The relationship between external threats and smoking in Central Harlem

Objectives. This study assessed the relationship between external risks, su ch as personal and neighborhood danger, and smoking by using a new theoreti cal framework based on competing mortality risk models. Methods. Regression analyses of self-reported data from residents of Centra l Harlem, New York, surveyed from 1992 through 1994 (n=695, response rate=7 2%) were used to assess the relationship between smoking and 2 measures of external health threats: levels of neighborhood danger and life-time trauma . Results. Support for the framework was mixed. At the 95% confidence level, exposure to lifetime trauma was positively related to current smoking statu s but was not related to the number of cigarettes smoked, conditional on be ing a smoker. Living in a "somewhat unsafe neighborhood" was also statistic ally significantly related to current smoking status. Conclusions. Although the framework implies that policies directed at impro ving the physical and social environment might improve health through their indirect effects on behaviors, little supporting evidence was found. Smoki ng rates may decrease if exposure to violence and neighborhood danger is re duced. This framework needs to be tested on larger and more information-ric h data sets.