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Adults who feel persistently threatened by violence are more apt to smoke than those who don't feel threatened

Adults living in Harlem in New York City, who have witnessed lifetime violence and perceive their neighborhood as unsafe, are more likely to be current smokers than those who feel less threatened, finds a study supported in part by the Agency for Healthcare Research and Quality (HS09610). The results suggest that negative external factors beyond the individual's control in his or her social and physical environment may be associated with unhealthy behaviors such as smoking. Public health interventions aimed at decreasing violence and improving housing and living conditions may improve health behaviors and, by implication, life expectancy, notes Michael Lee Ganz, Ph.D., M.S., of the Harvard School of Public Health, and formerly of Columbia University.

Dr. Ganz analyzed a survey of residents of Central Harlem from 1992 through 1994 (the Harlem Household Survey) to assess the relationship between smoking and two measures of external threats to health: level of neighborhood danger and lifetime trauma. The survey contained data on demographic and socioeconomic measures, as well as health practices, health conditions, living conditions, and other social factors thought to influence health behaviors and contribute to the high morbidity and mortality in Central Harlem.

Overall, Harlem residents experienced substantial lifetime trauma (for example, a serious accident while using public or other transportation, a large fire or explosion, physical assault or abuse, sexual assault or rape). The 44 percent of residents who were current smokers reported a higher prevalence of lifetime traumas than nonsmokers. Living in a "somewhat unsafe neighborhood" was also significantly related to current smoking status. On average, smokers smoked slightly more than half a pack a day (13 cigarettes) and were more likely to report living in a less-safe neighborhood, being unemployed, having fewer years of education, and having a lower household income than nonsmokers.

See "The relationship between external threats and smoking in Central Harlem, New York," by Dr. Ganz, in the March 2000 American Journal of Public Health 90(3), pp. 367-371.

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