The effect of violence on asthma: are our children facing a double-edged sword?

Low income, urban children with asthma are experiencing community violence that may contribute to asthma morbidity. The objective of this study was to examine the relationship between caregiver report of feeling unsafe, seeing community violence or child seeing community violence and asthma morbidity and health care utilization. Two hundred thirty-one caregivers of children with asthma enrolled in an asthma,education, intervention reported perceptions of safety and violence exposure in six months and frequency of child asthma symptoms, emergency department (ED), primary care (PCP) visits and hospitalizations over 12 months. Children were primarily male (93%), black (61%), and reported income <$30,000 (56%). Violence exposure was high: feeling unsafe (25%), seeing violence themselves (22%), child saw violence (14%). If caregivers or children saw violence, there were significantly more nighttime symptoms than those who were not exposed (caregiver: yes violence = 6.72 +/- 9.19, no violence = 4.23 +/- 6.98, P = 0.03; child: yes violence = 7.09 +/- 7.15, no violence = 4.37 +/- 9.49, P = 0.05). Children who saw violence were less likely to see their PCP. Families exposed to community violence report more asthma symptoms, but are less likely to seek care for asthma. Health care providers and asthma educators should evaluate potential violence exposure with asthma patients and tailor care and education to include violence prevention and avoidance.