The influence of community violence and protective factors on asthma morbidity and healthcare utilization in high-risk children

Melissa Bellin, Philip Osteen, Kathryn Collins, Arlene Butz, Cassie Land, Joan Kub

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)677-689
Number of pages13
JournalJournal of Urban Health
Volume91
Issue number4
DOIs
StatePublished - Aug 2014

Keywords

  • Asthma morbidity
  • Community violence
  • Healthcare utilization
  • Urban caregivers

ASJC Scopus subject areas

  • Health(social science)
  • Urban Studies
  • Public Health, Environmental and Occupational Health

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