| Violence: An Unrecognized Environmental Exposure that May Contribute to Greater Asthma Morbidity in High Risk Inner-City Populations Rosalind J. Wright and Suzanne F. Steinbach 1Beth Israel Deaconess Medical Center, Pulmonary and Critical Care Division and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; 2Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
Abstract
 
Harvard Medical School and
Boston Medical Center 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. Key words: asthma, case series, inner-city, stress, violence. Environ Health Perspect 109:1085-1089 (2001) . [Online 2 October 2001] http://ehpnet1.niehs.nih.gov/docs/2001/109p1089-1089wright/ abstract.html Address correspondence to R.J. Wright, Channing Laboratory, 181 Longwood Avenue, Boston, MA USA 02115. Telephone: (617) 525-0867. Fax: (617) 525-0958. E-mail: rosalind.wright@channing.harvard.edu R.J.W. received support from NIH training grant HL07427 and the Medical Foundation Deborah Munroe Noonan Memorial Fund. Received 24 April 2001 ; accepted 20 July 2001.
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