Exposure to Neighborhood Violence and Ed Visits for Asthma in Adults 5.7.09

Exposure to neighborhood violence and ED visits for asthma in adults L.A. Garcia, MPH, T. Ten Have, PhD, T. Sharpe, MSW, D. Jackson, MPH, X. Wang, MS, D. Bogen, PhD, R. Weber, A. Apter, MD, MSC University of Pennsylvania, Philadelphia, PA, United States Asthma morbidity rates are disproportionately elevated in low income populations. 1 Exposure to violence has been associated with symptoms of depression and anxiety among urban women, which in turn affects their physical health 2,3 Exposure to violence was associated with more symptom days in children and more lost sleep among their caretakers. 4 Violent crime is prevalent in Philadelphia: In 2007 392 homicides were reported by the Philadelphia Inquirer and in 2006 the police recorded 85,493 major crimes. We examined the influence of exposure to violence on asthma outcomes in adults with moderate or severe asthma. References Table 1. Characteristics of 112 Participants Table 3. Univariable and multivariable correlation of exposure to neighborhood violence (ENV) with asthma-related outcomes Support: HL073932, HL088469 Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Joseph, C. L. M., Williams, L. K., Ownby, D. R., Saltzgaber, J., & Johnson, C. C. J Allergy Clin Immunol 2006;117 ; 233-240. 2. Clark, C., Ryan, L., Kawachi, I., Canner, M.J., Berkman, L., & Wright, R.J. J Urban Health 2007; 85 : 22-38. 3. Wright, R.J. Clinics in Chest Medicine 2006; 27 :413-421. 4. Wright, R.J., Mitchell, H., Visness, C.M., Cohen, S., Stout, J., Evans, R., et. al. Am J Public Health 2004;94 , 625-632. 5. Juniper ER, Guyatt GH, et al. Eur Respir J 1999;14:32-8. 6. Apter AJ, Boston RC, George M, et al. J Allergy Clin Immunol 2003;111:1219-26. 7. Miller G, Gaudin A, Zysk E, Chen E. J Allergy Clin Immunol 2009;123:824-30. Support Results Introduction Results - continued Conclusions/Discussion Table 2. Exposed to neighborhood violence * 11 subjects reported witnessing at least 2 types of violence ** witnessed a murder, shooting, robbery related, an attack, gun shooting, murder with a gun, gun shooting involving police, at least 3 shootings resulting in death * Mean + Standard deviation **American Indian/Alaskan Native, Asian, Native Hawaiian/Pacific Islander, Multiple choices * Controlling for age, sex, educational attainment, and household income Age (years)* 48 ± 14 Female 81 Race Black/African American 79 White 21 Other** 6 No response 6 Ethnicity: Hispanic/Latino 13 Household income < $30,000 per year 67 (68%) # High school graduate 90 (80%) # Hospitalized for asthma in past year 36 # Had ED visits for asthma in past year 58 Baseline FEV 1 as percent predicted* 64% ± 18% Asthma-related quality of life 4.0 ± 1.4 Adherence 63% + 26% # Asthma interfered with school, job or housework in the last 30 days 85 Asthma-related outcome ENV rho p Univariable Hospitalizations for asthma in the last year 0.18 0.06 Emergency department visits for asthma in the last year 0.33 0.0003 FEV1 percent predicted -0.15 0.12 Asthma-related quality of life -0.11 0.26 Adherence with inhaled steroid regimens -0.07 0.48 Asthma interfering with school, job, housework in last 30 days 0.22 0.02 Multivariable* Emergency department visits for asthma in the last year 0.28 0.004 Asthma interfering with school, job, housework in last 30 days 0.15 0.11 # of participants Total witnessing violence in the last 6 months * 22 A fight in which a weapon was used 12 A violent argument between neighbors 11 A gang fight 5 A sexual assault or rape 1 A robbery or mugging 6 Other ** 7

Exposure to Neighborhood Violence and Ed Visits for Asthma in Adults 5.7.09

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Exposure to Neighborhood Violence and Ed Visits for Asthma in Adults 5.7.09