Take 10 inner-city children in Baltimore. By the time they're 18 years old, five of them will know someone who has been murdered and five will know someone who has been the victim of armed robbery. Two will have witnessed a murder and four a shooting. One of them will have been assaulted with a weapon, one raped and two had their lives threatened.
This is the level of violence that inner-city youths are growing up with, a team of researchers led by University of Maryland pediatrician Jack Gladstein has found.
"The problem has gotten so bad, we can't ignore it anymore. We're fixing them up just to send them back out there. It gets to be like M*A*S*H* sometimes," said Dr. Gladstein, whose findings are reported in the current issue of the Journal of Adolescent Medicine.
Violence, in addition to the more obvious physical harm that it does to its victims, has broader implications for the community at large, Dr. Gladstein said.
The study, for example, cites previous research that links exposure to violence to juvenile delinquency, depression, substance abuse and other problems. Even violence as depicted in television and movies has been linked to aggressive and anti-social behavior, the study notes.
"It's a public health problem in many ways," he said.
Based on questionnaires of about 400 youths aged 12 to 18, mostly black, who visited the university's adolescent medicine clinic during the summer of 1988, the amount of violence young persons are exposed to is "startling," he said. For comparison, the same questionnaire was given to 435 young persons who visited an Ocean City medical clinic during the same period, most of whom were white, upper middle-class college students working on the Shore during their summer break.
In just about every category, the inner-city youths were more likely to have been victimized, the study found. Thirty-nine reported being raped, for example, compared to 15 in the Ocean City group; 12 of the inner-city youths said they had been shot, compared with four of the Ocean City group.
The contrast is even more dramatic when the questions dealt with witnessing violence or personally knowing crime victims: More than half of the inner-city young persons knew someone who had been murdered, compared with 14 percent of the Ocean City group; 42 percent of the inner-city youths had witnessed a shooting, compared with 14 percent of the Ocean City respondents.
The differences between the two groups' experiences is even more striking considering that the inner-city youths were generally younger. Their average age was 16, compared with the Ocean City group's 21, meaning they had been exposed to more violence in a shorter time, Dr. Gladstein said.
Still, he added, researchers were surprised that a non-inner-city group had experienced even as much crime as it did. "We were struck by the fact that, while the resort group experienced less violence, even they saw plenty."
Researchers were concerned to find that many crime victims weren't receiving the medical or psychological care that such trauma would seem to warrant, Dr. Gladstein said. While 87 percent of the inner-city youths who had been shot had seen a doctor, only half or less of those who had been raped, assaulted or knifed had done so, the questionnaires revealed. And just half of the inner-city rape victims reported seeing a counselor, according to the study.
"[The inner-city youths] might not feel they have the same access to medical care, or they might not have insurance, or they just might be toughing it out," he said.
Dr. Gladstein said health-care workers such as himself increasingly are finding that violence is as much a part of their young patients' medical history as diabetes or asthma.
A group of doctors, social workers and other professionals at the university recently have started meeting to address the issue of what they can do about the violence in the community, especially as it affects young people, he said.