peer article

look over it fix the grammar and rephrase words

Journal Article Review

01/25/2021

South University

Dr. Dan
The viewed article, A Preventive Intervention Program for Urban African American Youth Attending an Alternative Education Program: Background, Implementation, and Feasibility seeks to address how this research is supposed to help young African American children that have problematic behavior and have engaged in risky sexual behaviors. The questions that the researchers were attempting to answer in this article were whether a program could help attempt to decrease the likelihood of school failure and school dropout.
They wanted to come up with school-based preventive intervention approaches targeting highly vulnerable individuals, which are primarily based on African American youth. Many questions about intervention approaches towards schools. What type of training would be provided for the staff? Can we change children’s behaviors? Would the children’s families want to be involved? Honestly, there are so many questions, especially trying to come up with a program idea. They believed that these questions needed to be answered to address the unique and specialized needs of troubled city youth. The legislature of the state in which the after-school program under investigation was implemented authorized the creation of Alternative Education Programs within the state’s largest city public school system ( Steven B. Carswell et al 2009) .
I will keep reading this article because I believe the research hypotheses can be found to be effective in urban African American youth. As stated, the independent variable stands alone and is not changed by the other variables. How the independent and dependent variables in this study should be presented. The African American youth were the only thing that remained constant. I think the dependent variable in this article is the deviant behaviors of the youth because the goal is to change the youth’s behavior and academic shortcomings, and there attended in school. These variables operationalized in a way in which the behaviors were measured by self-reported information about the children. How would they measure their behavior and activities? Whom would they be influenced by? Also, the parents took an interview base questionnaire to help with more personal background.
The participants are African American youth, male and female, ages 11–16, and how they were selected was in the process where youth in grades 6 through 10 were expelled from traditional city public schools for one or more of the following reasons: 1) violent and/or aggressive acts directed at teachers, students, or school personnel; 2) chronic behavioral problems and/or disruptive acts; 3) illegal drug possession; 4) arson offenses, bomb threats, and/or property destruction; and 5) bringing dangerous weapons (e.g., knives, guns) onto school property (Steven B. Carswell et al. 2009). The collected their data by having two pilot studies: one at an alternative education site, one involving the use of focus groups with both students and one using a case management approach involving the families of the students. If you get to know the family, there’s more to it, so you will understand the dynamics of the children. This pilot study gives them a much more realistic idea of the types of problems they would encounter. The procedures used to test the specific hypothesis are training for staff to help with the youth to understand how to approach the problems they will be having.
The student-to-teacher ratio in the classroom is a good idea. The award systems help with behaviors and getting parents involved in their children’s learning. The key finding is that during the program, of the 60 students who participated in the intervention, 21 failed to complete the program. Analysis of participant information indicated that students who failed to complete the program were essentially equivalent to those students who completed the program (Steven B. Carswell et al 2009).
As stated, it was hard to begin a program like this in which the child or the parent being involved as much as needed. When the research started, they noticed that most of the youth had been locked up already and that they were easily influenced by peers. For me, the hypotheses was supported, but I do not think it was the outcome they were hoping for. It seems like this was not the only research done on this topic, but it will be interesting to know more and how they can see what needs to be fixed. It would be very interesting to see if the methods and procedures they used were going to work.
The questionnaire for the parents was good. As stated, some parents are not involved, and a family member is raising the child, or they are single mothers or fathers was stated in the article. I was shocked as they stated that they were trying to reach out to the parents, but some did not respond to the phone call or even the business card. Were there noticeable strengths and weaknesses in the study y es, it was when they did the test pilot. They learned a lot from the families and children, but when they started the actual program, it seemed like they were struggling for a while with the building and trying to get everything in order also took time off. One of the things I notice is that they require extensive training for teachers in order for them to better understand the children. The results and conclusions fit into the understanding of the subject by the program. It needs a little more work to understand the program. I think they expected a better result from dealing with the program. Looking at the results, what can they change to better help the understanding of this research?

Reference
Preventive Intervention Program for Urban African American Youth Attending Alternative Education Programs: Background, Implementation, and Feasibility
Steven B. Carswell et al. – Education and Treatment of Children – 2009

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Published

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 Preventiv

e
Medicine

Introduction

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
i.org/10.1016/j.amepre.2015.02.021

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

e Medicine Am J Prev Med 2015;49(3):395–401 395

http://crossmark.crossref.org/dialog/?doi=10.1016/j.amepre.2015.02.021&domain=pdf

mailto:nanneyj@umsl.edu

http://dx.doi.org/10.1016/j.amepre.2015.02.021

Nanney et al / Am J Prev Med 2015;49(3):395–401396

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

crimes committed before and those committed after first
injury. This issue is important for the development of
trauma center–based interventions. Understanding
which behaviors occurring prior to the first trauma are
associated with rehospitalization is useful in identifying
those initial trauma victims most at risk of future violent
trauma. However, this information may be less relevant
for intervention development because these historic
risk factors may be static or unchangeable through
intervention. By contrast, understanding the risk behav-
iors that occur after the initial hospitalization is critical
for development of hospital-based interventions,17 as
these are the behaviors such interventions can influence
most directly. For example, the experience of trauma
may lead to new risk behaviors (e.g., regular gun
carrying or drug involvement).2,20,21 Whether such
changes increase risk of repeat trauma, making them
potential targets for intervention, has not been examined
directly.
The present case–control study aims to identify differ-

ences in criminal behavior between repeat and single-
episode victims of violence. To address limitations of
previous studies, administrative hospital and criminal
data are examined, and criminal behaviors occurring
prior to the initial trauma are coded separately from
those occurring after first injury. It is hypothesized that
violent crime, gun possession, gun use, and drug crime,
both prior to and following initial trauma, would predict
repeat violent trauma, but that property crime, both
before and after, would not. Finally, as a stronger
demonstration that risk behaviors may be useful targets
of intervention, it is examined whether those who do not
engage in specific criminal behaviors prior to the first

trauma but begin engaging in that crime afterwards have
higher chances of repeat violent injury than those who
continue to abstain. It is expected that initiating gun
possession, gun use, and violent or drug crime following
a violent trauma would increase risk of repeat violent
injury, but that initiating property crime would not.

Methods
Study Population

The study was approved and a waiver of informed consent was
granted by the IRB of the Louisiana State University Health
Sciences Center, New Orleans. A study population consisting of
all adult male patients aged r40 years from Orleans Parish who
were admitted to the Spirit of Charity Level 1 Trauma Center
(SOCTC) with a violent injury between April 2006 and December
2011 and who survived their initial injury was identified from the
trauma center trauma registry (N=1,243). The SOCTC is the only
Level 1 trauma center in New Orleans and thus treats all severe
violent injuries (e.g., gunshot wounds) that occur in the metro-
politan area. From Hurricane Katrina in August 2005 until the
Trauma Center’s reopening in April 2006, there is an 8-month gap
in the trauma registry. For this reason, only data after April 2006
were examined.

Violent trauma was operationalized as hospital presentations
with an ICD-9 e-code of 960–969, specifically indicating inten-
tional violent injury. Cases of violent trauma recidivism were
identified by linking trauma center presentations according to
patient name, Social Security Number (SSN), and birth date.
Patients who presented with a violent trauma between April 2006
and December 2011 and then presented with at least one
additional violent trauma between April 2006 and December
2012 were classified as violent trauma repeaters (n=93). The
control group consisted of patients who presented to the trauma
center with a violent trauma between April 2006 and December
2011 but no additional violent traumas from April 2006 to
December 2012 (n=1,150). All databases with patient identifiers
were destroyed following the linking of hospital and criminal
databases.

Data Sources

The trauma registry contains demographic, medical, and patient
outcome data on patients for whom the hospital trauma activation
protocol is initiated. Demographic data included date of injury;
name; birth date; SSN; gender; race (self-report or if necessary as
determined by medical staff); age; and ZIP code of residence.
Cause of injury data included the ICD-9 e-code identifying the
mechanism (e.g., gun or knife) and apparent intent (i.e., inten-
tional versus accidental) of injuries. Criminal data were retrieved
from the Orleans Parish Criminal District Court docket master.
Patients were linked to criminal records by their name and date of
birth. Dates and nature of all criminal convictions were recorded.
Criminal behavior was classified according to five categories: gun
possession, gun use, drug crime, violent crime, and property crime.
Gun possession crimes were defined as convictions that only
involved the illegal possession or use of a firearm, without any use
or threat of use against another person. Gun use crimes required

www.ajpmonline.org

Nanney et al / Am J Prev Med 2015;49(3):395–401 397

firearm use or threat of use against others. Violent crimes were
defined as all those involving interpersonal aggression or violence.
Drug crimes were defined as those that included the possession or
distribution of illicit substances. Property crimes were defined as
those that require the unlawful entry or unlawful taking, pos-
session, or destruction of another person’s property.
Criminal behavior categories, with the exception of gun

possession, were not mutually exclusive, so each criminal act
could count toward multiple categories (e.g., shooting a person
would count as a violent crime and a gun use crime). To better
isolate the impact of mere gun possession, gun possession and gun
use were coded to be mutually exclusive. That is, if an individual
used a gun in a crime at any point during a given time period (i.e.,
before or after initial injury) they could not be coded positive for
gun possession during that time period. Separate variables were
created for crimes committed before and crimes committed after
the initial injury. For those with multiple violent injuries, crime
after the first trauma included only those crimes that occurred
before the last violent injury in order to focus only on crimes that
could logically contribute to repeat trauma risk. Trained research
assistants conducted the crime ratings. Inter-rater reliability was
assessed by having independent raters separately code criminal
history for 20% of patients. Inter-rater reliability was excellent
(κ=0.90).

Statistical Analysis

Data were analyzed in April–June 2014 using SPSS, version 21.0. A
multivariate logistic regression model was used to examine the
independent contribution of crimes in predicting repeat trauma.
Criminal behaviors occurring prior to the initial injury were
entered at Step 1. Criminal behaviors occurring after the initial
trauma were then entered at Step 2.
To examine how behavior change following initial trauma may

impact repeat injury risk, patients who did not engage in a given

Table 1. Demographics and Injury Characteristics

Total
(n¼1,243)

Repea
(n¼93

Age (years), M (SD) 26.55 (6.12) 23.70 (5

18–25 622 (50.1) 67 (7

26–32 377 (30.3) 16 (1

33–40 244 (19.6) 10 (1

Race

Black 1089 (82.8) 90 (9

White 79 (6.4) 2 (2

Asian 11 (0.9) 0 (0

Other 124 (10.0) 1 (1

Time to second injury (years), M (SD) 1.68 (1

First injury gunshot 860 (69.2) 77 (8

Second injury gunshot 77 (8

Note: Boldface indicates statistical significance (po0.01) Values are n (%) u

September 2015

form of crime prior to the initial trauma were coded dichoto-
mously as to whether they either (1) continued to abstain from that
type of crime or (2) began engaging in that type of crime. For each
type of crime, a separate logistic regression was conducted with
repeat victimization as the dependent variable and this crime
initiation variable as the independent variable. History of other
types of crime was controlled.
A potential study confounder is time following initial injury in

which crime can be observed. For those without re-injury, there
was no repeat injury to signal end of observation, which then
continued until the end of the study (December 2012). The
observation period was thus considerably longer among those
without later injury compared with repeat victims (F=135.39,
po0.001), potentially biasing results. Observation time after the
first injury was thus controlled in all analyses. Race was controlled
in all analyses because African Americans may be disproportion-
ately likely to receive certain criminal convictions22 and be
assaulted with a weapon.18

Results
Demographics and injury characteristics appear in
Table 1. Repeat victims of violent trauma (n¼93)
comprised 7.5% of the overall sample (N¼1,243). Repeat
violent trauma victims were significantly younger than
those with only a single violent injury and were more
likely to have initially presented with a gunshot injury
than single-episode victims. Though African Americans
predominated in the overall population of violently
injured young men (82.8%), repeat victims of trauma
were almost exclusively black. Rates of criminal con-
viction, both before and after the first injury, are included

t
)

Single episode
(n¼1,150) χ2 F p-value

.29) 26.78 (6.13) 22.20 o0.001
2.0) 556 (48.3)

7.2) 360 (31.3)

0.8) 234 (20.3)

6.8) 939 (81.7) 13.81 o0.001

.2) 77 (6.7) 2.99 0.08

) 11 (1.0) 0.90 0.34

.1) 123 (10.7) 8.87 0.003

.37)

2.8) 783 (68.1) 8.73 0.003

2.8)

nless otherwise noted.

Table 3. Multivariate Logistic Regression of Crime and
Trauma Recidivism

Crime Wald OR (95% CI)

Before only

Race (black/not black) 7.77** 5.32 (1.64, 17.25)

Gun possession before 0.04 1.11 (0.54, 2.21)

Gun use before 0.13 0.75 (0.16, 3.54)

Violence before 0.71 1.36 (0.70, 2.46)

Drug crime before 5.43** 1.71 (1.09, 2.69)

Property crime before 0.17 0.88 (0.47, 1.63)

Table 2. Frequency of Crime

Number (%) with
conviction before

first injury

Number (%) with
conviction after

first injury

Gun
possession

105 (8.4) 72 (5.8)

Gun use 25 (2.0) 19 (1.5)

Violence 148 (11.9) 121 (9.8)

Drug 478 (38.5) 193 (15.5)

Property 172 (13.8) 77 (6.2)

Nanney et al / Am J Prev Med 2015;49(3):395–401398

in Table 2. Drug crime was most common and gun
crimes the least common, both before and after initial
injury.
Results of the multivariate logistic regression (Table 3)

indicate that when considering only crimes prior to the
initial trauma (Step 1), only pre-injury drug crime
significantly predicted repeat trauma (p¼0.01). When
crimes committed after the initial trauma were consid-
ered (Step 2), illegal gun possession after the initial injury
significantly predicted repeat violent trauma (p¼0.03)
and drug crime committed after the first injury trended
toward significance (p¼0.054). Drug crime before the
initial injury remained a significant predictor (p¼0.02).
A series of logistic regressions examining how crime

initiation following the first trauma related to risk of
repeat trauma (Table 4) found that initiating illegal gun
possession (p¼0.01) and drug crime (p¼0.01) signifi-
cantly predicted repeat trauma. Initiating gun use,
violence, and property crime did not.

Before and aftera,b

Race (black/not black) 4.45** 3.56 (1.10, 12.18)

Time after first injury 82.26** 0.91 (0.90, 0.93)

Gun possession before 0.02 1.06 (0.50, 2.24)

Gun use before 0.08 0.77 (0.13, 4.53)

Violence before 0.61 0.76 (0.39, 1.51)

Drug crime before 5.19** 1.80 (1.09, 2.97)

Property crime before 0.01 0.97 (0.49, 1.89)

Gun possession after 4.95* 2.70 (1.13, 6.48)

Gun use after 0.68 0.37 (0.03, 3.97)

Violence after 0.17 1.33 (0.52, 3.40)

Drug crime after 3.70 1.93 (0.99, 3.76)

Property crime after 0.26 0.76 (0.27, 2.14)

Note: Boldface indicates statistical significance (*po0.05; **po0.01).
aORs are adjusted by including in Step 2 the span of time covered when
evaluating criminal behavior after the first injury.

bHosmer-Lemeshow model goodness of fit χ2(8)¼9.78, p¼0.28.

Discussion
Gun and drug crimes, as expected, predict repeat violent
trauma. The relationship of these criminal behaviors to
repeat trauma appears to be more complex than pre-
viously recognized, however. At the time of the initial
injury, only a history of drug crime predicts repeat
victimization. This risk continues even when controlling
for subsequent criminal behavior. Once one becomes
involved and identified with the illicit drug market, it may
be difficult to extricate oneself from the violent social
milieu and intergroup conflict that surround it.19 Initia-
tion of drug crime following first injury is associated with
increased risk. Victims of trauma may turn to substances
in order to self-medicate,2,23 increasing their vulnerability
due to exposure to this violent market. Surprisingly,
overall drug crime following first trauma is only margin-
ally significant. Perhaps, for those already involved in the
drug market, additional drug crime confers only small

incremental risk. History of gun crime at first injury is not
associated with increased risk. Only after initial injury
does gun crime emerge as a predictor of later victim-
ization, and this is only for gun possession, not gun use.
For the emblematic patient at highest risk for repeat
violent trauma, an initial injury may enhance recognition
of the violence associated with the illicit drug market
leading to an increase in weapon carrying as a means of
protection.2,20,21 The present results underscore the grave
risks that may be associated with this, as it appears that
initiating gun possession following the initial injury is an
important determinant of an individual’s risk for repeat
violent injury. It is unclear why weapon carrying is a risk
factor after, but not before, the initial injury. Perhaps after
an initial injury, individuals may display weapons more
openly to deter possible assailants. Being known to carry a
weapon increases the likelihood that, when conflict does
occur, the other party will arm themselves similarly,

www.ajpmonline.org

Table 4. ORs for Initiation of Crime After Initial Trauma Predicting Trauma Recidivism

Crime initiateda n Unadjusted OR (95% CI) Wald AORa (95% CI)

Gun possession 1,116 2.15 (0.98, 4.69) 7.45 3.53 (1.43, 8.73)

Gun use 1,218 0.73 (0.10, 5.51) 0.36 0.59 (0.06, 4.62)

Violence 1,092 0.70 (0.27, 1.77) 0.08 0.87 (0.32, 2.38)

Drug crime 764 2.08 (0.89, 4.89) 9.03 5.12 (1.77, 14.84)

Property crime 1,070 1.38 (0.53, 3.57) 0.24 1.30 (0.45, 3.74)

Note: Boldface indicates statistical significance (po0.01).
aORs are adjusted for criminal history prior to the initial trauma, race, and individual differences in the span of time covered when evaluating criminal
behavior after the first injury.

Nanney et al / Am J Prev Med 2015;49(3):395–401 399

leading to higher chances of severe injury.18 Surprisingly,
the actual use of a gun in a crime and violence more
generally do not predict repeat violent injury. Such crimes
carry higher chances of lengthy prison terms, such that
some individuals engaging in them may be protected
from repeat violent trauma because of their incarceration.
Some convicted of gun possession may also have been
preparing to use the weapon absent legal intervention.
Finally, it is noteworthy that African American race is
associated with repeat injury even controlling for other
factors. Although it is possible that SES could in part
explain this relationship, this finding is consistent with
literature suggesting that a bias in perceiving African
American men as dangerous makes them more likely to
be targets of more severe, armed assaults when conflicts
emerge.18

Differentiating between risk behaviors that occur
before and those that occur after the initial trauma allows
us to provide more nuanced clinical guidance than prior
research. A history of drug crime at first injury marks
violent trauma patients as higher risk for violent re-
injury. Trauma centers may thus benefit from routinely
screening for drug involvement and targeting interven-
tions to this higher-risk group. Primary substance abuse
prevention models24 may help reduce repeat violence by
preventing involvement in the violent drug market in the
first place. The methods used in the present study allow
us to conclude with greater confidence that certain
behaviors occurring after the initial injury, particularly
gun carrying and drug involvement, may be appropriate
targets for trauma center–based interventions. Fortu-
nately, such interventions for both are developing. A
trauma center–based intervention directly targeting gun-
carrying adolescents was recently found to reduce
chances of continued firearm carrying at 1 year of
follow-up.25 Though replications with adults are
required, this finding—in combination with the present
findings—suggests that direct behavioral intervention
regarding gun carrying may have the potential to reduce
repeat violent trauma. Such interventions likely should

September 2015

not be limited to those who already have a history of
carrying guns. Indeed, many of those at risk may not yet
have begun engaging in significant gun carrying at the
time of the injury.2,20,21 Clinicians may anticipate that
patients without histories of gun use may be considering
arming themselves in the wake of their trauma. Develop-
ment of preventive interventions that directly inquire
about plans for gun use after the injury and attempt to
guide this decision-making process may be needed. With
respect to drug involvement, general substance abuse
prevention strategies are widely available20,26 and trauma
center–based interventions for illicit drug use are
developing.27

Limitations
Criminal data include only illegal behaviors that warrant
criminal prosecution and conviction. Such data cannot
determine if purely legal gun possession confers risk of
violent injury, though a relationship between legal gun
possession and violent injury has been suggested.28–31

Results also may not extend to less severe illegal
behaviors that do not lead to arrest, prosecution, and
conviction (e.g., occasional recreational drug use).
Whether risk of repeat injury from drug crime is a
function of drug use or drug distribution cannot be
determined given that both often may yield similar
convictions for drug possession.32 The trauma registry
contains only the most critical injuries that require
treatment at a Level I trauma center. Results thus may
not extend to the majority of violent injuries that do not
require this level of care.
Our study is limited to a single metropolitan area, New

Orleans, at a unique period in its history (i.e., the
aftermath of Hurricane Katrina). Owing to the high rates
of migration during this period, some participants in this
study may have been injured or may have engaged in
crime in another location. Even participants who resided
in New Orleans throughout the duration of the study
may have been injured or committed crimes while
outside of the area. Additional research using a broader

Nanney et al / Am J Prev Med 2015;49(3):395–401400

geographic region would thus be needed to confirm the
present findings. Also, given the gap in trauma registry
data owing to Hurricane Katrina, this study is com-
pressed into a relatively narrow time frame. The time
between first and second injury in our study suggests that
about 90% of patients who will return with repeat violent
injuries from the 2006–2011 population are captured in
these data, but that about 10% of the repeat victims of
violence in this population are likely “incorrectly”
classified as single-episode victims of violence because
they have not yet returned with their second violent
injury. Likewise, it is possible that an unknown number
of patients experienced violent injuries prior to the
beginning of the study data in 2006 such that they too
are incorrectly classified as single-episode victims. Anal-
ysis of a narrower cohort (2006–2008) for which 99% of
repeat trauma victims are likely captured produced
results substantively similar to the larger population,
increasing the confidence that the present findings would
persist if the database were extended in both the past and
future.

Conclusions
Though repeat violent injury is a public health priority
for young urban men and increasingly a focus of
intervention, research examining risk factors for
repeat trauma remains sparse. The present results
confirm previous scholarship suggesting that gun and
drug crimes predict repeat violent injury. Analysis of
timing of these crimes in relation to the initial injury
indicates that drug crime before and gun possession
after predict repeat trauma. Initiating gun or drug
crime after injury also predicts later violent injury.
Trauma center–based interventions targeting gun
carrying and drug involvement may thus have prom-
ise in reducing the violence that continues to plague
many urban neighborhoods.

The authors would like to acknowledge the assistance of Erin
Reuther, PhD for supervision of research assistants and for her
comments regarding the manuscript. The authors also
acknowledge the assistance of Samia Lalani, Christie Andolena,
BS, April Hartman, BS, Ian Comnick, BA, Elena Pueraro, and
Catherine Rochefort, BS, in collecting, entering, and managing
data. Without their diligent work, this project would not have
been possible.

The contents of this report do not represent the views of the
Department of Veterans Affairs or the U.S. Government.

JTN, EJC, and JIC contributed to the conception and
design of the study; the acquisition, analysis, and interpre-
tation of data; the drafting and revision of the manuscript;
and statistical analysis. JTN contributed to the supervision

of research assistants. EJC contributed to administrative
support. And MM contributed to the interpretation of the
data and the drafting and revision of the manuscript. JTN
had full access to all the data in the study and takes
responsibility for the integrity of the data and the accuracy
of the data analysis.
No financial disclosures were reported by the authors of

this paper.

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Criminal Behavior and Repeat Violent Trauma

Introduction
Methods
Study Population
Data Sources
Statistical Analysis
Results
Discussion
Limitations
Conclusions
References

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