Neighborhood vigilance, health locus of control, and smoking abstinence.

Recent literature has linked subjective perceptions of the neighborhood context to smoking behaviors. For example, self-reports of neighborhood problems and low ratings of neighborhood safety have been associated with increased smoking prevalence.1,2 Also, trust among neighbors has been inversely associated with smoking prevalence3 and the number of cigarettes smoked per day among smokers.4,5 Similarly, more self-reported neighborhood problems and greater endorsements of the need for vigilance in the neighborhood have been linked to tobacco dependence among smokers.6 Because these studies controlled for a number of individual- and (in some cases) neighborhood-level sociodemographic variables, they suggest that perceptions of the neighborhood environment may exert a unique influence on smoking behaviors. However, little research has addressed whether neighborhood perceptions affect other smoking-related outcomes, like smoking abstinence during a specific quit attempt, or the mechanisms through which such relations might operate. Threatening neighborhoods are marked by the presence and/or absence of features that lend to the perception that heightened vigilance is necessary to avoid danger or physical harm.7 For example, neighborhoods with high crime rates and a lack of police presence might engender high levels of vigilance among residents. Likewise, neighborhoods with substantial physical disorder, such as deserted or dilapidated housing, might also be associated with high vigilance for threat among those living nearby. The structural amplification theory of mistrust posits that high levels of neighborhood threat shape perceptions of powerlessness among residents, amplifying a general sense of mistrust.8 Powerlessness entails the expectation that one has limited control over life events, which might also extend to the perception of limited control over health behaviors. Thus, one potential mechanism linking threatening neighborhoods (ie, those engendering high levels of vigilance) with smoking abstinence might be health locus of control (HLOC), or the extent to which people believe they can control or affect health-related behaviors and outcomes. The multidimensional HLOC model specifies 3 causal loci for health outcomes: (1) internal or agent-related causes, (2) external causes determined by powerful others, and (3) external causes determined by chance.9 People with high internal attributions endorse control over their own health outcomes, whereas those attributing health out-comes to powerful others believe that health care professionals have the greatest influence. Those endorsing high chance attributions believe that health outcomes are based on circumstance or fate. In general, those with higher internal attributions for health outcomes are more likely to engage in healthy behaviors and more successful at making desirable behavior changes, whereas those with higher external attributions are not.10–14 Thus, it might be that high neighborhood vigilance leads to lower internal and more external HLOC attributions, which, in turn, might reduce the likelihood of smoking abstinence during a quit attempt. Although there are no studies examining the relations between neighborhood vigilance and HLOC specifically, there are a few studies that examine the effects of the neighborhood environment on perceived control more generally. These studies have found significant relations between neighborhood disorder and a sense of powerlessness among residents,15 neighborhood violence and greater external locus of control endorsements,16 and neighborhood strain and a lower sense of perceived control over various desired outcomes.7 In addition, research has supported relations between higher internal HLOC endorsements and smoking abstinence, 17 lower chance endorsements and abstinence, 17 and lower powerful others endorsements and abstinence,18 although the literature is mixed [eg,19]. However, many studies in this area have significant methodological limitations, including small sample sizes or a lack of biochemical verification of smoking status. The current study was designed to explore whether HLOC mediated the relation between neighborhood vigilance and short-term smoking abstinence among treatment-seeking smokers from Houston, Texas, while improving upon the methodological limitations of previous research. Based on the structural amplification theory of mistrust and associated empirical literature, we hypothesized that higher neighborhood vigilance would be associated with more external and less internal attributions for health-related outcomes (ie, a sense of powerlessness to affect health-related outcomes). Based on prior HLOC research and associated theory, we hypothesized that more external and less internal attributions for health-related outcomes would predict lower rates of continuous smoking abstinence during a smoking quit attempt. We improved upon previous work in this area by including a relatively large sample of 200 smokers undergoing a smoking quit attempt and biochemically verifying smoking status, as well as by controlling for multiple covariates in our analyses. The current study has potential to add to the literature by (1) examining if the sense of powerlessness associated with neighborhood vigilance, as posited by the structural amplification theory of mistrust, extends to powerlessness to affect health outcomes; (2) clarifying mixed findings in the literature about the relations between HLOC and smoking abstinence through increased methodological rigor; and (3) extending previous research linking neighborhood vigilance with other smoking-related outcomes (ie, tobacco dependence) to the actual process of smoking abstinence during a quit attempt. This work is a preliminary step in better understanding the links between neighborhood environments and smoking abstinence.