Coping with Asthma through Life Management (CALM)

Asthma medication nonadherence is a major contributor to asthma morbidity and mortality in Black adults. Asthma-related hospitalization and death rates are more than 3 times higher in Black adults than Whites. Disparities in asthma outcomes are due, in part, to disparate rates of medication adherence. While asthma medication adherence rates are low in the general population, they are particularly worse in Black adults (adjusted OR 0.35, 95% CI, 0.13-0.95) and optimizing adherence (>80%) could prevent 24.4% of all-cause asthma exacerbations (i.e., asthma-related hospitalizations, emergency department use, and use of oral steroids). Stress is a key barrier to asthma medication adherence and asthma control. In my preliminary focus groups, Black adults with asthma reported that increased psychosocial stress (e.g., job stress, caregiver burden), health-related stress (e.g., difficulty self-managing asthma), and economic stress (e.g., economic strain) were barriers to asthma medication adherence and control. However, interventions simultaneously targeting these stressors are not commonly evaluated in Black adults with asthma. To fill this evidence gap, I will identify types of minor stress, chronic stress, and coping strategies associated with increased asthma severity in a NHLBI-funded cohort (i.e., Jackson Heart Study) of Black adults (Aim 1). I will then use these findings to develop and culturally tailor a novel stress management intervention, called CALM (Coping with Asthma through Life Management) (Aim 2), and pilot its implementation in a health system (Aim 3). CALM will be an innovative, culturally-adapted, stress management intervention designed to promote adaptive coping by targeting 3 common sources of stress in Black adults with asthma—psychosocial issues, poor asthma self-management, and economic strain—with the aim of managing the effects of stress and ultimately improving asthma medication adherence and asthma control. My central hypothesis is that CALM, targeting multiple sources of stress specifically faced by Black adults with asthma, will be feasibly implemented in a health system, will be acceptable to program participants, and will provide a potentially effective intervention to increase asthma medication nonadherence and asthma control. The proposed research will be conducted under the mentorship of Dr. L. Ebony Boulware, MD, MPH (primary mentor, health disparities, qualitative methods), Dr. Loretta G. Que, MD (co-primary mentor, asthma research), Dr. Laura Porter, PhD (co-mentor, clinical psychology, health behavior), Dr. Christopher E. Cox, MD, MPH (consultant, coping skills training), and Dr. Maren Olsen, PhD (consultant, biostatistics). By accomplishing the research aims, I will yield a finalized CALM intervention that will be ready for a randomized controlled trial and will serve as foundation for an independent research career in asthma health disparities.