Self-Management Behaviors in World Trade Center Rescue and Recovery Workers with Asthma

Details

• Personal Author:
  Crane M ; Crowley L ; de la Hoz RE ; Goodman E ; Harrison D ; Markowitz S ; Rojano B ; Weiss JJ ; West E ; Wisnivesky JP
• Description:
  Background: Asthma is a major source of morbidity among World Trade Center (WTC) rescue and recovery workers. While physical and mental health comorbidities have been associated with poor asthma control, the potential role and determinants of adherence to self-management behaviors (SMB) among WTC rescue and recovery workers is unknown. Objectives: To identify modifiable determinants of adherence to asthma self-management behaviors in WTC rescue and recovery worker that could be potential targets for future interventions. Methods: We enrolled a cohort of 381 WTC rescue and recovery workers with asthma. Sociodemographic data and asthma history were collected during in-person interviews. Based on the framework of the Model of Self-regulation, we measured beliefs about asthma and controller medications. Outcomes included medication adherence, inhaler technique, use of action plans, and trigger avoidance. Results: Medication adherence, adequate inhaler technique, use of action plans, and trigger avoidance were reported by 44%, 78%, 83%, and 47% of participants, respectively. Adjusted analyses showed that WTC rescue and recovery workers who believe that they had asthma all the time (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.38-4.08), that WTC-related asthma is more severe (OR: 1.73; 95% CI: 1.02-2.93), that medications are important (OR: 12.76; 95% CI: 5.51-29.53), and that present health depends on medications (OR: 2.39; 95% CI: 1.39-4.13) were more likely to be adherent to their asthma medications. Illness beliefs were also associated with higher adherence to other SMB. Conclusions: Low adherence to SMB likely contributes to uncontrolled asthma in WTC rescue and recovery workers. Specific modifiable beliefs about asthma chronicity, the importance of controller medications, and the severity of WTC-related asthma are independent predictors of SMB in this population. Cognitive behavioral interventions targeting these beliefs may improve asthma self-management and outcomes in WTC rescue and recovery workers. Key message: This study identified modifiable beliefs associated with low adherence to self management behaviors among World Trade Center rescue and recovery rescue and recovery workers with asthma which could be the target for future interventions. Capsule summary: Improving World Trade Center-related asthma outcomes will require multifactorial approaches such as supporting adherence to controller medications and other self-management behaviors. This study identified several modifiable beliefs that may be the target of future efforts to support self-management in this patient population. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Emergency Responders Occupational Health Respiratory Tract Diseases Safety September 11 Terrorist Attacks
• Keywords:
  Author Keywords: Medication Adherence Beliefs About Medications Questionnaire Emergency Responders First Responders Health Care Model Of Self-regulation Rescue Workers Respiratory System Disorders Specific Modifiable Beliefs Trigger Avoidance World Trade Center WTC WTC-related Asthma

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• ISSN:
  0277-0903
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  411-421
• Volume:
  56
• Issue:
  4
• NIOSHTIC Number:
  nn:20052341
• Citation:
  J Asthma 2019 Apr; 56(4):411-421
• Contact Point Address:
  Juan P.Wisnivesky, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, NY, NY10029
• Email:
  juan.wisnivesky@mssm.edu
• Federal Fiscal Year:
  2019
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  True
• Start Date:
  20120901
• Source Full Name:
  Journal of Asthma
• End Date:
  20170831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:fd47d5fe396dc6820f14450782a09e8cccc903600f34ae84d9d2dfb851eff2020dfc43d4bcc74dbad4606a0edf2295aed1b1a6ad1c688d056afbcf2f0e01ef1c
• Download URL:
  https://stacks.cdc.gov/view/cdc/211884/cdc_211884_DS1.pdf
• File Type:
  [PDF - 695.54 KB ]