Suicide is the second leading cause of death among youth and emerging adults aged 10 to 29, accounting for 10,598 deaths in 2022. Several contextual factors are known to be associated with suicide rates, and many policies exist to address these contextual factors. The proposed project will examine how these policies impact suicide rates across geographic locations. The specific aims are 1) to examine individual and bundled effects of social welfare, drug and alcohol, and firearm policies on suicide rates among youth and emerging adults in rural compared to urban areas of the United States and 2) to explore the differential impact of these policies on suicide rates within rural counties across demographic groups (e.g., age, sex, race and ethnicity). Based on prior research, we hypothesize that more generous social welfare policy will reduce suicide rates in rural areas more so than in urban areas, whereas more restrictive firearm and drug and alcohol laws will have a greater impact at reducing suicide in urban areas.
The sample includes all individuals aged 10-29 who died by suicide between 1999 and 2023 while residing in the United States. Suicide decedents will be aggregated at the county-level, and information on age, sex, race and ethnicity, and county of residence will be collected from the death certificate. Policies relevant to this age group will be included in analyses and consist of three broad categories: social welfare (e.g., minimum wage laws, earned income tax credits); firearms (e.g., red flag laws, safe storage requirements); and drugs and alcohol (e.g., prescribing limits, sales tax) and will be pulled from publicly available data sources such as the State Firearm Law Database and the State Policy and Politics Database. County-level covariates will also be included and will account for socioeconomics (e.g., poverty rate, unemployment), provider availability (e.g., psychiatrist and primary care availability), and county demographics (e.g., proportion male, proportion Black). Analyses will use a difference-in-difference approach with a time-varying law status that allows counties to act as their own controls before a law is passed, but also accounts for differences between pre-law and post-law periods amongst all counties. Rural and urban counties will be compared to one another based on the rural-urban continuum codes to determine how these policies impact suicide differently by location. Policies will be examined alone and in combination based on indices and other methods used in prior work.
This project has the potential to help identify specific policies that are useful in decreasing suicide rates across the nation and within rural communities explicitly. Findings from this project can be used to influence policy and policy makers, providing evidence that policies can be used to combat the major public health concern of suicide. Further research can explore how these policies are practically being carried out at the local level to help fine tune how local officials may best be able to use policy to reduce suicide rates.
