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Introduction: Deaths of despair (i.e., suicide, drug/alcohol overdose, and chronic liver disease and cirrhosis) have been increasing over the past 2 decades. However, no large-scale studies have examined geographic patterns of deaths of despair in the U.S. This ecologic study identifies geographic and temporal patterns of individual and co-occurring clusters of deaths of despair., Methods: All individuals aged ≥10 years who died in the U.S. between 2000 and 2019 and resided within the 48 contiguous states and Washington, District of Columbia were included (N=2,171,105). Causes of death were limited to deaths of despair, namely suicide, drug/alcohol overdose, and chronic liver disease and cirrhosis. Univariate and multivariate space-time scan statistics were used to identify individual and co-occurring clusters with excess risk of deaths of despair. County-level RRs account for heterogeneity within each cluster. Analyses were conducted from late 2021 to early 2022., Results: Six suicide clusters, four overdose clusters, nine liver disease clusters, and three co-occurring clusters of all three types of deaths were identified. A large portion of the western U.S., southeastern U.S., and Appalachia/rust belt were contained within the co-occurring clusters. The co-occurring clusters had average county RRs ranging from 1.17 (p<0.001) in the southeastern U.S. to 4.90 (p<0.001) in the western U.S., Conclusions: Findings support identifying and targeting risk factors common to all types of deaths of despair when planning public health interventions. Resources and policies that address all deaths of despair simultaneously may be beneficial for the areas contained within the co-occurring high-risk clusters., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Electronic cigarette (e-cigarette) use among adolescents is associated with increased risk of subsequent cigarette smoking initiation in observational research. However, the existing research was not designed to answer causal questions about whether adolescent e-cigarette users would have initiated cigarette smoking if they had never used e-cigarettes. The current study used a causal inference framework to identify whether male adolescent e-cigarette users were at increased risk of initiating cigarette smoking and smokeless tobacco (SLT) use, compared to similar boys who had never used e-cigarettes., Methods: Boys from urban and Appalachian Ohio (N = 1220; ages 11-16 years at enrollment) reported use of e-cigarettes, cigarettes, and SLT at baseline and every six months for two years. A propensity score matching design was implemented, matching one e-cigarette user to two similar e-cigarette non-users. This analysis was completed in 25 multiple imputed datasets to account for missing data. Risk ratios (RRs) comparing risk of initiating cigarettes and SLT for e-cigarette users and nonusers were estimated., Results: Compared to non-users, e-cigarette users were more than twice as likely to later initiate both cigarette smoking (RR = 2.71; 95% CI: 1.89, 3.87) and SLT (RR = 2.42; 95% CI: 1.73, 3.38). They were also more likely to become current (i.e., past 30-day) cigarette smokers (RR = 2.20; 95% CI: 1.33, 3.64) and SLT users (RR = 1.64; 95% CI: 1.01, 2.64)., Conclusions: Adolescent boys who used e-cigarettes had increased risk of later initiating traditional tobacco products when compared to similar boys who had never used e-cigarettes., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Financially disadvantaged populations are more likely to live in communities that do not support healthy choices. This paper investigates whether certain characteristics of the built environment are associated with obesity or coronary heart disease (CHD) risk among uninsured low-income women., Methods: Using a sample of 2001-2002 data from 2692 women enrolled in the WISEWOMAN program of the Centers for Disease Control and Prevention, the study team performed regression analysis (conducted in January-April 2005) to estimate body mass index (BMI) and the log of 10-year CHD risk as a function of the built environment and socioecologic measures., Results: For women living in an environment of maximum mixed land use (i.e., an environment more conducive to healthy living), BMI was lower by 2.60 kg/m2 and CHD risk was lower by 20% than for women living in single-use uniform environments (i.e., environments less conducive to healthy living). An additional fitness facility per 1000 residents was associated with BMI and CHD risk that were lower by 1.39 kg/m2 and 15.1%, respectively. Crime was positively associated with BMI and CHD risk, whereas neighborhood affluence was negatively associated. Living in more racially segregated areas was negatively associated with CHD risk among black, Hispanic, and Asian women and positively associated with CHD risk among American Indian women., Conclusions: The built environment and socioecologic characteristics of financially disadvantaged women were associated with BMI and CHD risk. More research is needed to understand the effects of racial segregation or acculturation on health for specific subpopulations.