Childhood Asthma Research Innovation Program


Our program is comprised of a multi-disciplinary team of researchers and clinicians who examine psychophysiological interactions, management behaviors and health outcomes, and co-morbid conditions in children and adolescents with asthma using state-of- the art clinical and behavioral approaches.  Our work has included over 20 federally-funded observational and intervention studies, many of which are translational in nature and community-based.

A major emphasis of our program involves translating research into interventions and designing tools to improve children’s illness management and health outcomes, reduce health care use, and improve functioning and quality of life for children and their families. Much of our work has been devoted to identifying multi-level factors (biological, sociocultural, environmental, familial/cultural) that contribute to disparities in pediatric asthma outcomes. The Program’s clinical and research programs have excellent access and reach in the community and have the potential to improve the asthma control of children across the state, and to further contribute to the gaps that exist in asthma disparities research in a number of important ways.

This Initiative features three complementary projects: 1) Identifying Mechanisms Contributing to Asthma Onset, Control, and Morbidity; 2) Stress, Epigenetics, and Asthma Onset; and 3) Rhode Island Asthma Collaborative to Address Pediatric Disparities.

         Identifying Mechanisms Contributing to Asthma Onset, Control, and Morbidity

This research will feature a multi-level evaluation of pediatric asthma severity, immune-based biomarkers, and epigenetic factors such as DNA methylation (DNAm) as a function of stress exposure, and how these processes co-occur with behavioral factors such as medication adherence, sleep quality and duration, exposure to environmental tobacco smoke, in relation to key asthma outcomes (e.g. FEV1, asthma control). This study will enable us to identify immune-based and genetic biomarkers that may be associated with real-time behavioral (e.g. sleep, psychosocial) factors to understand the mechanisms underlying asthma disparities in high-risk groups.

Stress, Epigenetics, and Asthma Onset

This project will collect data from an ongoing birth cohort sample to evaluate multi-level risk and protective factors predicting (e.g., biological, sociocultural, behavioral) asthma onset in children. We will evaluate markers of maternal asthma, stress exposure, immune biomarkers, maternal DNA methylation (DNAm) as predictors of their child’s DNAm and asthma onset. Sleep and nutrition in children and caregivers will also be assessed. Stress, including stress experienced by mothers before/during pregnancy and by children in early life, is known to contribute to the development of asthma; however, the multiple pathways through which this occurs have yet to be clearly identified. This project will identify mechanisms underlying the associations among stress exposure, behavioral processes, and asthma onset in children. This approach will have important implications for descriptive science as well as immediate implications for the development of prevention and early intervention efforts.

Rhode Island Asthma Collaborative to Address Pediatric Disparities

In partnership with the Rhode Island Department of Health, this initiative will develop an integrated identification, screening, and referral network for children with asthma in Rhode Island. The Rhode Island Asthma Collaborative (RIAC) will facilitate data collection and referral to our evidence-based asthma programs for low-income families implemented in school and home settings. Such a program will build on our existing strengths and resources to use Rhode Island as a natural laboratory for a population-based, health services experiment to determine the impact of comprehensive, integrated medical and behavioral health care on the most chronic illnesses of childhood.

Contacts:

Sheryl Kopel, MSc (401) 444-7217, sjkopel@lifespan.org

Observational Studies:

Asthma Management and Developmental Transitions

Asthma Management and Ethnic Disparities at the Adolescent Transition; PI: McQuaid, Ph.D.; funded by NICHD

  • This recently concluded project assessed cultural and developmental factors in asthma management and medication adherence across the transition to high school in Latino and non-Latino white youth with persistent asthma.

Asthma, Biological and Behavioral Processes, and Co-morbidities (allergic rhinitis, sleep quality, physical activity/obesity)

Project NAPS: Nocturnal Asthma and Performance in School; PI: D. Koinis Mitchell, Ph.D.; funded by NICHD

  • The goals of this study are to examine the co-occurrence of asthma and allergic rhinitis symptoms, sleep quality, school absences and academic performance in elementary school aged urban children from African American, Latino and non-Latino white backgrounds.

Physical Activity and Asthma; PIs: D. Koinis Mitchell, Ph.D. and E. Jelalian, Ph.D.; funded by NHLBI

  • This study investigates the co-occurrence of asthma and allergic rhinitis status, physical activity, and sedentary behavior in urban, elementary school children, and examines cultural and contextual processes relevant to asthma and the neighborhood setting that influence physical activity in urban children.

Pediatric Asthma Disparities: The Role of Sleep and Immune Balance; PI: D. Koinis Mitchell, Ph.D.; funded by NHLBI

  • This project involves an innovative investigation of the effects of experimental sleep disruption on immune balance (Th1/Th2 cytokine ratio-Th1/Th2R; plasma IL-6 –pIL-6), and associated changes in asthma-related lung function (FEV1 by spirometry) and daytime performance in urban elementary school children with persistent asthma.

Culturally-Tailored Interventions:

Asthma Management in the School Setting

Peer-Administered Asthma Self-Management Intervention in Urban Middle Schools; PIs: D. Koinis Mitchell, Ph.D. and G. Canino, Ph.D.; funded by NICHD

  • The goals of this study are to design and test a culturally-tailored, group-based intervention that involves peer-facilitated asthma self-management intervention specific to the school setting for middle school-aged, urban and Latino children with asthma. The study is collaboration with the University of Puerto Rico and is being implemented in Rhode Island and Puerto Rico.

Controlling Asthma Effectively in School: PI: D. Koinis Mitchell, Ph.D; funded by RI DOH

  • The goals of this program are to implement multi-level asthma services within the urban elementary school setting to enhance child asthma control. Components involve during the day asthma education classes, school staff trainings, environmental walk-through assessments, caregiver after-school asthma educational workshops, and school nurse teacher support. Evaluation efforts are currently underway.

Asthma Environmental-Based Interventions

Project HARP; PI E. McQuaid, Ph.D.; funded by RI Department of Health and Center for Medicare and Medicaid Innovation Research

  • This project implements an environmental asthma intervention to low-income families to reduce recurrent health care use.  Our site is part of a multi-center New England Asthma Innovations Collaborative, funded by CMS, to evaluate return on investment of home-based asthma interventions to evaluate return on investment (ROI) for long-term sustainability.

Reducing Asthma Health Care Utilization

Project ED-AMAP: (Hasbro Asthma Research Team); PI A. Garro, MD, MPH; funded by NICHD

  • A tablet-based intervention implemented in the emergency department to increase adherence to inhaled corticosteroids in children with asthma.

Interventions for Children with Food Allergies

Web-Based and Interactive Virtual Environments for Children with Food Allergies; E. McQuaid, Ph.D. & J. Spitalnick, Ph.D.; funded by NICHD

  • This recently concluded Phase 1 SBIR Project developed an engaging web-based game to help school-aged children learn disease management skills and navigate social issues relating to food allergies. 

Friends, Family, and Food: Interactive Virtual Environments for Children with Food Allergies; E. McQuaid, PI; funded by NICHD

  • This project is a Phase II STTR to further develop an interactive computer game/app for children with food allergies, focusing on trigger avoidance, reaction management, and negotiating social situations.

Project FAST - Food Allergy School Transition; E. McQuaid and S. Rudders, Project Directors

  • An innovative food allergy education program for parents of children with food allergies designed to provide families with the knowledge, skills, and tools to effectively transition to pre-k or kindergarten