Exposure to Violence Adversely Affects Health Behaviors

WASHINGTON—The high rates of cancer in minority communities, some researchers have suggested, may derive from lifestyle factors detrimental to health. But a traditional public health approach emphasizing individual risk factors, poverty, lack of insurance, and limited access to medical services does not suffice to explain ethnic disparities in health behavior and health outcomes, said Kathy Sanders-Phillips, PhD, Distinguished Scientist in Drug Abuse and director of the research program in epidemiology, Howard University.

Rather, she said at the American Psychological Association Conference on Enhancing Outcomes in Women’s Health, deeper and more significant disparities in the social conditions of various groups contribute importantly to differences in their health.

For people living in inner-city minority communities, she said, exposure to violence adversely affects health promotion behaviors. On the simplest level, a dangerous neighborhood discourages residents from getting exercise through such means as taking regular walks.

But Dr. Sanders-Phillips sees the detrimental health effects of violence as far more subtle and pervasive, undermining people’s will and desire to take care of their health.

She reported on a study conducted in South Central Los Angeles to examine women’s health habits as well as their experience of violence. The results showed a striking relationship between these two apparently unrelated characteristics. The subjects, 55% black, 43% Hispanic, and all low income, were asked whether they had such healthful habits as sleeping 7 to 8 hours a night, eating breakfast, exercising three times a week, abstaining from alcohol and tobacco, and choosing a low-fat, high-fiber diet.

The women were also questioned about their willingness to improve their health practices in an effort to prevent breast cancer. In addition, the women were asked about their experience with violence in their community.

In this study, the women most likely to engage in healthy behavior were immigrant Hispanics, Dr. Sanders-Phillips said, and those least likely were black women who had experienced the murder of a family member. Intention to change unhealthy behaviors was also weakest in those from the most violent families and with lower incomes.

Feelings of Powerlessness

Exposure to violence, Dr. Sanders-Phillips commented, creates the perception of chronic danger along with feelings of alienation, hopelessness, and powerlessness. Isolated and depressed people who feel vulnerable to danger see survival as a higher priority than health, she said. Indeed, they may see little value in health at all.

In such circumstances, any change in a person’s condition seems beyond her powers, she suggested. "These psychological effects lead to a lack of persistence in overcoming obstacles and problems," she said.