Eakin Lab

Principal Investigator: Dr. Cynthia Rand
Project Number: R18HL107223
Project Dates: 07/01/2011 – 03/31/2016
​Funding Source: National Heart, Lung and Blood Institute

Despite advances in asthma therapies and the wide-spread dissemination of asthma clinical guidelines, low-income, minority children have disproportionately high morbidity and mortality from asthma. The National Center for Children in Poverty has strongly argued that effective interventions to improve asthma health disparities and reduce harm must begin in early childhood. Previous efficacy studies have suggested that asthma education programs can be effective in improving overall management of asthma for preschool children. However, for these promising asthma intervention strategies to have sustainable public health impact for low-income, minority children they must be integrated within those medical, educational and social structures that serve these young high risk children, such as community clinics, schools and day care programs. Because one of the core missions of federally- funded Head Start programs is to provide preventive health services and screening to their low-income preschool students, Head Start represents an ideal community setting for disseminating early asthma education. We propose to draw on our established health and research partnership with Head Start programs in Baltimore City to test the effectiveness of this home-based asthma education intervention with demonstrated efficacy, when delivered in the context of a Head Start-wide asthma education program. We further propose to partner with Head Start to support and evaluate adoption, maintenance and dissemination of new knowledge gained from this project. Specifically we hypothesize that participants receiving the ABC intervention combined with a HS-level asthma education will have more symptom free days at the 6-, 9-, and 12-month evaluation when compared with participants in the HS- level asthma education alone. We plan to enroll of 406 children age 2-6 years old enrolled in Head Start with symptomatic asthma. Secondary outcome measures include other measures of asthma morbidity (i.e., hospitalizations, ED visits, oral steroid bursts, school absences, and caregiver quality of life). We will also evaluate the mediating effects of outcomes expectancies, self-efficacy, asthma knowledge, motivation, and asthma management practices, as well as moderator effects, such as health literacy, caregiver depression, neighborhood cohesion, family management of asthma, and Head Start adoption and dissemination of an asthma education curriculum.

Principal Investigator: Dr. Cynthia Rand
Project Number: R18HL092901
Project Dates: 09/01/2008 – 06/30/2013
​Funding Source: National Heart, Lung and Blood Institute

Environmental tobacco smoke (ETS) exposure has been identified as a significant threat to children’s respiratory health and has been clearly linked to increased risk of asthma, bronchitis, wheeze and otitis media. ETS exposure is higher in households at or below poverty level and this same population has also been found to be at significantly increased risk for asthma morbidity, as well as other respiratory infections. Studies have reported that between 30-70% of low-income children with asthma enrolled in Head Start programs report a smoker in the home. Because of the increased health risks experienced by their students, Head Start programs have a mandate to help high-risk families improve the health of their preschool children. Further, in 2007 the Environmental Protection Agency (EPA) and the Office of Head Start announced a new initiative to promote smoke-free homes for Head Start Children. For these reasons, Head Start programs offer a timely and important venue for reaching high-risk, low-income pre-school children and intervening to reduce these children’s exposure to ETS. We therefore propose to draw on our established health and research partnership with Head Start programs in Baltimore City to test the effectiveness of an ETS reduction intervention with demonstrated efficacy, when delivered in the context of an overall EPA-based Head Start ETS reduction education program. Specifically, we will conduct a randomized clinical trial of a home-delivered, motivational interviewing-based ETS reduction intervention combined with a HS-level EPA/ETS education program in reducing children’s ETS exposure, compared to a HS-level EPA/ETS education program alone. We will enroll 350 HS students aged 2-5 years with a caregiver-reported smoker in the home from all 17 Baltimore City HS programs. The primary study outcome measure will be household ETS levels, as measured by home air nicotine levels at six month follow-up. Secondary outcomes include caregiver-reported home and car smoking bans, child’s salivary cotinine levels, children’s respiratory symptoms, caregiver smoking cessation, school absences, and health care utilization measures. In addition, at the HS level we will evaluate the degree of implementation of the HS-level EPA/ETS education program, change in the proportion of families who report smoking in home for all HS students, and change in HS staff knowledge, attitudes and practices related to ETS exposure and reduction. If successful, this demonstration and education project could have significant public health implications for school and community-based strategies to improve children’s long-term respiratory health. Environmental tobacco smoke (ETS) exposure has been identified as a significant threat to children’s respiratory health and has been clearly linked to increased risk of asthma, bronchitis, wheeze and otitis media. Low-income and minority children are more likely to be exposed to second-hand smoke and to suffer respiratory illnesses, such as asthma. The current study will test a behavioral intervention to reduce ETS exposure among low-income preschool children enrolled in Head Start and if successful, this project could have significant public health implications for school and community-based strategies to improve children’s long-term respiratory health.

Principal Investigator: Sophie Lanzkron and Michelle Eakin
Project Number: 23827
Project Dates: 6/1/2022-5/31/2025
​Funding Source: PCORI

SCD is a rare disease that impacts a predominantly minority Black population. Individuals with SCD are underserved and often have poor access to high quality care resulting in poor health outcomes. Our research has shown that infusion clinics are effective in delivering patient centered care, reduce hospital admissions and are perceived by patients to deliver more satisfactory care. Despite the clear benefits of the IC model, most adults with SCD do not have access to an IC due to lack of adoption and implementation. The IC model is an alternative to ED care for the treatment of VOC preferred by patients. While there are physicians who want to open these clinics, our work identifying barriers during our capacity building grant, demonstrated that key barriers included hospital administrators and a willingness to provide space and staff for the IC model and knowledge and protocols to successfully run a clinic. This implementation project will inform hospital and clinic administrators’ decisions to make ICs available for patients with SCD instead of relying on the current standard which is ED care. Many sites want to develop and implement an infusion clinic but need additional resources and ongoing facilitation, training and support for optimal success. SCD providers need support to work with health system administrators to implement and sustain infusion clinics and improve care delivery as well as ongoing education and clinical expertise.

Principal Investigator: Meredith McCormack and Michelle Eakin
Project Number: R61HL157845/ R33
Project Dates: 7/15/2021-6/30/2026
​Funding Source: NHLBI

Despite a strong evidence-base for the efficacy of asthma care programs in reducing asthma morbidity among low-income minority children, little progress has been made implementing and sustaining interventions in at–risk communities. Effective interventions require a multi-level approach and reducing asthma disparities requires engaging community stakeholders in implementing and sustaining systems of care that reach high-risk children. Schools are an ideal location for reaching children given the strong connection to families and trust from communities. Our multi-disciplinary asthma health disparities collaborative group has a long and successful history of developing and evaluating multi-level community based interventions for asthma management tailored for urban pediatric populations. We have established a strong partnership with Baltimore City Public schools and Health Department to identify potential contributors to poor asthma control. The long-term goal is to implement an evidence-based asthma intervention based on the CDC recommended framework (EXHALE) within Baltimore City Schools. To provide the foundation for success, we will seek to identify and engage local key stakeholders, conduct a community needs assessment to inform necessary refinement and adaptations of the interventions, and build on strong partnerships with collaborative strategies to ensure successful implementation of an asthma intervention program. Results for this multi-phase project will inform the implementation of a tailored multi-level asthma intervention program (Asthma CHAMPS: Community and Home Asthma Management Program in Schools). Implementation of the Asthma CHAMPS Program will be evaluated in a pragmatic trial applying a stepped-wedge design among 32 elementary schools in Baltimore City. The conduct of this project has high potential to demonstrate a successful program that reduces asthma morbidity among Baltimore City children as well as effective implementation strategies for urban communities.

Principal Investigator: Michelle Eakin
Project Number: R01HL146785
Project Dates: 8/1/2020-7/31/2025
​Funding Source: NHLBI

Despite a strong evidence-base for the efficacy of asthma care intervention programs in reducing asthma morbidity among low-income minority children, gaps remain in our understanding of how best to translate and scale up these efficacious interventions into sustainable, broad-based programs that reduce known asthma health disparities. Head Start (HS) serves over one million low income children each year by focusing on early learning, physical health, and family and is committed to implementing evidence based programs to promote overall child wellbeing. It is unknown how to best scale up and implement these evidence based asthma interventions into low resource community organizations that serve children at risk. Implementation strategies are frequently developed atheoretically and may not be tailored to the setting. MD ABC Asthma is a multilevel asthma program that includes both staff and family asthma education training as well an integrated care with medical providers. The overall purpose of this project is to inform best practices of implementation of an asthma education program by 1) systematically evaluating the use of intervention mapping to develop a tailored implementation strategy in partnership with Head Start stakeholders, 2) examining both staff and organizational level determinants associated with implementation of MD ABC Asthma, and 3) evaluating the success of tailored implementation strategies on implementation outcomes and school absences and other health outcomes.. As part of this implementation, we will conduct a multiphase sequential mixed methods study to inform and evaluate the implementation process using the Consolidated Framework of Implementation Research (CFIR). Aim1 will focus on a pre-implementation evaluation of Head Start staff and directors to inform a tailored implementation strategy using intervention mapping. Aims 2 will be an ongoing evaluation and support of the implementation process using a sequential mixed methods approach. Aim 3 will identify both staff and organizational determinants of implementation outcomes to inform national scalability within Head Start. Results will identify innovative methods for implementation and sustainability in low resource settings by partnering with existing community and government agencies as well as evaluate the impact effectiveness of an integrated multilevel asthma program, school absences, asthma control, and healthcare utilization. Successful implementation of this effective intervention has the potential to be included in federal guidelines and integrated into national guidelines on management of asthma nationally through the Office of Head Start.

Principal Investigator: Michelle Eakin
Project Number: R01HL128620
Project Dates: 4/1/2016-3/31/2023
​Funding Source: NHLBI

COPD is the third leading cause of death and the leading cause of disability in the US. Despite the growing availability of efficacious pharmacotherapy for COPD, patients still experience a significant disease burden and with more than half reporting significant impairment in functioning. Thus the efficacy of COPD medications in clinical trials stands in stark contrast to the poor outcomes experienced by patients in the real world. One possible explanation for this gap is low rates of medication adherence. Only 25% of COPD patients are adherent, which is the lower than other chronic illnesses including diabetes, hypertension and congestive heart failure. Despite the high prevalence of nonadherence in COPD interventions there are significant gaps in the development and evaluation of interventions for adherence. Previous research has been based on cross sectional studies using self-reported measures of adherence and largely a theoretical. In the absence of data, many hospital systems are developing interventions to address medication adherence as part of their clinical program to reduce hospital readmissions and avoid financial penalties from CMS. This project proposes to recruit 360 patients with COPD to longitudinally evaluate potential determinants on adherence and disease progression based on theory of self-regulation. Participants will use novel electronic medication monitors to measure adherence to long term controller and rescue medications and ecological momentary assessments to measure patient reported respiratory symptoms and patients reactions including outcome expectancies, self-efficacy to management symptoms and medication health beliefs. This data will be used to evaluate the theory of self-regulation in COPD. Participants will also complete bi-annual clinical visits to track disease progression on clinical outcomes (e.g., lung function, functional status, quality of life) and psychological/ cognitive functioning. The impact f this study is to identify novel and potentially powerful targets for behavioral interventions in COPD which has been understudied despite its tremendous detrimental impact on overall public health.

Principal Investigator: Michelle Eakin
Project Number: U34HL130752
Project Dates: 9/9/2015-8/13/2017
​Funding Source: NHLBI

Despite a strong evidence-base for the efficacy of asthma care intervention programs in reducing asthma morbidity among low-income minority children, little progress has been made in implementing and sustaining asthma care programs at the community and state level. In order to reduce asthma disparities it is critical to engage community stakeholders in implementing and sustaining systems of care that reach high-risk children. Because one of the core missions of federally-funded Head Start programs is to provide preventive health services and screening to their low-income preschool students, Head Start represents an ideal community setting for establishing an Asthma Empowerment Zone. Our multi-disciplinary asthma health disparities collaborative group has a long and successful history of developing and evaluating multi-level community based interventions for asthma management in Head Start. We propose to draw on our established health and research partnership with Maryland Head Start programs, the Maryland State Department of Education Office of Child Care and the Maryland Head Start Association to implement and evaluate a multi-level intervention for pediatric asthma entitled Head Start Controls Asthma in Preschoolers (HS-CAP), built upon our evidence-based asthma interventions. We propose to leverage a recent policy initiative, Maryland EXCELS that provides incentives for child care centers to obtain quality ratings in asthma care. The purpose of this planning grant will be to identify and engage Head Start and other key community stakeholders to conduct a community needs assessment based on the USDHHS community needs assessment toolkit that will inform necessary refinement and adaptations of HS-CAP, and establish strong partnerships to ensure successful implementation of the HS-CAP program. Results of this project will directly inform a controlled trial that will evaluate the effectiveness of the HS-CAP program in improving child asthma outcomes, as well as help identify best practices for implementation of an asthma care program within a statewide early childhood education program, such as Head Start.