CONTACT: For copies of articles or for information on scheduling interviews with an expert, please contact Megan Lowry, 202-777-3913. Links to the below articles will go live once the embargo lifts.

EMBARGOED UNTIL August 17, 2017, 4 p.m. EDT

American Journal of Public Health October Issue research highlights:

Life expectancy and voting patterns in the 2016 US presidential election

Newswise — This research found that changes in county life expectancy from 1980 to 2014 were strongly negatively associated with votes supporting President Donald Trump in the 2016 election. Counties in which life expectancy stagnated or declined saw a 10-percentage-point increase in the Republican vote share between 2008 and 2016. Authors also point out that in counties with above-average gains in life expectancy, most voters chose Hillary Clinton.

Authors discuss the factors implicated in diverging life expectancy across U.S. counties, including widening gaps in economic opportunity, changing burdens of chronic disease risk factors, the emergence of the opioid epidemic, and disparities in access to medical care.

The research concluded that residents of counties left out from broader life expectancy gains abandoned the Democratic Party in the 2016 presidential election. Authors note that since coming to power, the Trump administration has proposed cuts to health insurance for the poor, social programs, health research, and environmental worker protections, which are key determinants of population health.

["Diverging life expectancies and voting patterns in the 2016 US presidential election." Contact: Jacob Bor, Departments of Global Health and Epidemiology, Boston University School of Public Health, Boston, MA].

The epidemic of despair among white Americans: trends in the leading causes of premature death, 1999-2015

This research found that of 48 American subpopulations, all 9 subpopulations that showed increased death rates from 1991 to 2001 and 2013 to 2015 were non-Hispanic whites, largely outside large urban areas. Most increases in death rates were attributable to suicide, poisoning and liver disease. The authors place these increased death rates in context: the age-adjusted premature death rates for all adults in the U.S. decreased by 8 percent between 1999 to 2001 and 2013 to 2015. Most decreases were attributable to HIV, cardiovascular disease, and cancer.

Authors detail the economic burdens placed on this specific population, which are added to by rural disparities in access to quality health care, higher levels of isolation, and striking differences in health behavior and attitudes, such as higher rates of smoking, sedentary activity and stigmatization of mental illness. Authors add that social programs should be broadened in the United States to strengthen the diminishing middle class and combat despair.

The authors concluded that the unfavorable recent trends in premature death rate among non-Hispanic whites outside large urban areas were primarily caused by self-destructive health behaviors likely related to underlying social and economic factors in these communities.

["The epidemic of despair among white Americans: trends in the leading causes of premature death, 1999-2015." Contact: Elizabeth Stein, MD, MS, Preventive Medicine Residency Program, University of Wisconsin School of Medicine and Public Health, Madison, WI].

Urban-rural differences in suicide in the state of Maryland: the role of firearms

Researchers assessed whether the use of firearms explains rural-urban differences in suicide rates, performing a retrospective analysis of all adult suicides in Maryland from 2003-2015. They concluded male firearm use drives the increased rate of suicide in rural areas. The opposite association between urbanicity and suicide in men and women may be driven by the male preference for firearms as a method for committing suicide.

Authors include in their discussion that suicide rates are higher in rural counties than in urban ones, with rural rates in 2015 reaching as high as 19 per 100,000, compared with 11 per 100,000 in central urban settings.

Researchers found that men in rural counties had a higher suicide risk than those in urban counties, and this higher rural risk is limited to those who die by firearm. Authors concluded that their findings suggest the higher rural suicide rates are driven by firearm suicides in men. The findings also highlight the potential benefits of more robust rural firearm safety and control initiatives on decreasing the rural suicide rates.

[“Urban-rural differences in suicide in the state of Maryland: the role of firearms.” Contact: Paul S. Nestadt, MD, Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD].

Rural versus urban use of traditional and emerging tobacco products in the United States, 2013-2014

Researchers found that nationally, cigarette use and smokeless tobacco use, as well as dual or polytobacco use of traditional products, were more prevalent in rural than in urban areas.

Research found the prevalence of any daily cigarette use was 18.3 percent in urban areas. Separate analyses of urban-rural differences among men and women showed that prevalences were generally higher among men. Authors explain that urban-rural differences remained when prevalences were categorized according to poverty level.

Authors concluded that rural Americans remain an at-risk segment of the U.S. population in need of more attention from tobacco control efforts.

[“Rural versus urban use of traditional and emerging tobacco products in the United States, 2013-2014.” Contact: Megan E. Roberts, PhD, College of Public health, Ohio State University, Columbus, OH].

Find a full list of AJPH research papers published online below:

  • Tobacco industry research on nicotine replacement therapy: "If anyone is going to take away our business it should be us"
  • Readiness to vaccinate critical personnel during an influenza pandemic, United States, 2015
  • Killed by police: Quantifying misclassification in vital statistics and validating media-based demographic data (Massachusetts, 2004-2016)
  • Lead Content of Sindoor, a Hindu Religious Powder and Cosmetic: New Jersey and India, 2014-2015
  • Violent Death Reporting in Maryland: Demographic Variability in Data Completeness
  • Children's Access to Dental Care Impacted by Reimbursement Rates, Dentist Density and Dentist Participation in Medicaid
  • Health and politics: diverging life expectancies and the Trump vote
  • Revisiting Medicaid reimbursement of the female condom: Implications of the Affordable Care Act
  • Prevention optimism related to HIV pre-exposure prophylaxis: shifting the focus from individual to community-level risk compensation
  • Legal, Practical, and Ethical Considerations for Making Online Patient Portals Accessible for All
  • The standard period life table used to compute the life expectancy of diseased subpopulations — more confusing than helpful
  • HIV Pre-Exposure Prophylaxis and Condomless Sex: Disentangling Personal Values from Public Health Priorities
  • A way forward for bipartisan health reform? Democrat and Republican state legislator priorities for the goals of health policy
  • Oral Health Integration into a Pediatric Practice and Coordination of Referrals to a Co-located Dental Home at a Federally Qualified Health Center
  • The Epidemic of Despair Among White Americans: Trends in the Leading Causes of Premature Death, 1999-2015.
  • Assessing Years of Life Lost vs. Number of Deaths in the US over the Past 20 Years
  • Urban-Rural Differences in Suicide in the State of Maryland: The Role of Firearms
  • Community health worker impact on chronic disease outcomes within primary care examined using electronic health records
  • Community Health Worker Support for Disadvantaged Patients with Multiple Chronic Diseases: a Randomized Clinical Trial
  • Living outside the gender box in Mexico: Testimony of transgender Mexican asylum seekers
  • Rural vs. Urban Use of Traditional and Emerging Tobacco Products in the United States, 2013-2014

The articles above will be published online August 17, 2017, at 4 p.m. EDT by AJPH under “First Look.” “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association, and is available at

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