Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled trial.

Confusion between panic and asthma symptoms can result in serious self-management errors. A cognitive behavior psychophysiological therapy (CBPT) intervention was culturally adapted for Latinos consisting of CBT for panic disorder (PD), asthma education, differentiation between panic and asthma symptoms, and heart rate variability biofeedback. An RCT compared CBPT to music and relaxation therapy (MRT), which included listening to relaxing music and paced breathing at resting respiration rates. Fifty-three Latino (primarily Puerto Rican) adults with asthma and PD were randomly assigned to CBPT or MRT for 8 weekly sessions. Both groups showed improvements in PD severity, asthma control, and several other anxiety and asthma outcome measures from baseline to post-treatment and 3-month follow-up. CBPT showed an advantage over MRT for improvement in adherence to inhaled corticosteroids. Improvements in PD severity were mediated by anxiety sensitivity in CBPT and by depression in MRT, although earlier levels of these mediators did not predict subsequent improvements. Attrition was high (40%) in both groups, albeit comparable to CBT studies targeting anxiety in Latinos. Additional strategies are needed to improve retention in this high-risk population. Both CBPT and MRT may be efficacious interventions for comorbid asthma-PD, and CBPT may offer additional benefits for improving medication adherence.

Exploring family and social context through the electronic health record: Physicians' experiences.

INTRODUCTION: There is ample evidence that social and familial context significantly impacts health. However, family and social history templates typically used in clinical practice exclude prompts to explore important contextual information, such as family dynamics, health beliefs, housing, and neighborhood environment. METHOD: At the Residency Program in Social Medicine at Montefiore Medical Center/Albert Einstein College of Medicine in Bronx, NY, we developed and piloted an expanded family and social information (FSI) template in our electronic health record (EHR) system. After 10 physicians used the FSI template during routine clinical practice, we conducted and qualitatively analyzed transcripts of semistructured interviews to assess their experiences. RESULTS: The major themes of physician's experiences using the FSI template included: expanded thinking (promoted thinking and discussion about contextual information), relevancy to care (highlighted important life events, helpful resource for future care or for team-based care), fragmentation (patient narrative difficult to categorize into discrete sections), and abstract phrasing (prompts too abstract and/or too complex to explore well). Some minor themes (themes that were repeated often, but not consistent in all interviews) were also noted: practice demands, educational purpose, and wish list. DISCUSSION: Within our small sample, we found that an expanded family and social information template broadened physicians' clinical thinking during routine visits. We also found that the structure of the EHR and practice demands create significant barriers to exploring a patient's narrative effectively. Themes identified in this research will inform national efforts to prioritize a contextual and biopsychosocial perspective in EHR systems. (PsycINFO Database Record

Crossing borders: the impact of the California Tobacco Control Program on both sides of the US-Mexico border.

We examined the association between exposure to the California Tobacco Control Program and tobacco-related behaviors and perceptions among adults of Mexican descent. Three cross-sectional population-based surveys were conducted among adults in cities that represent full, partial, and no exposure to the program: San Diego, Calif, Tijuana, Mexico, and Guadalajara, Mexico, respectively. After we controlled for socioeconomic differences, we found significantly different rates of smoking, exposure to environmental tobacco smoke, and smoking bans in the 3 cities. We also observed a parallel gradient of cross-city differences in theoretical mediators of tobacco control. This suggests a significant association among the California Tobacco Control Program, tobacco-control outcomes, and theoretical mediators of these outcomes. Similar programs should be implemented in other regions; they have widespread effects on social norms and behaviors related to smoking and environmental tobacco smoke and can help achieve tobacco control across nations.

Correlates of home smoking bans among Mexican-Americans.

PURPOSE: This study examines the individual and environmental correlates of home smoking bans among a population-based sample of Mexican-Americans. Design. A telephone survey on tobacco use and home policies was conducted using stratified, random sampling of listed phone numbers. SETTING: Surveys were completed by telephone in San Diego, California. SUBJECTS: The sample consisted of San Diego adult residents of Mexican descent (N=1103). MEASURES: The interview included questions on home rules regarding smoking in the household and a number of potential correlates, based on the Behavioral Ecological Model (BEM). This model emphasizes the influence of family, social, and cultural factors on health behaviors. RESULTS: Overall, 90.6% of all respondents reported a ban on smoking in the home. Multivariate analyses indicated that home bans on smoking are more likely among individuals that do not smoke, live with children, are more acculturated to U.S. society, report greater aversion to ETS, and/or report more social pressure against indoor smoking. In contrast, smoking bans are less likely among Mexican Americans who live with smokers. CONCLUSIONS: Individual and environmental factors play a protective role by increasing the likelihood of smoking bans in the home of Mexican-descent individuals. These factors should be considered for the design of interventions to sustain and promote the adoption of smoking bans in the home among this and other populations.