The relationship between external threats and smoking in central Harlem

This study assessed the relationship between external risks, such as personal and neighborhood danger, and smoking by using a new theoretical framework based on competing mortality risk models.

Regression analyses of self-reported data from residents of Central Harlem, New York, surveyed from 1992 through 1994 (n = 695, response rate = 72%) were used to assess the relationship between smoking and 2 measures of external health threats: levels of neighborhood danger and lifetime trauma.

Support for the framework was mixed. At the 95% confidence level, exposure to lifetime trauma was positively related to current smoking status but was not related to the number of cigarettes smoked, conditional on being a smoker. Living in a "somewhat unsafe neighborhood" was also statistically significantly related to current smoking status.

Although the framework implies that policies directed at improving the physical and social environment might improve health through their indirect effects on behaviors, little supporting evidence was found. Smoking rates may decrease if exposure to violence and neighborhood danger is reduced. This framework needs to be tested on larger and more information-rich data sets.