Areas of Study

• Behavioral Interventions
• Health Disparities
• Health Information Technology
• Measurement
• Patient-Provider Communication
• Provider Behavior and Quality of Care
• Psychosocial Issues in Adherence

Health Disparities

JHARC has a long-standing partnership with Baltimore City Head Start to design and implement community based interventions to address health disparities. Family and community research activities include:

• Health surveillance and screening of preventive health and risk behaviors;
• Head Start staff training and education programs;
• Home-based psycho-educational interventions designed for low-income populations;
• Understanding multi-level influences on self-management and health outcomes.

Relevant Projects:

• A Multifaceted Prompting Intervention for Urban Children with Asthma

• A+ Asthma Early Intervention for Asthma Management

• A+ Asthma Rural Partnership

• ABC Head Start

• ABC: Adherence Intervention for Minority Children with Asthma

• BEST: Motivating Asthma Adherence in Urban Teens

• Breathmobile: Improving Asthma Care for Minority Children in Head Start

• Center for Childhood Asthma in the Urban Environment

• Directly Administered HIV Therapy in Methadone Clinics

• Early Intervention in Pulmonary Exacerbation in CF

• Eliminating Asthma Disparities: A Pediatric Asthma Community-Based Program

• Hydroxyurea to Prevent CNS Complications of Sickle Cell Disease in Children

• Improving Asthma Communication in Minority Families

• Mechanisms of Asthma-Dietary Interventions Against Environmental Triggers

• Nebulizer Intervention in Minority Children with Asthma

• PRIDE: A+ Head Start Intervention for Smoke Free Homes

• TEAM: Adherence Intervention for Minority Children with Asthma

Relevant Publications:

• Bartlett SJ, Krishnan JA, Riekert KA, Butz AM, Malveaux FJ, Rand CS. Maternal depressive symptoms and adherence to therapy in inner-city children with asthma. Pediatrics. 2004;113(2):p. 229-37.
• Bartlett SJ, Lukk P, Butz A, Lampros-Klein F, Rand CS. Enhancing medication adherence among inner-city children with asthma: results from pilot studies. J Asthma. 2002;39(1):p. 47-54.
• Borrelli B, Riekert KA, Weinstein A, Rathier L. Brief motivational interviewing as a clinical strategy to promote asthma medication adherence. J Allergy Clin Immunol. 2007;120(5):p. 1023-30.
• Butz AM, Breysse P, Rand C, Curtin-Brosnan J, Eggleston P, Diette GB, Williams D, Bernert JT, Matsui EC. Household smoking behavior: effects on indoor air quality and health of urban children with asthma. Matern Child Health J. 2011;15(4):p. 460-8.
• Butz AM, Donithan M, Bollinger ME, Rand C, Thompson RE. Monitoring nebulizer use in children: comparison of electronic and asthma diary data. Ann Allergy Asthma Immunol. 2005;94(3): p.360-5.
• Butz AM, Eggleston P, Huss K, Kolodner K, Rand C. Nebulizer use in inner-city children with asthma: morbidity, medication use, and asthma management practices. Arch Pediatr Adolesc Med. 2000;154(10): p.984-90.
• Butz AM, Eggleston P, Huss K, Kolodner K, Vargas P, Rand C. Children with asthma and nebulizer use: parental asthma self-care practices and beliefs. J Asthma. 200;38(7): p.565-73.
• Butz AM, Huss K, Mudd K, Donithan M, Rand C, Bollinger ME. Asthma management practices at home in young inner-city children. J Asthma. 2004;41(4): p.433-44.
• Butz A, Pham L, Lewis L, Lewis C, Hill K, Walker J, Winkelstein M. Rural children with asthma: impact of a parent and child asthma education program. J Asthma. 2005;42(10): p.813-21.
• Butz AM, Riekert KA, Eggleston P, Winkelstein M, Thompson RE, Rand C. Factors associated with preventive asthma care in inner-city children. Clin Pediatr (Phila). 2004;43(8): p.709-19.
• Butz AM, Syron L, Johnson B, Spaulding J, Walker M, Bollinger ME. Home-based asthma self-management education for inner city children. Public Health Nurs. 2005;22(3): p.189-99.
• Butz AM, Thompson RE, Tsoukleris MG, Donithan M, Hsu VD, Mudd K, Zuckerman IH, Bollinger ME. Seasonal patterns of controller and rescue medication dispensed in underserved children with asthma. J Asthma. 2008;45(9): p.800-6.
• Butz AM, Tsoukleris M, Donithan M, Hsu VD, Mudd K, Zuckerman IH, Bollinger ME. Patterns of inhaled antiinflammatory medication use in young underserved children with asthma. Pediatrics. 2006;118(6): p.2504-13.
• Butz AM, Tsoukleris MG, Donithan M, Hsu VD, Zuckerman I, Mudd KE, Thompson RE, Rand C, Bollinger ME. Effectiveness of nebulizer use-targeted asthma education on underserved children with asthma. Arch Pediatr Adolesc Med. 2006;160(6): p.622-8.
• Canino G, McQuaid EL, Rand CS. Addressing asthma health disparities: a multilevel challenge. J Allergy Clin Immunol. 2009;123(6): p.1209-17; quiz 1218-9.
• Canino G, Vila D, Cabana M, Quiñones A, Otero M, Acosta E, Pabón-Cruz K, Colón FM, Rand C. Barriers to Prescribing Controller Anti Inflammatory Medication among Puerto Rican Asthmatic Children with Public Insurance: Results of National Survey of Pediatricians. Pediatr Allergy Immunol Pulmonol. 2010;23(3): p.169-174.
• Canino G, Vila D, Normand SL, Acosta-Pérez E, Ramírez R, García P, Rand C. Reducing asthma health disparities in poor Puerto Rican children: the effectiveness of a culturally tailored family intervention. J Allergy Clin Immunol. 2008;121(3): p.665-70.
• Clerisme-Beaty EM, Karam S, Rand C, Patino CM, Bilderback A, Riekert KA, Okelo SO, Diette GB. Does higher body mass index contribute to worse asthma control in an urban population? J Allergy Clin Immunol. 2009;124(2): p.207-12.
• Clerisme-Beaty E, Rand CS. The effect of obesity on asthma incidence: moving past the epidemiologic evidence. J Allergy Clin Immunol. 2009;123(1): p.96-7.
• Collaco JM, Choi SJ, Riekert KA, Eakin MN, McGrath-Morrow SA, Okelo SO. Socio-economic factors and outcomes in chronic lung disease of prematurity. Pediatr Pulmonol. 2011;46(7): p.709-16.
• Collaco JM, Kole AJ, Riekert KA, Eakin MN, Okelo SO, McGrath-Morrow SA. Respiratory medication adherence in chronic lung disease of prematurity. Pediatr Pulmonol. 2012;47(3): p.283-91.
• Diette GB, McCormack MC, Hansel NN, Breysse PN, Matsui EC. Environmental issues in managing asthma. Respir Care. 2008;53(5): p.602-15; discussion 616-7. Review.
• Diette GB, Rand C. The contributing role of health-care communication to health disparities for minority patients with asthma. Chest. 2007; p.132(5 Suppl):802S-809S. Review.
• Eggleston PA, Butz A, Rand C, Curtin-Brosnan J, Kanchanaraksa S, Swartz L, Breysse P, Buckley T, Diette G, Merriman B, Krishnan JA. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95(6): p.518-24.
• Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, Borrelli B. A pilot study to enhance preventive asthma care among urban adolescents with asthma. J Asthma. 2011;48(5): p.523-30.
• Hansel NN, Eggleston PA, Krishnan JA, Curtin-Brosnan J, Rand CS, Patino CM, Diette GB. Asthma-related health status determinants of environmental control practices for inner-city preschool children. Ann Allergy Asthma Immunol. 2006;97(3): p.409-17.
• Krishnan V, Diette GB, Rand CS, Bilderback AL, Merriman B, Hansel NN, Krishnan JA. Mortality in patients hospitalized for asthma exacerbations in the United States. Am J Respir Crit Care Med. 2006;174(6): p.633-8.
• Krishnan JA, Riekert KA, McCoy JV, Stewart DY, Schmidt S, Chanmugam A, Hill P, Rand CS. Corticosteroid use after hospital discharge among high-risk adults with asthma. Am J Respir Crit Care Med. 2004;170(12): p.1281-5.
• Kub J, Jennings JM, Donithan M, Walker JM, Land CL, Butz A. Life events, chronic stressors, and depressive symptoms in low-income urban mothers with asthmatic children. Public Health Nurs. 2009;26(4): p.297-306.
• Le TT, Bilderback A, Bender B, Wamboldt FS, Turner CF, Rand CS, Bartlett SJ. Do asthma medication beliefs mediate the relationship between minority status and adherence to therapy? J Asthma. 2008;45(1): p.33-7.
• Lucas GM, Chaudhry A, Hsu J, Woodson T, Lau B, Olsen Y, Keruly JC, Fiellin DA, Finkelstein R, Barditch-Crovo P, Cook K, Moore RD. Clinic-based treatment of opioid-dependent HIV-infected patients versus referral to an opioid treatment program: A randomized trial. Ann Intern Med. 2010;152(11): p.704-11.
• Martínez KG, Pérez EA, Ramírez R, Canino G, Rand C. The role of caregivers’ depressive symptoms and asthma beliefs on asthma outcomes among low-income Puerto Rican children. J Asthma. 2009;46(2): p.136-41.
• Matsui EC, Hansel NN, McCormack MC, Rusher R, Breysse PN, Diette GB. Asthma in the inner city and the indoor environment. Immunol Allergy Clin North Am. 2008;28(3): p.665-86. Review.

• McNally KA, Rohan J, Schluchter M, Riekert KA, Vavrek P, Schmidt A, Redline S, Kercsmar C, Drotar D. Adherence to combined montelukast and fluticasone treatment in economically disadvantaged african american youth with asthma. J Asthma. 2009;46(9): p.921-7.
• Morkjaroenpong V, Rand CS, Butz AM, Huss K, Eggleston P, Malveaux FJ, Bartlett SJ. Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma. J Allergy Clin Immunol. 2002;110(1): p.147-53.
• Mudd K, Bollinger ME, Hsu VD, Donithan M, Butz A. Pharmacy fill patterns in young urban children with persistent asthma. J Asthma. 2006;43(8): p.597-600.
• Mudd KE, Bollinger ME, Hsu VD, Manning A, Tsoukleris MG, Butz AM. Concordance of Medicaid and pharmacy record data in inner-city children with asthma. Contemp Clin Trials. 2008;29(1): p.13-20.
• Mullen BA, Cook K, Moore RD, Rand C, Galai N, McCaul ME, Glass S, Oursler KK, Lucas GM. Study design and participant characteristics of a randomized controlled trial of directly administered antiretroviral therapy in opioid treatment programs. BMC Infect Dis. 2011;11: p. 45.
• Naumann PL, Huss K, Calabrese B, Smith T, Quartey R, Van de Castle B, Lewis C, Hill K, Walker J, Winkelstein M. A+ Asthma Rural Partnership coloring for health: an innovative rural asthma teaching strategy. Pediatr Nurs. 2004;30(6):490-4.
• Otsuki M, Eakin MN, Arceneaux LL, Rand CS, Butz AM, Riekert KA. Prospective relationship between maternal depressive symptoms and asthma morbidity among inner-city African American children. J Pediatr Psychol. 2010;35(7): p.758-67.
• Otsuki M, Eakin MN, Rand CS, Butz AM, Hsu VD, Zuckerman IH, Ogborn J, Bilderback A, Riekert KA. Adherence feedback to improve asthma outcomes among inner-city children: a randomized trial. Pediatrics. 2009;124(6): p.1513-21.
• Paasche-Orlow MK, Riekert KA, Bilderback A, Chanmugam A, Hill P, Rand CS, Brancati FL, Krishnan JA. Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med. 2005;172(8): p.980-6.
• Patino CM, Okelo SO, Rand CS, Riekert KA, Krishnan JA, Thompson K, Quartey RI, Perez-Williams D, Bilderback A, Merriman B, Paulin L, Hansel N, Diette GB. The Asthma Control and Communication Instrument: a clinical tool developed for ethnically diverse populations. J Allergy Clin Immunol. 2008;122(5): p.936-943.e6.
• Rand CS, Apter AJ. Mind the widening gap: have improvements in asthma care increased asthma disparities? J Allergy Clin Immunol. 2008;122(2): p.319-21.
• Riekert KA, Borrelli B, Bilderback A, Rand CS. The development of a motivational interviewing intervention to promote medication adherence among inner-city, African-American adolescents with asthma. Patient Educ Couns. 2011;82(1): p.117-22.
• Riekert KA, Butz AM, Eggleston PA, Huss K, Winkelstein M, Rand CS. Caregiver-physician medication concordance and undertreatment of asthma among inner-city children. Pediatrics. 2003;111(3):p. 214-20.
• Rohan J, Drotar D, McNally K, Schluchter M, Riekert K, Vavrek P, Schmidt A, Redline S, Kercsmar C. Adherence to pediatric asthma treatment in economically disadvantaged African-American children and adolescents: an application of growth curve analysis. J Pediatr Psychol. 2010;35(4): p.394-404.
• Smith A, Krishnan JA, Bilderback A, Riekert KA, Rand CS, Bartlett SJ. Depressive symptoms and adherence to asthma therapy after hospital discharge. Chest. 2006;130(4): p.1034-8.
• Vila D, Rand CS, Cabana MD, Quiñones A, Otero M, Gamache C, Ramírez R, García P, Canino G. Disparities in asthma medication dispensing patterns: the case of pediatric asthma in Puerto Rico. J Asthma. 2010;47(10): p.1136-41.

Measurement

JHARC is committed to the development and evaluation of state-of-the-art measurement strategies and tools related to adherence and outcomes, including:

• Illness-specific health beliefs and behaviors;
• Standardization of the use of pharmacy records as a measure of adherence;
• Development of quality control procedures for electronic monitors.

Relevant Projects:

• Adherence with Oral Montelukast Sodium or Fluticasone Propionate

• Assessment Mode and Validity of Self-Report in Adults

Relevant Publications:

• Bender BG, Bartlett SJ, Rand CS, Turner C, Wamboldt FS, Zhang L. Impact of interview mode on accuracy of child and parent report of adherence with asthma-controller medication. Pediatrics. 2007;120(3): p.471-7.

• Butz AM, Breysse P, Rand C, Curtin-Brosnan J, Eggleston P, Diette GB, Williams D, Bernert JT, Matsui EC. Household smoking behavior: effects on indoor air quality and health of urban children with asthma. Matern Child Health J. 2011;15(4): p.460-8.

• Butz AM, Donithan M, Bollinger ME, Rand C, Thompson RE. Monitoring nebulizer use in children: comparison of electronic and asthma diary data. Ann Allergy Asthma Immunol. 2005;94(3): p.360-5.

• Butz A, Pham L, Lewis L, Lewis C, Hill K, Walker J, Winkelstein M. Rural children with asthma: impact of a parent and child asthma education program. J Asthma. 2005;42(10): p.813-21.

• Clerisme-Beaty EM, Karam S, Rand C, Patino CM, Bilderback A, Riekert KA, Okelo SO, Diette GB. Does higher body mass index contribute to worse asthma control in an urban population? J Allergy Clin Immunol. 2009;124(2): p.207-12.

• Collaco JM, Choi SJ, Riekert KA, Eakin MN, McGrath-Morrow SA, Okelo SO. Socio-economic factors and outcomes in chronic lung disease of prematurity. Pediatr Pulmonol. 2011;46(7): p.709-16.

• Eakin MN, Bilderback A, Boyle MP, Mogayzel PJ, Riekert KA. Longitudinal association between medication adherence and lung health in people with cystic fibrosis. J Cyst Fibros. 2011;10(4): p.258-64.

• Hayes M, Yaster M, Haythornthwaite JA, Riekert KA, McMillan KN, White E, Mogayzel PJ Jr, Lechtzin N. Pain is a common problem affecting clinical outcomes in adults with cystic fibrosis. Chest. 2011;140(6): p.1598-603.

• Morkjaroenpong V, Rand CS, Butz AM, Huss K, Eggleston P, Malveaux FJ, Bartlett SJ. Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma. J Allergy Clin Immunol. 2002;110(1): p.147-53.

• Mudd KE, Bollinger ME, Hsu VD, Manning A, Tsoukleris MG, Butz AM. Concordance of Medicaid and pharmacy record data in inner-city children with asthma. Contemp Clin Trials. 2008;29(1): p.13-20.

• O’Connor SL, Bender BG, Gavin-Devitt LA, Wamboldt MZ, Milgrom H, Szefler S, Rand C, Wamboldt FS. Measuring adherence with the Doser CT in children with asthma. J Asthma. 2004;41(6): p.663-70.

• Patino CM, Okelo SO, Rand CS, Riekert KA, Krishnan JA, Thompson K, Quartey RI, Perez-Williams D, Bilderback A, Merriman B, Paulin L, Hansel N, Diette GB. The Asthma Control and Communication Instrument: a clinical tool developed for ethnically diverse populations. J Allergy Clin Immunol. 2008;122(5): p.936-943

• Perry TT, Wood RA, Matsui EC, Curtin-Brosnan J, Rand C, Eggleston PA. Room-specific characteristics of suburban homes as predictors of indoor allergen concentrations. Ann Allergy Asthma Immunol. 2006;97(5): p.628-35.

• Rand CS. Non-adherence with asthma therapy: more than just forgetting. J Pediatr. 2005;146(2): p.157-9.

• Rand C, Bilderback A, Schiller K, Edelman JM, Hustad CM, Zeiger RS; MIAMI Study Research Group. Adherence with montelukast or fluticasone in a long-term clinical trial: results from the mild asthma montelukast versus inhaled corticosteroid trial. J Allergy Clin Immunol. 2007;119(4): p.916-23.

• Riekert KA, Eakin M. Factor analysis: a primer for asthma researchers. J Allergy Clin Immunol. 2008;121(5): p.1181-3. Review.

• Vollmer WM, Xu M, Feldstein A, Smith D, Waterbury A, Rand C. Comparison of pharmacy-based measures of medication adherence. BMC Health Serv Res. 2012;12(1): p.155.

Provider Behavior and Quality of Care

JHARC investigates the critical role of provider behavior in optimizing patient safety and quality of care. Partnering with the Armstrong Institute of Patient Safety and Quality, JHARC is leading the field by:

• Examining associations between safety culture and provider behavior;
• Understanding provider perceptions of safety culture;
• Developing frameworks of provider safety behavior to guide clinical investigation and practice.

Relevant Projects:

• ACCI: Howard/Hopkins Center for Reducing Asthma Disparities

• The Aliki Initiative

• iCARE: I Change Adherence and Raise Expectations

• Preventing Nosocomial Respiratory Infections: Patient Safety in the ICU

Relevant Publications:

• Butz A, Kub J, Donithan M, James NT, Thompson RE, Bellin M, Tsoukleris M, Bollinger ME. Influence of caregiver and provider communication on symptom days and medication use for inner-city children with asthma. J Asthma. 2010;47(4): p.478-85.

• Canino G, Vila D, Cabana M, Quiñones A, Otero M, Acosta E, Pabón-Cruz K, Colón FM, Rand C. Barriers to Prescribing Controller Anti Inflammatory Medication among Puerto Rican Asthmatic Children with Public Insurance: Results of National Survey of Pediatricians. Pediatr Allergy Immunol Pulmonol. 2010;23(3): p.169-174.

• Daugherty EL, Perl TM, Needham DM, Rubinson L, Bilderback A, Rand CS. The use of personal protective equipment for control of influenza among critical care clinicians: A survey study. Crit Care Med. 2009;37(4): p.1210-6.

• Daugherty EL, Perl TM, Rubinson L, Bilderback A, Rand CS. Survey study of the knowledge, attitudes, and expected behaviors of critical care clinicians regarding an influenza pandemic. Infect Control Hosp Epidemiol. 2009;30(12): p.1143-9.

• Daugherty EL, Speck KA, Rand CS, Perl TM. Perceptions and influence of a hospital influenza vaccination policy. Infect Control Hosp Epidemiol. 2011;32(5): p.449-55.

• Demissie S, Riekert KA, Eakin MN, Bilderback A, Diette GB, Okelo SO. How Do Perceptions of Asthma Control and Severity Relate to Indicators of Asthma Status and Treatment Recommendations by Pediatricians? Pediatr Allergy Immunol Pulmonol. 2012;25(1): p.17-23.

• Diette GB, Patino CM, Merriman B, Paulin L, Riekert K, Okelo S, Thompson K, Krishnan JA, Quartey R, Perez-Williams D, Rand C. Patient factors that physicians use to assign asthma treatment. Arch Intern Med. 2007;167(13): p.1360-6.

• Glauser TA, Nevins PH, Williamson JC, Abdolrasulnia M, Salinas GD, Zhang J, Debonnett L, Riekert KA. Adherence to the 2007 Cystic Fibrosis Pulmonary Guidelines – A National Survey of CF Care Centers. Pediatric Pulmonology. 2012; 47: p.434-40.

• Hanyok LA, Hellmann DB, Rand C, Ziegelstein RC. Practicing Patient-Centered Care: The Questions Clinically Excellent Physicians Use to Get to Know their Patients as Individuals. Patient. 2012;5(3): p.141-5.

• Okelo SO, Eakin MN, Patino CM, Teodoro AP, Bilderback AL, Thompson DA, Loiaza-Martinez A, Rand CS, Thyne S, Diette GB, Riekert KA. The PACCI Asthma Questionnaire: For Use in Diverse Children of All Ages. Journal of Allergy & Clinical Immunology (In Press)

• Okelo SO, Patino CM, Riekert KA, Merriman B, Bilderback A, Hansel NN, Thompson K, Thompson J, Quartey R, Rand CS, Diette GB. Patient factors used by pediatricians to assign asthma treatment. Pediatrics. 2008 Jul;122(1):e195-201.

• Patino CM, Okelo SO, Rand CS, Riekert KA, Krishnan JA, Thompson K, Quartey RI, Perez-Williams D, Bilderback A, Merriman B, Paulin L, Hansel N, Diette GB. The Asthma Control and Communication Instrument: a clinical tool developed for ethnically diverse populations. J Allergy Clin Immunol. 2008;122(5): p.936-943.e6.

• Ratanawongsa N, Federowicz MA, Christmas C, Hanyok LA, Record JD, Hellmann DB, Ziegelstein RC, Rand CS. Effects of a focused patient-centered care curriculum on the experiences of internal medicine residents and their patients. J Gen Intern Med. 2012;27(4): p.473-7.

• Record JD, Rand C, Christmas C, Hanyok L, Federowicz M, Bilderback A, Patel A, Khajuria S, Hellmann DB, Ziegelstein RC. Reducing heart failure readmissions by teaching patient-centered care to internal medicine residents. Arch Intern Med. 2011;171(9): p.858-9.

• Srinivasan A, Song X, Richards A, Sinkowitz-Cochran R, Cardo D, Rand C. A survey of knowledge, attitudes, and beliefs of house staff physicians from various specialties concerning antimicrobial use and resistance. Arch Intern Med. 2004;164(13): p.1451-6.

• Vila D, Rand CS, Cabana MD, Quiñones A, Otero M, Gamache C, Ramírez R, García P, Canino G. Disparities in asthma medication dispensing patterns: the case of pediatric asthma in Puerto Rico. J Asthma. 2010;47(10): p.1136-41.

• Ziegelstein RC, Rand CS, Hellmann DB. Redesign of internal-medicine teaching. N Engl J Med. 2010;363(6): p.594; author reply 594.