIVES: To compare the effects of resident physician motivational interviewing (MI), resident physician MI plus registered nurse (RN), and the standard of care counseling approach--ask, advise, assess, assist, and arrange follow-up (5 As)--on current smokers' behaviors (readiness to quit, cigarettes smoked per day, current smoking rates), self-efficacy to quit smoking, and nicotine dependence. METHODS: The study design was quasi-experimental pretest/posttest with a comparison group. Pencil/paper measures were completed in the clinic setting at baseline and via telephone approximately 1 and 2 months after the clinic visit. RESULTS: There were no differences among the three groups in the proportion of participants who quit smoking, and the stages of change did not differ among the groups or over time. There was a significant time effect and a decrease in the number of cigarettes smoked per day (F2,160 = 41.04, P < 0.001). Significant group × time interactions were present for self-efficacy (F4,140 = 8.20, P < 0.001), nicotine dependence (F4,140 = 6.22, P < 0.001) and satisfaction with clinician (F4,160 = 3.81, P = 0.006). Post hoc analyses showed that participants in the MI groups smoked fewer cigarettes, had higher self-efficacy, and had lower nicotine dependence scores. Only participants in the MD-plus-RN follow-up group had significant positive changes in satisfaction scores. CONCLUSIONS: Resident physicians who use MI techniques have a tremendous effect on patients' smoking behaviors. When the resident physician and the RN worked together, participants achieved better outcomes.