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.
• Mangan, J. M., Merkle, S., & Gerald, L. B. (2010). Asthma in the Schools. In Asthma. Springer, Boston, MA. doi:10.1007/978-0-387-78285-0_14
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  As other chapters in this text have illustrated, asthma is affected by a myriad of social and economic factors. It is also greatly influenced by factors in the physical environment of a person with asthma. As children spend a significant amount of time at school, the conditions at school are important for their asthma control. For example, they may experience asthma symptoms or exacerbations while at school and need to take medication. Moreover, they may need to use preventive medication before engaging in physical education activities or take steps to avoid other asthma triggers throughout the day. These precautions often require support from school administrators and assistance from school staff.
• Gerald, L. B., & Mangan, J. M. (2008). Chapter 54 – Evaluating Individual and Program Outcomes. In Asthma. Elsevier Inc. doi:10.1016/B978-032304289-5.10054-2

Journals/Publications

• Lowe, A. A., Gerald, J. K., Clemens, C., Gaither, C., & Gerald, L. B. (2022). Medication Administration Practices in United States' Schools: A Systematic Review and Meta-synthesis. The Journal of school nursing : the official publication of the National Association of School Nurses, 38(1), 21-34.
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  Schools often provide medication management to children at school, yet, most U.S. schools lack a full-time, licensed nurse. Schools rely heavily on unlicensed assistive personnel (UAP) to perform such tasks. This systematic review examined medication management among K-12 school nurses. Keyword searches in three databases were performed. We included studies that examined: (a) K-12 charter, private/parochial, or public schools, (b) UAPs and licensed nurses, (c) policies and practices for medication management, or (d) nurse delegation laws. Three concepts were synthesized: (a) level of training, (b) nurse delegation, and (c) emergency medications. One-hundred twelve articles were screened. Of these, 37.5% (42/112) were comprehensively reviewed. Eighty-one percent discussed level of training, 69% nurse delegation, and 57% emergency medications. Succinct and consistent policies within and across the United States aimed at increasing access to emergency medications in schools remain necessary.
• Carvajal, S. C., Wilkinson-Lee, A. M., Gerald, L. B., Dubinsky, E., McClelland, D. J., Van Gorden, N., & Lohr, A. M. (2021). Updating Search Strategies for Literature Reviews with OUR2D2: An Open Source Computer Application. Journal of the Medical Library Association.
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  Background: While writing a scoping review, we needed to update our search strategy. We wanted to capture articles generated by our additional search terms and articles published since our original search. Simultaneously, we strove to optimize project resources by not re-screening articles that had been captured in our original results. Case Presentation: In response, we created Open Update Re-run Deduplicate (OUR2D2), a computer application that allows the user to compare search results from a variety of library databases. OUR2D2 supports Extensible Markup Language (XML) files from EndNote and comma-separated values (CSV) files using article titles for comparisons. We conducted unit tests to ensure appropriate functionality as well as accurate data extraction and analysis. We tested OUR2D2 by comparing original and updated search results from PubMed, Embase, Clarivate Web of Science, CINAHL, Scopus, ProQuest Dissertation and Theses, and Lens and estimate that this application saved 21 hours of work during the screening process. Conclusions: OUR2D2 could be useful for individuals seeking to update literature review strategies across fields without re-screening articles from previous searches. Because the OUR2D2 source code is freely available with a permissive license, we recommend this application for researchers conducting literature reviews who need to update their search results over time, want a powerful and flexible analysis framework, and may not have access to paid subscription tools.
• Georas, S. N., Wright, R. J., Ivanova, A., Israel, E., LaVange, L. M., Akuthota, P., Carr, T. F., Denlinger, L. C., Fajt, M. L., Kumar, R., O'Neal, W. K., Phipatanakul, W., Szefler, S. J., Aronica, M. A., Bacharier, L. B., Burbank, A. J., Castro, M., Crotty Alexander, L., Bamdad, J., , Cardet, J. C., et al. (2021). The Precision Interventions for Severe and/or Exacerbation-Prone (PrecISE) Asthma Network: An overview of Network organization, procedures, and interventions. The Journal of allergy and clinical immunology.
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  Asthma is a heterogeneous disease, with multiple underlying inflammatory pathways and structural airway abnormalities that impact disease persistence and severity. Recent progress has been made in developing targeted asthma therapeutics, especially for subjects with eosinophilic asthma. However, there is an unmet need for new approaches to treat patients with severe and exacerbation-prone asthma, who contribute disproportionately to disease burden. Extensive deep phenotyping has revealed the heterogeneous nature of severe asthma and identified distinct disease subtypes. A current challenge in the field is to translate new and emerging knowledge about different pathobiologic mechanisms in asthma into patient-specific therapies, with the ultimate goal of modifying the natural history of disease. Here, we describe the Precision Interventions for Severe and/or Exacerbation-Prone Asthma (PrecISE) Network, a groundbreaking collaborative effort of asthma researchers and biostatisticians from around the United States. The PrecISE Network was designed to conduct phase II/proof-of-concept clinical trials of precision interventions in the population with severe asthma, and is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Using an innovative adaptive platform trial design, the PrecISE Network will evaluate up to 6 interventions simultaneously in biomarker-defined subgroups of subjects. We review the development and organizational structure of the PrecISE Network, and choice of interventions being studied. We hope that the PrecISE Network will enhance our understanding of asthma subtypes and accelerate the development of therapeutics for severe asthma.
• Gerald, L. B., Gerald, J. K., VanBuren, J. M., Lowe, A., Guthrie, C. C., Klein, E. J., Morrison, A., Startup, E., & Denninghoff, K. (2021). Randomized trial of the feasibility of ED-initiated school-based asthma medication supervision (ED-SAMS). Pilot and feasibility studies, 7(1), 179.
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  While using an inhaled corticosteroid (ICS) in the weeks after an ED visit reduces repeat visits, few children receive a needed prescription. Because a prescription may not be filled or used, dispensing ICS at discharge and supervising its use at school could overcome both barriers until follow-up care is established. To assess the feasibility of such an intervention, we conducted a pilot study among elementary-age school children with persistent asthma who were discharged from the ED following an asthma exacerbation.
• Lohr, A. M., Van Gorden, N., McClelland, D. J., Dubinsky, E., Gerald, L. B., Wilkinson-Lee, A., & Carvajal, S. C. (2021). Updating search strategies for literature reviews with OUR2D2: an open-source computer application. Journal of the Medical Library Association : JMLA, 109(2), 317-322.
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  While writing a scoping review, we needed to update our search strategy. We wanted to capture articles generated by our additional search terms and articles published since our original search. Simultaneously, we strove to optimize project resources by not rescreening articles that had been captured in our original results.
• Lowe, A. A., Gerald, J. K., Clemens, C. J., Stern, D. A., & Gerald, L. B. (2021). Managing respiratory emergencies at school: A county-wide stock inhaler program. The Journal of allergy and clinical immunology, 148(2), 420-427.e5.
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  A total of 15 states allow schools to manage respiratory emergencies among multiple students by using a single albuterol inhaler (stock inhaler) paired with a disposable holding chamber.
• Lutrick, K., Rivers, P., Yoo, Y. M., Grant, L., Hollister, J., Jovel, K., Khan, S., Lowe, A., Baccam, Z., Hanson, H., Olsho, L. E., Fowlkes, A., Caban-Martinez, A. J., Porter, C., Yoon, S., Meece, J., Gaglani, M., Burns, J., Mayo Lamberte, J., , Nakayima Miiro, F., et al. (2021). Interim Estimate of Vaccine Effectiveness of BNT162b2 (Pfizer-BioNTech) Vaccine in Preventing SARS-CoV-2 Infection Among Adolescents Aged 12-17 Years - Arizona, July-December 2021. MMWR. Morbidity and mortality weekly report, 70(5152), 1761-1765.
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  The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine has demonstrated high efficacy in preventing infection with SARS-CoV-2 (the virus that causes COVID-19) in randomized placebo-controlled Phase III trials in persons aged 12-17 years (referred to as adolescents in this report) (1); however, data on real-word vaccine effectiveness (VE) among adolescents are limited (1-3). As of December 2021, the Pfizer-BioNTech vaccine is approved by the Food and Drug Administration (FDA) for adolescents aged 16-17 years and under FDA emergency use authorization for those aged 12-15 years. In a prospective cohort in Arizona, 243 adolescents aged 12-17 years were tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) each week, irrespective of symptoms, and upon onset of COVID-19-like illness during July 25-December 4, 2021; the SARS-CoV-2 B.1.617.2 (Delta) variant was the predominant strain during this study period. During the study, 190 adolescents contributed fully vaccinated person-time (≥14 days after receiving 2 doses of Pfizer-BioNTech vaccine), 30 contributed partially vaccinated person-time (receipt of 1 dose or receipt of 2 doses but with the second dose completed
• Stern, D. A., Lowe, A. A., Gerald, L. B., Gerald, J. K., & Clemens, C. J. (2021). Managing respiratory emergencies at school: A county-wide stock inhaler program.. The Journal of allergy and clinical immunology, 148(2), 420-427.e5. doi:10.1016/j.jaci.2021.01.028
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  A total of 15 states allow schools to manage respiratory emergencies among multiple students by using a single albuterol inhaler (stock inhaler) paired with a disposable holding chamber..Our aim was to evaluate implementation barriers and facilitators, as well as satisfaction with a stock inhaler program across K through12 schools in Pima County, Arizona..All public, charter, private, and parochial schools were offered supplies, web-based training, and technical assistance at no cost. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate program implementation. School documentation logs were reviewed, school health personnel were surveyed, and a convenience sample of health personnel were interviewed. Chi-square tests evaluated categoric outcomes and Poisson hurdle regression examined stock inhaler use by school organization type, grade levels served, and type of school health personnel employed..In all, 229 schools (68%) participated, reaching 82% of students in the county. A total of 152 schools (66%) used a stock inhaler, accounting for 1038 events. The mean number of puffs administered was 2.7 (SD = 1.2) per event, and most events (79%) involved students with asthma. Although most events (83.9%) resulted in the student returning to class, 15.6% resulted in students being sent home. Only 6 events resulted in 911 calls, and 5 of these led to an ambulance transport. School health personnel reported high levels of satisfaction, and all schools renewed participation for a second year. Program costs were $156 per school..With technical assistance, stock inhaler programs can be feasibly implemented by schools in a wide range of settings, thereby increasing their capacity to safely manage respiratory emergencies.
• Trivedi, M., Hoque, S., Luther, J., Spano, M., Shillan, H., Pearl, H., Seay, H., Phipatanakul, W., Gerald, L. B., & Pbert, L. (2021). Incorporating systems-level stakeholder perspectives into the clinical trial design of school-supervised asthma therapy. Contemporary clinical trials, 108, 106510.
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  Few evidence-based public health interventions are adopted in practice, in part due to a disconnect between the outcomes measured in clinical trials and the outcomes important to stakeholders that determine implementation in real-world practice. AsthmaLink is a school-supervised asthma therapy program which partners pediatric providers, school nurses, and families. To inform the design of a cluster randomized controlled trial of AsthmaLink, we elicited systems-level stakeholder input.
• Volerman, A., Lowe, A. A., Pappalardo, A. A., Anderson, C. M., Blake, K. V., Bryant-Stephens, T., Carr, T., Carter, H., Cicutto, L., Gerald, J. K., Miller, T., Moore, N. S., Phan, H., Sadreameli, S. C., Tanner, A., Winders, T. A., & Gerald, L. B. (2021). Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement. American journal of respiratory and critical care medicine, 204(5), 508-522.
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  For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access. To provide policy recommendations and outline steps for passing and implementing stock albuterol laws. We assembled a diverse stakeholder group and reviewed guidelines, literature, statutes, regulations, and implementation documents related to school-based medication access. Stakeholders were divided into two groups-legislation and implementation-on the basis of expertise. Each group met virtually to review documents and draft recommendations. Recommendations were compiled and revised in iterative remote meetings with all stakeholders. We offer several recommendations for crafting state legislation and facilitating program implementation. ) Create a coalition of stakeholders to champion legislation and implement stock albuterol programs. The coalition should include school administrators, school nurses and health personnel, parents, or caregivers of children with asthma, pediatric primary care and subspecialty providers (e.g., pulmonologists/allergists), pharmacists, health department staff, and local/regional/national advocacy organizations. ) Legislative components critical for effective implementation of stock albuterol programs include specifying that medication can be administered in good faith to any child in respiratory distress, establishing training requirements for school staff, providing immunity from civil liability for staff and prescribers, ensuring pharmacy laws allow prescriptions to be dispensed to schools, and suggesting inhalers with valved holding chambers/spacers for administration. ) Select an experienced and committed legislator to sponsor legislation and guide revisions as needed during passage and implementation. This person should be from the majority party and serve on the legislature's health or education committee. ) Develop plans to disseminate legislation and regulations/policies to affected groups, including school administrators, school nurses, pharmacists, emergency responders, and primary/subspecialty clinicians. Periodically evaluate implementation effectiveness and need for adjustments. Stock albuterol in schools is a safe, practical, and potentially life-saving option for children with asthma, whether asthma is diagnosed or undiagnosed, who lack access to their personal quick-relief medication. Legislation is imperative for aiding in the adoption and implementation of school stock albuterol policies, and key policy inclusions can lay the groundwork for success. Future work should focus on passing legislation in all states, implementing policy in schools, and evaluating the impact of such programs on academic and health outcomes.
• Yohannes, A. M., N Eakin, M., Holbrook, J. T., Sugar, E. A., Henderson, R., Baker, A. M., Casper, A. S., Kaminsky, D. A., Rea, A. L., Mathews, A. M., Que, L. G., Ramsdell, J. W., Gerald, L. B., Wise, R. A., & Hanania, N. A. (2021). Association of mild cognitive impairment and characteristic of COPD and overall health status in a cohort study. Expert review of respiratory medicine, 15(1), 153-159.
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  : We evaluated risk factors and demographic characteristics of associated with mild cognitive impairment (MCI) in patients with COPD. : 220 individuals with COPD enrolled in a cohort study designed to evaluate anxiety conducted at 16 clinical centers. Cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA), a cutoff score of
• Berryhill, S., Morton, C. J., Dean, A., Berryhill, A., Provencio-Dean, N., Patel, S. I., Estep, L., Combs, D., Mashaqi, S., Gerald, L. B., Krishnan, J. A., & Parthasarathy, S. (2020). Effect of wearables on sleep in healthy individuals: a randomized crossover trial and validation study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 16(5), 775-783.
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  The purpose of this study was to determine whether a wearable sleep-tracker improves perceived sleep quality in healthy participants and to test whether wearables reliably measure sleep quantity and quality compared with polysomnography.
• Carvajal, S. C., Wilkinson-Lee, A. M., Del Casino, V. J., Gerald, L. B., Van Gorden, N., Mcclelland, D. J., Krause, K. C., & Lohr, A. M. (2021). The Impact of School Gardens on Youth Social and Emotional Learning: A Scoping Review. Journal of Adventure Education and Outdoor Learning. doi:DOI: 10.1080/14729679.2020.1838935
• Cordova-Marks, F. M., Cunningham, J., Harris, R. B., Gerald, L., Norton, B., Mastergeorge, A., & Teufel-Shone, N. I. (2020). Resilience and Stress among Hopi Female Caregivers. American Indian and Alaska native mental health research (Online), 27(2), 76-89.
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  Resilience and stress are important factors in the caregiving experience, but research has yet to examine their association among American Indian (AI) caregivers. This study examines resilience and stress in a group of Hopi female caregivers. Data came from the Hopi Adult Caregiver Survey (2017), which conducted interviews with 44 Hopi women who were providing care without remuneration to an adult family member. Measures included the abbreviated Connor-Davidson Resilience Scale (CD-RISC-10), the Perceived Stress Scale (PSS-10), and questions about caregiver characteristics, care recipient characteristics, social support/ community support, and cultural factors. Stress and resilience were looked at above the median (higher stress or higher resilience) and below the median (lower stress or lower resilience). Caregivers who reported relatively lower resilience were more likely to report that they lived separately from their care recipients and that all Hopis are expected to be caregivers. Caregivers who reported relatively higher stress reported a higher total number of caregiver difficulties, a poorer self-perception of their own health, use of a traditional healer in the past 5 years, and that females are expected to be caregivers. A regression analysis adjusting for age, education, and employment status indicated that higher resilience among the caregivers was significantly associated with lower stress. In light of these findings, programs working with AI caregivers may wish to explore whether supporting the resilience of these caregivers is a means towards limiting their stress.
• Gerald, L. B. (2020). Alignment of Stakeholder Agendas to Facilitate Adoption of School-Supervised Asthma Therapy. Pediatric Pulmonology.
• Lohr, A. M., Krause, K. C., Mcclelland, D. J., Van Gorden, N., Gerald, L. B., Del Casino, V. J., Wilkinson-Lee, A. M., & Carvajal, S. C. (2019). The Impact of School Gardens on Youth Social and Emotional Learning: A Scoping Review. Health Education & Behavior.
• Lohr, A. M., Krause, K. C., Mcclelland, D. J., Van Gorden, N., Gerald, L. B., Del Casino, V. J., Wilkinson-Lee, A. M., Carvajal, S. C., Lohr, A. M., Krause, K. C., Mcclelland, D. J., Van Gorden, N., Gerald, L. B., Del Casino, V. J., Wilkinson-Lee, A. M., & Carvajal, S. C. (2020). The Impact of School Gardens on Youth Social and Emotional Learning: A Scoping Review. Journal of Adventure Education and Outdoor Learning. doi:DOI: 10.1080/14729679.2020.1838935
• Trivedi, M., Patel, J., Hoque, S., Mizrahi, R., Biebel, K., Phipatanakul, W., Lemon, S. C., Byatt, N., Gerald, L. B., Rosal, M., & Pbert, L. (2020). Alignment of stakeholder agendas to facilitate the adoption of school-supervised asthma therapy. Pediatric pulmonology, 55(3), 580-590.
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  School-supervised inhaled corticosteroid (ICS) therapy improves pediatric asthma medication adherence, outcomes, and morbidity. However, school-supervised ICS therapy has not been widely adopted into practice. We developed Asthma Link™ as a sustainable, low-cost model of school-supervised asthma therapy, designed for real-world adoption. Initial outcomes of Asthma Link™ demonstrated a significant improvement in health outcomes.
• Yohannes, A., Eakin, M. N., Holbrook, J. T., Sugar, E. A., Hendersen, R., Baker, a. M., Casper, A. S., Kaminsky, D. A., Rea, A. L., Matthews, A. M., Que, L. G., Ramsdell, J. W., Gerald, L. B., Wise, R. A., & Hanania, N. (2020). Association of mild cognitive impairment and characteristics of COPD and overall health status in a cohort study. Expert Review of Respiratory Medicine, 15(1), 153-159. doi:https://doi.org/10.1080/17476348.2021.1838278
• Billheimer, D., Billheimer, D., Martinez, F. D., Martinez, F. D., Hallmark, B., Hallmark, B., Gerald, L. B., Gerald, L. B., Gerald, J. K., Gerald, J. K., Billheimer, D., & Billheimer, D. (2019). Are Latino children of Mexican origin with asthma less responsive to inhaled corticosteroids than white children?. The journal of allergy and clinical immunology. In practice, 7(7), 2419-2421. doi:10.1016/j.jaip.2019.02.032
• Clemens, C. J., Carvajal, S. C., Billheimer, D., Stefan, N., Moore, M. A., Gerald, L. B., Gerald, J. K., Fisher, J. M., Clemens, C. J., Carvajal, S. C., Bryson, D., Brown, M. A., & Billheimer, D. D. (2019). School-supervised use of a once-daily inhaled corticosteroid regimen: A cluster randomized trial.. The Journal of allergy and clinical immunology, 143(2), 755-764. doi:10.1016/j.jaci.2018.06.048
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  School-supervised use of a once-daily inhaled corticosteroid regimen (supervised therapy) can improve medication adherence and asthma control..We sought to evaluate the effectiveness of supervised therapy in a unique setting and population..We conducted a cluster randomized trial of supervised therapy in 20 elementary schools with a disproportionate enrollment of low-income Latino students. Schools were purposively selected, matched, and randomized to receive 9 months of supervised therapy with mometasone furoate or usual care. All English- or Spanish-speaking students with self-reported asthma were eligible. The Asthma Control Questionnaire (ACQ) was interviewer administered quarterly at school. Students in supervised therapy schools were hypothesized to have lower ACQ scores than students in usual-care schools..Of 393 enrolled students, 189 students receiving immediate intervention and 143 students receiving delayed intervention provided 1 or more ACQ data points, were between 6 and 10 years of age, and were included in the primary analysis. At baseline, 39% of students reported taking a controller medication, and 24% had well-controlled asthma. Eighty percent of students receiving immediate intervention were prescribed mometasone. Schools administered 98% of prescribed doses when students attended school. Absences, weekends, and holidays reduced calendar adherence to 53%. During the first year, the mean ACQ score for students receiving immediate and delayed intervention was 1.55 (95% CI, 1.41-1.70) and 1.64 (95% CI, 1.47-1.80), respectively. The estimated treatment effect was -0.08 (95% CI, -0.31 to 0.14)..Compared with usual care, supervised therapy did not improve asthma control among this population of Latino students. Additional research is warranted to confirm these results.
• 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.
• Harris, R. B., Cunningham, J. K., Cordova-marks, F. M., Teufel-shone, N. I., Norton, B., Mastergeorge, A. M., Harris, R. B., Gerald, L. B., Cunningham, J. K., & Cordova-marks, F. (2019). AMERICAN INDIAN FEMALE CAREGIVERS: STRESS AND RESILIENCE. Innovation in Aging, 3(Supplement_1), S941-S942. doi:10.1093/geroni/igz038.3423
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  Abstract Background/Introduction: Increased stress has been found to be a part of the caregiving experience. However, how stress is handled is important. Resilience has been shown to decrease stress in non-caregivers. There is a lack of information about American Indian (AI) caregiver stress. In this study, we seek to investigate if resilience acts as a stress buffer in this population of AI female caregivers.Methods: The Hopi Adult Caregiver Survey was conducted in 2017 with 44 female Hopi caregivers. Resilience and stress scale questions were asked as well as variables potentially affecting these. Resilience as measured by the Connor Davidson Resilience Scale-10 (CD-RISC) and stress as measured by the Perceived Stress Scale-10 scores were calculated as well as categorical levels of higher and lower stress/resilience. Variables possibly associated with each were assessed using linear regression analyses. Results: Forty-four female caregivers were surveyed. The overall mean stress score for caregivers was 17.9 ± 6.2 on the PSS. For difference between higher and lower stress, expectation of females to be caregivers, number of times using a traditional healer/traditional medicine person, number of caregiver difficulties, self-perceived health rating, self-perceived changes to eating habits since becoming a caregiver were significant. Average sum resilience score was 28.7 ± 6.2 on the CD-RISC. In linear regression, it was found that with an increase in the resilience score, stress score decreased.Discussion: In these caregivers, resilience acts as a stress buffer. Increasing resilience and countering factors that decrease resilience may reduce stress experienced by caregivers.
• 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).
• Ryu, J., Yasin, R., Wise, R. A., Teague, W. G., Saams, J. N., Ryu, J., Lang, J. E., Krishnan, S., Kaminsky, D. A., Irvin, C. G., Holbrook, J. T., Henderson, R. J., Gerald, L. B., Farber, H. J., Dozor, A. J., Brown, M. A., Bose, S., & Bacharier, L. B. (2019). 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, 56(6), 611-617. doi:10.1080/02770903.2018.1477956
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  To characterize a cohort of children with airflow limitation resistant to bronchodilator (BD) therapy..Pulmonary function tests performed in children 6-17 years of age at 15 centers in a clinical research consortium were screened for resistant airflow limitation, defined as a post-BD FEV1 and/or an FEV1/FVC less than the lower limits of normal. Demographic and clinical data were analyzed for associations with pulmonary function..582 children were identified. Median age was 13 years (IQR: 11, 16), 60% were males; 62% were Caucasian, 28% were African-American; 19% were obese; 32% were born prematurely and 21% exposed to second hand smoke. Pulmonary diagnoses included asthma (93%), prior significant pneumonia (28%), and bronchiectasis (5%). 65% reported allergic rhinitis, and 11% chronic sinusitis. Subjects without a history of asthma had significantly lower post-BD FEV1% predicted (p = 0.008). Subjects without allergic rhinitis had lower post-BD FEV1% predicted (p = 0.003). Children with allergic rhinitis, male sex, obesity and Black race had better pulmonary function post-BD. There was lower pulmonary function in children after age 11 years without a history of allergic rhinitis, as compared to those with a history of allergic rhinitis..The most prevalent diagnosis in children with BD-resistant airflow limitation is asthma. Allergic rhinitis and premature birth are common co-morbidities. Children without a history of asthma, as well as those with asthma but no allergic rhinitis, had lower pulmonary function. Children with BD-resistant airflow limitation may represent a sub-group of children with persistent obstruction and high risk for life-long airway disease.
• Warren, B. B., Saboda, K., Roe, D. J., Moreno, V., Manco-johnson, M. J., Lentz, S. R., Large, C., Journeycake, J. M., Harris, D. T., Gerald, L. B., Bhasin, N., & Badowski, M. (2019). Role of Low Albumin Levels in Pediatric Patients with Central Venous Catheters at Risk for Thrombosis. Blood, 134(Supplement_1), 3650-3650. doi:10.1182/blood-2019-124858
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  Introduction: The incidence of venous thromboembolism (VTE) in children has been increasing by about 10% per year for the past decade. This rise in VTE in children is attributed to improved survival of pediatric subspecialty patients as well as increased utilization of life-saving measures such as central venous catheters (CVCs) that can lead to catheter related thromboses (CRTs). More than 50% of venous thromboses in children and 90% of thromboses in neonates are CRTs, making catheter placement the single most significant risk factor for thrombosis in children. Association studies in adults have suggested an inverse relationship between serum albumin and risk of VTE. Given the paucity of data about albumin levels in pediatric patients in relation to VTE, we first performed a retrospective study to determine the prevalence of low albumin levels in pediatric patients with CRTs. We then initiated a prospective study to evaluate the incidence of hypoalbuminemia in pediatric patients at the time of CVC placement. Methods: We initially performed a retrospective study of 78 pediatric patients with a documented thrombotic event referred to the pediatric hematology service at University of Arizona between Aug 2014 and Jul 2017. Data collected included patient demographics, clinical diagnoses, type and location of thrombosis, presence or absence of a CVC, and albumin level within four days of the thrombotic event. We then designed a prospective study of pediatric patients undergoing CVC placement. Baseline data collected included patient demographics, clinical diagnoses, type of CVC placed, and laboratory results for albumin, factor VIII activity, D-dimer, and antithrombin activity within 4 days of CVC placement. Results: In the retrospective cohort of 78 consecutive pediatric patients with thrombosis, 84 thrombotic events were documented, of which 41 (49%) were CRTs. CRTs occurred in 22/35 (63%) patients less than 12 years of age and 14/42 (33%) patients aged 12 to 23 (P = 0.02). Serum albumin levels were available for 53 thrombotic events. Albumin levels were below the normal reference range in 27/30 (90%) of CRTs compared with 12/23 (52%) non-CRTs (P = 0.003). In the prospective study, data have been analyzed for the first 58 patients enrolled ages 2 months-17 years. At baseline, the prevalence of serum albumin below the lower limit of normal was 71% (41/58). Factor VIII activity was above 200% in 28/58 patients (48%), D-dimer was elevated in 48/58 patients (83%), and antithrombin was below 85% in 21/58 patients (36%). The mean duration of follow-up is 12 months. Four of the first 58 (6.9%) patients enrolled have had a CRT, all of whom had low albumin and elevated D-dimer levels at baseline. Conclusion: Hypoalbuminemia is highly prevalent in pediatric patients with thrombosis and also in patients with CVCs, who are at increased risk of thrombosis. In our retrospective analysis of pediatric patients with thrombosis, a low serum albumin level was documented in 74% of patients with thrombosis, including 90% of patients with a CRT. Preliminary analysis of the first 58 patients enrolled in a prospective study of patients with CVCs demonstrates a high prevalence (71%) of low albumin levels at the time of CVC placement. Further analysis is needed to define the value of serum albumin in thrombotic risk prediction and further explore potential prothrombotic mechanisms in CRT. Disclosures Lentz: Novo Nordisk Inc.: Consultancy, Honoraria, Research Funding.
• 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.
• Rothers, J., Rothers, J., Horne, Y. O., Horne, Y. O., Vercelli, D., Vercelli, D., Halonen, M., Halonen, M., Wright, A. L., Wright, A. L., Wright, A. L., Wright, A. L., Vercelli, D., Vercelli, D., Stern, D. A., Stern, D. A., Rothers, J., Rothers, J., Rosales, C. B., , Rosales, C. B., et al. (2017). Prevalence of Asthma in School Children on the Arizona-Sonora Border.. The journal of allergy and clinical immunology. In practice, 5(1), 114-120.e2. doi:10.1016/j.jaip.2016.07.001
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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..The objective of this study was to determine if the prevalence of asthma and wheeze in these children varies across the AZ-Sonora border..The International Study of Asthma and Allergy in Children written and video questionnaires were administered to 1753 adolescents from 5 middle schools: Tucson (school A), Nogales, AZ (schools B, C), and Nogales, Sonora, Mexico (schools D, E). The prevalence of asthma and symptoms was compared, with analyses in the AZ schools limited to self-identified Mexican American students..Compared with the Sonoran reference school E, the adjusted odds ratio (OR) for asthma was significantly higher in US schools A (OR 4.89, 95% confidence interval [CI] 2.72-8.80), B (OR 3.47, 95% CI 1.88-6.42), and C (OR 4.12, 95% CI 1.78-9.60). The adjusted OR for wheeze in the past year was significantly higher in schools A (OR 2.19, 95% CI 1.20-4.01) and B (OR 2.67, 95% CI 1.42-5.01) on the written questionnaire and significantly higher in A (OR 2.13, 95% CI 1.22-3.75), B (OR 1.95, 95% CI 1.07-3.53), and Sonoran school D (OR 2.34, 95% CI 1.28-4.30) on the video questionnaire compared with school E..Asthma and wheeze prevalence differed significantly between schools and was higher in the United States. Environmental factors that may account for these differences could provide insight into mechanisms of protection from asthma.
• Wright, A. L., Wright, A. L., Wright, A. L., Wright, A. L., Stern, D. A., Stern, D. A., Oren, E., Oren, E., Martinez, F. D., Martinez, F. D., Gerald, L. B., & Gerald, L. B. (2017). Self-Reported Stressful Life Events During Adolescence and Subsequent Asthma: A Longitudinal Study.. The journal of allergy and clinical immunology. In practice, 5(2), 427-434.e2. doi:10.1016/j.jaip.2016.09.019
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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..The objective of this study was to explore whether life events in adolescence are associated with either concurrent or new active asthma..The Tucson Children's Respiratory Study, a prospective population-based birth cohort, surveyed participants at 10 ages between 6 and 29 years regarding respiratory health. Asthma was defined as a physician-diagnosis of asthma with symptoms during the previous year. At age 16, participants (n = 318) were queried regarding stressful life events using the 67-item Life Events Questionnaire for Adolescents (LEQA). LEQA scores were examined in relation to both concurrent and new active asthma. Estimates were obtained with logistic regression and mixed models..There was no relation between asthma prevalence at age 16 and LEQA scores in the overall sample, although males with high LEQA scores had higher prevalence of asthma compared with males with low scores (relative risk [RR]: 3.03; 95% confidence interval [CI]: 1.37, 6.69; P = .006). Among adolescents with no asthma through age 16, risk of new asthma was greater for those with high LEQA scores (adjRR: 4.07; 95% CI: 1.33, 12.43; P = .014), after adjustment for potential confounders including smoking. Emotional support from family and friends slightly diminished the relation of stress to new asthma..Stressful life events during adolescence are associated with subsequent new asthma. Additional biological and psychological measures of stress would complement these findings.
• 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.
• Gordon, J. S., Berry, C. E., Sekhon, K., Gordon, J. S., Golden, T., Ghazala, L., Gerald, L. B., Bime, C., & Berry, C. E. (2015). Cross Sectional Survey of Electronic Cigarettes Use Among Ambulatory COPD Patients. Chest, 148(4), 1076A. doi:10.1378/chest.2256166
• 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.
• Wise, R. A., Sugar, E. A., Rayapudi, S., Peters, S. P., Mohapatra, S. S., Irvin, C. G., Holbrook, J. T., Gerald, L. B., Dixon, A. E., Cohen, R. I., & Castro, M. (2015). Efficacy of nasal mometasone for the treatment of chronic sinonasal disease in patients with inadequately controlled asthma.. The Journal of allergy and clinical immunology, 135(3), 701-9.e5. doi:10.1016/j.jaci.2014.06.038
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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..We sought to determine whether treatment of chronic sinonasal disease with nasal corticosteroids improves asthma control, as measured by the Childhood Asthma Control Test and Asthma Control Test in children and adults, respectively..A 24-week multicenter, randomized, placebo-controlled, double-blind trial of placebo versus nasal mometasone in adults and children with inadequately controlled asthma was performed. Treatments were randomly assigned, with concealment of allocation..Two hundred thirty-seven adults and 151 children were randomized to nasal mometasone versus placebo, and 319 participants completed the study. There was no difference in the Childhood Asthma Control Test score (difference in change with mometasone - change with placebo [ΔM - ΔP], -0.38; 95% CI, -2.19 to 1.44; P = .68; age 6-11 years) or the Asthma Control Test score (ΔM - ΔP, 0.51; 95% CI, -0.46 to 1.48; P = .30; age ≥12 years) in those assigned to mometasone versus placebo. In children and adolescents (age 6-17 years) there was no difference in asthma or sinus symptoms but a decrease in episodes of poorly controlled asthma defined by a decrease in peak flow. In adults there was a small difference in asthma symptoms measured by using the Asthma Symptom Utility Index (ΔM - ΔP, 0.06; 95% CI, 0.01 to 0.11; P < .01) and in nasal symptoms (sinus symptom score ΔM - ΔP, -3.82; 95% CI, -7.19 to -0.45; P = .03) but no difference in asthma quality of life, lung function, or episodes of poorly controlled asthma in adults assigned to mometasone versus placebo..Treatment of chronic sinonasal disease with nasal corticosteroids for 24 weeks does not improve asthma control. Treatment of sinonasal disease in asthmatic patients should be determined by the need to treat sinonasal disease rather than to improve 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.
• Soler, X., Brown, R. H., Ramsdell, J. W., Berkowitz, E. A., Zach, J. A., Wise, R. A., Wilson, C., Willis, A., Williams, A. A., Westney, G., Wendt, C. H., Wells, J. M., Weissfeld, J. L., Washko, G. R., Washington, L., Trinh, C., Thompson, D. L., Thomashow, B., Tashjian, J. H., , Stinson, D., et al. (2014). Prediction of acute respiratory disease in current and former smokers with and without COPD.. Chest, 146(4), 941-950. doi:10.1378/chest.13-2946
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  The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown..Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score..At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV1), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George's Respiratory Questionnaire score). Risks were similar for those with and without COPD..Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.
• 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).
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  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.
• Wheeler, L., Stroupe, N., Mcclure, L. A., Gerald, L. B., & Gerald, J. K. (2012). Availability of Asthma Quick Relief Medication in Five Alabama School Systems.. Pediatric allergy, immunology, and pulmonology, 25(1), 11-16. doi:10.1089/ped.2011.0118
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  OBJECTIVES: This paper documents individual asthma action plan presence and quick relief medication (albuterol) availability for elementary students enrolled in five Alabama school systems. PATIENTS AND METHODS: Data were obtained during baseline data collection (fall 2005) of a school-based supervised asthma medication trial. All students attended 1 of 36 participating elementary schools across five school systems in Jefferson County, Alabama. In addition, they had to have physician-diagnosed asthma requiring daily controller medication. Each school system had its own superintendent and elected school board. Asthma action plan presence and albuterol availability was confirmed by study personnel. Asthma action plans had to contain daily and acute asthma management instructions. Predictors of asthma action plan presence and albuterol availability were also investigated. Associations between albuterol availability and self-reported characteristics including health care utilization prior to study enrollment and outcomes during the study baseline period were also investigated. RESULTS: Enrolled students had a mean (SD) age of 11.0 (2.1) years, 91% were African American, and 79% had moderate persistent asthma. No student had a complete asthma action plan on file and only 14% had albuterol physically available at school. Albuterol availability was not predicted by gender, race, insurance status, second-hand smoke exposure, need for pre-exercise albuterol, asthma severity, or self-reported health care utilization prior to study enrollment. Albuterol availability did not predict school absences, red/yellow peak flow recordings, or medication adherence during the study's baseline period. CONCLUSION: Despite policies permitting students to possess albuterol, few elementary students across five independent school systems in Alabama actually had it readily available at school.
• Yang, C. T., Tuggle, C., Schwiebert, L. M., Gerald, L. B., Estell, K., Dransfield, M. T., Craig, C., Boyd, A., Bonner, J. C., Bamman, M. M., & Atkinson, T. P. (2012). Feasibility of exercising adults with asthma: a randomized pilot study.. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology, 8(1), 13. doi:10.1186/1710-1492-8-13
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  Aerobic exercise appears to have clinical benefits for many asthmatics, yet a complete understanding of the mechanisms underlying these benefits has not been elucidated at this time..The objective of this study was to determine feasibility for a larger, future study that will define the effect of aerobic exercise on cellular, molecular, and functional measures in adults with mild-moderate asthma..Recruited subjects were randomized into usual care (sedentary) or usual care with moderate intensity aerobic exercise treatment groups..Nineteen adults with mild-moderate asthma but without a recent history of exercise were recruited at the UAB Lung Health Center, Birmingham, AL..The exercise group underwent a 12 week walking program exercising at 60 - 75% of maximum heart rate (HRmax). Subjects self-monitored HRmax levels using heart rate monitors; exercise diaries and recreation center sign-in logs were also used..Functional measures, including lung function and asthma control scores, were evaluated for all subjects at pre- and post-study time-points; fitness measures were also assessed for subjects in the exercise group. Peripheral blood and nasal lavage fluid were collected from all subjects at pre- and post-study visits in order to evaluate cellular and molecular measures, including cell differentials and eosinophilic cationic protein (ECP)..Sixteen subjects completed the prescribed protocol. Results show that subjects randomized to the exercise group adhered well (80%) to the exercise prescription and exhibited a trend toward improved fitness levels upon study completion. Both groups exhibited improvements in ACQ scores. No changes were observed in lung function (FEV1, FEV1/FVC), cell differentials, or ECP between groups..Results indicate that a moderate intensity aerobic exercise training program may improve asthma control and fitness levels without causing asthma deterioration in adult asthmatics. As such, these findings demonstrate the feasibility of the study protocol in preparation for a larger, clinical trial that will elucidate the functional consequences of aerobic exercise on asthmatic cellular and molecular responses.
• Zhang, B., Mcclure, L. A., Harrington, K. F., Gerald, L. B., Gerald, J. K., & Bailey, W. C. (2012). Can a school-based hand hygiene program reduce asthma exacerbations among elementary school children?. The Journal of allergy and clinical immunology, 130(6), 1317-24. doi:10.1016/j.jaci.2012.08.031
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  Viral upper respiratory tract infections have been implicated as a major cause of asthma exacerbations among school-aged children. Regular hand washing is the most effective method to prevent the spread of viral respiratory tract infections, but effective hand-washing practices are difficult to establish in schools..This randomized controlled trial evaluated whether a standardized regimen of hand washing plus alcohol-based hand sanitizer could reduce asthma exacerbations more than schools' usual hand hygiene practices..This was a 2-year, community-based, randomized controlled crossover trial. Schools were randomized to usual care and then intervention (sequence 1) or intervention and then usual care (sequence 2). Intervention schools were provided with alcohol-based hand sanitizer, hand soap, and hand hygiene education. The primary outcome was the proportion of students experiencing an asthma exacerbation each month. Generalized estimating equations were used to model the difference in the marginal rate of exacerbations between sequences while controlling for individual demographic factors and the correlation within each student and between students within each school..Five hundred twenty-seven students with asthma were enrolled among 31 schools. The hand hygiene intervention did not reduce the number of asthma exacerbations compared with the schools' usual hand hygiene practices (P = .132). There was a strong temporal trend because both sequences experienced fewer exacerbations during year 2 compared with year 1 (P < .001)..Although the intervention was not found to be effective, the results were confounded by the H1N1 influenza pandemic that resulted in substantially increased hand hygiene behaviors and resources in usual-care schools. Therefore these results should be viewed cautiously.
• Mcclure, L. A., Harrington, K., Gerald, L. B., Gerald, J. K., Erwin, S., & Bailey, W. C. (2011). Redesigning a large school-based clinical trial in response to changes in community practice.. Clinical trials (London, England), 8(3), 311-9. doi:10.1177/1740774511403513
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  Asthma exacerbations are seasonal with the greatest risk in elementary-age students occurring shortly after returning to school following summer break. Recent research suggests that this seasonality in children is primarily related to viral respiratory tract infections. Regular hand washing is the most effective method to prevent the spread of viral respiratory infections; unfortunately, achieving hand washing recommendations in schools is difficult. Therefore, we designed a study to evaluate the effect of hand sanitizer use in elementary schools on exacerbations among children with asthma..To describe the process of redesigning the trial in response to changes in the safety profile of the hand sanitizer as well as changes in hand hygiene practice in the schools..The original trial was a randomized, longitudinal, subject-blinded, placebo-controlled, community-based crossover trial. The primary aim was to evaluate the incremental effectiveness of hand sanitizer use in addition to usual hand hygiene practices to decrease asthma exacerbations in elementary-age children. Three events occurred that required major modifications to the original study protocol: (1) safety concerns arose regarding the hand sanitizer's active ingredient; (2) no substitute placebo hand sanitizer was available; and (3) community preferences changed regarding hand hygiene practices in the schools..The revised protocol is a randomized, longitudinal, community-based crossover trial. The primary aim is to evaluate the incremental effectiveness of a two-step hand hygiene process (hand hygiene education plus institutionally provided alcohol-based hand sanitizer) versus usual care to decrease asthma exacerbations. Enrollment was completed in May 2009 with 527 students from 30 schools. The intervention began in August 2009 and will continue through May 2011. Study results should be available at the end of 2011..The changed design does not allow us to directly measure the effectiveness of hand sanitizer use as a supplement to traditional hand washing practices..The need to balance a rigorous study design with one that is acceptable to the community requires investigators to be actively involved with community collaborators and able to adapt study protocols to fit changing community practices.
• 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).
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  Much has been done to promote population-based childhood asthma screening; however, concerns remain regarding its cost-effectiveness.
• Smith, L. J., Kalhan, R., Gerald, L. B., Dransfield, M. T., Colangelo, L. A., & Arynchyn, A. (2010). Lung function in young adults predicts airflow obstruction 20 years later.. The American journal of medicine, 123(5), 468.e1-7. doi:10.1016/j.amjmed.2009.07.037
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  The burden of obstructive lung disease is increasing, yet there are limited data on its natural history in young adults. To determine in a prospective cohort of generally healthy young adults the influence of early adult lung function on the presence of airflow obstruction in middle age..A longitudinal study was performed of 2496 adults who were 18 to 30 years of age at entry, did not report having asthma, and returned at year 20. Airflow obstruction was defined as an forced expiratory volume in 1 second/forced vital capacity ratio less than the lower limit of normal..Airflow obstruction was present in 6.9% and 7.8% of participants at years 0 and 20, respectively. Less than 10% of participants with airflow obstruction self-reported chronic obstructive pulmonary disease. In cross-sectional analyses, airflow obstruction was associated with less education, smoking, and self-reported chronic obstructive pulmonary disease. Low forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity ratio, and airflow obstruction in young adults were associated with low lung function and airflow obstruction 20 years later. Of those with airflow obstruction at year 0, 52% had airflow obstruction 20 years later. The forced expiratory volume in 1 second/forced vital capacity at year 0 was highly predictive of airflow obstruction 20 years later (c-statistic 0.91; 95% confidence interval, 0.89-0.93). The effect of cigarette smoking on lung function decline with age was most evident in young adults with preexisting airflow obstruction..Airflow obstruction is mostly unrecognized in young and middle-aged adults. Low forced expiratory volume in 1 second, low forced expiratory volume in 1 second/forced vital capacity ratio, airflow obstruction in young adults, and smoking are highly predictive of low lung function and airflow obstruction in middle age.
• 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).
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  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).
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  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.
• Mcclure, L. A., Mangan, J. M., Harrington, K. F., Grad, R., Gibson, L., Gerald, L. B., Erwin, S., & Atchison, J. (2009). Increasing adherence to inhaled steroid therapy among schoolchildren: randomized, controlled trial of school-based supervised asthma therapy.. Pediatrics, 123(2), 466-74. doi:10.1542/peds.2008-0499
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  We aimed to determine the effectiveness of school-based supervised asthma therapy in improving asthma control. The primary hypothesis was that the supervised-therapy group would have a smaller proportion of children experiencing an episode of poor asthma control each month, compared with those in the usual-care group..Children were eligible if they had physician-diagnosed persistent asthma, the need for daily controller medication, and the ability to use a dry-powder inhaler and a peak flowmeter. The trial used a 2-group, randomized, longitudinal design with a 15-month follow-up period. A total of 290 children from 36 schools were assigned randomly to either school-based, supervised therapy or usual care. Ninety-one percent of the children were black, and 57% were male. The mean age was 11 years (SD: 2.1 years). An episode of poor asthma control was defined as > or =1 of the following each month: (1) an absence from school attributable to respiratory illness/asthma; (2) average use of rescue medication >2 times per week (not including preexercise treatment); or (3) > or =1 red or yellow peak flowmeter reading..Two hundred forty children completed the study. There were no differences in the likelihood of an episode of poor asthma control between the baseline period and the follow-up period for the usual-care group. For the supervised-therapy group, however, the odds of experiencing an episode of poor asthma control during the baseline period were 1.57 times the odds of experiencing an episode of poor asthma control during the follow-up period. Generalized estimating equation modeling revealed a marginally significant intervention-time period interaction, indicating that children in the supervised-therapy group showed greater improvement in asthma control..Supervised asthma therapy improves asthma control. Clinicians who have pediatric patients with asthma with poor outcomes that may be attributable to nonadherence should consider supervised therapy.
• Wheeler, L., Morrison, T. A., Merkle, S., Gerald, L. B., & Buckley, R. (2009). Working With Schools to Improve Pediatric Asthma Management. Applied Immunohistochemistry & Molecular Morphology, 22(4), 197-207. doi:10.1089/pai.2009.0023
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  Asthma morbidity in pediatric patients can be significantly reduced through the coordinated efforts of asthma care clinicians, families, and schools. The efforts of asthma care clinicians and schools, both individually and collectively, should address the medical and psychosocial needs of the patient. The synergy created by each playing an active role in pediatric asthma management assists the patient in gaining adequate asthma control. In addition to writing asthma action plans for their patients, clinicians can work with schools more effectively by focusing their efforts on the following key actions: promoting asthma-friendly schools; identifying school-aged children with asthma; educating patients and school staff about asthma; assisting patients, families, and schools in reducing exposure to environmental triggers; assisting the school staff in helping students manage their asthma at school; and playing an active role in monitoring and coordinating care with schools and families by working closely wit...
• Zhang, S., Patel, K., Mcclure, L. A., Gibson, L., Gerald, L. B., & Gerald, J. K. (2009). Changes in environmental tobacco smoke exposure and asthma morbidity among urban school children.. Chest, 135(4), 911-916. doi:10.1378/chest.08-1869
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  Environmental tobacco smoke (ETS) exposure is associated with poor asthma outcomes in children. However, little is known about natural changes in ETS exposure over time in children with asthma and how these changes may affect health-care utilization. This article documents the relationship between changes in ETS exposure and childhood asthma morbidity among children enrolled in a clinical trial of supervised asthma therapy..Data for this analysis come from a large randomized clinical trial of supervised asthma therapy in which 290 children with persistent asthma were randomized to receive either usual care or supervised asthma therapy. No smoking cessation counseling or ETS exposure education was provided to caregivers; however, children were given 20 min of asthma education, which incorporated discussion of the avoidance of asthma triggers, including ETS. Asthma morbidity and ETS exposure data were collected from caregivers via telephone interviews at baseline and at the 1-year follow-up..At baseline, 28% of caregivers reported ETS exposure in the home and 19% reported exposure outside of the primary household only. Among children whose ETS exposure decreased from baseline, fewer hospitalizations (p = 0.034) and emergency department (ED) visits (p < or = 0.001) were reported in the 12 months prior to the second interview compared to the 12 months prior to the first interview. Additionally, these children were 48% less likely (p = 0.042) to experience an episode of poor asthma control (EPAC)..This is the first study to demonstrate an association between ETS exposure reduction and fewer EPACs, respiratory-related ED visits, and hospitalizations. These findings emphasize the importance of ETS exposure reduction as a mechanism to improve asthma control and morbidity. Potential policy implications include supporting ETS reductions and smoking cessation interventions for parents and caregivers of children with asthma. Research to identify the most cost-effective strategy is warranted.
• Mcclure, L. A., Harrington, K. F., Graham, H., & Gerald, L. B. (2008). Internet-based monitoring of asthma symptoms, peak flow meter readings, and absence data in a school-based clinical trial.. Clinical trials (London, England), 5(1), 31-7. doi:10.1177/1740774507086647
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  Asthma is the most common chronic childhood disease and has significant impact on morbidity and mortality in children. Proper adherence to asthma medication has been shown to reduce morbidity among those with asthma; however, adherence to medications is known to be low, especially among low-income urban populations. We conducted a randomized clinical trial to examine the effectiveness of an intervention designed to increase adherence to asthma medication among children with asthma that required daily collection of data..and.A specifically designed web-based data collection system, the Asthma Agents System, was used to collect daily data from participant children at school. These data were utilized to examine the intervention's effectiveness in reducing the frequency of asthma exacerbations. This study examines the Asthma Agents System's effect on the frequency of missing data. Data collection methods are discussed in detail, as well as the processes for retrieving missing data..For the 290 children randomized, 97% of the daily data expected were available. Of the outcome data retrieved via the Asthma Agents System, 5% of those expected were missing during the period examined..Challenges encountered in this study include issues regarding the use of technology in urban school settings, transfer of data between study sites, and availability of data during school breaks..Use of the Asthma Agents System resulted in lower rates of missing data than rates reported elsewhere in the literature. Clinical Trials 2008; 5: 31-37. http://ctj.sagepub.com.
• Mcclure, L. A., Mangan, J. M., Harrington, K. F., Grad, R., Gibson, L., Gerald, L. B., & Atchison, J. (2008). Design of the supervised asthma therapy study: implementing an adherence intervention in urban elementary schools.. Contemporary clinical trials, 29(2), 304-10. doi:10.1016/j.cct.2007.07.010
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  Inhaled corticosteroids, when properly used, can offer considerable protection against asthma-related morbidity. However, adherence to prescribed inhaled steroids among children is low and rates differ markedly by population. The lowest rates of adherence and highest rates of morbidity are among inner-city and low income populations..To describe the design of a school-based clinical trial in a largely minority population that is examining the efficacy of a school-based intervention intended to increase adherence to daily inhaled corticosteroids..The supervised asthma therapy study is a two-group randomized longitudinal trial. Children were randomly assigned to either school-based supervised asthma therapy or parent supervised asthma therapy. Children were followed longitudinally for 15 months. The primary outcome of the study is the time-averaged difference between the two groups in the percentage of children experiencing at least one asthma exacerbation each month..A web-based data collection system was designed to capture data at school. A total of 295 students, recruited from community and school sites, who attended one of 36 urban elementary schools enrolled in the study and 290 were randomized. The average age of the students was 10.0 years (sd=2.1), 91% were African American, 8% were white, and 1% were of other racial groups. 57% of students were male. The study has been recently completed and results are being analyzed..Intervention studies requiring daily medication supervision and daily data collection can be successfully conducted within the elementary school environment.
• Rowe, S. M., Johnson, J. E., Gerald, L. B., Dransfield, M. T., & Bailey, W. C. (2008). Use of beta blockers and the risk of death in hospitalised patients with acute exacerbations of COPD.. Thorax, 63(4), 301-5. doi:10.1136/thx.2007.081893
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  Cardiovascular disease is a major cause of death in patients with chronic obstructive pulmonary disease (COPD) and predicts hospitalisation for acute exacerbation, in-hospital death and post-discharge mortality. Although beta blockers improve cardiovascular outcomes, patients with COPD often do not receive them owing to concerns about possible adverse pulmonary effects. There are no published data about beta blocker use among inpatients with COPD exacerbations. A study was undertaken to identify factors associated with beta blocker use in this setting and to determine whether their use is associated with decreased in-hospital mortality..Administrative data from the University of Alabama Hospital were reviewed and patients admitted between October 1999 and September 2006 with an acute exacerbation of COPD as a primary diagnosis or as a secondary diagnosis with a primary diagnosis of acute respiratory failure were identified. Demographic data, co-morbidities and medication use were recorded and subjects receiving beta blockers were compared with those who did not. Multivariate regression analysis was performed to determine predictors of in-hospital death after controlling for known covariates and the propensity to receive beta blockers..825 patients met the inclusion criteria. In-hospital mortality was 5.2%. Those receiving beta blockers (n = 142) were older and more frequently had cardiovascular disease than those who did not. In multivariate analysis adjusting for potential confounders including the propensity score, beta blocker use was associated with reduced mortality (OR = 0.39; 95% CI 0.14 to 0.99). Age, length of stay, number of prior exacerbations, the presence of respiratory failure, congestive heart failure, cerebrovascular disease or liver disease also predicted in-hospital mortality (p
• Suissa, S., Rowe, S. M., Johnson, J. E., Gerald, L. B., Ernst, P., Dransfield, M. T., & Bailey, W. C. (2008). Biases in the observational study of p blockers in COPD. Authors' reply. Thorax, 63(11), 1026-1027.
• Wittich, A. R., Mangan, J. M., & Gerald, L. B. (2007). The potential for reducing asthma disparities through improved family and social function and modified health behaviors.. Chest, 132(5 Suppl), 789S-801S. doi:10.1378/chest.07-1908
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  The National Workshop To Reduce Asthma Disparities assembled a multidisciplinary group comprised of scientists, clinicians, and community representatives to examine factors related to asthma disparities. Attention was given to the importance of discerning family, social, and behavioral factors that facilitate or impede the use of health-care services suitable to the medical status of an individual. This review highlights select biopsychosocial factors that contribute to these disparities, the manner in which they may contribute or protect persons affected by asthma, and recommended directions for future research.
• Wittich, A. R., Wang, W., Mangan, J. M., Grad, R., & Gerald, L. B. (2007). Pediatric asthma: caregiver health literacy and the clinician's perception.. The Journal of asthma : official journal of the Association for the Care of Asthma, 44(1), 51-5. doi:10.1080/02770900601125672
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  Health literacy was assessed in pediatric asthma caregivers attending a university-based clinic. The medical provider's perception of caregiver health literacy was also examined. Eighty-six percent of the caregivers had adequate health literacy, 4% and 10% had marginal and inadequate health literacy, respectively. Health literacy was significantly higher for caregivers who were younger (p = 0.039) and had a higher level of education (p = 0.037). An agreement analysis revealed moderate agreement between provider perception of caregiver's health literacy and measured health literacy (Kappa = 0.51). The results suggest that medical providers may not accurately assess caregivers' actual health literacy level.
• Yuksel, B., Yawn, B. P., Williams, P. V., Wheeler, L. S., Taggart, V. S., Sockrider, M. M., Schwindt, C. D., Schmidt, D. K., Redding, G. J., Mangan, J. M., Madden, J. A., Kaplan, R. M., Joseph, C. L., Hook, K. N., Grad, R., Gerritsen, J., Gerald, L. B., Galant, S. P., Boss, L. P., & Bender, B. G. (2007). An official ATS workshop report: issues in screening for asthma in children.. Proceedings of the American Thoracic Society, 4(2), 133-41. doi:10.1513/pats.200604-103st
• Zhang, S., Patel, K., Mcclure, L. A., & Gerald, L. B. (2007). SECONDHAND SMOKE EXPOSURE AND ASTHMA MORBIDITY AMONG ELEMENTARY SCHOOL CHILDREN ENROLLED IN A CLINICAL TRIAL. Chest, 132(4), 461-461. doi:10.1378/chest.132.4_meetingabstracts.461
• Gerald, L. B., Dransfield, M. T., Davis, J. J., & Bailey, W. C. (2006). Racial and gender differences in susceptibility to tobacco smoke among patients with chronic obstructive pulmonary disease.. Respiratory medicine, 100(6), 1110-6. doi:10.1016/j.rmed.2005.09.019
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  Although chronic obstructive pulmonary disease (COPD) has been considered a disease of Caucasian men, recent data show mortality rising faster among women and African-Americans. Some have suggested these groups are more susceptible to tobacco smoke. We examined this issue in our own population of COPD patients..Beginning in March 2003 we prospectively developed a COPD research database to facilitate recruitment for clinical trials. Enrollees are recruited from clinics and paid advertising and their demographics, medical/smoking histories, and spirometric data are recorded. We examined the smoking histories and pulmonary function of enrollees over 45, with 20 pack-years of smoking, FEV(1)/FVC (forced expiratory volume forced vital capacity)
• Gerald, L. B., Dransfield, M. T., Davis, J. J., & Bailey, W. C. (2006). Racial and gender differences in susceptibility to tobacco smoke among patients with chronic obstructive pulmonary disease: Respir Med 2005; published online ahead of print on 15 October 2005 as doi:10.1016/j.rmed.2005.09.019. Respiratory Medicine: Copd Update, 1(3), 96. doi:10.1016/j.rmedu.2006.01.002
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  Background Although chronic obstructive pulmonary disease (COPD) has been considered a disease of Caucasian men, recent data show mortality rising faster among women and African-Americans. Some have suggested these groups are more susceptible to tobacco smoke. We examined this issue in our own population of COPD patients. Methods Beginning in March 2003 we prospectively developed a COPD research database to facilitate recruitment for clinical trials. Enrollees are recruited from clinics and paid advertising and their demographics, medical/smoking histories, and spirometric data are recorded. We examined the smoking histories and pulmonary function of enrollees over 45, with ⩾20 pack-years of smoking, FEV1/FVC (forced expiratory volume forced vital capacity)
• Lin, H. Y., Zhou, J., Zhang, P., Yang, P. A., Wu, Q., Wood, R. H., Traylor, C. P., Su, L. J., Standberry, F. N., Scott, D. K., Schroeder, H. W., Schmidt, B., Rothschild, H., Robertson, Y., Ravussin, E., Mountz, J. D., Lopez, K., Lin, H., Li, L., , Kimball, B., et al. (2006). CD8 T-cell immune phenotype of successful aging.. Mechanisms of ageing and development, 127(3), 231-9. doi:10.1016/j.mad.2005.10.001
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  The nonagenarian population by definition represents individuals who have demonstrated success in aging. We determined the status of CD8(+) T-cell senescence in nonagenarians by analyzing the expression of CD28 and Fas (CD95), and analyzing activation and activation-induced cell death (AICD). Peripheral blood mononuclear cells (PBMCs) were isolated from three groups of subjects: adults (20-64-year-old), older adults (65-89-year-old), and nonagenarians (>or=90-year-old). PBMCs were stimulated with phytohemagglutinin (PHA) (10 microg/ml). The cells were labeled with conjugated antibodies specific for CD4, CD8, CD28, CD45RO, and Fas, and were analyzed by FACS((R)). There was a strong negative correlation of the percentage of CD28(+)Fas(-) CD8(+) T-cells with the age of each individual prior to stimulation in vitro (R(2)=0.76, por=65-year-old that expresses both CD28(+) and Fas(+) at day 3. Surprisingly, the AICD response of CD8(+) T-cells at day 7 in the nonagenarians was higher than that in the other two groups. These results suggest that successful aging does not prevent development of the senescent phenotype of unstimulated CD8(+) T cells, but is associated with preservation of CD8 T cell functions including activation and AICD. Increased AICD may result in enhanced rejuvenation capacity of T cells and limit the impact of aging on T cell function in nonagenarians.
• Mangan, J. M., & Gerald, L. B. (2006). Asthma agents: monitoring asthma in school.. The Journal of school health, 76(6), 300-2. doi:10.1111/j.1746-1561.2006.00116.x
• Wheeler, L. S., Taggart, V. S., Merkle, S. L., & Gerald, L. B. (2006). Introduction: learning from each other about managing asthma in schools.. The Journal of school health, 76(6), 202-4. doi:10.1111/j.1746-1561.2006.00096.x
• Wheeler, L. S., Taggart, V. S., Merkle, S. L., & Gerald, L. B. (2006). Managing asthma in schools: lessons learned and recommendations.. The Journal of school health, 76(6), 340-4. doi:10.1111/j.1746-1561.2006.00125.x
• Wittich, A. R., Li, Y., & Gerald, L. B. (2006). Comparison of parent and student responses to asthma surveys: students grades 1-4 and their parents from an urban public school setting.. The Journal of school health, 76(6), 236-40. doi:10.1111/j.1746-1561.2006.0104_1.x
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  This study compared parent and child responses to a symptom questionnaire as a means of determining whether child and parent responses are equally valuable in case-detection procedures. We completed a study validating a multistage case-detection procedure. The case-detection procedure classified students into 3 categories based on their parents' questionnaire responses (probable asthma, possible asthma, and negative for asthma). Those who were classified as possible asthma by questionnaire underwent further testing, including spirometry and exercise challenge. The children with abnormal testing results were considered to have probable asthma. McNemar's test and kappa coefficients were used to examine parent-child agreement. Sensitivity and specificity of the case-detection procedure were compared using either the parent's or the child's responses to the questionnaire. The data indicated moderate agreement between parent and child responses to questions regarding previous diagnosis of asthma and past asthma therapy (p < .001, kappa coefficients of 0.6030 and 0.5966, respectively). Sensitivity, specificity, and predictive values in the multistage case-detection procedure were similar when using either parent or child responses to the questionnaire. Among the false negatives, the distribution of asthma severity was consistent whether using child or parent responses. Parent-child agreement did not differ significantly by gender or age of the child or whether the child had a previous diagnosis of asthma. These results suggest that the use of child responses is a viable option for case detection, particularly in identifying those with a previous diagnosis of asthma
• Wittich, A. R., Turner-henson, A., Redden, D. T., Hemstreet, M. P., Hains, C., Gerald, L. B., Feinstein, R. A., Erwin, S., & Bailey, W. C. (2006). Outcomes for a comprehensive school-based asthma management program.. The Journal of school health, 76(6), 291-6. doi:10.1111/j.1746-1561.2006.00114.x
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  This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff, students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools.
• Mcclure, L. A., Mangan, J. M., Grad, R., Gibson, L., & Gerald, L. B. (2005). REMOVAL OF FINANCIAL AND ACCESS BARRIERS DOES NOT GUARANTEE ADHERENCE TO ASTHMA CONTROLLER THERAPY. Chest, 128(4), 1-7. doi:10.1378/chest.128.4_meetingabstracts.187s-a
• Gerald, L. B., Dransfield, M. T., Davis, J. J., & Bailey, W. C. (2004). Racial and Gender Differences in Susceptibility to Tobacco Smoke Among Patients with Chronic Obstructive Pulmonary Disease. Chest, 126(4), 7-8. doi:10.1378/chest.126.4_meetingabstracts.738s-b
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  ee front matter & 2005 med.2005.09.019 s: COPD, Chronic obst ndex; WHO, World Heal ; IL, Interleukin; Ig, Imm s have no financial inte ing author. 215 THT, 19 ess: mdransfield99@msn Summary Background: Although chronic obstructive pulmonary disease (COPD) has been considered a disease of Caucasian men, recent data show mortality rising faster among women and African-Americans. Some have suggested these groups are more susceptible to tobacco smoke. We examined this issue in our own population of COPD patients. Methods: Beginning in March 2003 we prospectively developed a COPD research database to facilitate recruitment for clinical trials. Enrollees are recruited from clinics and paid advertising and their demographics, medical/smoking histories, and spirometric data are recorded. We examined the smoking histories and pulmonary function of enrollees over 45, with X20 pack-years of smoking, FEV1/FVC (forced expiratory volume forced vital capacity) o0.70, and a race-adjusted postbronchodilator FEV1o80%. The primary outcome was the loss of lung function per pack-year smoked, or Susceptibility Index (SI), calculated using the formula: (% predicted FEV1 100)/pack-years. Results: A total of 585 patients enrolled during the study period and 330 met our inclusion criteria. Caucasians were older than African-Americans (63 vs. 58, P 1⁄4 0:0003) and had more pack-years of smoking (57 vs. 43, P 1⁄4 0:0003). There were no differences in lung function or bronchodilator reversibility among the racial or gender subgroups. Caucasians had less loss of lung function per pack-year smoked
• Wille, K. M., Turner-henson, A., Tang, S., Hains, C., Grad, R., Gerald, L. B., Feinstein, R. A., Erwin, S., & Bailey, W. C. (2004). Validation of a multistage asthma case-detection procedure for elementary school children.. Pediatrics, 114(4), e459-68. doi:10.1542/peds.2004-0455
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  The purpose of this study was to validate a 3-stage asthma case-detection procedure for elementary school-aged children..The study was performed in 10 elementary schools in 4 inner-city school systems, with a total enrollment of 3539 children. Results of the case-detection procedure were compared with the diagnosis of an asthma specialist study physician, to determine the sensitivity and specificity of the case-detection procedure..Ninety-eight percent of children returned the asthma symptoms questionnaires, and 79% of those children consented to additional testing. Results indicated that the 3-stage procedure had good validity, with sensitivity, specificity, and predictive value of 82%, 93%, and 93%, respectively. A 2-stage procedure using questionnaires and spirometry had similar validity, with sensitivity, specificity, and predictive value of 78%, 93%, and 93%, respectively. However, given the time and expense associated with the 2- or 3-stage procedure and the difficulty of obtaining physician follow-up evaluation of the case-detection diagnosis, schools may prefer to use a 2-item questionnaire that has a lower sensitivity (66%) but higher specificity (96%) and predictive value (95%)..Case-detection programs are generally well received by school personnel and can identify children with unrecognized or undiagnosed disease, as well as those with a current diagnosis but poorly controlled disease. This study yields substantial information regarding the validity, yield, and specific types of children who might be identified with the use of such procedures. For the choice of the method of case detection used in a school, the strengths and weaknesses of each procedure, as well as the resources available for case detection, physician referral, and follow-up procedures, must be considered.
• Sanderson, B. K., Phillips, M. M., Gerald, L. B., Dilillo, V., & Bittner, V. (2003). Factors associated with the failure of patients to complete cardiac rehabilitation for medical and nonmedical reasons.. Journal of cardiopulmonary rehabilitation, 23(4), 281-9. doi:10.1097/00008483-200307000-00005
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  Cardiac rehabilitation (CR) provides effective secondary prevention services, but many patients fail to complete the recommended program. The purposes of this study were to describe completion rates in a hospital-based outpatient CR program, and to identify factors associated with patients failing to complete CR because of nonmedical and medical reasons..Data used for the analyses were from a hospital-based CR program involving 526 discharged patients between January 1996 and February 2002. Patient discharge status was classified into three categories: complete, noncomplete-medical reasons, and noncomplete-nonmedical reasons. Logistic regression modeling identified factors associated with the groups failing to complete CR..The rate of CR completion was 58% (304/526). Among the 222 patients who did not complete CR, 139 (63%) had nonmedical reasons. As compared with the patients who completed CR, the adjusted odds ratio (AOR) for those who did not complete CR because of nonmedical reasons were more likely to be employed (AOR 2.2), to be obese (AOR 2.5), to be smokers (AOR 2.1), and to have shorter 6-minute walk distances (AOR 1.7). They were less likely to be women (AOR 0.6) or have diabetes (AOR 0.5). Patients not completing CR for medical reasons were more likely to be categorized as being at high clinical risk (AOR 4.2) and having shorter 6-minute walk distances (AOR 1.9)..Except for low functional capacity, baseline factors associated with patients failing to complete CR differed on the basis of medical or nonmedical reasons. The development of interventions that address the special needs of patients with low functional capacity may be especially important in attempts to retain this high-risk group in CR therapy.
• Windsor, R. A., Kimerling, M. E., Gerald, L. B., Bruce, F., Brooks, C. M., Brook, N., & Bailey, W. C. (2003). Standardizing contact investigation protocols.. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 7(12 Suppl 3), S369-74.
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  The State of Alabama Department of Public Health Division of Tuberculosis Control..To standardize contact investigation protocols and implement an intervention to increase TB field worker adherence to the protocols with the goal of promoting efficiency and effectiveness in contact investigations..A process evaluation of existing data collection and management systems and protocols was performed. Standardized protocols and an intervention to increase TB field worker adherence to the protocols were created and pilot tested. These were then implemented and formative evaluation data were collected..The process evaluation revealed considerable variance among field workers with regard to protocols and definitions of variables related to contact investigations. Protocols were standardized and an intervention targeted at TB field workers was developed. The intervention consisted of a training workshop and the development of a computer-based contact investigation module. This was successfully implemented throughout the state..To perform effective contact investigations and conduct studies to improve the effectiveness of these investigations, TB control programs must pay careful attention to precisely defining variables and concepts related to the contact investigation. Furthermore, protocols must be standardized and resources devoted to training of TB field workers to ensure adherence to protocols.
• Wise, R. A., Tashkin, D. P., Scanlon, P. D., Madhok, T. C., Gerald, L. B., Eichenhorn, M. S., & Bailey, W. C. (2003). Lack of long-term adverse adrenal effects from inhaled triamcinolone: Lung Health Study II.. Chest, 124(1), 57-62. doi:10.1378/chest.124.1.57
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  Inhaled corticosteroids (ICS) are widely used in the treatment of COPD. One of the potential adverse effects of their use is the development of adrenal suppression. Our study aimed to determine the effects of ICS on adrenal function over 3 years of use in patients with COPD..Two hundred twenty-one subjects were recruited from the 1,116 patients already enrolled in Lung Health Study II and were randomized to receive either triamcinolone, 1,200 microg, or placebo daily. Basal cortisol levels and cortisol levels at 30 min and 60 min following cosyntropin injection were measured at study entry and after 1 year and 3 years of participation..Basal cortisol levels in the placebo group were higher than in those receiving active drug at all time points and rose through the study period. There was no suppression of cortisol levels after cosyntropin stimulation at any study point in any subgroup..Use of inhaled triamcinolone, 1,200 microg/d, over 3 years does not suppress baseline adrenal function or diminish adrenal responsiveness to cosyntropin stimulation.
• Gerald, L. B., & Bailey, W. C. (2002). Global initiative for chronic obstructive lung disease.. Journal of cardiopulmonary rehabilitation, 22(4), 234-44. doi:10.1097/00008483-200207000-00004
• Tang, S., Redden, D. T., Kimerling, M. E., Gerald, L. B., Dunlap, N. E., Bruce, F., Brook, N., & Bailey, W. C. (2002). A decision tree for tuberculosis contact investigation.. American journal of respiratory and critical care medicine, 166(8), 1122-7. doi:10.1164/rccm.200202-124oc
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  The University of Alabama at Birmingham and the Alabama Department of Public Health recently developed a logistic regression model showing those variables that are most likely to predict a positive tuberculin skin test in contacts of tuberculosis cases. However, translating such a model into field application requires a stepwise approach. This article describes a decision tree developed to assist public health workers in determining which contacts are most likely to have a positive tuberculin skin test. The Classification and Regression Tree analysis was performed on 292 consecutive cases and their 2,941 contacts seen by the Alabama Department of Public Health from January 1, 1998, to October 15, 1998. Several decision trees were developed and were then tested using prospectively collected data from 366 new tuberculosis cases and their 3,162 contacts from October 15, 1998, to April 30, 2000. Testing showed the trees to have sensitivities of 87-94%, specificities of 22-28%, and false-negative rates between 7 and 10%. The use of the decision trees would decrease the number of contacts investigated by 17-25% while maintaining a false-negative rate that was close to that of the presumed background rate of latent tuberculosis infection in the state of Alabama.
• Tang, S., Redden, D. T., Kimerling, M. E., Gerald, L. B., Dunlap, N. E., Duncan, S., Bruce, F., Brooks, C. M., Brook, N., & Bailey, W. C. (2002). Factors in Tuberculosis Contact Investigations—Reply. JAMA, 287(22), 2944-2945. doi:10.1001/jama.287.22.2942
• Tang, S., Redden, D. T., Kimerling, M. E., Gerald, L. B., Dunlap, N. E., Duncan, S., Bruce, F., Brooks, C. M., Brook, N., & Bailey, W. C. (2002). Predictive model to identify positive tuberculosis skin test results during contact investigations.. JAMA, 287(8), 996-1002. doi:10.1001/jama.287.8.996
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  Budgetary constraints in tuberculosis (TB) control programs require streamlining contact investigations without sacrificing disease control..To develop more efficient methods of TB contact investigation by creating a model of TB transmission using variables that best predict a positive tuberculin skin test among contacts of an active TB case..After standardizing the interview and documentation process, data were collected on 292 consecutive TB cases and their 2941 contacts identified by the Alabama Department of Public Health between January and October 1998. Generalized estimating equations were used to create a model for predicting positive skin test results in contacts of active TB cases. The model was then validated using data from a prospective cohort of 366 new TB cases and their 3162 contacts identified between October 1998 and April 2000..Tuberculin skin test result..Using generalized estimating equations to build a predictive model, 7 variables were found to significantly predict a positive tuberculin skin test result among contacts of an active TB case. Further testing showed this model to have a sensitivity, specificity, and positive predictive value of approximately 89%, 36%, and 26%, respectively. The false-negative rate was less than 10%, and about 40% of the contact workload could be eliminated using this model..Certain characteristics can be used to predict contacts most likely to have a positive tuberculin skin test result. Use of such models can significantly reduce the number of contacts that public health officials need to investigate while still maintaining excellent disease control.
• Taylor, Z., Tank, S., Reichler, M. R., Redden, D. T., Kimerling, M. E., Gerald, L. B., Dunlap, N. E., Duncan, S., Castro, K. G., Bruce, F., Brooks, C. M., Brook, N., & Bailey, W. C. (2002). Factors in tuberculosis contact investigations. Authors' reply. JAMA, 287(22), 2944-2945.
• Turner-henson, A., Redden, D. T., Hemstreet, M. P., Hains, C., Gerald, L. B., Feinstein, R. A., Erwin, S., Brooks, C. M., & Bailey, W. C. (2002). A multi-stage asthma screening procedure for elementary school children.. The Journal of asthma : official journal of the Association for the Care of Asthma, 39(1), 29-36. doi:10.1081/jas-120000804
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  This paper describes an asthma screening procedure developed to identify children with asthma for an intervention study. Students were classified into three categories based on questionnaire responses (previous asthma, suspected asthma, and no evidence of asthma). Those classified as suspected asthma by questionnaire underwent further testing, including spirometry and exercise challenge. Using the questionnaire alone, the measured asthma prevalence was 32%; the addition of spirometry and step testing reduced this estimate to 9.89%. The diagnosis of asthma was confirmed in 96% of children who saw the study physician. This screening procedure can identify school children with suspected undiagnosed asthma.
• Wise, R. A., Holbrook, J. T., & Gerald, L. B. (2002). Drug distribution for a large crossover trial of the safety of inactivated influenza vaccine in asthmatics.. Controlled clinical trials, 23(1), 87-92. doi:10.1016/s0197-2456(01)00193-3
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  We report on the drug packaging, masking, and distribution procedures for a large double-masked, randomized, controlled, crossover trial. The Study of Inactivated Influenza Vaccine in Asthmatics was performed to evaluate whether influenza vaccination was safe for asthmatics. Nineteen clinical centers enrolled 2032 participants from 15 September to 30 November 2000. The participants were assigned individual kits with two syringes (placebo and vaccine); the order of injection was randomly assigned. All participants enrolled in the trial received the first injection and 2009 participants received the second injection. Five participants received their injections in the wrong order; we have no evidence that any participant received an injection from the wrong kit. Challenges faced by the trial were a manufacturing shortage of vaccine, the lack of a commercially available placebo, short time periods for planning and startup, and a diverse set of clinical centers. Utilizing individual syringe kits, using the same identification for patient, kit, and drug assignment, and dispensing drug from a central facility helped to successfully meet these challenges.
• Murray, R. P., Gerald, L. B., Eichenhorn, M. S., Connett, J. E., & Buist, A. S. (2001). Experience of Black participants in the Lung Health Study smoking cessation intervention program.. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 3(4), 375-82. doi:10.1080/14622200110081435
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  This paper evaluates the hypothesis that Black smokers will respond differently than Whites to a smoking cessation intervention program where no adjustments are made in recognition of cultural differences. The responses of Black smokers who were recruited into the Lung Health Study (LHS) to the smoking cessation intervention are described. Black quit rates are compared with those of Whites. The LHS enrolled 5887 men and women smokers, aged 35-60 years, of whom 3923 were randomized to a group cessation intervention and 1964 to usual care. Blacks and Whites from six clinics who had complete covariate data (200 Blacks and 2868 Whites) were compared on baseline smoking characteristics and subsequent smoking cessation outcomes. Logistic models were constructed to adjust for baseline smoking variables and demographic characteristics to evaluate the effect of treatment group on smoking cessation among Blacks and Whites. At baseline, Blacks reported smoking fewer cigarettes than Whites, but had higher mean levels of salivary cotinine. The adjusted odds ratio of quitting at 1 year for the smoking intervention group vs. the usual care group was 1.48 for Blacks and 5.99 for Whites. This difference between Blacks and Whites was highly significant (p = 0.002). Across 5 years, the adjusted odds ratios of quitting were 1.87 for Blacks and 3.34 for Whites (p = 0.06). Although the treatment effect was stronger for Whites than for Blacks, over the 5 years of the study there was a significant treatment effect for Blacks. Indicators of physical dependence on nicotine at baseline were inconsistent in indicating whether Blacks were more dependent. We conclude that Blacks and Whites differed significantly in their response to the LHS group smoking intervention program.
• Sanderson, B., Redden, D. T., Gerald, L. B., & Bailey, W. C. (2001). Chronic obstructive pulmonary disease stage and 6-minute walk outcome.. Journal of cardiopulmonary rehabilitation, 21(5), 296-9. doi:10.1097/00008483-200109000-00007
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  Although physicians generally reserve pulmonary rehabilitation (PR) referral for patients in later stages of chronic obstructive pulmonary disease (COPD), there is no evidence to suggest that PR programs are more effective for these persons than for those in earlier stages of the disease. This study examined the relationship between 6-minute walk change and COPD stage in patients completing PR..The sample consisted of 76 patients who enrolled in the University of Alabama at Birmingham's Cardiopulmonary Rehabilitation Program with a primary diagnosis of COPD between January 1996 and June 2000. Data was collected on 6-minute walk upon entry into the program and upon program completion. Patients were stratified according to COPD stage using the American Thoracic Society staging system..There were significant differences among the three stages with regard to initial and ending 6-minute walk distances such that persons in later stages of the disease have shorter initial and ending 6-minute walk distances. However, all three stages show significant improvements in the 6-minute walk after PR. There were no significant differences in the median change among groups indicating that the median change was not better (or worse) for patients in any particular COPD stage..This study suggests that PR is equally effective in increasing physical performance for all patients regardless of COPD stage. This type of information can be used to support the recommendation of PR for patients early in the disease process.
• Rand, C. S., Murray, R. P., Lindgren, P. G., Gerald, L. B., Connett, J. E., & Anthonisen, N. R. (2000). Characteristics of participants who stop smoking and sustain abstinence for 1 and 5 years in the Lung Health Study.. Preventive medicine, 30(5), 392-400. doi:10.1006/pmed.2000.0642
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  This study describes baseline and Year 1 predictors of abstinence from smoking for the 3,523 intervention participants who had complete annual 5-year follow-up data in the Lung Health Study (LHS)..The LHS enrolled 5,887 smokers, aged 35 to 60 years, of whom 3,923 were offered a cessation intervention. Of these, 22% achieved biochemically verified abstinence for 5 years. Logistic regressions were performed. The first outcome variable was abstinence from smoking at 1 year. Then for those who were quit at 1 year, the outcome variable was 5 years of sustained abstinence..All participants who were not using nicotine gum after 1 year in the study were more likely to sustain cessation over 5 years than were gum users at year 1 (OR ranged from 0.31 to 0.44 for four age- and sex-specific groups). Baseline number of previous quit attempts was negatively associated with 5-year quitting success among younger and older men (OR = 0.82 and 0.83). Older participants who were less likely to associate smoking with emotional coping had higher abstinence rates at 5 years of follow-up (OR = 0.89 and 0.84)..Different mechanisms may be responsible for achieving cessation in age/gender groups. These results have implications for planning successful interventions.
• Sanderson, B., Li, Y., Gerald, L. B., Fish, L., Brooks, C. M., Bittner, V., & Bailey, W. C. (2000). Advance directives in cardiac and pulmonary rehabilitation patients.. Journal of cardiopulmonary rehabilitation, 20(6), 340-5. doi:10.1097/00008483-200011000-00002
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  Advance directives have been available in parts of the United States for more than 20 years, but research shows that only a small percentage of adults (5-25%) have some form of written advance directive. The purose of this study was to examine the presence of advance directives among persons entering cardiac and pulmonary rehabilitation, and identify characteristics of persons most likely to have advance directives..The sample consisted of 336 cardiac patients and 181 pulmonary patients who enrolled in the University of Alabama at Birmingham's Cardiopulmonary Rehabilitation Program between January 1996 and December 1999. As part of the initial program assessment, patients were asked two questions: (1) Do you have a living will? (2) Do you have any advance directives? For the purposes of this study, the two questions were combined to examine the presence of either a living will or other type of advance directive..Results indicate that 25% of both subgroups (cardiac and pulmonary patients) report having written advance directives. Logistic regression analysis indicates that among cardiac patients whites and older persons were more likely to have advance directives. Among pulmonary patients, females and whites were more likely to have advance directives..These results indicate that only a minority of cardiopulmonary rehabilitation patients have advance directives upon entry into the program, and that the prevalence differs among gender, racial, and age groups. Cardiac and pulmonary rehabilitation programs may be valuable sites for educating patients about advance directives and efforts by rehabilitation personnel may increase the prevalence of advance directives among patients.
• Sanderson, B., Li, Y., Gerald, L. B., Bailey, W. C., & Adams, C. (1999). ADVANCED DIRECTIVES IN CARDIOPULMONARY REHABILITATION PATIENTS. 11:45 AM. Journal of Cardiopulmonary Rehabilitation, 19(5), 296. doi:10.1097/00008483-199909000-00021
• Sanderson, B., Li, Y., Gerald, L. B., Breland, J., & Bittner, V. (1999). CARDIAC REHABILITATION AND ACHIEVING GOALS IN LIPID MANAGEMENT: ARE WE NARROWING THE GAP? 4:30 PM. Journal of Cardiopulmonary Rehabilitation, 19(5), 308. doi:10.1097/00008483-199909000-00042
• Windsor, R. A., Richards, J. M., Martin, B., Liu, T., Kohler, C. L., Higgins, D. M., Gerald, L. B., Brooks, C. M., & Bailey, W. C. (1999). Asthma self-management: do patient education programs always have an impact?. Archives of internal medicine, 159(20), 2422-8. doi:10.1001/archinte.159.20.2422
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  During the past 15 years, programs to improve self-management practices in adults with asthma have reported improvement in functional status and reduction of inappropriate use of health care services. However, these programs usually represent an ideal approach, applying multiple patient education methods. Consequently, when these programs are found to be efficacious, it is important to replicate the programs as well as to evaluate less complex methods that may be more appropriate for nonacademic health care settings..We compared the following 3 standardized self-management treatments in a randomized, controlled trial: (1) a replication of the self-management program developed at a university medical center that was previously shown to be efficacious; (2) a modified version of this program including only the core elements; and (3) a usual-care program. Outcome measures included medication and inhaler regimen adherence, asthma symptoms, respiratory illness, functional status, and use of health care resources..All 3 groups improved on measures of respiratory illnesses, use of health care services, and functional status. Patients in both education groups did no better than the usual-care group..The results are inconsistent with the results of the first asthma self-management study at this institution and with those of efficacy studies of similar programs. Two factors, selection of the patient population and historical changes in asthma treatment, most likely contributed to the lack of impact of the self-management programs. As a result of the improved standards for usual care due to both factors, the opportunity to effect patient outcomes was substantially reduced.
• Gerald, L. B., Gammon, R. B., & Bailey, W. C. (1998). Getting the most out of your metered-dose inhaler. The Consultant, 38(5), 1233-1334.
• Waldrum, M., Sanderson, B., Gerald, L. B., & Bailey, W. C. (1998). Clinical events detected during pulmonary rehabilitation: Using the ATS staging system as a measure of risk. Chest, 114.
• Waldrum, M., Sanderson, B., Redden, D. T., Gerald, L. B., Dunlap, N. E., & Bailey, W. C. (1998). STAGES OF COPD: COMPARISON OF PULMONARY REHABILITATION OUTCOME. 3: 00 PM. Journal of Cardiopulmonary Rehabilitation, 18(5), 357. doi:10.1097/00008483-199809000-00033
• Trimm, R. F., Johnson, G. D., Hoff, C., Gerald, L. B., & Anderson, A. (1994). Social class, social support and obesity risk in children.. Child: care, health and development, 20(3), 145-63. doi:10.1111/j.1365-2214.1994.tb00377.x
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  Selected characteristics of the social environment are tested as predictors of children's risk for obesity. Data were collected during the summer of 1991 at the University of South Alabama Springhill Paediatric Clinic (Mobile, AL, USA). Data were collected on 77 children, aged 2.5-5 years, and their primary caretaker. Obesity risk was measured by the child's weight for height score and calorie intake. Caretaker's socio-economic status, marital status, and social support predict children's obesity risk for this sample. Lower social class position, lower expressive social support, and unmarried status of the caretaker are associated with a higher calorie intake and a higher weight for height score in the child.
• Gerald, L. B. (1993). Paid family caregiving: a review of progress and policies.. Journal of aging & social policy, 5(1-2), 73-89. doi:10.1300/j031v05n01_06
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  Policymakers in the United States have begun to examine solutions that encourage increased sharing of caregiving responsibilities between government and family. Initiatives in Sweden and the United Kingdom are now in place. Support includes a care leave policy implemented at the federal level, paying salaries to family members when caregiving is a regular job, providing job training to salaried caregivers when their personal caregiving experience ends, community-based programs for caregivers, and allowances to be used for providing care to an elderly person. In the United States, 13 states pay caregivers as Medicaid providers. Policymakers have considered tax incentives and, in 1975, U.S. Senate Bill 1161 was introduced but failed as an attempt to provide cash subsidies to families caring for the elderly. A proposal has been made to expand the Temporary Disability Model to include care of family members of all ages by providing adequate wage replacement to assist caregivers. At present, 34 states provide some type of economic support for caregivers. Research is needed to determine what types of programs are most acceptable and beneficial to caregivers as well as cost effective for government.

Proceedings Publications

• Trivedi, M., Spano, M., Shillan, H., Seay, H., Rosal, M. C., Phipatanakul, W., Pearl, H., Pbert, L., Luther, J., Lemon, S. C., Hoque, S., Gerald, L. B., & Byatt, N. (2021). Engagement of Systems-Level Stakeholders in the Clinical Trial Design of School-Supervised Asthma Therapy. In TP15. TP015 UPDATES IN ADHERENCE AND TREATMENT OF LUNG DISEASE.
• Lowe, A. A., Todacheenie, S., Lowe, A. A., Liu, A. H., Lee, A., Jones, C., Jim, S., Gerald, L. B., Gerald, J. K., Bender, B. G., & Begay, C. (2020). Indoor Environmental Exposures and Asthma Control Among Navajo Children in Tuba City, Arizona - NNHRRB Approval #NNR-16.247. In B102. CARING FOR LUNG DISEASES IN UNDERSERVED AND VULNERABLE POPULATIONS.
• Phan, H., Lowe, A. A., Liu, A. H., Kobernick, A. K., Gerald, L. B., Bryson, D., Bender, B. G., & Aina, B. (2020). Pharmacists' Contributions in a Community Asthma Program in Navajo Nation, NNR-16.247. In B102. CARING FOR LUNG DISEASES IN UNDERSERVED AND VULNERABLE POPULATIONS.
• Trivedi, M., Rosal, M. C., Phipatanakul, W., Pbert, L., Patel, J., Mizrahi, R., Lemon, S. C., Hoque, S., Gerald, L. B., & Byatt, N. (2020). Motivators and Barriers to Participant Engagement in Real-World School-Supervised Asthma Therapy: A Qualitative Study. In B52. PEDIATRIC ASTHMA AND ALLERGY.
• Illendula, S. D., Wise, R. A., Sugar, E. A., Seoane, L., Roy, G., Rommes, J. M., Rennard, S. I., Putcha, N., Prieto-centurion, V., Pinto-plata, V. M., Ouellette, D. R., Mularski, R. A., Millard, M. W., Meldrum, C. A., Mannino, D. M., Malanga, E., Labedz, S. L., Krishnan, J. A., Illendula, S., , Holbrook, J. T., et al. (2019). Feasibility of Screening Electronic Health Records to Identify Participants for a Multi-Center Clinical Effectiveness Trial in COPD. In B44. COPD: TREATMENT AND OTHER TOPICS.
• Lowe, A. A., Clemens, C. J., Lowe, A. A., Gerald, L. B., Gerald, J. K., & Clemens, C. J. (2019). Implementation of a County-Wide Stock Inhaler for Schools Program in Pima County, Arizona. In B102. DISPARITIES IN ASTHMA MANAGEMENT.
• Lowe, A. A., Phan, H., Phan, H., Lowe, A. A., Gerald, L. B., Gerald, J. K., Black, S., Bender, B. G., & Begay, J. (2019). Caregiver Reported Asthma Outcomes of School-Age Navajo Children in Tuba City, Arizona. In B102. DISPARITIES IN ASTHMA MANAGEMENT.
• Martinez, F. D., Gerald, L. B., Gerald, J. K., Chinchilli, V. M., & Bioty, N. (2012). Adherence To Rescue Inhaled Corticosteroid Use During The TREXA Trial. In A93. IDENTIFYING RISK FACTORS AND POTENTIAL INTERVENTIONS FOR ASTHMA ADHERENCE.
• Martinez, F. D., Graber, N. J., Gerald, L. B., Gerald, J. K., & Chinchilli, V. M. (2012). Predictors Of Response To Inhaled Corticosteroids: Stratified Results From The TREXA Trial. In C27. EVALUATION AND MANAGEMENT OF DIFFICULT ASTHMA POPULATIONS.
• Zhang, B., Harrington, K. F., Gerald, L. B., & Bailey, W. C. (2012). Effect Of Supplying Schools With Soap And Hand Sanitizer In A Controlled School-Based Hand Hygiene Trial To Reduce Respiratory Infections. In B38. BARRIERS TO SELF-MANAGEMENT AND ACCESS TO CARE AND STRATEGIES TO OVERCOME THEM.
• Zhang, B., Harrington, K. F., Gerald, L. B., & Bailey, W. C. (2012). Impact Of A School-Based Environmental Hand Hygiene Intervention For Children With Asthma: Potential Bias In A Cross-Over Design. In B15. CLINICAL OUTCOMES RESEARCH METHODOLOGY.
• Zhang, B., Magruder, T., Harrington, K. F., Gerald, L. B., & Bailey, W. C. (2012). Associations Among Parent's Health Literacy, Asthma Knowledge And Child's Asthma Control. In A22. PSYCHOSOCIAL FACTORS ASSOCIATED WITH RESPIRATORY HEALTH OUTCOMES.
• Zhang, B., Mcclure, L. A., Harrington, K., Gerald, L. B., Gerald, J. K., & Bailey, W. C. (2012). Is A School-Based Hand Washing And Hand Sanitizer Program Effective In Reducing Asthma Exacerbations Among Elementary School Children?. In B38. BARRIERS TO SELF-MANAGEMENT AND ACCESS TO CARE AND STRATEGIES TO OVERCOME THEM.
• Zhang, B., Stroupe, N., Mcclure, L. A., Harrington, K. F., Gerald, L. B., Gerald, J. K., & Bailey, W. C. (2012). Does Obesity Increase The Risk Of Asthma Exacerbations Among Elementary School Children. In A110. EMERGING INSIGHTS INTO OBSTRUCTIVE LUNG DISEASE: LATE BREAKING ABSTRACTS.
• Zhang, B., Mcclure, L. A., Harrington, K. F., Gerald, L. B., Gerald, J. K., & Bailey, W. C. (2011). Predictors Of Hand Sanitizer Use At Home Among Children With Asthma. In B101. ASTHMA: PSYCHOSOCIAL FACTORS, ADHERENCE AND QUALITY OF CARE TO IMPROVE OUTCOMES AND REDUCE DISPARITIES.
• Zhang, B., Mcclure, L. A., Harrington, K. F., Gerald, L. B., Gerald, J. K., & Bailey, W. C. (2011). Seasonal Influenza And H1N1 Vaccine Prevalence Among Children With Asthma. In C25. PEDIATRIC RESPIRATORY INFECTIONS.
• Mcclure, L. A., Grad, R., Gerald, L. B., & Gerald, J. K. (2010). Daily Symptom And Peak Flow Monitoring: Do They Predict Respiratory-related School Absences?. In A92. IDENTIFYING BARRIERS AND DEVELOPING INTERVENTIONS TO IMPROVE PEDIATRIC ASTHMA CARE.
• Mcclure, L. A., Harrington, K. F., Gerald, L. B., Gerald, J. K., & Bailey, W. C. (2010). Daily Respiratory Symptom Reporting Versus Two-Week Recall In Children With Asthma. In D40. INNOVATIVE APPROACHES AND NEW DEVELOPMENTS IN LUNG HEALTH RESEARCH.
• Mcclure, L. A., Magruder, T., Johnston, J., Harrington, K. F., Gerald, L. B., & Bailey, W. C. (2010). Health Care Provider Perceptions Of Parents' Health LIteracy And Effect On Treatment Recommendations For Children With Asthma. In A92. IDENTIFYING BARRIERS AND DEVELOPING INTERVENTIONS TO IMPROVE PEDIATRIC ASTHMA CARE.
• Mcclure, L. A., Magruder, T., Kannar, P., Johnston, J., Harrington, K. F., Gerald, L. B., & Bailey, W. C. (2010). How Accurate Is A Single Health Literacy Question For Assessing Parents Of Pediatric Asthma Patients. In D40. INNOVATIVE APPROACHES AND NEW DEVELOPMENTS IN LUNG HEALTH RESEARCH.
• Johnston, J., Harrington, K. F., & Gerald, L. B. (2009). Agreement between Medical Record Documentation and Parent Report of Asthma Education Given in Pediatric Asthma Clinic Visit.. In A91. MEASURING AND IMPROVING THE QUALITY OF CARE IN LUNG DISEASE.
• Mcclure, L. A., Grad, R., Gerald, L. B., & Gerald, J. K. (2009). Quick Relief Medication Orders at School.. In B14. PEDIATRIC ASTHMA: OPPORTUNITIES AND CHALLENGES TO IMPROVING OUTCOMES.
• Mcclure, L., Lee, T., Harrington, K., Gerald, L. B., & Gerald, J. K. (2009). Parent and Child Agreement on the Pediatric Asthma Health Outcome Measure.. In B14. PEDIATRIC ASTHMA: OPPORTUNITIES AND CHALLENGES TO IMPROVING OUTCOMES.
• Mcclure, L., Lee, T., Harrington, K., Gerald, L. B., & Gerald, J. K. (2009). The Pediatric Asthma Health Outcome Measure, Not Just Quality-of-Life?.. In C33. PATIENT-REPORTED OUTCOMES AND MEASURES: NEW TOOLS AND UNDERSTANDING EXISTING ONES.

Presentations

• Berryhill, S., Morton, C. J., Dean, A., Berryhill, A., Provencio-Dean, N., Patel, S. I., Estep, L., Combs, D., Gerald, L. B., Krishnan, J. A., & Parthasarathy, S. (2020, June). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.
• 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.
• Parthasarathy, S., Krishnan, J. A., Gerald, L. B., Combs, D., Estep, L., Patel, S. I., Provencio-Dean, N., Berryhill, A., Dean, A., Morton, C. J., & Berryhill, S. (2020, June). Effect of Wearables on Sleep in Healthy Individuals: A Randomized Cross-Over Trial and Validation Study. 2020 meeting of the Associated Professional Sleep Societies. Philadelphia, PA.

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., Oren, E., Combs, D. A., Combs, D. A., Combs, D. A., Fisher, J., Fisher, J., Fisher, J., Goodwin, J., Goodwin, J., Goodwin, J., Billheimer, D. D., Billheimer, D. D., Billheimer, D. D., Gerald, J. K., Gerald, J. K., Gerald, J. K., Clemens, C. J., , Clemens, C. J., 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. C., Jenkins, I., 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.