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  • Childhood Asthma Linked to Sexual and Physical Abuse
    Physical or sexual abuse may more than double the odds of a child having asthma, according to a study of children in Puerto Rico.Violence and abuse were second only to maternal asthma among risk factors and more important than socioeconomic status, reported Robyn T. Cohen, M.D., M.P.H., of Brigham and Women's Hospital and Harvard, and colleagues in the Sept. 1 issue of the American Journal of Respiratory and Critical Care Medicine.

    Their population-based cohort study is the first to link childhood abuse to asthma specifically but affirms the elevated risk seen with stress and violence among children in other studies.

    "Our findings highlight the importance of screening for asthma among victims of childhood abuse," the researchers said, "and to be aware of the possibility of physical or sexual abuse among children with asthma." Among ethnic minorities in the United States, Puerto Ricans have the highest asthma mortality rate and a substantially higher lifetime prevalence of asthma than whites, blacks, and other Hispanic groups.


    Children living in Puerto Rico are even more likely to have asthma than Puerto Ricans living in the continental U.S. One potential explanation is exposure to the high level of personal and community violence seen in Puerto Rican communities, the researchers noted.

    To see if this was the case, Dr. Cohen's group prospectively studied a randomly sampled group of 1,213 children (average age 11.7) and their primary caregivers, separately when possible, living in the metropolitan areas of San Juan and Caguas, Puerto Rico. The majority of households were interviewed again two years later. A high percentage of children reported at least two stressful life events in the prior year.

    Overall, 14.4% had witnessed an act of violence in their neighborhood, 7% had been a victim of neighborhood violence, and 6.3% of children reported a history of physical or sexual abuse. Likewise, physician-diagnosed asthma was common among the children as was physician-diagnosed allergic rhinitis.

    Caregivers reported symptoms in the prior year for nearly all the children with a lifetime history of asthma, and most required medical attention "Patients with asthma exhibit a reduced glucocorticoid response to stress, which may result in decreased suppression of inflammation in the airway, leading to increased airway responsiveness and airflow obstruction," they wrote.

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