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CHICAGO – Childhood exposure to community violence may manifest in cardiovascular disease later in life, researchers suggested here at the annual scientific sessions of the American Heart Association.

"For every one standard deviation in adverse childhood events experienced among adolescents, there is a 6% increase in the risk of cardiovascular disease," said Michelle Albert, MD, of the University of California San Francisco, during a panel discussion of how violence affects communities and overall health.

"One in two children experience an adverse childhood event," said Albert, who heads UCSF's Center for the Study of Adversity and Cardiovascular Disease. "One in four children experience two childhood adverse events. And black and Hispanic children experience these events more often than white children in the United States."

"Violence is a form of adversity," she said. "The exposure of violence to children is as high as 30%, which is astounding."

She said that violence is prevalent in adolescents as well. She said studies show that in 2016, 3.25% of adolescent males and 1.74% of adolescent females experienced violent victimization.

By the time people reach adulthood, violence is statistically linked with cardiovascular disease. There is a threefold greater risk of cardiovascular disease for every seven adverse childhood events, Albert said.

Studies in Mississippi and Sweden have found that, in neighborhoods where community violent crime or unemployment increase, there is an accompanying increase in cardiovascular disease in both men and women.

"Violence is a prevalent form of adversity that is preventable," Albert said. "Community violence is understudied as a cardiovascular health issue. Violence exposure is a form of toxic stress that is biologically embedded."

She explained that violence as a stressor affects the brain and modulates the autonomic, sympathetic, and parasympathetic nervous systems. Over time, the body adapts to various stressors, and some of that can be maladaptive, resulting in disease processes such as metabolic perturbations, diabetes, or coronary artery disease.

Albert said studies show that depending on the level of violence, imaging scans reveal differences in brain structure and function that occur over time with exposure to violence. Adults who reported violence in childhood have also been found to have elevated inflammation markers such as high levels of C-reactive protein.

"There are biological changes associated with violence that result in hypervigilance, that result in changes in activity in executive function and other parts of the brain that track directly and indirectly into other physical health issues."

Another panel member, Selwyn Rogers, Jr., MD, chief of the University of Chicago's section of trauma and acute care surgery, said, "Violence is complex and intersectional." He said it involves a multitude of environmental factors including racism, the criminal justice incarceration, economic outlooks, policing, individual decision making, and access to guns. These factors lead to events that create post-traumatic stress disorder among exposed individuals, which in turn may contribute to feedback loops based on community fragility.

Rogers suggested that such loops can be broken by improving local "built environments": infrastructure, schools, businesses, quality of housing, public spaces, and transit. With such improvements, he said, "people feel safe using parks, playgrounds, and walking paths in their neighborhoods."

Rev. Rodney Carter Jr., chief operating officer at Bright Star Community Outreach in Chicago, said that despite experiencing more than 4,000 murders in Chicago since 2012, "very few to none people seek trauma counseling to receive long-term emotional support from a restorative counseling perspective." To answer that call, Carter said that local faith leaders are now offering initial trauma counseling. He suggested that community members are more likely to seek counseling from clergy rather than government or medical agencies.

And part of the spectrum of violence that cuts across society includes spanking. Marjorie Fujara, MD, a pediatrician and child abuse specialist at Chicago's John H. Stroger Jr. Hospital, commented, "It probably is not rocket science, but there is literature to show that in a group of young adults that experienced harsh corporal punishment – that may not meet the level of child abuse in that it doesn't leave a mark – had a reduced gray matter in the frontal lobe. That is important because the prefrontal cortex is where executive functioning occurs, where good decisions are made."

Fujara said the evidence shows that the impact on children who are spanked may be as bad or worse than that from lead-based paint, asbestos, or passive smoke.

She said that most people in surveys believe it is okay to hit a child as a form of discipline, but she suggested that -- like smoking on airplanes or in restaurants -- there is the possibility of change that can occur in just one generation.

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