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. 2001 Oct;109(10):1085–1089. doi: 10.1289/ehp.011091085

Violence: an unrecognized environmental exposure that may contribute to greater asthma morbidity in high risk inner-city populations.

R J Wright 1, S F Steinbach 1
PMCID: PMC1242087  PMID: 11675274

Abstract

In the United States, rising trends in asthma prevalence and severity, which disproportionately impact minorities and the urban poor, have not been fully explained by traditional physical environmental risk factors. Exigencies of inner-city living can increase psychosocial risk factors (e.g., stress) that confer increased asthma morbidity. In the United States, chronic exposure to violence is a unique stressor existing in many high-risk urban neighborhoods. In this paper, we describe a series of cases that exemplify a temporal association between exposure to violence and the precipitation of asthma exacerbations in four urban pediatric patients. In the first three cases, the nature of the exposure is characterized by the proximity to violence, which ranged from direct victimization (through either the threat of physical assault or actual assault) to learning of the death of a peer. The fourth case characterizes a scenario in which a child was exposed to severe parental conflict (i.e., domestic violence) in the hospital setting. Increasingly, studies have begun to explore the effect of living in a violent environment, with a chronic pervasive atmosphere of fear and the perceived or real threat of violence, on health outcomes in population-based studies. Violence exposure may contribute to environmental demands that tax both the individual and the communities in which they live to impact the inner-city asthma burden. At the individual level, intervention strategies aimed to reduce violence exposure, to reduce stress, or to counsel victims or witnesses to violence may be complementary to more traditional asthma treatment in these populations. Change in policies that address the social, economic, and political factors that contribute to crime and violence in urban America may have broader impact.

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Selected References

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  1. Acierno R. A., Kilpatrick D. G., Resnick H. S., Saunders B. E., Best C. L. Violent assault, posttraumatic stress disorder, and depression. Risk factors for cigarette use among adult women. Behav Modif. 1996 Oct;20(4):363–384. doi: 10.1177/01454455960204001. [DOI] [PubMed] [Google Scholar]
  2. Adler N. E., Boyce T., Chesney M. A., Cohen S., Folkman S., Kahn R. L., Syme S. L. Socioeconomic status and health. The challenge of the gradient. Am Psychol. 1994 Jan;49(1):15–24. doi: 10.1037//0003-066x.49.1.15. [DOI] [PubMed] [Google Scholar]
  3. Baum A. Stress, intrusive imagery, and chronic distress. Health Psychol. 1990;9(6):653–675. doi: 10.1037//0278-6133.9.6.653. [DOI] [PubMed] [Google Scholar]
  4. Beckham J. C., Roodman A. A., Shipley R. H., Hertzberg M. A., Cunha G. H., Kudler H. S., Levin E. D., Rose J. E., Fairbank J. A. Smoking in Vietnam combat veterans with post-traumatic stress disorder. J Trauma Stress. 1995 Jul;8(3):461–472. doi: 10.1007/BF02102970. [DOI] [PubMed] [Google Scholar]
  5. Boxer G. H., Carson J., Miller B. D. Neglect contributing to tertiary hospitalization in childhood asthma. Child Abuse Negl. 1988;12(4):491–501. doi: 10.1016/0145-2134(88)90066-x. [DOI] [PubMed] [Google Scholar]
  6. Braun-Fahrländer C., Ackermann-Liebrich U., Schwartz J., Gnehm H. P., Rutishauser M., Wanner H. U. Air pollution and respiratory symptoms in preschool children. Am Rev Respir Dis. 1992 Jan;145(1):42–47. doi: 10.1164/ajrccm/145.1.42. [DOI] [PubMed] [Google Scholar]
  7. Brosschot J. F., Benschop R. J., Godaert G. L., Olff M., De Smet M., Heijnen C. J., Ballieux R. E. Influence of life stress on immunological reactivity to mild psychological stress. Psychosom Med. 1994 May-Jun;56(3):216–224. doi: 10.1097/00006842-199405000-00007. [DOI] [PubMed] [Google Scholar]
  8. Busse W. W., Gern J. E., Dick E. C. The role of respiratory viruses in asthma. Ciba Found Symp. 1997;206:208–219. doi: 10.1002/9780470515334.ch13. [DOI] [PubMed] [Google Scholar]
  9. Busse W. W., Kiecolt-Glaser J. K., Coe C., Martin R. J., Weiss S. T., Parker S. R. NHLBI Workshop summary. Stress and asthma. Am J Respir Crit Care Med. 1995 Jan;151(1):249–252. doi: 10.1164/ajrccm.151.1.7812562. [DOI] [PubMed] [Google Scholar]
  10. Cohen S., Tyrrell D. A., Smith A. P. Psychological stress and susceptibility to the common cold. N Engl J Med. 1991 Aug 29;325(9):606–612. doi: 10.1056/NEJM199108293250903. [DOI] [PubMed] [Google Scholar]
  11. Donovan C. E., Finn P. W. Immune mechanisms of childhood asthma. Thorax. 1999 Oct;54(10):938–946. doi: 10.1136/thx.54.10.938. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Feigelman W., Gorman B. Toward explaining the higher incidence of cigarette smoking among black Americans. J Psychoactive Drugs. 1989 Jul-Sep;21(3):299–305. doi: 10.1080/02791072.1989.10472171. [DOI] [PubMed] [Google Scholar]
  13. Fitzpatrick K. M., Boldizar J. P. The prevalence and consequences of exposure to violence among African-American youth. J Am Acad Child Adolesc Psychiatry. 1993 Mar;32(2):424–430. doi: 10.1097/00004583-199303000-00026. [DOI] [PubMed] [Google Scholar]
  14. Fleming A. W., Sterling-Scott R. P., Carabello G., Imari-Williams I., Allmond B., Foster R. S., Kennedy F., Shoemaker W. C. Injury and violence in Los Angeles. Impact on access to health care and surgical education. Arch Surg. 1992 Jun;127(6):671–676. doi: 10.1001/archsurg.1992.01420060037007. [DOI] [PubMed] [Google Scholar]
  15. Fong R. L. Violence as a barrier to compliance for the hypertensive urban African American. J Natl Med Assoc. 1995 Mar;87(3):203–207. [PMC free article] [PubMed] [Google Scholar]
  16. Gellhorn E. The neurophysiological basis of anxiety: a hypothesis. Perspect Biol Med. 1965 Summer;8(4):488–515. doi: 10.1353/pbm.1965.0058. [DOI] [PubMed] [Google Scholar]
  17. Gergen P. J., Weiss K. B. Changing patterns of asthma hospitalization among children: 1979 to 1987. JAMA. 1990 Oct 3;264(13):1688–1692. [PubMed] [Google Scholar]
  18. Gortmaker S. L., Must A., Sobol A. M., Peterson K., Colditz G. A., Dietz W. H. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Arch Pediatr Adolesc Med. 1996 Apr;150(4):356–362. doi: 10.1001/archpedi.1996.02170290022003. [DOI] [PubMed] [Google Scholar]
  19. Graham N. M., Douglas R. M., Ryan P. Stress and acute respiratory infection. Am J Epidemiol. 1986 Sep;124(3):389–401. doi: 10.1093/oxfordjournals.aje.a114409. [DOI] [PubMed] [Google Scholar]
  20. Gustafsson P. A., Kjellman N. I., Ludvigsson J., Cederblad M. Asthma and family interaction. Arch Dis Child. 1987 Mar;62(3):258–263. doi: 10.1136/adc.62.3.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Herman A. A. Political violence, health, and health services in South Africa. Am J Public Health. 1988 Jul;78(7):767–768. doi: 10.2105/ajph.78.7.767. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kauffman K. S. Center as haven: findings of an urban ethnography. Nurs Res. 1995 Jul-Aug;44(4):231–236. [PubMed] [Google Scholar]
  23. Kawachi I., Kennedy B. P. Income inequality and health: pathways and mechanisms. Health Serv Res. 1999 Apr;34(1 Pt 2):215–227. [PMC free article] [PubMed] [Google Scholar]
  24. Kawachi I., Kennedy B. P., Wilkinson R. G. Crime: social disorganization and relative deprivation. Soc Sci Med. 1999 Mar;48(6):719–731. doi: 10.1016/s0277-9536(98)00400-6. [DOI] [PubMed] [Google Scholar]
  25. Krause N. Stress and isolation from close ties in later life. J Gerontol. 1991 Jul;46(4):S183–S194. doi: 10.1093/geronj/46.4.s183. [DOI] [PubMed] [Google Scholar]
  26. Mannino D. M., Homa D. M., Pertowski C. A., Ashizawa A., Nixon L. L., Johnson C. A., Ball L. B., Jack E., Kang D. S. Surveillance for asthma--United States, 1960-1995. MMWR CDC Surveill Summ. 1998 Apr 24;47(1):1–27. [PubMed] [Google Scholar]
  27. Martinez F. D., Cline M., Burrows B. Increased incidence of asthma in children of smoking mothers. Pediatrics. 1992 Jan;89(1):21–26. [PubMed] [Google Scholar]
  28. McEwen B. S., Biron C. A., Brunson K. W., Bulloch K., Chambers W. H., Dhabhar F. S., Goldfarb R. H., Kitson R. P., Miller A. H., Spencer R. L. The role of adrenocorticoids as modulators of immune function in health and disease: neural, endocrine and immune interactions. Brain Res Brain Res Rev. 1997 Feb;23(1-2):79–133. doi: 10.1016/s0165-0173(96)00012-4. [DOI] [PubMed] [Google Scholar]
  29. Nadel J. A., Barnes P. J. Autonomic regulation of the airways. Annu Rev Med. 1984;35:451–467. doi: 10.1146/annurev.me.35.020184.002315. [DOI] [PubMed] [Google Scholar]
  30. Osofsky J. D., Wewers S., Hann D. M., Fick A. C. Chronic community violence: what is happening to our children? Psychiatry. 1993 Feb;56(1):36–45. doi: 10.1080/00332747.1993.11024619. [DOI] [PubMed] [Google Scholar]
  31. Pike J. L., Smith T. L., Hauger R. L., Nicassio P. M., Patterson T. L., McClintick J., Costlow C., Irwin M. R. Chronic life stress alters sympathetic, neuroendocrine, and immune responsivity to an acute psychological stressor in humans. Psychosom Med. 1997 Jul-Aug;59(4):447–457. doi: 10.1097/00006842-199707000-00015. [DOI] [PubMed] [Google Scholar]
  32. Rabkin J. G., Struening E. L. Live events, stress, and illness. Science. 1976 Dec 3;194(4269):1013–1020. doi: 10.1126/science.790570. [DOI] [PubMed] [Google Scholar]
  33. Reijneveld S. A. The impact of individual and area characteristics on urban socioeconomic differences in health and smoking. Int J Epidemiol. 1998 Feb;27(1):33–40. doi: 10.1093/ije/27.1.33. [DOI] [PubMed] [Google Scholar]
  34. Robicsek F., Ribbeck B., Walker L. G., Thomason M. H., Hollenbeck J. I., Baker J. W. The cost of violence. The economy of health care delivery for non-accidental trauma in an urban southeastern community. N C Med J. 1993 Nov;54(11):578–582. [PubMed] [Google Scholar]
  35. Romano P. S., Bloom J., Syme S. L. Smoking, social support, and hassles in an urban African-American community. Am J Public Health. 1991 Nov;81(11):1415–1422. doi: 10.2105/ajph.81.11.1415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Sampson R. J., Raudenbush S. W., Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997 Aug 15;277(5328):918–924. doi: 10.1126/science.277.5328.918. [DOI] [PubMed] [Google Scholar]
  37. Sheehan K., DiCara J. A., LeBailly S., Christoffel K. K. Children's exposure to violence in an urban setting. Arch Pediatr Adolesc Med. 1997 May;151(5):502–504. doi: 10.1001/archpedi.1997.02170420072012. [DOI] [PubMed] [Google Scholar]
  38. Sporik R., Holgate S. T., Platts-Mills T. A., Cogswell J. J. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med. 1990 Aug 23;323(8):502–507. doi: 10.1056/NEJM199008233230802. [DOI] [PubMed] [Google Scholar]
  39. Stenius-Aarniala B., Poussa T., Kvarnström J., Grönlund E. L., Ylikahri M., Mustajoki P. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ. 2000 Mar 25;320(7238):827–832. doi: 10.1136/bmj.320.7238.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Sternberg E. M. Neural-immune interactions in health and disease. J Clin Invest. 1997 Dec 1;100(11):2641–2647. doi: 10.1172/JCI119807. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Stringham P. Violence anticipatory guidance. Pediatr Clin North Am. 1998 Apr;45(2):439–448. doi: 10.1016/s0031-3955(05)70018-3. [DOI] [PubMed] [Google Scholar]
  42. Strunk R. C., Mrazek D. A., Fuhrmann G. S., LaBrecque J. F. Physiologic and psychological characteristics associated with deaths due to asthma in childhood. A case-controlled study. JAMA. 1985 Sep 6;254(9):1193–1198. [PubMed] [Google Scholar]
  43. Taylor L., Zuckerman B., Harik V., Groves B. M. Witnessing violence by young children and their mothers. J Dev Behav Pediatr. 1994 Apr;15(2):120–123. [PubMed] [Google Scholar]
  44. Taylor S. E., Repetti R. L., Seeman T. Health psychology: what is an unhealthy environment and how does it get under the skin? Annu Rev Psychol. 1997;48:411–447. doi: 10.1146/annurev.psych.48.1.411. [DOI] [PubMed] [Google Scholar]
  45. Vingerhoets A. J. The role of the parasympathetic division of the autonomic nervous system in stress and the emotions. Int J Psychosom. 1985;32(3):28–34. [PubMed] [Google Scholar]
  46. Wallace D., Wallace R. Scales of geography, time, and population: the study of violence as a public health problem. Am J Public Health. 1998 Dec;88(12):1853–1858. doi: 10.2105/ajph.88.12.1853. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Weiss K. B., Gergen P. J., Crain E. F. Inner-city asthma. The epidemiology of an emerging US public health concern. Chest. 1992 Jun;101(6 Suppl):362S–367S. doi: 10.1378/chest.101.6.362s. [DOI] [PubMed] [Google Scholar]
  48. Wright R. J., Rodriguez M., Cohen S. Review of psychosocial stress and asthma: an integrated biopsychosocial approach. Thorax. 1998 Dec;53(12):1066–1074. doi: 10.1136/thx.53.12.1066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Zapata B. C., Rebolledo A., Atalah E., Newman B., King M. C. The influence of social and political violence on the risk of pregnancy complications. Am J Public Health. 1992 May;82(5):685–690. doi: 10.2105/ajph.82.5.685. [DOI] [PMC free article] [PubMed] [Google Scholar]

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