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Homicide is one of the five leading causes of death for all persons 1-44 years of age. Over half of the homicides occurring in 1979 did not involve the perpetration of another crime. The authors have defined these as primary homicides and suggest that these deaths require the formulation of public health and social services prevention strategies. An epidemiologic assessment of primary homicides in the United States for 1976 through 1979 showed the following. Sixty per cent of primary homicides were male victim/male offender events; 40% involved a female as a victim and/or as an offender. Three per cent of primary homicides were female victim/female offender events; 97% involved a male as a victim and/or as an offender. Primary homicides involving female victims or offenders were more frequently intrafamilial than those involving males, but rates of intrafamilial homicides by males were greater than those involving females. The preponderance of all primary homicides occurred between acquaintances, but the relationship between victim and offender varied with age, sex, and race. The weapons used varied with the victim's and offender's age, sex, and race, and with the relationship between victim and offender. Based on the described patterns, prevention measures should be divided into three broad areas: intrafamilial violence, extrafamilial violence, and male patterns of aggression. Key target populations for the first area include females, rural households, and the very young or very old. A key target population for the second area is teenage males.

In 1979, over 20,000 people in the United States were victims of homicide, but public health agencies have not yet defined their role in its prevention. Role definition might begin with differentiating various forms of homicide, so the authors used data on all homicides reported by law enforcement agencies for 1976-1979 to determine whether homicides that did not occur during the perpetration of another crime (primary homicides) differ from those that occurred during the perpetration of another crime (secondary homicides). Primary and secondary homicide rates were highest in the South and West, respectively. The relative risk for Standard Metropolitan Statistical Areas (SMSAs) compared with non-SMSAs was 2.4 for secondary homicide but only 1.3 for primary homicide. It was found that 17% of primary homicides and 3% of secondary homicides had a female offender. Primary homicides were more frequently intersexual and intraracial than were secondary homicides. Victim and offender ages were similar to one another in primary homicides and dissimilar in secondary ones. Over 75% of primary homicides involved family members or acquaintances, compared to only 24% of secondary homicides. The authors conclude that primary and secondary homicides are epidemiologically dissimilar, and they suggest that public health concern should focus on primary homicide. Prevention and intervention measures should concentrate on discussed target populations. Techniques might include stress reduction and conflict avoidance.