Risk factors for excess mortality in Harlem - Findings from the Harlem Household Survey

Introduction: In 1980, age-adjusted mortality rates in Central Harlem were the highest among New York City's 30 health districts. This population-base d study was designed to describe the self-reported frequency of selected he alth conditions, behavioral risk factors, preventive health practices, and drug use in the Harlem community. Methods: From 1992 to 1994, in-person interviews were conducted among 695 a dults aged 18 to 65 years who were randomly selected from dwelling-unit enu meration lists for the Central Harlem health district. Descriptive statisti cs were computed for men and women separately, and compared to other popula tion-based surveys. Results: Self-reported medical insurance coverage in Harlem was unexpectedl y high (74% of men, 86% of women) as was lifetime use of preventive health practices, e.g., blood cholesterol screening (58% of men, 70% of women). Ho wever, lifetime rates of substance use, e.g. crack cocaine (14%) and self-r eported history of traumatic events, e.g., witnessing someone seriously inj ured or violently killed (49% of men, 21% of women) were also high in Harle m, especially in comparison to other populations. Conclusions: This study has identified important patterns of similarities a nd differences in risk behaviors between Harlem and other populations. Pote ntial solutions to the health problems of Harlem may lie in the creation of strategies that operate at the community, municipal, and regional level, a s well as at the level of individual behavior and risk-taking.