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Summary

In contrast with falling mortality rates in other comparable race/ethnic groups, the last decade and a half has seen rising rates of premature mortality among U.S. white non-Hispanics in their midlife, particularly among those with no more than a high school degree. This anomaly has been linked to increases in premature deaths due to suicides, drug overdoses, and alcohol-related liver disease. These causes dubbed "deaths of despair" have been linked with deteriorating economic conditions for low-educated workers. The  research will study the development of these diseases in young adults just entering this period of rising mortality throuhg secondary data analysis leveraging two rich, complementary, prospective-longitudinal epidemiologic data sets, one nationally-representative sociologic-demographic and the other community-representative in design, focused on individual psychopathology. The National Longitudinal Study of Adolescent to Adult Health (Add Health) is a national study that allows for a fine-grained socio-structural, family-demographic characterization of US communities at particular risk for diseases of despair; its contextual data come at high resolution down to the census tract level. The Great Smoky Mountains Study (GSMS) is a community-representative study set in a mostly impoverished rural community in Appalachia, one of the epicenters of the epidemic of the diseases of despair. Both studies began with childhood/ adolescent assessments and have collected extensive data through age 30. A subgroup of GSMS participants began receiving cash transfers 4 years into the study, so GSMS data will illuminate whether increased money can help to alleviate diseases of despair. The first aim will estimate the public health impact of these diseases by looking at how these diseases cluster in population subgroups including: rural/urban, educated/uneducated, male/female, White, American Indian, Black, Hispanic, residing in low-risk versus high-risk census tracts. The second aim will test a risk/resilience model that clarifies shared and unique factors from childhood/adolescence and young adulthood. Finally, the third aim will test whether a childhood intervention addressing a key risk factor prevents the development and clustering of diseases of despair. By leveraging the complementary datasets, this study has the potential to generate insights to aid prevention science and public policy efforts to curb the troubling new premature mortality trend.

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