Criminal Behavior-Repeat Violent Trauma


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Criminal Behavior and Repeat Violent Trauma

A Case-Control Study 

John T. Nanney, PhD, Erich J. Conrad, MD, Michael McCloskey, PhD, Joseph I. Constans, PhD

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Introduction: Repeat violent injury is common among young urban men and is increasingly a focus of trauma center–based injury prevention efforts. Though understanding risk factors for repeat violent injury may be critical in designing such interventions, this knowledge is limited. This study aims to determine which criminal behaviors, both before and after the initial trauma, predict repeat violent trauma. Gun, violent, and drug crimes are expected to increase risk of subsequent violent injury among victims of violence.

Methods: A case–control design examined trauma registry and publicly available criminal data for all male patients aged o40 years presenting for violent trauma between April 2006 and December 2011 (N¼1,142) to the sole Level 1 trauma center in a city with high rates of violence. Logistic regression was used to determine criminal behaviors predictive of repeat violent injury. Data were obtained and analyzed between January 2013 and June 2014.

Results: Regarding crimes committed before the first injury, only drug crime (OR¼5.32) predicted repeat violent trauma. With respect to crimes committed after the initial injury, illegal gun possession (OR¼2.70) predicted repeat victimization. Initiating gun (OR¼3.53) or drug crime (OR¼5.12) was associated with increased risk. Conclusions: Prior drug involvement may identify young male victims of violence as at high risk of repeat violent injury. Gun carrying and initiating drug involvement after the initial injury may increase risk of repeat injury and may be important targets for interventions aimed at preventing repeat violent trauma. (Am J Prev Med 2015;49(3):395–401) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine


V iolent trauma plagues young men in many urban, typically African American, commun- ities.1–4 Violence is the leading cause of death for

African American men aged 18–35 years and remains a

theastern Louisiana Veterans Healthcare System (Nanney, epartment of Psychiatry (Nanney, Conrad, Constans), e University School of Medicine; South Central Veterans Illness Research, Education, and Clinical Center (Nanney,

partment of Psychology (Constans), Tulane University, New siana; Department of Psychological Sciences (Nanney), issouri-Saint Louis, Saint Louis, Missouri; and the Depart-

chology (McCloskey), Temple University, Philadelphia,

rrespondence to: John T. Nanney, PhD, University of Louis, Department of Psychological Sciences, 1 University

adler Hall Room 236, Saint Louis MO 63121. E-mail: .edu. $36.00

Elsevier Inc. on behalf of American Journal of Preventiv

leading cause of death through age 40 years.3,4 For victims of violence, repeat injury is common,5–9 and trauma center–based interventions to reduce repeat violent trauma have recently emerged.10–15 Such inter- ventions have yielded only mixed results, possibly because most interventions focus on enrolling patients in general outpatient case management services rather than changing specific risk behaviors.16 Interventions targeted at specific behaviors known to increase risk of later violence/violence injury may have greater chances of success.17

Certain criminal behaviors—specifically violent, gun, and drug offenses—may be strong candidate risk factors for repeat violent trauma.2,5,7 Violent behavior invites violent retaliation. Assaults are more likely to involve more-severe gunshot injuries if assailants expect the target to be similarly armed.18 Violence also permeates illicit drug economies, as disputes cannot be settled

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legally.19 Other forms of crime, like unarmed, non- confrontational property crime (e.g., auto theft) may be less likely to provoke retaliatory violence and may be less associated with repeat injury risk. Empirical studies focused on crime and trauma recidivism are generally consistent with this pattern, but methodologic limita- tions preclude definitive conclusions. One study5 found that violent, gun, and drug crimes were more common among repeat victims of violence than among patients injured accidentally. This study, however, did not com- pare repeat to single episode victims of violence and it relied exclusively on survey methods to assess criminal- ity. A second study7 found that gun, drug, and violent crime, but not property crime or crime in general, were more common among repeat than single-episode trauma patients. Nonetheless, this study7 combined violent and accidental trauma patients, so it is not clear if these findings hold for those who specifically experience violent trauma. Extant literature also has not differentiated between