Document Type


Date of Degree

Fall 2013

Degree Name

PhD (Doctor of Philosophy)

Degree In

Community and Behavioral Health

First Advisor

Yang, Jingzhen

Second Advisor

Peek-Asa, Corinne

First Committee Member

Campo, Michelle L.

Second Committee Member

Lowe, John B.

Third Committee Member

Ramirez, Marizen

Fourth Committee Member

Shields, Richard K.


As a growing body of research has focused on the individual, social, and environmental factors that facilitate life after spinal cord injury (SCI), particular emphasis has been placed on health conditions that are modifiable and preventable. Subsequent injuries are a serious health problem for individuals with SCI. They are a direct threat to further morbidity and mortality, and are both a cause and consequence other secondary health conditions.

As a first step toward understanding this public health problem, the purpose of this dissertation research was to describe the patterns, burdens, and prevention of subsequent injury among individuals with SCI. In three distinct, but related studies, this dissertation examined the characteristics of hospitalizations due to an injury among individuals with paraplegia, and compared the differences in length of stay (LOS) and hospital costs of injury hospitalizations between individuals with quadriplegia versus paraplegia. In addition, it explored the experience of subsequent injury among individuals with SCI who return to work and examined perceptions of threat and efficacy in preventing subsequent injury using the Extended Parallel Process Model. Using discharge level weighting available in the Nationwide Inpatient Sample, Study 1 calculated national estimates of injury hospitalizations for individuals with paraplegia by patient, hospital, and injury characteristics. Most injury hospitalizations occurred among males, to individuals 35-49 years, and were due to falls, poisonings, or motor vehicle traffic. With the same dataset, Study 2 used logistic regression to estimate the effect of patient characteristics on odds of hospitalized patients with quadriplegia versus paraplegia, and linear regression to estimate predicted differences in hospital costs for individuals with quadriplegia compared to paraplegia. Fewer injury hospitalizations but longer hospital stays, and higher hospital costs per discharge were found for individuals with quadriplegia compared to individuals with paraplegia. Males, younger age, and the uninsured were significant predictors of higher hospital costs. Finally, Study 3 used in-depth interviews to qualitatively explore the perceptions on subsequent injury among individuals with SCI who return to work, and found individuals with SCI who return to work recognized the importance of preventing subsequent injury, and were taking actions to prevent subsequent injury in their daily life and in the workplace.

The significance of this research is that it is the first description of injury hospitalizations for all causes of injury by specific type of SCI, and the associated medical outcomes of LOS and direct medical costs. Prevention of subsequent injury should be a priority. The perceptions of individuals with SCI about the severity of and their susceptibility to injury and the efficacy of individual and environmental actions to prevent subsequent injury described in this research should be used to inform the development of interventions that prevent subsequent injury.


Extended Parallel Process Model, Hospital costs, Perceived efficacy, Perceived threat, Spinal cord injury, Subsequent injury


xiv, 170 pages


Includes bibliographical references (pages 160-170).


Copyright 2013 Erin Ose Heiden