The impact of neighbourhood violence and social cohesion on smoking behaviours among a cohort of smokers in Mexico

Abstract

Background Recent increases in violent crime may impact a variety of health outcomes in Mexico. We examined relationships between neighborhood-level violence and smoking behaviors in a cohort of Mexican smokers from 2011–2012, and whether neighborhood-level social cohesion modified these relationships. Methods Data were analyzed from adult smokers and recent ex-smokers who participated in Waves 5–6 of the International Tobacco Control Mexico Survey. Self-reported neighborhood violence and social cohesion were asked of Wave 6 survey participants (n=2129 current and former smokers, n=150 neighborhoods). Neighborhood-level averages for violence and social cohesion (range 4–14 and 10–25, respectively) were assigned to individuals. We used generalized estimating equations to determine associations between neighborhood indicators and individual-level smoking intensity, quit behaviors, and relapse. Results Higher neighborhood violence was associated with higher smoking intensity (Risk Ratio (RR)=1.17, 95% Confidence Interval (CI) 1.02–1.33), and fewer quit attempts (RR=0.72, 95% CI 0.61–0.85). Neighborhood violence was not associated with successful quitting or relapse. Higher neighborhood social cohesion was associated with more quit attempts and more successful quitting. Neighborhood social cohesion modified the association between neighborhood violence and smoking intensity: in neighborhoods with higher social cohesion, as violence increased, smoking intensity decreased and in neighborhoods with lower social cohesion, as violence increased, so did smoking intensity. Conclusion In the context of recent increased violence in Mexico, smokers living in neighborhoods with more violence may smoke more cigarettes per day and make fewer quit attempts than their counterparts in less violent neighborhoods. Neighborhood social cohesion may buffer the impact of violence on smoking intensity.

Cross-sectional and longitudinal associations of neighbourhood social environment and smoking behaviour: the multiethnic study of atherosclerosis

“…Slopen et al 23 found no association between neighbourhood stress, a scale related to safety and trust in the neighbourhood, and smoking behaviour change among a cohort of middle-aged US adults. In contrast, Fleischer et al 18 analysed a cohort of Mexican smokers (mean age 40 years) and found positive associations between neighbourhood social cohesion and both quit attempts and successful quitting. However, the study by Fleischer et al included only 2 years of data and could not evaluate whether smoking behaviour changes were sustained over a longer time period.…”

“…Fewer studies have evaluated the effect of neighbourhood problems and crime on smoking intensity, defined as the number of cigarettes smoked per day by current smokers. Prior work found no association with neighbourhood problems;9 17 however, neighbourhood violence/crime was associated with higher smoking intensity 12 18…”

“…Neighbourhood social cohesion, or how connected people feel with their neighbours,19 is thought to influence health by promoting supportive neighbourhoods that buffer stress and connect residents to shared resources and services; this may in turn lead to adoption of healthy behaviours 20. Prior research suggests that social cohesion may have a protective effect on smoking prevalence14–16 21 although results for smoking intensity have been mixed 14 18…”

“…The association of neighbourhood social environment with smoking over time has been examined in only a few studies 18 22 23. In addition, individual domains of the neighbourhood social environment such as social cohesion14–16 and safety12 have been examined separately, but studies have not integrated these distinct measures into one composite score to reflect the overall neighbourhood social context.…”

Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study

“…Additionally, cross-sectional data has shown that concern for neighborhood problems and disorder is correlated with higher blood pressure, higher BMI, and increased likelihood of tobacco use, all of which negatively associate with ideal cardiovascular health [13,14]. In contrast, more favorable perceptions of social cohesion have been associated with decreased likelihood of tobacco use [15,16]. These associations inform the development of a socio-ecological model specifically tailored to healthcare utilization behavior (Fig 1).…”