The Influence of Community Violence and Protective Factors on Asthma Morbidity and Healthcare Utilization in High-Risk Children
The Influence of Community Violence and Protective Factors on Asthma Morbidity and Healthcare Utilization in High-Risk Children
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DOI：
10.1007/s11524-014-9883-6
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发表时间：
2014-08-01
影响因子：
6.6
通讯作者：
Kub, Joan
中科院分区：
文献类型：
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作者：
Bellin, Melissa;Osteen, Philip;Kub, Joan
我们研究了社区风险和保护因素对哮喘发病率和医疗保健利用的纵向影响。300名患有控制不良的哮喘儿童的城市照顾者参加了一项随机对照试验，测试行为/教育干预的有效性，以及完整的社区暴力暴露(ECV)、社会凝聚力(SC)、非正式社会控制(ISC)、儿童哮喘控制、儿童哮喘症状昼夜和医疗保健利用的措施。潜伏期生长曲线模型检测了ECV、SC和ISC在12个月内对哮喘预后的直接和交互作用。照顾者主要是生母(92%)、单身(70%)和贫穷(50%的收入不到10,000美元)。儿童是非洲裔美国人(96%)和年轻(平均年龄=5.5岁，SD=2.2)。基线时的ECV很高，24.7%的照顾者报告在过去6个月中接触过两次以上暴力(M=1.45，SD=1.61)。护理人员在基线(b=0.19，SE=0.07，p=0.003)和2个月(b=0.12，S.E.=0.05，p=0.04)。ISC和SC缓和了ECV对医疗利用的影响。我们的发现表明，可能需要采取多方面的干预措施，包括在低收入城市居民中遏制暴力和培养凝聚力的战略，以减少与哮喘相关的急救服务。
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.