Year of Publication



Public Health

Date Available


Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

Sabrina Brown, DrPH

Committee Member

Steve Browning, PhD

Committee Member

Heather Bush, PhD



Background: Lethal violence, homicides and suicides, is a growing issue in the US. Historically homicides and suicides have been studied separately, but with stream analogy of lethal violence homicides and suicides are both currents of lethal violence, just branching in opposite directions. The purpose of this study is to understand which county-level factors increase risk of lethal violence.

Methods: This ecological study combined open-source datasets to create one dataset of socioeconomic risk factors of lethal violence. Counties with 10 or more lethal violent deaths were included (n=2751). Negative Binomial models examined the relationship between risk factors and the outcome of lethal violence for the following lethal violence risk factors: veteran status, disconnectedness of youth, housing problems, and single-parent households.

Results: There were 476,621 lethal violence deaths in the US from 2010 to 2017, 472,176 occurred in 2,751 of 3,146 counties that were included in this study. On average, a county’s population was 10% veterans, 32.5% of children lived in a single-parent household, 18.6% of teens aged 16-19 were considered disconnected youths, and 14.4% of houses had a severe housing problem. Veteran status, disconnected youth, and single-parent households all experienced a dose-response relationship among its quartiles. Counties with greater than 11.5% veterans in the general population experienced a 28% increase in risk of lethal violence than communities with less than 8.6% veterans. Counties with greater than 38% of children living in single-parent households experienced an increase of lethal violence at 1.20 times greater than counties with less than 26% of children living in a single-parent household. Geographically more southern and western counties in the US had statistically significant higher rates of lethal violence.

Discussion: The rate of lethal violence has increased throughout the study period. Increased veteran status, disconnectedness of youth, housing problems, single-parent households, increased risk of lethal violence. Reducing lethal violence on a community level may involve addressing the social and economic structures of a community. Additionally, creating a community to help veterans reintegrate or support single-parent house-holds could also reduce lethal violence. Due to the design, this study is limited in the interpretation of results.

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