title: Exposure to community violence is associated with asthma hospitalizations and emergency department visits.
abstract: BACKGROUND
  Exposure to community violence (ECV) has been associated with asthma morbidity of children living in inner-city neighborhoods.
  
  
  OBJECTIVE
  To examine with prospective longitudinal data whether ECV is independently associated with asthma-related health outcomes in adults.
  
  
  METHODS
  Adults with moderate-severe asthma, recruited from clinics serving inner-city neighborhoods, completed questionnaires covering sociodemographics, asthma severity, and ECV and were followed for 26 weeks. Longitudinal models were used to assess unadjusted and adjusted associations of subsequent asthma outcomes (emergency department [ED] visits, hospitalizations, FEV(1), quality of life).
  
  
  RESULTS
  A total of 397 adults, 47 +/- 14 years old, 73% women, 70% African American, 7% Latino, mean FEV(1) 66% +/- 19%, 133 with hospitalizations and 222 with ED visits for asthma in the year before entry, were evaluated. Ninety-one reported ECV. Controlling for age, sex, race/ethnicity, and household income, those exposed to violence had 2.27 (95% CI, 1.32-3.90) times more asthma-related ED visits per month and 2.49 (95% CI, 1.11-5.60) times more asthma-related hospitalizations per month over the 26-week study period compared with those unexposed. Violence-exposed participants also had 1.71 (95% CI, 1.14-2.56) times more overall ED visits per month and 1.72 (95% CI, 0.95-3.11) times more overall hospitalizations per month from any cause. Asthma-related quality of life was lower in the violence-exposed participants (-0.40; 95% CI, -0.77 to -0.025; P = .04). Effect modification by depressive symptoms was only statistically significant for the ECV association with overall ED visits and quality-of-life outcomes (P < .01).
  
  
  CONCLUSIONS
  In adults, ECV is associated with increased asthma hospitalizations and emergency care for asthma or any condition and with asthma-related quality of life.
authors.affiliation: Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA. apter@mail.med.upenn.edu
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Apter
authors.forename: Laura A
authors.initials: LA
authors.lastname: Garcia
authors.forename: Rhonda C
authors.initials: RC
authors.lastname: Boyd
authors.forename: Xingmei
authors.initials: X
authors.lastname: Wang
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Bogen
authors.forename: Thomas
authors.initials: T
authors.lastname: Ten Have
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology; D001249:Asthma / Q000191:economics / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014754:Violence / Q000706:statistics & numerical data*
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