All ETDs from UAB

Advisory Committee Chair

Gerald McGwin Jr

Advisory Committee Members

Gregory G Davis

Emily B Levitan

Paul A Maclennan

David T Redden

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Homicide is a leading cause of mortality in the United States, with approximately 18,000 homicides occurring annually. Most prevention efforts for homicide are aimed at primary (e.g., culling aggressive behaviors among youth) or secondary (e.g., preventing repeat violence) efforts. To date, there has been limited research on tertiary prevention efforts of homicide (i.e., preventing homicide by preventing deaths from assault-related injuries). With the advent of trauma systems (TS), which allow for rapid emergency medical response for injured individuals, it is possible that these systems may be an ef-fective effort of tertiary prevention of homicides. Using data from the Jefferson County Coroner/Medical Examiner's Office from 1987-2008, the aim of the current research was to determine whether the presence of a TS affects homicide risk. The first study of the current research assessed whether the temporal distribution of homicide mortality changed in the presence of a TS. A total of 2,612 homicides oc-curred in this time span, with 1,858 having a known time of injury and death. The pres-ence of a TS resulted in the proportional decrease of deaths occurring six hours or later, with a concomitant increase in the proportion of deaths occurring within one hour. These results suggest that a TS is effective in preventing deaths after one hour, but other means (e.g., secondary prevention efforts) are needed to prevent deaths within the first hour. The second study of the current research examined whether suffering a traumatic injury is a risk factor for subsequent homicide. A total of 532 homicides and 532 matched controls (i.e., non-homicide deaths) from 2002-2008 were included. Homicides were twice as likely (OR 1.98, 95% CI 1.13-3.14) to have a previous traumatic injury. This association was differential by intent, with no statistical association observed for previous unintentional injury, but a 2.5-fold increase in homicide risk for previous assault injury (OR 2.53, 95% CI 1.24-5.17). The associations were particularly strong for assault injuries occurring within the two years prior to death. These results suggest trauma centers may be an effective setting for secondary prevention of homicide.

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