Background. Studies show that youth who experience homelessness are an exceptionally vulnerable population, but little is known about the consequences of youth homelessness. Research has found experiences of youth homelessness to be linked to health concerns such as mental health disorders, pregnancy, and substance use, but limited research has examined early mortality. One notable, rigorous study in this realm draws on a small sample of youth in a single city, inhibiting a broader understanding of the correlates of mortality among a population of homelessness for youth and young adults across the United States (US). Objective. We examine mortality rates and associated risk factors using a longitudinal dataset following nearly 10,000 youth experiencing homelessness and housing instability across multiple US communities. Methods. Descriptive and logistic regression analyses were conducted on a longitudinal dataset of 9,614 youth ages 15-24 who sought housing support services in 10 states in the US. Youth completed the 28-item Next Step Tool, which is used as a risk assessment and triage tool for youth under age of 25. Items capture the extent and duration of homelessness and exposure to a myriad of risk factors. Longitudinal follow-up information was entered by social workers and incorporated the type and date of exit from homelessness, including death. We analyzed mortality rates and used logistic regression analyses to identify prominent risk factors for mortality. Results. Participants were, on average, 19 years old, and nearly half were White, 30% Black, 15% Hispanic, and 6% another race/ethnicity. Most (78%) identified as male and about 2/3 lived in urban communities. More than 1% of youth had died by follow-up, which represents a mortality rate of 1,450 per 100,000, more than 20 times the annual US death rate for 15-24 year-olds. Compared with youth who were not deceased at follow-up, adjusted risk of mortality was increased for youth who were homeless for more than one year, were homeless four or more times, had a drinking or drug problem, had a physical or mental health problems, could not care for their basic needs, or were misusing or failing to use prescribed medications. Risk ratios ranged from 1.6 to 2.7. Adjusted risk of mortality was significantly less among youth who were homeless for less than four weeks. Conclusions. Findings draw attention to the severe vulnerability of youth experiencing homelessness and the urgency of treating this national challenge as a public health problem. The analysis also identified risk factors for early mortality among a population of youth and young adults. While addressing these risk factors may help to reduce mortality rates in this population, these results also underscore the need for improved systems, such as strengthening communities’ data and monitoring systems, to effectively end youth homelessness.

Background Premature death, or death before the age of 75, has been on the rise since 2014 in Riverside County and has increased among all racial/ethnic groups. Premature deaths are influenced by the environment and conditions where people live, learn, work and play. These social determinants of health (SDOH) affect a wide range of health risks and outcomes. There are striking differences in communities with poor SDOH such as unstable housing, low income or unsafe neighborhoods. Objectives Evaluate premature death by injury, both intentional and unintentional, in Riverside County. Assess premature death by homicide and suicide. Differentiate premature death in adolescents and younger adults from all premature death. Methods By measuring premature death rather than overall death, the attention is focused on lives that could have been extended. Years of potential life lost, or YPLL, is used to measure premature death before age 75. Age-adjusted death rates are calculated to accurately analyze leading causes of death. Death data was pulled from CDPH Vital Records Business Intelligence System (VRBIS). Results Four in five deaths due to unintentional injury were premature in Riverside County. Unintentional injury (816 deaths), suicide (236 deaths) and homicide (108 deaths) in Riverside County made up only 15% of premature deaths, but accounted for 34% of all years of potential life lost (YPLL), highlighting the impact of injuries on younger residents. Disturbingly, 77% of deaths in 15-24 year olds were due to varying types of injury including unintentional injury, suicide or homicide. Additionally, over half (56%) of deaths among 35-44 year olds were due to injury. Higher injury rates are seen among children ages 1-14 (36%) and adults ages 35-44% (36%). Specifically, homicide and suicide account for 15% and 14% of death in young adults 15-24 years old. Unintentional injury is the third leading cause of death overall, and the leading cause of death among Hispanics. While only accounting for 11% of total YPLL, Native Americans and Blacks have the highest death rates, indicating a disparity in premature death among racial/ethnic groups. Native Americans and Blacks are dying at a younger age compared to other racial/ethnic groups. Females accounted for 7,383 YPLL while males accounted for 17,564 YPLL in unintentional injury, emphasizing the impact on younger males in the County. For males, homicide accounted for 3,785 YPLL and suicide accounted for 5,265 YPLL. For females, homicide accounted for 475 YPLL and suicide accounted for 1,635 YPLL. Conclusion Premature death due to unintentional injury, suicide and homicide disproportionately affects young adults and adolescents. From 2011-2015, 56% of residents who died in Riverside County were premature, meaning nearly 40,000 deaths could have been prevented in men and women under 75.

Background: Rates of childhood obesity have risen rapidly in recent decades, with 31.2% of U.S. youth classified as overweight or obese. The neighborhood built and social environment, encompassing characteristics such as walkability and social cohesion, is associated with obesity risk. There is evidence to suggest that the environment has differential effects on weight among men and women. Few studies, however, have examined gender differences in the influence of both the social and built environment on overweight and obesity risk among adolescents. Objectives: This study aimed to 1) describe gender-specific patterns of overweight and obesity among adolescents in a national sample and 2) identify gender differences in the influence of built and social environmental factors on risk of overweight or obesity. Methods: Data were analyzed from the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Survey questions examined psychosocial, generational, and environmental factors among adolescents aged 12-17 years in April-October 2014 (n=1,530). Instances of overweight or obesity (body mass index 85th percentile) were examined using descriptive statistics. Multivariate logistic regression was used to identify the influence of eight built and social neighborhood environment factors (shops, transit stops, sidewalks, recreation facilities, crime, social support, watching out for each other’s children, and litter) on weight status. Analyses were stratified by gender and adjusted for sociodemographic and economic characteristics of the adolescent and household. Results: 24.7% of adolescent girls compared to 29.1% of adolescent boys were overweight or obese (p<0.05). Among adolescent girls, access to a store or market within a 10- 15-minute walk from home was associated with an increased risk of overweight or obesity compared to those with more limited access (OR=1.57; p<0.05). Having sidewalks on most streets in the neighborhood was associated with a nearly 40% reduced risk of overweight or obesity compared to neighborhoods with limited sidewalks (OR=0.61; p<0.05). Social support was associated with a nearly 70% increased risk of overweight or obesity (OR=1.69; p<0.05). Among adolescent boys, litter or garbage on the streets or sidewalks was associated with a decreased risk of overweight or obesity compared to clean streets and sidewalks (OR=0.64, p<0.05). Conclusion: Results indicate that aspects of the built and social environment have differential effects on risk of overweight or obesity among adolescent girls and boys. Future research should examine the potential pathways through which these environmental factors may be associated with overweight or obesity risk, with the aim of developing community-based interventions.