Concordance among children, caregivers, and clinicians on barriers to controller medication use.

OBJECTIVE: While much research has addressed asthma medication adherence, few have combined quantitative and qualitative data, and none has addressed the triad of child, caregiver, and clinician simultaneously. This study assessed, with mixed methods, barriers to medication adherence within this triad. METHODS: We conducted interviews with publicly-insured children with asthma, their caregivers, and their primary-care clinicians. Children (7-17 years) had been prescribed daily inhaled corticosteroids and visited the ED for asthma (past year). Participants answered open-ended and survey questions, rating suggested barriers to medication use (never vs. ever a barrier). McNemar's tests compared report of barriers by each group (children, caregivers, clinicians), and assessed concordance within triads. RESULTS: Fifty child-caregiver dyads participated (34 clinicians). Children (40% female; median age 10 years) had mostly non-Hispanic black (90%) caregivers with less than or equal to high-school education (68%). For barriers, children and clinicians were more likely than caregivers to report medications running out. Clinicians were also more likely to cite controllers being a "pain to take" (vs. children) and forgetfulness (vs. caregivers) (all p < .05). There was a lack of within-triad concordance regarding barriers to adherence, especially regarding medication running out, worrying about taking a daily medication, and medication being a pain to take. Qualitative data revealed themes of competing priorities, home routines, and division of responsibility as prominent contributors to medication adherence. CONCLUSIONS: There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications. To tailor asthma management conversations, clinicians should understand family-specific barriers and child-caregiver disagreements.

HUD Housing Assistance and Levels of Physical Activity Among Low-Income Adults.

INTRODUCTION: Receipt of housing assistance from the US Department of Housing and Urban Development (HUD) is associated with improved health among adults and lower rates of unmet medical need among adults and young children. However, it is unclear whether HUD housing assistance is associated with healthier behaviors. The objective of our study was to assess whether participation in HUD housing assistance programs is associated with increased physical activity among low-income adults. METHODS: In 2017, we pooled cross-sectional data from the 2004-2012 National Health Interview Survey (NHIS) linked to administrative records of HUD housing assistance participation. Our primary sample was low-income adults (aged ≥18; <200% of federal poverty level). Using multivariate logistic regression, we calculated the odds of being physically active (≥150 min/week of moderate-intensity activity or equivalent combination of moderate- and vigorous-intensity activity) among current HUD housing assistance residents compared with a control group of future residents (adults who would receive assistance within the next 2 years). In a secondary analyses, we examined neighborhood socioeconomic status as a modifier and conducted a subanalysis among nonsenior adults (aged <65). RESULTS: Among all low-income adults, the adjusted odds of being physically active were similar for current and future residents (odds ratio =1.17; 95% confidence interval, 0.95-1.46). Among nonseniors, current residents were more likely to be physically active than future residents (odds ratio = 1.47; 95% confidence interval, 1.10-1.97). Associations did not differ by neighborhood socioeconomic status. CONCLUSION: Receiving HUD housing assistance is associated with being physically active among nonsenior low-income adults.