Community Violence and Asthma Morbidity: The Inner-City Asthma Study
Rosalind J. Wright, MD, MPH,
Herman Mitchell, PhD,
Cynthia M. Visness, MA, MPH,
Sheldon Cohen, PhD,
James Stout, MD, MPH,
Richard Evans, MD, MPH and
Diane R. Gold, MD, MPH
Rosalind J. Wright is with the Beth Israel Deaconess Medical Center, Pulmonary and Critical Care Division, and the Channing Laboratory, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Mass. Herman Mitchell and Cynthia M. Visness are with Rho Inc, Federal Systems Division, Chapel Hill, NC. Sheldon Cohen is with the Department of Psychology, Carnegie Mellon University, Pittsburgh, Pa. James Stout is with the Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash. Richard Evans is with the Department of Pediatrics and Medicine, Northwestern University Medical School, Chicago, Ill. Diane R. Gold is with the Channing Laboratory, Dept of Medicine, Brigham and Womens Hospital, Harvard Medical School.
Correspondence: Requests for reprints should be sent to Rosalind J. Wright, MD, MPH, Channing Laboratory, 181 Longwood Ave, Boston, MA 02115 (e-mail: rosalind.wright{at}channing.harvard.edu).
Objectives. We examined the association between exposure toviolence and asthma among urban children.
Methods. We obtained reports from caretakers (n = 851) of violence,negative life events, unwanted memories (rumination), caretaker-perceivedstress, and caretaker behaviors (keeping children indoors, smoking,and medication adherence). Outcomes included caretaker-reportedwheezing, sleep disruption, interference with play because ofasthma, and effects on the caretaker (nights caretaker lostsleep because of childs asthma).
Results. Increased exposure to violence predicted higher numberof symptom days (P = .0008) and more nights that caretakerslost sleep (P = .02) in a graded fashion after control for socioeconomicstatus, housing deterioration, and negative life events. Controlfor stress and behaviors partially attenuated this gradient,although these variables had little effect on the associationbetween the highest level of exposure to morbidity, which suggeststhere are other mechanisms.
Conclusions. Mechanisms linking violence and asthma morbidityneed to be further explored.
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