Repeat victims of violence are overwhelming urban trauma centers, yet little about them appears in the literature. This study examined medical record and survey data on patients presenting at the emergency department of St. Elizabeth Hospital in Youngstown, Ohio during a 4-year period. Two-fifths of urban trauma patients were repeat victims, who were more likely to be poor African-American males, have substance abuse and mental health problems, and live in neighborhoods where violence was pervasive; most had no health insurance. Demographic characteristics were less important in explaining recidivism than were the circumstances surrounding violent behaviors. Emergency department physicians should be trained to take into account a wide variety of environmental, personal, and circumstantial factors in treating and managing urban trauma patients. This may require reforms in health care financing. Tables, notes, references