Emphasis on African-Americans and Latinos Who Have Had Angioplasty or Are Being Treated for Asthma or Hypertension
Promoting Positive Mood May Help Improve Patient Outcome
Dec 12, 2002
Weill Cornell Medical College has received a major $7.6 million award from the National Heart, Lung, and Blood Institute (NHLBI) to establish a consortium that will support three clinical trials on new ways to help patients with cardiopulmonary disease make beneficial changes in their behavior.
The grant, which will be administered by the Medical College's Center for Complementary and Integrative Medicine (CCIM), will evaluate over a thousand patients to assess a strategy of promoting positive mood to assist them to change their behavior and improve their outcomes after angioplasty or when being treated for asthma or hypertension. The trials will pay special attention to the African-American and Latino populations, and the investigators will include scientists from those groups. The study hypothesizes that positive mood may help patients with cardiopulmonary disease make beneficial changes in their behavior such as stopping smoking, exercising more, taking their medications, or changing their diets.
"This will be a major study in health education," said Dr. Mary Charlson, Executive Director of the CCIM, and the Principal Investigator of the study. "By focusing on the mind-body connection, it will serve one of the essential aims of CCIM's mission." Dr. Charlson is also a Professor of Medicine and the Chief of the Division of General Internal Medicine at the Medical College.
"Between 30 percent and 40 percent of patients who undergo angioplasty have another cardiac event within two years," Dr. Charlson said, referring to one of the problems that will be addressed in one of the three clinical trials. "That is largely because the patients do not change their behavior. The doctor can tell the patient, 'Change!,' but the change often does not take place, because the right psychological conditions have not been created to lead the patient to change."
The study will be carried out by a multidisciplinary consortium that combines talents from several institutions. Along with Dr. Charlson, researchers include Dr. Alice Isen, the S. C. Johnson Professor in the Johnson School of Management, and a Professor of Psychology in the Arts College, of Cornell University (Ithaca); Dr. John Allegrante, a behavioral scientist and Professor of Health Education, whose primary appointment is at Columbia Teachers College, and who is also an Adjunct Professor of Behavioral Science at Weill Cornell Medical College; Dr. Laura Robbins, an Associate Scientist at the Hospital for Special Surgery and Assistant Professor of Psychosocial Science at the Weill Cornell Graduate School of Medical Sciences; and four scientists in the Department of Medicine at Weill Cornell Medical College: Dr. Godwin Ogedegbe, Dr. James Hollenberg, Dr. Carla Boutin-Foster, and Dr. Carol Mancuso.
The study comprises three randomized clinical trials over five years—enrolling nearly 1,200 patients. Participants will first be evaluated in one-on-one interviews, and this information will be used to guide and tailor the interventions. The three trials focus on: (1) Promoting multiple health behaviors in angioplasty patients; (2) Improving exercise and physical-activity behavior in asthma patients; and (3) Increasing medication adherence in hypertensive African-American patients.
In asthma, the investigators observe, "Up to 60 percent of patients avoid needed exercise because they are concerned it will exacerbate their respiratory symptoms. This study will evaluate whether a novel intervention of positive mood will increase physical activity in Caucasian, African-American, and Latino patients with asthma."
With hypertension, or high blood pressure, which is a pronounced problem in the African-American population, more than half of hypertensive patients have poor adherence to prescribed medications. Again, the study will examine if positive mood can help these patients stick to their medications.
Dr. Charlson commented, "This study is noteworthy and important for the rigor of the clinical trials and for the involvement of basic behavioral scientists in tackling what have been intractable clinical problems. Medical science has tried innumerable approaches to improving the management of cardiopulmonary disease, and with this study, we should get some helpful answers."