Department of Health Promotion and Research, National Institute of Public Health, Wako-shi, Saitama, Japan.

Recent research shows that exposure to community violence is, directly and indirectly, associated with asthma. This article reviews the findings on the impact of violence on asthma, and the pathways for the association of violence and asthma are suggested: 1) exposure to violence is directly associated with asthma, mainly through dysregulation of sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axis, 2) exposure to violence is associated with the change of susceptibility of outdoor air pollution on asthma, probably through the change of an immune response, and 3) behavioral change due to exposure to violence (e.g. keeping children indoors) leads to more exposure to indoor pollutants. The suggested framework may be useful to develop health policy on asthma in high-violence communities.