Mothers in this study were exposed to a high level of neighborhood violence in the prior year. While this study classified mothers into groups based on the summation of their exposure, the importance of each experience should not be overlooked. Nearly 30% of mothers had witnessed someone shot in the last year. Just over half had witnessed someone beaten or stabbed in the past year. Even more had witnessed someone arrested and witnessed drug deals (76% and 87%, respectively). The majority had awakened to the noise of gunshots or police and ambulances at least once in the past year.
For mothers in our study, exposure to neighborhood violence was negatively associated with five diverse health determinants or outcomes: self-reported health, smoking, exercise, amount of sleep, and sleep interruption. While the impact of exposure to neighborhood violence on one of these variables is important, mothers in neighborhoods with high exposure to violence have a greater odds of reporting all five poor health-related outcomes.
Interestingly, this association was not present when analyzing mothers’ perception of neighborhood safety. While mothers’ ratings of neighborhood safety and their experiences were correlated, mothers tended to have a better perception of their neighborhoods than one might expect from the level of violence reported. Previous studies have found that individuals’ perceptions of neighborhood safety are determined by more than just specific experiences of violence.33–36
For example women are more likely to perceive threats to their safety than men, with women over the age of 30 perceiving their neighborhood as less safe than younger women.34
Additionally, mothers may report higher ratings of neighborhood safety to self-validate their decision to remain in a violent neighborhood, perhaps in part due to their inability to move to a new neighborhood.47
This study demonstrates that measuring exposure to violence-related experiences using discrete measures may be a better method for assessing the influence of neighborhood violence on health than perceptions of safety alone. Participants’ ratings of neighborhood safety may not capture the full health consequences of living in a violent neighborhood. As the experience of violence does relate to participants’ perceptions of safety, experienced violence measures may still capture aspects of perceived safety. While this study did not support perceived safety as a mediator between the relationships of neighborhood violence exposure and health (due to the lack of association with the outcome variables), this possibility should be investigated further.48
Additionally, while this study did not attempt to compare exposure to violence with actual levels of crime and disorder, these more objective measures may mask certain areas or population subgroups with extreme exposure to violence. More research should be undertaken to understand the interrelationships between various types of measures of neighborhood violence.
Strengths and Weaknesses
This study was a large cross-sectional survey. As with any cross-sectional research the connections made are simply associations, without the ability to determine causation between violence exposure and health determinants or outcomes. When measuring neighborhood effects, it is difficult to separate out the effects of the neighborhood versus the effects of other associated variables. This study attempted to control for these factors by including education, marital status, race, and household size in the model. However, this study did not control for the duration of exposure, personal, or family victimization.
Participants in this study included mothers living in Baltimore City in a specific geographic locale. Additionally, the $10 paid to participants for completion of the study instrument may have resulted in selection bias with those most disadvantaged participating in the study. While this limits the generalizability of our findings, it does allow for more equal comparisons, as mothers are more likely to be similar for any unmeasured factors. As this geographic area is in a violent area of Baltimore City, neighborhood violence categories were probably skewed to the high end of violence exposure and the low end of neighborhood safety.49
This may have actually resulted in an underestimation of neighborhood violence effects as the reference categories were set at a higher than “normal” level. While this sample’s social conditions may be considered extreme, they are unfortunately reflective of the experiences of many poor, minority, urban city residents.39
This study has several strengths. The findings are based on a large sample of African-American mothers living in the inner-city. Data were collected by a computer-kiosk enhancing confidentiality and perhaps limiting self-report bias of neighborhood violence. Statistical methods were used to ensure that neighborhood violence questions were indeed representative of perceived safety and exposure to violence, with exposure to neighborhood violence questions based on previously validated measures. Additionally, efforts were made to control for many factors that may have independently impacted our health-related outcomes.