Lynn B Gerald

Interests

Teaching

Grantwriting, research methods

Research

Community based clinical trials; clinical trials; school based health; behavioral and clinical research in asthma and other pulmonary diseases

Courses

Scholarly Contributions

Books

• Gerald, L. B. (2014). Health Disparities in Lung Disease. Springer.
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  Am co-editing this book with Cristine Berry in Pulmonary Medicine. We have solicited all the chapters which are due by March 2013 with planned publication by Fall 2013.
• Gerald, L. B. (2015). Health Disparities in Respiratory Medicine. Springer.
• Gerald, L. B., & Berry, C. E. (2016). Health Disparities in Respiratory Medicine. Switzerland: Humana Press.

Chapters

• Carr, T. F., & Gerald, L. B. (2016). Patient education: How to use a peak flow meter (Beyond the Basics). In UpToDate.
• Carr, T. F., & Gerald, L. B. (2016). Peak expiratory flow rate monitoring in asthma. In UpToDate.
• Carr, T. F., & Gerald, L. B. (2015). Patient education: How to use a peak flow meter (Beyond the Basics). In UpToDate.
• Carr, T. F., & Gerald, L. B. (2015). Peak expiratory flow rate monitoring in asthma. In UpToDate.

Journals/Publications

• Cordova-Marks, F. M., Harris, R., Teufel-Shone, N. I., Norton, B., Mastergeorge, A. M., & Gerald, L. (2019). Characteristics of American Indian Female Caregivers on a Southwest American Indian Reservation. Journal of community health, 44(1), 52-60.
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  American Indian (AI) caregivers have been excluded from national survey efforts. Drawing from a 2012 survey administered on the Hopi Reservation in northern Arizona, 20% of adults are caregivers. More information is needed to guide program development tailored to Hopi needs. In a University-Community collaboration, a 58 question survey was administered to self-identified caregivers of a family member about amount and type of care provided, difficulties, caregiver health, and desired support services. Characteristics of caregivers and their experiences were described. Forty-four (44) female Hopi caregivers were interviewed from June-October 2017, mean age of 59 years (± 12.6) with mean 5.5 year (± 4.4) history of providing care. Over 84% provided care to either a parent or grandparent. Most caregivers provided transportation (93.2%), housework (93.2%), and medical related care (72.7%). Caregivers stated they had difficulties with not having enough time for family and or friends (88.6%), financial burdens (75.0%), and not having enough time for themselves (61.4%). The most frequently identified difficulty was stress (45.5%). Caregivers would like additional services, with 76.7% asking for training. Over 77% would not consider placing their relative in an assisted living facility. Compared to national data, Hopi female caregivers are older, provide more care hours/week, more caregiving duties, and for a longer number of years. Stress is the most reported difficulty, although lower than national levels. As caregivers are resistant to placing the recipient in assisted living, educational efforts should focus on training caregivers to assist the care recipient and decreasing caregiver stress.
• Martin, M. A., Kapheim, M. G., Erwin, K., Ignoffo, S., McMahon, K., OʼRourke, A., Gerald, L. B., Barrett, M., Press, V. G., Darabi, H., & Krishnan, J. A. (2019). Childhood Asthma Disparities in Chicago: Developing Approaches to Health Inequities. Family & community health, 41(3), 135-145.
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  We conducted a needs assessment to develop an evidence-based, locally tailored asthma care implementation plan for high-risk children with asthma in Chicago. Our team of health policy experts, clinicians, researchers, and designers included extensive stakeholder engagement (N = 162) in a mixed-methods community needs assessment. Results showed the lines of communication and collaboration across sectors were weak; caregivers were the only consistent force and could not always manage this burden. A series of recommendations for interventions and how to implement and measure them were generated. Cooperative, multidisciplinary efforts grounded in the community can target wicked problems such as asthma.
• Papp, E. M., Gerald, J. K., Sadreameli, S. C., & Gerald, L. B. (2019). Why Every School Should Have a Stock Inhaler: One Nurse's Experience. American journal of public health, 109(11), 1528-1529.
• Pappalardo, A. A., & Gerald, L. B. (2019). Let Them Breathe: A Plea to Pediatricians to Advocate for Stock Inhaler Policies at School. Pediatrics, 144(1).
• Baker, A., Holbrook, J. T., Yohannes, A., Eakin, M., Sugar, E., Henderson, R., Casper, A., Kaminsky, D., Rae, A., Mathews, A., Que, L., Ramsdell, J., Gerald, L. B., Wise, R., & Hanania, N. (2018). Test performance characteristics of the AIR, GAD-7 and HADS-Anxiety Screening Questionnaire for Anxiety in Chronic Obstructive Pulmonary Disease. Annals of the American Thoracic Society, 15(8), 926-934.
• DiMango, E., Rogers, L., Reibman, J., Gerald, L. B., Brown, M., Sugar, E. A., Henderson, R., & Holbrook, J. T. (2018). Risk Factors for Asthma Exacerbation and Treatment Failure in Adults and Adolescents with Well-controlled Asthma during Continuation and Step-Down Therapy. Annals of the American Thoracic Society, 15(8), 955-961.
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  Although national and international guidelines recommend reduction of asthma controller therapy or "step-down" therapy in patients with well-controlled asthma, it is expected that some individuals may experience worsening of asthma symptoms or asthma exacerbations during step-down. Characteristics associated with subsequent exacerbations during step-down therapy have not been well defined. The effect of environmental tobacco smoke exposure on risk of treatment failure during asthma step-down therapy has not been reported.
• Gerald, J. K., Fisher, J. M., Brown, M. A., Clemens, C. J., Moore, M. A., Carvajal, S. C., Bryson, D., Stefan, N., Billheimer, D., & Gerald, L. B. (2018). School-supervised use of a once-daily inhaled corticosteroid regimen: A cluster randomized trial. The Journal of allergy and clinical immunology.
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  School-supervised use of a once-daily inhaled corticosteroid regimen (supervised therapy) can improve medication adherence and asthma control.
• Gerald, L. B. (2017). Effect of Intranasal Corticosteroids on Allergic Airway Disease in Asthma. Journal of Asthma, Allergy and Clinical Immunology in Practice.
• Gerald, L. B., Lowe, A., Moore, M. A., & Clemens, C. J. (2018). Stock Inhalers for School: New Legislation in the State of ARizona. Pediatric Digest.
• Gerald, L. B., Strother, J., Burkholder, B., & Gerald, J. K. (2018). Translating Research into Health Policy: Stock Albuterol Legislation. Annals of the American Thoracic Society, 15(4), 413-416.
• Goodwin, J. L., Gerald, L. B., Johnson, J. L., & Gerald, J. K. (2018). Use of a disposable valved-holding chamber (spacer) in a school-based asthma trial. The journal of allergy and clinical immunology. In practice, 6(1), 307-309.
• Kobernick, A., Liu, A. H., Bender, B., Lowe, A. A., Morgan, W. J., Gerald, L. B., & Solomon, T. G. (2018). Environmental concerns for children with asthma on the Navajo Nation. Annals of American Thoracic Society, 15(6), 745-753.
• Krishnan, S., Dozor, A. J., Bacharier, L., Lang, J. E., Irvin, C. G., Kaminsky, D., Farber, H. J., Gerald, L., Brown, M., Holbrook, J. T., Wise, R. A., Ryu, J., Bose, S., Yasin, R., Saams, J., Henderson, R. J., Teague, W. G., & , A. L. (2018). Clinical characterization of children with resistant airflow obstruction, a multicenter study. The Journal of asthma : official journal of the Association for the Care of Asthma, 1-7.
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  To characterize a cohort of children with airflow limitation resistant to bronchodilator (BD) therapy.
• Lowe, A. A., Bender, B., Liu, A. H., Solomon, T., Kobernick, A., Morgan, W., & Gerald, L. B. (2018). Environmental Concerns for Children with Asthma on the Navajo Nation. Annals of the American Thoracic Society, 15(6), 745-753.
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  Navajo children living on the reservation have high rates of asthma prevalence and severity. Environmental influences may contribute to asthma on the Navajo Nation and are inadequately understood.
• Patel, M. R., Press, V. G., Gerald, L. B., Barnes, T., Blake, K., Brown, L. K., Costello, R. W., Crim, C., Forshag, M., Gershon, A. S., Goss, C. H., Han, M. K., Lee, T. A., Sweet, S., & Gerald, J. K. (2018). Improving the Affordability of Prescription Medications for People with Chronic Respiratory Disease. An Official American Thoracic Society Policy Statement. American journal of respiratory and critical care medicine, 198(11), 1367-1374.
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  Mounting evidence indicates that out-of-pocket costs for prescription medications, particularly among low- and middle-income patients with chronic diseases, are imposing financial burden, reducing medication adherence, and worsening health outcomes. This problem is exacerbated by a paucity of generic alternatives for prevalent lung diseases, such as asthma and chronic obstructive pulmonary disease, as well as high-cost medicines for rare diseases, such as cystic fibrosis. Affordability and access challenges are especially salient in the United States, as citizens of many other countries pay lower prices for and have greater access to prescription medications.
• Soler, X., Holbrook, J. T., Gerald, L. B., Berry, C. E., Saams, J., Henderson, R. J., Sugar, E., Wise, R. A., & Ramsdell, J. W. (2018). Validity of the Asthma Control Test Questionnaire Among Smoking Asthmatics. The journal of allergy and clinical immunology. In practice, 6(1), 151-158.
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  Smoking asthmatics respond worse to existing asthma therapies and have more asthma symptoms and exacerbations.
• Sonney, J., Insel, K. C., Segrin, C., Gerald, L. B., & Ki Moore, I. M. (2018). Association of Asthma Illness Representations and Reported Controller Medication Adherence Among School-Aged Children and Their Parents. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 31(6), 703-712.
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  This study examined the relationship between asthma illness representations and reported controller medication adherence of school-aged children (6-11 years) with persistent asthma and their parents. Thirty-four parent-child dyads independently reported on asthma controller medication adherence and asthma illness representations. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of reported medication adherence. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported adherence (β = .55, p < .01), and child treatment control was also a significant predictor of parent-reported adherence (β = -.50, p < .01). Child beliefs about medication necessity versus concerns was a significant predictor of child-reported adherence (β = .50, p < .01), and no parent variables reached significance. Although there are similarities between parent and child asthma illness representations, findings indicate that school-aged children develop illness representations somewhat independently from their parents and, therefore, are critical participants in both asthma care and research.
• Dixon, A. E., Castro, M., Gerald, L. B., Holbrook, J. T., Henderson, R. J., Casale, T. B., Irvin, C. G., Black, K., Wise, R. A., Sugar, E. A., & , A. L. (2017). Effect of intranasal corticosteroids on allergic airway disease in asthma. The journal of allergy and clinical immunology. In practice, 5(4), 1125-1128.e3.
• Gerald, L. B., Strother, J., Burkholder, B., & Gerald, J. K. (2017). Translating Research into Health Policy: Stock Albuterol Legislation. Annals of the American Thoracic Society.
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  Not applicable.
• Irani, F., Barbone, J. M., Beausoleil, J., & Gerald, L. (2017). Is asthma associated with cognitive impairments? A meta-analytic review. Journal of clinical and experimental neuropsychology, 39(10), 965-978.
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  Asthma is a chronic disease with significant health burden and socioeconomic and racial/ethnic disparities related to diagnosis and treatment. Asthma primarily affects the lungs, but can impact brain function through direct and indirect mechanisms. Some studies have suggested that asthma negatively impacts cognition, while others have failed to identify asthma-related cognitive compromise. We aimed to conduct a meta-analysis of cognition in individuals with asthma compared to that in healthy controls. We also examined the impact of some key potential moderators.
• Lowe, A. A., Bender, B., Liu, A. H., Solomon, T. G., Kobernick, A., Morgan, W. J., & Gerald, L. B. (2017). Environmental concerns for children with asthma on the Navajo Nation. Annals of American Thoracic Society.
• Oren, E., Bell, M. L., Garcia, F., Perez-Velez, C., & Gerald, L. B. (2017). Promoting adherence to treatment for latent TB infection through mobile phone text messaging: study protocol for a pilot randomized controlled trial. Pilot and feasibility studies, 3, 15.
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  An estimated two billion people, over one third of the world's population, have latent infection with Mycobacterium tuberculosis (LTBI). Patient adherence to LTBI treatment is currently poor given that individuals show no symptoms of illness and may not feel that they are at risk of developing active tuberculosis (TB). Short text messages can serve as a simple reminder to take medications and address barriers to adherence such as forgetfulness and lack of social support.
• Berry, C. E., Billheimer, D., Jenkins, I. C., Lu, Z. J., Stern, D. A., Gerald, L. B., Carr, T. F., Guerra, S., Morgan, W. J., Wright, A. L., & Martinez, F. D. (2016). A Distinct Low Lung Function Trajectory from Childhood to the Fourth Decade of Life. American journal of respiratory and critical care medicine, 194(5), 607-12.
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  Low maximally attained lung function increases the risk of chronic obstructive pulmonary disease irrespective of the subsequent rate of lung function decline.
• Bime, C., Gerald, J. K., Wei, C. Y., Holbrook, J. T., Teague, W. G., Wise, R. A., & Gerald, L. B. (2016). Measurement characteristics of the childhood Asthma-Control Test and a shortened, child-only version. NPJ primary care respiratory medicine, 26, 16075.
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  The childhood Asthma-Control Test (C-ACT) is validated for assessing asthma control in paediatric asthma. Among children aged 4-11 years, the C-ACT requires the simultaneous presence of both parent and child. There is an unmet need for a tool that can be used to assess asthma control in children when parents or caregivers are not present such as in the school setting. We assessed the psychometric properties and estimated the minimally important difference (MID) of the C-ACT and a modified version, comprising only the child responses (C-ACTc). Asthma patients aged 6-11 years (n=161) from a previously completed multicenter randomised trial were included. Demographic information, spirometry and questionnaire scores were obtained at baseline and during follow-up. Participants or their guardians kept a daily asthma diary. Internal consistency reliabilities of the C-ACT and C-ACTc were 0.76 and 0.67 (Cronbach's α), respectively. Test-retest reliabilities of the C-ACT and C-ACTc were 0.72 and 0.66 (intra-class correlation), respectively. Significant correlations were noted between C-ACT scores and ACQ scores (Spearman's correlation r=-0.56, 95% CI (-0.66, -0.44), P
• Carr, T. F., Beamer, P. I., Rothers, J., Stern, D. A., Gerald, L. B., Rosales, C. B., Van Horne, Y. O., Pivniouk, O. N., Vercelli, D., Halonen, M., Gameros, M., Martinez, F. D., & Wright, A. L. (2016). Prevalence of Asthma in School Children on the Arizona-Sonora Border. The journal of allergy and clinical immunology. In practice.
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  Mexican-born children living in the United States have a lower prevalence of asthma than other US children. Although children of Mexican descent near the Arizona (AZ)-Sonora border are genetically similar, differences in environmental exposures might result in differences in asthma prevalence across this region.
• Gerald, J. K., & Gerald, L. B. (2016). The Unfulfilled Promise of School-Centered Asthma Care. The journal of allergy and clinical immunology. In practice, 4(5), 980-1.
• Gerald, J. K., Carr, T. F., Wei, C. Y., Holbrook, J. T., & Gerald, L. B. (2016). Albuterol Overuse: A Marker of Psychological Distress?. The journal of allergy and clinical immunology. In practice, 3(6), 957-62.
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  Albuterol overuse, 3 or more canisters per year, is associated with poor asthma control and frequent exacerbations.
• Gerald, J. K., Gerald, L. B., Vasquez, M. M., Morgan, W. J., Boehmer, S. J., Lemanske, R. F., Mauger, D. T., Strunk, R. C., Szefler, S. J., Zeiger, R. S., Bacharier, L. B., Bade, E., Covar, R. A., Guilbert, T. W., Heidarian-Raissy, H., Kelly, H. W., Malka-Rais, J., Sorkness, C. A., Taussig, L. M., , Chinchilli, V. M., et al. (2016). Markers of Differential Response to Inhaled Corticosteroid Treatment Among Children with Mild Persistent Asthma. The journal of allergy and clinical immunology. In practice, 3(4), 540-6.e3.
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  Inhaled corticosteroids are recommended as first-line therapy for children with mild persistent asthma; however, specific patient characteristics may modify the treatment response.
• Gerald, L. B. (2016). Caregiving on the Hopi Reservation: Findings from the 2012 Hopi Survey of Cancer and Chronic Disease. Journal of Community Health, 1-10.
• Gerald, L. B. (2016). Impact of Supervised Asthma Medication Use on Sleep Outcomes of Elementary School Children. American Journal of Respiratory and Critical Care Medicine, abstract.
• Gerald, L. B. (2016). Mobile Telemedicine Programs in Schools Could Increase Clinician Efficiency and Improve Access to Health Care Among Children with Asthma. American Journal of Respiratory and Critical Care Medicine, abstract.
• Gerald, L. B. (2016). Resistant Airways Obstruction in Children. American Journal of Respiratory and Critical Care Medicine, abstract.
• Gerald, L. B. (2016). Time Motion Study of Health Assistant Activities in Tucson Unified School District Elementary Schools. American Journal of Respiratory and Critical Care Medicine, abstract.
• Gerald, L. B. (2017). Prevalence of asthma in adolescents across the Arizona-Sonora border using ISAAC written and video questionnaires. American Journal of Respiratory and Critical Care Medicine, abstract.
• Gerald, L. B., Snyder, A., Disney, J., Gerald, J. K., Thomas, A., Wilcox, G., & Brown, M. A. (2016). Implementation and Evaluation of a Stock Albuterol Program for Students with Asthma. Annals of the American Thoracic Society, 13(2), 295-6.
• Oren, E., Gerald, L., Stern, D. A., Martinez, F. D., & Wright, A. L. (2016). Self-Reported Stressful Life Events During Adolescence and Subsequent Asthma: A Longitudinal Study. The journal of allergy and clinical immunology. In practice.
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  Although exposure to stressful life events in adolescence has been associated with poor health as measured by number of physicians' visits and symptom scores, little is known regarding stress in adolescence and either concurrent or subsequent asthma.
• Sonney, J. T., Gerald, L. B., & Insel, K. C. (2016). Parent and child asthma illness representations: a systematic review. The Journal of asthma : official journal of the Association for the Care of Asthma, 1-7.
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  The purpose of this article is to synthesize the current literature on parent and child asthma illness representations and their consequent impact on parent-child asthma shared management.
• Weiss, C. H., Krishnan, J. A., Au, D. H., Bender, B. G., Carson, S. S., Cattamanchi, A., Cloutier, M. M., Cooke, C. R., Erickson, K., George, M., Gerald, J. K., Gerald, L. B., Goss, C. H., Gould, M. K., Hyzy, R., Kahn, J. M., Mittman, B. S., Mosesón, E. M., Mularski, R. A., , Parthasarathy, S., et al. (2016). An Official American Thoracic Society Research Statement: Implementation Science in Pulmonary, Critical Care, and Sleep Medicine. American journal of respiratory and critical care medicine, 194(8), 1015-1025.
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  Many advances in health care fail to reach patients. Implementation science is the study of novel approaches to mitigate this evidence-to-practice gap.
• Bender, B. G., Krishnan, J. A., Chambers, D. A., Cloutier, M. M., Riekert, K. A., Rand, C. S., Schatz, M., Thomson, C. C., Wilson, S. R., Apter, A., Carson, S. S., George, M., Gerald, J. K., Gerald, L., Goss, C. H., Okelo, S. O., Mularski, R. A., Nguyen, H. Q., Patel, M. R., , Szefler, S. J., et al. (2015). American Thoracic Society and National Heart, Lung, and Blood Institute Implementation Research Workshop Report. Annals of the American Thoracic Society, 12(12), S213-21.
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  To advance implementation research (IR) in respiratory, sleep, and critical care medicine, the American Thoracic Society and the Division of Lung Diseases from the NHLBI cosponsored an Implementation Research Workshop on May 17, 2014. The goals of IR are to understand the barriers and facilitators of integrating new evidence into healthcare practices and to develop and test strategies that systematically target these factors to accelerate the adoption of evidence-based care. Throughout the workshop, presenters provided examples of IR that focused on the rate of adoption of evidence-based practices, the feasibility and acceptability of interventions to patients and other stakeholders who make healthcare decisions, the fidelity with which practitioners use specific interventions, the effects of specific barriers on the sustainability of an intervention, and the implications of their research to inform policies to improve patients' access to high-quality care. During the discussions that ensued, investigators' experience led to recommendations underscoring the importance of identifying and involving key stakeholders throughout the research process, ensuring that those who serve as reviewers understand the tenets of IR, managing staff motivation and turnover, and tackling the challenges of scaling up interventions across multiple settings.
• Dixon, A. E., & Gerald, L. B. (2015). Promoting weight loss in asthma. Respirology (Carlton, Vic.), 20(2), 179-80.
• Dixon, A. E., Castro, M., Cohen, R. I., Gerald, L. B., Holbrook, J. T., Irvin, C. G., Mohapatra, S., Peters, S. P., Rayapudi, S., Sugar, E. A., Wise, R. A., & , A. L. (2015). Reply: To PMID 25174863. The Journal of allergy and clinical immunology, 136(1), 212-3.
• Harrington, K. F., Zhang, B., Magruder, T., Bailey, W. C., & Gerald, L. B. (2015). The Impact of Parent's Health Literacy on Pediatric Asthma Outcomes. Pediatric allergy, immunology, and pulmonology, 28(1), 20-26.
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  Background: Health literacy has been associated with health disparities in many disease outcomes, including children's asthma. Parents are responsible for most of children's healthcare. Therefore, parents' health literacy may impact children's health outcomes, including asthma control. This study sought to determine the association between parent health literacy and children's asthma control among a cohort of predominately minority urban children aged between 6 and 12 years. Methods: This cross-sectional study assessed children with asthma and their parents at a single outpatient visit. English-speaking parents and their children, aged between 6 and 12 years with physician-diagnosed asthma, were eligible for this study. Healthcare providers assessed asthma control and severity, and parents completed demographic, health literacy, asthma control, and asthma knowledge measures. Children completed a pulmonary function test as part of the Asthma Control Questionnaire (ACQ) scoring. Results: A total of 281 parent-child dyads provided data, with the majority of parents being mothers and African American, with a high school level education or less. Lower parent health literacy was associated with worse asthma control as rated both by the provider (p=0.007) and the ACQ (p=0.013), despite only moderate concordance between ratings (ρ=0.408, p
• Harrington, K., Zhang, B., Magruder, T., Bailey, W. C., & Gerald, L. B. (2014). The Impact of Parent's Health Literacy on Pediatric Asthma Outcomes. Pediatric Allergy, Immunology, and Pulmonology, 26(2), 69-75.
• Smith, L. J., Kalhan, R., Wise, R. A., Sugar, E. A., Lima, J. J., Irvin, C. G., Dozor, A. J., Holbrook, J. T., & , A. L. (2015). Effect of a soy isoflavone supplement on lung function and clinical outcomes in patients with poorly controlled asthma: a randomized clinical trial. JAMA, 313(20), 2033-43.
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  Soy isoflavone supplements are used to treat several chronic diseases, although the data supporting their use are limited. Some data suggest that supplementation with soy isoflavone may be an effective treatment for patients with poor asthma control.
• , A. L., Dixon, A. E., Castro, M., Cohen, R. I., Gerald, L. B., Holbrook, J. T., Irvin, C. G., Mohapatra, S., Peters, S. P., Rayapudi, S., Sugar, E. A., & Wise, R. A. (2014). Efficacy of nasal mometasone for the treatment of chronic sinonasal disease in patients with inadequately controlled asthma. The Journal of allergy and clinical immunology.
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  Chronic sinonasal disease is common in asthmatic patients and associated with poor asthma control; however, there are no long-term trials addressing whether chronic treatment of sinonasal disease improves asthma control.
• Gibson-Young, L., Turner-Henson, A., Gerald, L. B., Vance, D. E., & Lozano, D. (2014). The relationships among family management behaviors and asthma morbidity in maternal caregivers of children with asthma. Journal of family nursing, 20(4), 442-61.
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  Numerous studies have identified the relationship of the family caregiver's perception regarding asthma management and the child's asthma outcomes, although few have examined family caregiver asthma management behaviors. The primary aim of this study was to examine the relationship among family management behaviors and asthma morbidity as perceived by maternal caregivers. The Family Management Style Framework was used to guide the research. Maternal caregivers (N = 101) with school-aged children diagnosed with persistent asthma and living in the United States were recruited from a specialty asthma clinic. When caregivers perceived they were expending much effort on their child's asthma management and were not confident in their ability to perform management activities, the child's asthma outcomes were worse. This is the first study to examine family management behaviors with maternal caregivers of school-aged children with asthma. Findings from this study encourage health care providers to tailor each educational opportunity with families to improve child asthma outcomes. An ongoing effort must be made to include families in asthma management. Health care partnerships between provider and family can lead to improved asthma management.
• Carson, S. S., Goss, C. H., Patel, S. R., Anzueto, A., Au, D. H., Elborn, S., Gerald, J. K., Gerald, L. B., Kahn, J. M., Malhotra, A., A Mularski, R., A Riekert, K., D Rubenfeld, G., E Weaver, T., & Krishnan, J. A. (2013). An official american thoracic society research statement: comparative effectiveness research in pulmonary, critical care, and sleep medicine. American journal of respiratory and critical care medicine, 188(10).
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  Background: Comparative effectiveness research (CER) is intended to inform decision making in clinical practice, and is central to patient-centered outcomes research (PCOR). Purpose: To summarize key aspects of CER definitions and provide examples highlighting the complementary nature of efficacy and CER studies in pulmonary, critical care, and sleep medicine. Methods: An ad hoc working group of the American Thoracic Society with experience in clinical trials, health services research, quality improvement, and behavioral sciences in pulmonary, critical care, and sleep medicine was convened. The group used an iterative consensus process, including a review by American Thoracic Society committees and assemblies. Results: The traditional efficacy paradigm relies on clinical trials with high internal validity to evaluate interventions in narrowly defined populations and in research settings. Efficacy studies address the question, "Can it work in optimal conditions?" The CER paradigm employs a wide range of study designs to understand the effects of interventions in clinical settings. CER studies address the question, "Does it work in practice?" The results of efficacy and CER studies may or may not agree. CER incorporates many attributes of outcomes research and health services research, while placing greater emphasis on meeting the expressed needs of nonresearcher stakeholders (e.g., patients, clinicians, and others). Conclusions: CER complements traditional efficacy research by placing greater emphasis on the effects of interventions in practice, and developing evidence to address the needs of the many stakeholders involved in health care decisions. Stakeholder engagement is an important component of CER.
• Harrington, K. F., Haven, K. M., Bailey, W. C., & Gerald, L. B. (2013). Provider Perceptions of Parent Health Literacy and Effect on Asthma Treatment Recommendations and Instructions. Pediatric allergy, immunology, and pulmonology, 26(2).
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  Little is known about how pediatric providers assess parental health literacy, how concordant they are with validated measures of health literacy, and how these perceptions may influence treatment recommendations, how instructions are given or how reliable they perceive parents to be in carrying out instructions. Two hundred and eighty-one parents of 6-12-year-old asthma patients attending a pediatric clinic visit were recruited to a cross-sectional study of health literacy and asthma outcomes. Fourteen pediatric healthcare providers participated. Parents completed surveys that included 2 measures of health literacy: the Test of Function Health Literacy in Adults (TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM). Immediately postvisit, pediatric providers completed a brief survey asking their assessment of the parent's health literacy and how it impacted treatment instructions and recommendations. Kappa statistics tested concordance; chi square and logistic regression tested associations among provider ratings, rating concordance, and demographic factors. Six providers were interviewed regarding the bases for their ratings. Providers
• Harrington, K. F., Haven, K. M., Nuño, V. L., Magruder, T., Bailey, W. C., & Gerald, L. B. (2013). Parent report and electronic medical record agreement on asthma education provided and children's tobacco smoke exposure. The Journal of asthma : official journal of the Association for the Care of Asthma, 50(9).
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  Abstract Objective: To examine the concordance between parent report and electronic medical record documentation of asthma health education provided during a single clinic visit and second-hand tobacco smoke exposure among children with asthma. Methods: Parents of children with asthma were recruited from two types of clinics using different electronic medical record systems: asthma-specialty or general pediatric health department clinics. After their child's outpatient visit, parents were interviewed by trained study staff. Interview data were compared to electronic medical records for agreement in five categories of asthma health education and for the child's environmental tobacco smoke exposure. Kappa statistics were used to identify strength of agreement. Chi square and t-tests were used to examine differences between clinic types. Results: Of 255 parents participating in the study 90.6% were African American and 96.1% were female. Agreement was poor across all clinics but was higher within the asthma specialty clinics than the health department clinics for smoke exposure (κ = 0.410 versus 0.205), asthma diagnosis/disease process (κ = 0.213 versus -0.016) and devices reviewed (κ = 0.253 versus -0.089) with parents generally reporting more education provided. For the 203 children with complete medical records, 40.5% did not have any documentation regarding smoking exposure in the home and 85.2% did not have any documentation regarding exposure elsewhere. Conclusions: We found low concordance between the parent's report and the electronic medical record for smoke exposure and asthma education provided. Un- or under-documented smoke exposure and health education have the potential to affect continuity of care for pediatric patients with asthma.
• McCallister, J. W., Holbrook, J. T., Wei, C. Y., Parsons, J. P., Benninger, C. G., Dixon, A. E., Gerald, L. B., & Mastronarde, J. G. (2013). Sex differences in asthma symptom profiles and control in the American Lung Association Asthma Clinical Research Centers. Respiratory medicine, 107(10).
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  Important differences between men and women with asthma have been demonstrated, with women describing more symptoms and worse asthma-related quality of life (QOL) despite having similar or better pulmonary function. While current guidelines focus heavily on assessing asthma control, they lack information about whether sex-specific approaches to asthma assessment should be considered. We sought to determine if sex differences in asthma control or symptom profiles exist in the well-characterized population of participants in the American Lung Association Asthma Clinical Research Centers (ALA-ACRC) trials.
• Nguyen, J. M., Holbrook, J. T., Wei, C. Y., Gerald, L. B., Teague, W. G., & Wise, R. A. (2013). Validation and psychometric properties of the Asthma Control Questionnaire among children. The Journal of allergy and clinical immunology.
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  The Asthma Control Questionnaire (ACQ) is a patient-centered tool for evaluating asthma control. It has been validated in adults, but not well-validated among children.
• Gerald, L., Gerald, J. K., McClure, L. A., Harrington, K. F., Moore, T., Hernández-Martínez, A. C., & Gerald, L. B. (2012). Measurement characteristics of the pediatric asthma health outcome measure. The Journal of asthma : official journal of the Association for the Care of Asthma, 49(3).
  More info

  The Pediatric Asthma Health Outcome Measure (PAHOM) was designed to measure quality-adjusted life years (QALYs) in children with asthma. Our objective was to compare parent- and child-reported PAHOM scores to each other, to parent-reported scores on the Juniper Asthma Control Questionnaire (ACQ), and to physician-rated asthma control.
• Gerald, L., Gerald, J. K., Grad, R., Bailey, W. C., & Gerald, L. B. (2010). Cost-effectiveness of school-based asthma screening in an urban setting. The Journal of allergy and clinical immunology, 125(3).
  More info

  Much has been done to promote population-based childhood asthma screening; however, concerns remain regarding its cost-effectiveness.
• Gerald, L., Gerald, J. K., Sun, Y., Grad, R., & Gerald, L. B. (2009). Asthma morbidity among children evaluated by asthma case detection. Pediatrics, 124(5).
  More info

  Population-based asthma detection is a potential strategy to reduce asthma morbidity in children; however, the burden of respiratory symptoms and health care use among children identified by case detection is not well known.
• Gerald, L., Grad, R., McClure, L., Zhang, S., Mangan, J., Gibson, L., & Gerald, L. B. (2009). Peak flow measurements in children with asthma: what happens at school?. The Journal of asthma : official journal of the Association for the Care of Asthma, 46(6).
  More info

  Self-monitoring of symptoms or peak flow monitoring (PFM) is recommended for all asthma patients and is commonly included in asthma management plans. Limited data are available documenting PFM outcomes in school settings.

Presentations

• Gerald, L. B. (2018, October). Asthma Outcomes in School Age Navajo Children in Tuba City, AZ. Navajo Nation Human Research Review Board Conference. Window Rock, AZ.
• Labedz, S., Albert, R., Avdalovic, M., Bellham, S., Bracken, N., Castex, J., David, S., Dixon, A., Drummond, M., Erwin, K., Flores, V., Folz, R., Gallardo, R., Gerald, L. B., Hanley, M., HArt, M., Hatipoglu, M., Mulawski, R., Ouelette, D., , Pinto-Plata, V., et al. (2018, May). Feasibility of Electronic Health Records to Identify Participants for a Multi-Center Clinical Effectiveness Trial in COPD. American Thoracic Society. Dallas, TX.
• Lowe, A., Gerald, J. K., Black, S., Begay, J., Phan, H., Bender, B., & Gerald, L. B. (2018, May). Caregiver Reported Asthma Outcomes of School Age Navajo Children in Tuba City, AZ. American Thoracic Society. Dallas, TX.
• Lowe, A., Gerald, J. K., Clemens, C. J., & Gerald, L. B. (2019, June). Implementation for a County Wide Stock INhaler Program for Schools in Pima County, AZ. Arizona Academy of Pediatrics. Sedona, AZ.
• Lowe, A., Gerald, J. K., Clemens, C. J., & Gerald, L. B. (2019, May). Implementation of a County Wide Stock INhaler Program in Pima County, Arizona. American Thoracic Society International Conference. Dallas, TX.
• Gerald, J. K., Fisher, J., Billheimer, D. D., Brown, M., Clemens, C. J., Moore, M. A., & Gerald, L. B. (2018, May). Controller medication prescribing and adherence among medicaid insured children enrolled in the supervised asthma medicine in schools study. American Thoracic Society International Conference. San Diego, CA: American Thoracic Society.
• Gerald, J. K., Fisher, J., Billheimer, D., Brown, M., Clemens, C. J., Moore, M. A., & Gerald, L. B. (2018, May). Controller Medication Prescribing and Adherence among Medicaid Insured Children Enrolled in the Supervised Asthma Medicine in Schools Study. American Thoracic Society International Conference. San Diego.
• Gerald, J. K., Hallmark, B., Billheimer, D. D., Martinez, F., & Gerald, L. B. (2018, May). Are hispanic children of mexican origin less responsive to ICS treatment than non-hispanic white children: A Meta-Analysis of CARE trials. American Thoracic Society International Conference. San Diego, CA: American Thoracic Society.
• Gerald, J. K., Hallmark, B., Billheimer, D., Martinez, F., & Gerald, L. B. (2018, May). Are Hispanic Children of Mexican Origin Less Responsive to ICS treatment than non-Hispanic White Children? A Meta-Analysis of CARE Trials.. American Thoracic Society International Conference. San Diego, California.
• Lowe, A., Cardenas, K. R., Snyder, A., Clemens, C. J., Gerald, J. K., & Gerald, L. B. (2018, Fall). The Pima County Stock Inhaler for Schools Program: Using Policy to Improve Child Health. Oregon Public Health Association. Portland Oregon: Oregon Public Health Association.
• Lowe, A., Garcia, D. L., Stern, D., Gerald, L. B., & Bime, C. (2018, May). Feasibility of home based exercise intervention with remote guidance for obese asthmatics. American Thoracic Society International Conference. San Diego, CA: American Thoracic Society.
• Lowe, A., Garcia, D. L., Stern, D., Gerald, L. B., & Bime, C. (2018, May). Home based exercise intervention versus remote asthma care guidance via telephone/text message in obese asthmatics. American Thoracic Society International Conference. San Diego, CA: American Thoracic Society.
• Lowe, A., Nez, P., Bender, B., & Gerald, L. B. (2018, Fall). Environmental and social determinants of pediatric asthma from the perspective of Navajo families living on the Navajo reservation: A Pilot Study. American Public Health Association. San Diego, CA: APHA.
• Trivedi, M., Hoque, S., Rosal, M., Biebel, K., Pbert, L., & Gerald, L. B. (2018, May). Barriers and facilitators to real-world implementation of supervised asthma therapy in school: A qualitative study of school nurse perspectives. American Thoracic Society International Conference. San Diego, CA: American Thoracic Society.
• Andrade, R. Y., Gerald, L. B., Bryson, D., Govindarajan, L., Healy, E., Taren, D. L., & Thomas, A. (2017, Nov). Development of the Stock Inhaler Training for School Personnel: A Course for Use in Pima County Schools. American Public Health Association International Meeting. Atlanta, GA: American Public Health Association.
• Gerald, J. K., Brown, M., Fisher, J., Billheimer, D. D., Clemens, C. J., Moore, M. A., Carvajal, S. C., Bryson, D., Stefan, N., & Gerald, L. B. (2017, May). Supervised Medicine in Schools: The SAMS Study. American Thoracic Society International Conference. Washington, DC: American Thoracic Society.
• Lowe, A., Bender, B., Liu, A., Solomon, T. G., Kobernick, A., Morgan, W. J., Nez, P., & Gerald, L. B. (2017, October). Asthma severity determinants and needs assessment in children living on the Navajo Nation: A pilot study. Navajo Nation Human Research Review Board Conference. Window Rock, AZ: Navajo Nation Human Research Review Board.
• Lowe, A., Gerald, J. K., Fisher, J., Billheimer, D. D., Carvajal, S. C., & Gerald, L. B. (2017, May). Among children with asthma, greater acculturation is associated with having a medical home. American Thoracic Society International Conference. Washington, DC: American Thoracic Society.
• Oren, E., Barrett, E., Fisher, J., Billheimer, D. D., Laudenslager, M., & Gerald, L. B. (2017, May). Hair Biomarkers Among Middle-School Children in Relation to School Stress and Asthma. Society for Behavioral Medicine International Conference. San Diego, CA: Society for Behavioral Medicine.
• David*, S., Gerald, L. B., Jenkins, I., Clemens, C. J., Brown, M. A., Billheimer, D., Goodwin, J., Johnson, D., Bryson, D., & Gerald, J. K. (2015, May). School-Based Asthma Management Programs Could Provide a Source of Care for Children Who Otherwise Lack Access. American Thoracic Society. Denver, CO: American Thoracic Society.
• Oren, E., Gerald, L. B., Stern, D., Wright, A. L., & Martinez, F. (2015, May). Self-reported Stressful Life Events During Adolescence and Asthma. American Thoracic Society. Denver, CO.

Poster Presentations

• Gerald, L. B., Bender, B., Phan, H., Begay, J., Black, S., Gerald, J. K., & Lowe, A. A. (2019, Fall). Caregiver Reported Asthma Outcomes of School-Age Navajo Children in Tuba City, Arizona.. American Thoracic Society (ATS) Annual ConferenceAmerican Thoracic Society (ATS).
• Oren, E., Combs, D. A., Fisher, J., Goodwin, J., Billheimer, D. D., Gerald, J. K., Clemens, C. J., Brown, M. A., & Gerald, L. B. (2016, May). Impact of supervised asthma medication use on sleep outcomes of elementary school children. 2016 International Meeting of the American Thoracic Society. San Francisco, CA.
• Mpody, C., Stern, D., Gerald, L. B., Morgan, W. J., Martinez, F., Wright, A. L., & Oren, E. (2017, April). Early caregiver stress and child's subsequent lung function through early adulthood: a longitudinal study from birth to 32 years of age. MEZCOPH Public Health Research Forum. Tucson, AZ: MEZCOPH.
• Oren, E., Oren, E., Gerald, L. B., Oren, E., Combs, D. A., Combs, D. A., Brown, M. A., Combs, D. A., Fisher, J., Fisher, J., Fisher, J., Clemens, C. J., Goodwin, J., Goodwin, J., Goodwin, J., Gerald, J. K., Billheimer, D. D., Billheimer, D. D., Billheimer, D. D., , Billheimer, D. D., et al. (2016, May). Impact of supervised asthma medication use on sleep outcomes of elementary school children. 2016 International Meeting of the American Thoracic Society. San Francisco, CA.
• Berry, C. E., Berry, C. E., Berry, C. E., Lu, Z. J., Lu, Z. J., Lu, Z. J., Jenkins, I. C., Jenkins, I., Jenkins, I. C., Billheimer, D., Billheimer, D., Billheimer, D., Stern, D. A., Stern, D., Stern, D. A., Gerald, L. B., Gerald, L. B., Gerald, L. B., Carr, T. F., , Carr, T. F., et al. (2015, May). Lung Function Trajectories in the Tucson Children's Respiratory Study. American Thoracic Society. Denver, CO: American Thoracic Society.
• Gerald, J. K., Brown, M. A., Clemens, C. J., Jenkins, I., Fisher*, J., Billheimer, D., Goodwin, J., Johnson, D., Bryson, D., Snyder*, A., & Gerald, L. B. (2015, May). Association Between BMI and Baseline Demographic Characteristics among Hispanic Children with Asthma. American Thoracic Society. Denver, CO: American Thoracic Society.
• Ghazala*, L., Ghazala*, L., Gordon, J. S., Gordon, J. S., Berry, C. E., Berry, C. E., Bime, C., Bime, C., Gerald, L. B., Gerald, L. B., Golden*, T., Golden*, T., Sekhon*, K., & Sekhon*, K. (2015, October). Cross-section survey of electronic cigarette use among ambulatory COPD patients. CHEST.
• Oren, E., Gerald, L. B., Stern, D., Wright, A. L., & Martinez, F. (2015, May). Self-reported Stressful Life Events During Adolescence and Asthma. American Thoracic Society. Denver, CO: American Thoracic Society.
• Valencia*, C., Gerald, L. B., Jenkins, I., Fisher*, J., Billheimer, D., Moore, M. A., Goodwin, J., Aguilar, P., Bryson, D., Johnson, D., & Gerald, J. K. (2015, May). Association Between Health Insurance Status and Clinical and Demographic Characteristics Among Hispanic Children with Asthma. American Thoracic Society. Denver, CO: American Thoracic Society.