title: The influence of community violence and protective factors on asthma morbidity and healthcare utilization in high-risk children.
abstract: We examined the longitudinal effects of community risk and protective factors on asthma morbidity and healthcare utilization. Three hundred urban caregivers of children with poorly controlled asthma were enrolled in a randomized controlled trial testing the effectiveness of a behavioral/educational intervention and completed measures of exposure to community violence (ECV), social cohesion (SC), informal social control (ISC), child asthma control, child asthma symptom days/nights, and healthcare utilization. Latent growth curve modeling examined the direct and interaction effects of ECV, SC, and ISC on the asthma outcomes over 12 months. Caregivers were primarily the biological mother (92 %), single (70 %), and poor (50 % earned less than $10,000). Children were African American (96 %) and young (mean age = 5.5 years, SD = 2.2). ECV at baseline was high, with 24.7 % of caregivers reporting more than two exposures to violence in the previous 6 months (M = 1.45, SD = 1.61). Caregiver ECV-predicted asthma-related healthcare utilization at baseline (b = 0.19, SE = 0.07, p = 0.003) and 2 months (b = 0.12, s.e. = 0.05, p = 0.04). ISC and SC moderated the effect of ECV on healthcare utilization. Our findings suggest that multifaceted interventions that include strategies to curb violence and foster feelings of cohesion among low-income urban residents may be needed to reduce asthma-related emergency services.
authors.affiliation: University of Maryland, Baltimore, MD, USA, mbellin@ssw.umaryland.edu.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bellin
authors.forename: Philip
authors.initials: P
authors.lastname: Osteen
authors.forename: Kathryn
authors.initials: K
authors.lastname: Collins
authors.forename: Arlene
authors.initials: A
authors.lastname: Butz
authors.forename: Cassie
authors.initials: C
authors.lastname: Land
authors.forename: Joan
authors.initials: J
authors.lastname: Kub
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001249:Asthma / Q000453:epidemiology* / Q000628:therapy; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009017:Morbidity; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D065840:Protective Factors; D012924:Social Conditions; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D014754:Violence