Research Track

Dr. Klinnert's research focuses on the role of psychological processes in pediatric asthma.  Major research themes have included: 1) psychosocial factors associated with asthma onset and persistence; 2) the relationship between psychosocial functioning, the family’s asthma management system (medical management, exposure to allergens and cigarette smoke) and the persistence and severity of asthma symptoms, and 3) the effectiveness of psychosocial intervention in preventing and/or reducing the severity of early childhood asthma.
Funded by NIH, the Childhood Asthma Prevention Study (CAPS) was designed to intervene with families of wheezing infants who are from low-income families and are thus at both biological and social risk for persistent asthma.  The goal of the CAPS study was to determine if an intensive intervention using nurse home visitors can reduce asthma prevalence or symptoms in these infants.  Nurse home visitors visited parents for one year to target allergens in the home, environmental tobacco smoke, and quality of maternal caregiving as it relates to asthma prevention and management.  Baseline data showed significant covariation among biological and psychosocial variables that increased infants’ risk for developing asthma. Outcome was assessed at age 4 in terms of asthma status and severity, pulmonary functions, and quality of life and child behavioral adjustment.  Preliminary data indicate the study was successful in reducing asthma among infants with less severe illness at baseline. This may indicate that infants with more severe wheezing illness are not amenable to the type of intervention provided by CAPS.  A follow-up to age 7 was funded and is underway to determine intervention effects on asthma in school-age children. Further investigation of the data will focus on biological and psychosocial determinants of early and school-age asthma in this low income, high risk group, regardless of intervention.
The Colorado Tobacco Research Program funded a second intervention study with families of children with asthma age 2 to 13 who were exposed to cigarette smoke in the home.  Counselors visited a randomly chosen half of the sample and used behavioral techniques to help families reduce their children’s exposure to cigarette smoke. Exposure was assessed through urinary cotinine as well as parent report of number of cigarettes smoked in the child’s presence.  The children’s asthma was assessed through symptom report as well as pulmonary functions.  The intervention has been completed, and 12-month follow-up will soon be complete, allowing data analysis of the effectiveness of the intervention.
The role of psychosocial factors and asthma has been central to a longitudinal cohort study that is ongoing in this laboratory.  The Asthma Risk Study (ARS) is a longitudinal prospective study investigating the role of stress in the onset of asthma among genetically predisposed infants.  Assessments of family functioning were made prior to the birth of the index children.  Quality of parenting in the neonatal period was related to asthma onset at age 3 and at age 6.  The children received a comprehensive assessment of asthma and psychosocial functioning at 12 years of age.  Asthma status at age 12 was related not only to lung functions and allergic status, but also to youth report of psychological functioning.  Data analyses are planned to evaluate the longitudinal interplay of biological and psychosocial variables in relation to the expression of asthma.