Exclusionary School Discipline and Black-White Disparities in Mortality through Early-Midlife

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Tuder, Carlyn E. Graham, Robert A. Hummer This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8079204/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract In the U.S., Black Americans live significantly shorter lives than White Americans. Prior research has named inequitable social exposures as critical determinants of the Black survival disadvantage during middle- and later-adulthood. Other work documents that unequal educational experiences are precursors to Black-White health disparities later in life. Still, no studies have linked educational exposures to racial disparities in subsequent mortality risk during adolescence and young adulthood. To that end, we use the National Study of Adolescent to Adult Health (Add Health) and Cox proportional hazard models to document the extent of Black-White disparities in all-cause and cause-specific mortality through young adulthood for a nationally representative cohort of Americans who were adolescents in the mid-1990s. We examine whether racially unequal exposure to exclusionary school discipline during adolescence accounts for any of this disparity. Results indicate a strong, positive associations between exclusionary school discipline and mortality from both internal (HR = 1.62) and external (HR = 2.27) causes of death, even after adjustment for socioeconomic and health covariates. We also find that Black-White disparities in mortality are heterogenous by cause of death: there is a large Black disadvantage in internal-cause mortality (HR = 1.74) and a modest Black advantage in external-cause mortality (HR = 0.65). Accounting for exclusionary school discipline in statistical models attenuates the Black-White hazard ratios for both internal and external causes of death. Our fundings underscore the critical need to reform exclusionary disciplinary practices to reduce premature mortality in the United States, particularly among Black Americans. exclusionary school discipline Black-White disparities life course mortality Figures Figure 1 Figure 2 Introduction Over the past two decades, mortality rates during early and midlife have increased markedly in the United States (Bor et al. 2023). Despite progress in reducing disparities during the 21 st century, Black Americans continue to die at much higher rates than White Americans (Arias, Xu, and Kochanek 2025). Black-White disparities in all-cause mortality are largest under age 64 years, and are particularly wide among adolescents and young adults (Rogers et al. 2017). For many causes, Black-White mortality disparities during adolescence and early adulthood have increased in recent years (Schwandt et al. 2021; Wolf et al. 2024). These enduring Black-White disparities in mortality account for thousands of excess deaths per year and signal that current efforts to eliminate racial health inequities are inadequate (Wrigley-Field 2020). Despite being far too common and largely preventable, surprisingly little research investigates the social determinants of Black-White mortality disparities before midlife. At the same time, a small but growing body of literature investigates adolescent social exposures as important precursors to subsequent adult mortality risk (Lawrence, Rogers, and Hummer 2024; Graham, Hummer, and Halpern 2025). Adolescence is a sensitive period in human development during which social exposures matter greatly for identity formation, subsequent life chances, and later life health (Harris 2010; Sawyer et al. 2012). It is also a time when racially-unequal exposure to social stressors may be particularly salient antecedents to Black-White inequities in survival (Gee et al. 2019). In particular, adolescents spend a considerable amount of time in schools. Accordingly, a growing body of literature has emphasized the critical role of early-life educational environments as precursors to later-life wellbeing (Boen 2020; Hargrove 2024; Payne and Welch 2016). Exclusionary school discipline—the practice of using suspension or expulsion as punishments for school policy violations—has gained research attention in recent years as a potential explanation for racial disparities in adverse health and social outcomes across the life course (e.g., Duarte et al. 2023; Leban and Masterson 2022). Exclusionary discipline is ubiquitous, highly racially unequal, yet understudied as a determinant of health. Five million youth are exposed to exclusionary discipline each year, more than a third of whom are Black (United States Department of Education 2022). There are wide Black-White disparities in suspension or expulsion for children as young as five years old (Owens and McLanahan 2020). By the end of their K-12 school career, over 35 percent of students have been suspended at least once, a figure that rises to 45 percent for Black girls and 67 percent for Black boys (Schollenberger 2013). Despite mounting evidence of the inefficacy of exclusionary discipline in improving student achievement or deterring classroom disruptions (Maag 2012; Perry and Morris 2014), the majority of public schools currently mandate suspension or expulsion for code of conduct violations (Perera and Dilberty 2023). Building on both the Black-White mortality literature and the adolescent school disciplinary literature, this paper first seeks to document U.S. Black-White disparities in mortality through early-midlife in a nationally representative cohort. Second, we interrogate whether school suspension and expulsion are associated with subsequent mortality risk, and if so, to what extent this exposure may account for racial disparities in mortality. Together, we aim to shed new light on racial disparities in early adult mortality by focusing on adolescent processes that unfold in the context of schools. Background Racism as a Fundamental Cause of Disparities in Early-Life Mortality For as long as life expectancy has been measured in the United States, Black Americans have, on average, lived shorter lives than White Americans (Hummer 2023 ). In 2022, life expectancy at birth among Black Americans was 72.8 years, compared to 77.5 years among White Americans (Arias, Xu, and Kochanek 2025). Before the COVID-19 pandemic, during which Black Americans lost nearly twice as many years of life expectancy as White Americans (Masters, Aron, and Woolf 2024), considerable progress had been made in reducing Black-White disparities in mortality (Dwyer-Lindgren et al. 2023 ). This progress was in part attributable to reductions in premature mortality among Black Americans due to improving socioeconomic conditions and reductions in certain acute and chronic diseases such as HIV/AIDS and cardiovascular disease (Fuchs 2016 ; Harper, Riddell, and King 2021 ; Masters et al. 2014 ), but also due to rising mortality rates among middle-aged Whites in recent years (Sasson 2016 ). Structural racism is a fundamental cause of Black-White disparities in mortality in the United States (Phelan and Link 2015 ). By “structural racism,” we refer to the interconnected web of racially discriminatory systems in multiple domains (e.g., housing, employment, education, and the criminal legal system) that create and maintain racialized subordination by disproportionately allocating resources to those in racially privileged groups, at the expense of those in racially minoritized groups (Brown and Homan 2024). Structural racism has persisted and transformed over time, from chattel enslavement, to Jim Crow, to the “colorblind” racism of the post-Civil Rights era (Bonilla-Silva 1997 , 2022 ). A core tenet of fundamental cause theory is the consistent operation of the fundamental cause over time, for a variety of health phenomena, and in spite of innovations in health-promoting resources (Phelan et al. 2004 ). It follows, then, that the endurance of structural racism contributes to persistent Black-White disparities in mortality over time, in spite of changing population health threats and across a wide range of causes of death (Geronimus, Bound, and Colen 2011 ; Kramer, Valderrama, and Casper 2015 ; Tilstra et al. 2022 ). Fundamental cause theory also contends that the more “preventable” a cause of disease or death is, whether by medical or social interventions, the larger the disparity will be, owing to the inequitable allocation of these health-promoting resources between racially privileged and racially disadvantaged groups (Levine et al. 2010 ; Macinko and Elo 2009 ; Tehranifar et al. 2016 ). Given that mortality under age 50 years is widely preventable for most causes of death, it is unsurprising that Black-White disparities in mortality rates have historically been especially large early in the life course (Cunningham et al. 2017 ). Indeed, Black-White all-cause mortality disparities are widest before age 55 (Kershaw et al. 2021 ), and are particularly wide among children, for whom mortality rates are 1.75 times higher among Black youth relative to White youth (Wolf et al. 2024 ). Black-White disparities in mortality during adolescence and young adulthood are also large and persistent over time (Tilstra et al. 2022 ). These disparities exist for numerous causes such as circulatory and infectious diseases, maternal mortality, and homicide (Patterson, Andréa Becker, and Baluran 2022; Wolf et al. 2024 ; Strassle et al. 2025). However, the broad patterns of elevated early-life mortality among Blacks relative to Whites are not universal. For certain causes of death, White Americans have higher mortality rates than Black Americans at these ages. The most notable example is mortality from drug-related causes, which skyrocketed among White people, and particularly White men, during the 2010s (Tilstra, Simon, and Masters 2021). It bears mentioning that drug-related mortality among Black American young adults under age 44 surged during and after the COVID-19 pandemic, and now roughly equals that of White Americans (Friedman, Nguemeni Tiako, and Hansen 2024). Similarly, suicide and alcohol-related mortality have historically been higher among White adolescents and young adults, but have increased markedly among young Black Americans since 2019 (Martínez-Alés et al. 2022 ; Wolf et al. 2024 ). The high mortality rates from some causes among Whites relative to Blacks exemplify the need for caution when interpreting Black-White disparities in mortality, given that the absence or reversal of a Black-White disparity does not necessarily indicate favorable outcomes among Whites (Wrigley-Field 2025 ). Nor does it automatically signal positive progress in curtailing racism’s effect on population health, given that the poor health of Whites is also in part a result of the ways that racism harms all racial groups in a racialized social system, albeit to very different extents (Malat, Mayorga-Gallo, and Williams 2018 ; Louie and DeAngelis 2024; Metzl 2019 ). Racism, Schools, and Health Across the Life Course In this study, we employ a life course perspective to frame the ways that educational exposures work to shape life chances and health into adulthood (Elder, Johnson, and Crosnoe 2003). Childhood and adolescence are periods during which individuals develop a sense of identity, undergo rapid physical and social transitions, and form understandings of the social world, and are thus foundational for subsequent outcomes (Crosnoe and Johnson 2011). We integrate a stress process framework into the life course perspective to contextualize how exposures to major stressors—in this case, to exclusionary school discipline and its associated social consequences—may negatively impact health and wellbeing into adulthood (Pearlin et al. 2005 ). The American education system is a key institution involved in the maintenance of racial inequality, and literature increasingly links racialized exposures in K-12 schools to racial inequities in health across the life course (Goosby and Walsemann 2012). Students who attended lower-resourced schools in adolescence tend to have worse mental health outcomes and elevated levels of inflammation during early adulthood (Boen, Kozlowski, and Tyson 2020 ). High levels of structural racism within schools are associated with elevated depressive symptomatology among Black adolescents, especially Black girls, during adolescence (Polos et al. 2022 ). Black students, particularly those with the darkest skin tones, who attend majority-White schools have especially steep trajectories of depressive symptoms into midlife (Hargrove 2024 ). School composition is not the only educational factor shaping the future life chances of adolescents. The “punitive turn” of the 1980s and 1990s emerged in response to growing, and often overtly racist, fears of social disorder, crime, and violence that resulted in the vast and historically unprecedented expansion of the criminal legal system (Weaver 2007 ; Pettit and Gutierrez 2018). But the punitive turn did not begin and end with prisons. Beginning in the mid-1990s, “zero tolerance policies” also emerged in schools across the country (Mallett 2016 ). These policies mandated harsh, non-negotiable, and automatic expulsions that were first designed to curb firearm use on school grounds, but later applied to an increasingly broad swath of school policy violations (Hanson 2005 ). Zero-tolerance policies operate irrespective of a student’s age, ignore precipitating circumstances leading to alleged violations, and rely on little administrative discretion in their implementation (Advancement Project 2000 ; Skiba and Knesting 2002). Evidence suggests that exclusionary school discipline initiates a cascade of negative social and health outcomes in three key domains that may place adolescents and young adults at elevated risk of early adult mortality. First, school suspension and expulsion harms academic performance and is linked to lower likelihood of high school completion, which in turn negatively impacts future socioeconomic status (Cholewa et al. 2018 ; Lacoe and Steinberg 2019). Educational attainment is a critical protective factor for stress-related health outcomes, including substance use disorder (Reingle Gonzalez et al. 2016 ) and cardiometabolic risk (Richardson, Goodwin, and Hummer 2021 ). Additionally, an extensive literature documents that adults with less than a high school education are at elevated risk of mortality from a variety of causes, including cardiometabolic diseases, cancers, and external causes (Hummer and Lariscy 2011 ; Masters, Link, and Phelan 2015 ). In this way, reduced educational attainment may be a critical link between exclusionary school discipline and mortality. Second, the “school-to-prison pipeline” often begins with exclusionary school discipline (Hemez, Brent, and Mowen 2020 ; Mallett 2016 ). Specifically, young adults who were suspended during adolescence are at least 1.3 times more likely to have been arrested after their suspension, and 1.25 times more likely to have been incarcerated than those who were not, even after adjustment for behavioral risk factors (Rosenbaum 2020 ). There is a dose-response relationship between frequency of suspension and likelihood of arrest (Mowen and Brent 2016). Criminal legal system involvement implies exposure to countless social stressors, including violence victimization, social stigmatization, and increased economic precarity (McFarland, Geller, and McFarland 2019 ; Williams 2018 ; Beckett and Murakawa 2012). Contact with the criminal legal system is a well-documented risk factor for a host of negative physical and mental health outcomes including depressive symptoms, stress-related physiological dysregulation, and infectious disease morbidity (Boen 2020 ; LeMasters et al. 2024 ; Massoglia 2008 ; Porter and DeMarco 2019), as well as with subsequent mortality risk (Binswanger 2013 ; Daza, Palloni, and Jones 2020; LeMasters et al. 2022 ). Third, exclusionary discipline is associated with social stigma, strain in relationships, and reduced social integration. Specifically, students who are suspended or expelled receive stigmatizing labels, and are thus less likely to have close, prosocial relationships with their instructors and peers (Anyon, Zhang, and Hazel 2016; Jacobsen 2020 ; Novak and Krohn 2021). In addition, labels of deficiency and delinquency spill over to parents, who are often encouraged by schools to use harsher disciplinary practices against their children at home, putting further strain on the parent-child relationship (Dunning-Lozano 2018 ). Given (a) the inequitable sorting of Black students into suspension or expulsion; (b) the important role that schools play in shaping adult health outcomes; and (c) the critical role of exclusionary school discipline in shaping social outcomes, it is quite possible that exclusionary school discipline is implicated in Black-White inequities in subsequent mortality risk. Gaps in the Literature Despite increasing attention to Black-White patterns in rising mortality rates during young adulthood, three critical gaps in the literature remain. First, comparatively few studies interrogate the life-course determinants of premature mortality using longitudinal data, and even fewer detail the specific determinants of mortality during adolescence (Braudt et al. 2019 ; Graham, Hummer, and Halpern 2025 ; Lawrence, Rogers, and Hummer 2024 ). Second, while a growing body of literature documents the critical function that schools play in shaping Black-White disparities in health across the life course, few investigate the specific role of exclusionary school discipline. One study of children and adolescents in New York City documents a strong association between school suspension or expulsion and suicide mortality (Gould 1996 ). Other recent studies have documented strong relationships between exclusionary school discipline and elevated depressive symptoms (Angton et al. 2024 ) as well as poor self-rated health into adulthood (Niño et al. 2024). Still, to our knowledge, this is the first study to specifically investigate whether and to what extent exclusionary school discipline patterns mortality risk by race/ethnicity. Third, there are relatively few prospective studies that consider cause-specific mortality among adolescents and young adults. The differing profiles of cause-specific mortality between young Black and White Americans warrants cause-specific analyses when possible. In this way, the relatively scant literature on the early-life determinants of mortality indicates that our understanding of the precursors to mortality is far from complete. The Current Study To address these gaps in the literature, we use detailed nationally representative longitudinal data to advance address the following questions: Are there Black-White disparities in adolescent and young adult all-cause and cause-specific mortality risk for this cohort? Is exclusionary school discipline during early life associated with adolescent and young adult mortality risk? How do Black-White differences in adolescent and young adult mortality risk change when accounting for exclusionary school discipline? In light of these questions and the literature discussed above, we hypothesize the following. First, based on a long and substantial body of literature, Black adolescents and young adults have higher mortality risk than White adolescents and young adults, particularly from internal-cause mortality. We also hypothesize that experiencing exclusionary school discipline is associated with increased subsequent mortality risk, especially from external-cause mortality. Lastly, we expect that the Black disadvantage in mortality risk will narrow after the inclusion of exclusionary discipline, both for all-cause as well as for cause-specific mortality. Data and Methods Data Data come from The National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative, longitudinal study of US adolescents who are now in their 30s and 40s (Harris et al. 2019 ). Add Health began with Wave I (1994–1995) by administering in-school questionnaires and in-home interviews to adolescents in grades 7–12 (ages 12–19) based on a school-based complex clustered sampling design. The 20,745 adolescents from Wave I have been subsequently followed with for five waves between 1996 and 2018. This study uses data from the in-home and parent interviews conducted at Wave I; neighborhood contextual data at the Census tract level derived from Wave I home addresses; school administrator data from the in-school survey at Wave I; school-related contextual data at Wave I from the 1990 Census and Common Core of Data (Schwartz 2023 ); and death record data from the National Death Index and other sources of follow-up linked to respondent identifiers through December 31, 2022 (Trani et al. 2024 ). Measures Outcomes We consider two outcomes in this study. The first is all-cause mortality versus survival from the date of Wave I interview until December 31, 2022. Mortality data is sourced from the Add Health Mortality Outcomes Surveillance Data file, which links decedent records to respondents in the Add Health cohort. Detailed discussion of the data linkage procedure can be found elsewhere (Trani et al. 2023 ). The Mortality Outcomes Surveillance data is comparable to other nationally-representative cohort studies with mortality follow up (Lawrence et al. 2024 ). The second outcome is cause-specific mortality versus survival by broad cause-of-death grouping (internal vs. external causes), conditional on survival from other causes of death. Internal causes of death include disease-related causes, such as heart disease and cancers. Examples of external causes include suicides, homicides, and traffic accidents. We use these broad cause of death categories to maximize statistical power, and to comply with Add Health’s deductive disclosure policies. To determine cause of death, we use data on the underlying cause of death from the Mortality Outcomes Surveillance data based on International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) classifications (World Health Organization 2007 ). A table of cause of death classification can be found in Appendix Table 1. Of the original Add Health cohort, 706 (3.4%) people were identified as deceased by the end of 2022. Table 1 Weighted Sample Characteristics by Race/Ethnicity, Vital Status, and Broad Cause of Death Full sample (N = 14,069) Black (N = 4,060) White (N = 10,009) Alive (N = 13,536) Died All Causes (N = 533) Internal (N = 223) External (N = 289) Mean SE Mean SE Mean SE Mean SE Mean SE Mean SE Mean SE Age at Wave I 15.96 0.12 16.16 0.22 15.91 0.13 15.95 0.12 16.09 0.18 16.34 0.22 15.86 0.20 Male 0.51 0.01 0.50 0.01 0.51 0.01 0.50 0.01 0.63 b 0.03 0.53 0.05 0.71 b 0.03 Non-Hispanic White 0.81 0.03 0.81 0.03 0.77 0.04 0.69 0.05 0.84 0.04 Non-Hispanic Black 0.19 0.03 0.19 0.03 0.23 0.04 0.31 0.05 0.16 0.04 Deceased by 12/31/2022 0.04 0.00 0.05 0.001 0.04 0.001 Age at death (Among decedents) 33.99 0.49 33.81 0.93 34.04 0.53 36.85 0.72 31.91 0.68 Ever suspended or expelled 0.28 0.02 0.49 a 0.02 0.24 0.01 0.28 0.02 0.49 b 0.03 0.45 b 0.05 0.53 b 0.04 Wave I Controls Parents < Bachelors’ degree 0.57 0.02 0.64 0.03 0.56 0.02 0.57 0.02 0.64 0.03 0.65 0.05 0.63 0.04 Household receives public assistance 0.13 0.01 0.27 a 0.02 0.10 0.01 0.13 0.01 0.18 0.03 0.18 0.03 0.18 0.04 Delinquency scale (Z-score) -0.01 0.02 0.02 0.04 -0.02 0.02 -0.02 0.02 0.20 b 0.08 0.11 0.13 0.29 b 0.11 Self-rated health (1 = excellent, 5 = poor) 2.11 0.01 2.12 0.02 2.10 0.02 2.10 0.01 2.31 b 0.06 2.40 b 0.09 2.24 0.08 Depressive symptoms (0–15) 2.76 0.04 3.18 a 0.07 2.66 0.04 2.74 0.04 3.26 b 0.18 3.05 0.34 3.39 b 0.22 Neighborhood poverty rate 0.12 0.01 0.22 a 0.01 0.09 0.01 0.12 0.01 0.13 0.01 0.14 0.01 0.13 0.01 Teacher retention 0.68 0.02 0.65 0.02 0.69 0.02 0.68 0.02 0.66 0.03 0.65 0.03 0.67 0.03 Average class size 25.28 0.38 26.52 0.63 24.98 0.40 25.29 0.38 25.08 0.55 25.10 0.76 25.15 0.54 Proportion students of color 0.26 0.02 0.60 a 0.04 0.18 0.02 0.26 0.02 0.28 0.03 0.31 0.04 0.25 0.03 Proportion students testing below grade level 0.21 0.02 0.27 0.03 0.20 0.02 0.21 0.02 0.21 0.02 0.20 0.02 0.22 0.02 Notes: Data Source: Add Health. a Two-tailed t-test between Black and White respondents significant at alpha = 0.05, b two-tailed t-test between decedents and surviving Wave I respondents significant at alpha = 0.05. Explanatory Variables The exposure of interest is self-reported race/ethnicity (Non-Hispanic Black and Non-Hispanic White) measured at Wave I, which we operationalize to measure Black-White disparities in mortality risk. This variable is a proxy for racialized social status, a sociohistorical construct that varies across time and space (Martinez et al. 2023 ). In addition to quantifying Black-White disparities in mortality, this variable represents a confluence of racialized exposures to health risks and/or rewards (Brown and Homan 2024). Due to low numbers of deaths among respondents of other ethnoracial groups, we only include those who identify as Non-Hispanic Black or White. Also central to our investigation is the association between exclusionary school discipline (ESD) and subsequent mortality risk. We measure ESD at Wave I with a binary variable based on whether the respondent answers “Yes” to either of the following questions: “Have you ever received an out-of-school suspension?” and/or “Have you ever been expelled from school?” These questions were asked in Wave I when the respondents were as young as age 12; thus, they likely underestimate the true prevalence of ESD in this cohort. Due to attrition between Waves I and III, when the question is next asked and respondents are at least 18, we measure ESD at Wave I to preserve as many cases as possible. Covariates We also adjust for measures of adolescent sex, socioeconomic status, behavior, school environment, and health. We adjust for sex assigned at birth (1 = male, 0 = female) due to large sex disparities in early-life mortality (Lawrence et al. 2024 ). We measure parental SES through parental education (1 = at least one parent with less than a Bachelors’ degree) and household receipt of public assistance (1 = household received public assistance) sourced from Wave I parent interview data. We adjust for Wave I neighborhood poverty with a continuous measure of the tract-level proportion of households below the federal poverty line. To measure adolescent behavior, which may select adolescents into both ESD and heightened mortality risk, we use a standardized delinquency scale of 15 items asking the frequency in the past year with which respondents participated in behavior such as property damage, graffiti, and shoplifting. To isolate the association of ESD with mortality risk, we further adjust for measures of school socioeconomic status and disorder, which are associated with health and wellbeing in other studies using Add Health data (Boen et al. 2020 ). We adjust for teacher retention via the proportion of teachers who have worked at the respondent’s school for 5 years or longer. Teacher turnover is a proxy for school disorder and the availability of social support for students. Teachers are more likely to leave schools with high levels of disorder (Allensworth, Ponisciak, and Mazzeo 2009), and high levels of teacher turnover make close relationships between teachers and students more challenging (Ronfeldt, Loeb, and Wyckoff 2013). We adjust for average class size, which is another indicator of teacher burnout and school socioeconomic status: schools with large class sizes tend to have lower socioeconomic status, and teachers’ material, academic, and emotional resources for students may be spread thinner. We also adjust for the proportion of students of color as a measure of school racial segregation, which is associated with poor health among adolescents (Allgood et al. 2024 ). Finally, we adjust for the school-level proportion of students testing below grade level as a measure of school SES. This measure is not intended to capture the academic performance of students, but rather the level of material resources in a school environment, given strong and enduring socioeconomic gradients in standardized testing performance (Carbonaro, Lauen, and Levy 2023 ). These measures are each sourced from the Wave I school administrator dataset. Lastly, we adjust for physical and mental health during adolescence. We adjust for self-rated health, a predictor of subsequent mortality risk (Jylhä 2009 ), at Wave I (1 = excellent, 2 = very good, 3 = good, 4 = fair, 5 = poor). We treat self-rated health as a continuous measure. We also adjust for depressive symptoms during adolescence using a 5-item index adapted from the Center of Epidemiologic Studies Depression Scale (CES-D). Participants were asked how often during the past seven days they “could not shake off the blues,” “felt depressed,” “were happy,” “felt sad,” and “felt life was not worth living” (0 = never or rarely, 1 = sometimes, 2 = a lot of the time, 3 = most or all of the time). The five items were added together to create an index of depressive symptoms ranging from 0 to 15 points. Analytic Sample We include all Black and White respondents with valid Wave I sampling weights and demographic covariates (age and sex). This results in an analytic sample of 14,069 observations (533 deaths). To address missingness, we use multiple imputation with chained equations (MICE) and conduct our analyses in Stata 17 (StataCorp 2021 ). All analyses adjust for Add Health’s complex stratified sampling design and account for variance clustering within schools (Trani et al. 2023 ). Methods We begin with descriptive analyses, paying particular attention to patterns between key exposures—race/ethnicity and exclusionary school discipline—and vital status. We then use Cox proportional hazard models to investigate mortality disparities by race/ethnicity and exposure to ESD. We use age at Wave I interview as the entry point. The duration (in months) is age at death minus age at Wave I interview for decedents, and age at 12/31/2022 minus age at Wave I interview for those who survived the study period. Because the duration variable implicitly includes age, we do not adjust for age in statistical models (Thiébaut and Bénichou 2004). We conduct two sets of hazard models. In the first, we use all-cause mortality as the outcome of interest. In Model 1 we include race/ethnicity and sex to document sex-adjusted Black-White disparities in all-cause mortality risk. Model 2 adds exclusionary school discipline to Model 1. In Model 3, we include race/ethnicity, sex, and the array of covariates to examine whether socioeconomic, school, and behavioral factors account for any Black-White disparities in mortality risk. Finally, in Model 4, we include race/ethnicity, sex, ESD, and all covariates to present fully adjusted associations between race/ethnicity, ESD, and all-cause mortality risk. In the second set of models, we use competing-risk regressions for internal-cause and external-cause mortality conditional on survival from other causes of death. We mirror the structure of the first set of models, but for the sake of brevity, only present results from models that adjust for control variables. Thus, in Model 1, we include race/ethnicity, sex, and control variables to display Black-White disparities in internal-cause mortality risk after adjustment for covariates. In Model 2, we add exclusionary school discipline to Model 1. We repeat this procedure for external-cause mortality in Models 3 and 4. To test the proportional hazard assumptions, we interact each variable in our regressions with the duration variable in fully adjusted models (Model 4). There were no significant interaction terms between time and race/ethnicity or between time and suspension/expulsion, indicating that Cox models do not violate the proportionality assumption. Results [Figure 1 about here] Figure 1 displays the risk of all-cause mortality by exclusionary discipline history (Panel A) and by race/ethnicity (Panel B). Almost immediately following the Wave I interview, a large and growing disparity in mortality risk by suspension/expulsion history emerges. By the early 40s, those who have been suspended or expelled in adolescence are more than twice as likely to have died than those who were not. Panel B shows that, although Black respondents have lower survival probability than White respondents at most ages, there is not a statistically significant difference in mortality hazard during adolescence and young adulthood at the 0.05 level. [Table 1 about here] Table 1 shows weighted descriptive statistics of the sample by race/ethnicity, vital status, and broad cause of death. Participants were an average age of 16 years at Wave I interview. The sample is 19 percent Black and 81 percent White. Around four percent of the analytic sample was deceased by 12/31/2022, with an average age at death of 34 years. Exclusionary school discipline is quite common, and highly unequal by race/ethnicity and by vital status. More than one quarter (28%) of the full sample had been suspended or expelled from school by Wave 1. Black adolescents were more than twice as likely to be suspended or expelled than White adolescents (49% vs. 24%, p < 0.05). Decedents were also much more likely to have been suspended or expelled than those who survived to the end of the study period (49% vs 28%, p < 0.05). Suspension/expulsion is particularly prevalent among those who died from external causes, of whom more than half were previously suspended or expelled from school, but is also disproportionately prevalent among internal-cause decedents. Table 1 also demonstrates large inequalities in certain covariates by race/ethnicity and by vital status. Specifically, Black respondents were more likely live in households receiving public assistance and lived in neighborhoods with higher poverty rates than White respondents. Black respondents also attended schools with much larger proportions of non-White students than White respondents did (60% vs 18%, p < 0.05). White respondents reported lower levels of depressive symptoms than did Black respondents during adolescence (2.66 vs. 3.18, p < 0.05). Almost two-thirds of all-cause decedents are males (63%), a figure that rises to more than 70 percent for external causes. There is no significant overrepresentation of males among internal-cause decedents. Decedents also reported worse health in adolescence than those who survived: external-cause decedents had higher levels of depressive symptoms in adolescence (3.39 vs. 2.74, p < 0.05), while internal-cause decedents had worse self-rated health (2.40 vs 2.10, p < 0.05). [Table 2 here] Table 2 Distribution of Causes of Death by Race/Ethnicity Non-Hispanic Black Non-Hispanic White Unweighted count Weighted proportion SE Unweighted count Weighted proportion SE All internal causes 86 0.58* 0.05 137 0.38 0.03 Circulatory and metabolic causes 35 0.23 0.05 56 0.16 0.02 Cancers 17 0.13 0.04 34 0.09 0.02 Infectious diseases (including COVID-19) 19 0.10+ 0.03 13 0.03 0.01 Other internal causes 15 0.12 0.04 34 0.10 0.02 All external causes 74 0.39* 0.05 215 0.60 0.03 Suicide and accidental poisoning 22 0.10** 0.03 113 0.35 0.03 Homicide 24 0.13* 0.04 10 0.02 0.01 Transport accidents 17 0.09 0.03 69 0.17 0.02 Other external causes 11 0.08 0.03 23 0.05 0.02 Missing/suppressed 8 0.03 0.02 13 0.03 0.01 Total 168 365 Data Source: Add Health Notes: ** p < 0.01; * p < 0.05; + p < 0.1 for two-tailed t-test between Black and White decedents. Proportions may not add to 1 due to rounding. In Table 2 , we present the distribution of causes of death by race/ethnicity. There are notable Black-White disparities in the relative shares of internal and external causes of death. Specifically, the majority (58%) of deaths among Black decedents are from internal causes. Black decedents are more than 1.5 times as likely to have died from internal causes than White decedents. Black decedents were more than 3 times as likely to have died from infectious diseases (including COVID-19) by early-middle adulthood than White decedents (10% vs. 3%, p < 0.1), as well as from circulatory and metabolic diseases, cancers, and other internal causes, though these differences do not reach statistical significance. White decedents, on the other hand, were 1.5 times more likely to have died from external causes than Black decedents. More than 35% of deaths in the White population were from suicide and accidental poisoning, compared to 10% of deaths in the Black population (p < 0.01). Whites were also more likely to die from transport accidents and other external causes. A notable exception to the elevated level of external-cause mortality among Whites relative to Blacks is homicide, from which Black decedents were more than 6 times more likely to die than White decedents (p < 0.05). [Table 3 here] Table 3 Results from Weighted Cox Proportional Hazards Models for All-Cause Mortality vs. Survival Model 1: Race/ethnicity and sex Model 2: Model 1 + suspension/expulsion Model 3: Model 1 + covariates Model 4: Model 3 + suspension/expulsion HR 95% CI P HR 95% CI P HR 95% CI P HR 95% CI P Non-Hispanic Black (ref = Non-Hispanic White) 1.25^ (0.98, 1.61) 0.08 1.00 (0.78, 1.29) 1.00 1.05 (0.71, 1.54) 0.82 0.94 (0.64, 1.37) 0.73 Male (ref = female) 1.64*** (1.26, 2.14) 0.00 1.39* (1.05, 1.85) 0.02 1.72*** (1.32, 2.25) 0.00 1.52*** (1.15, 2.01) 0.00 Ever suspended or expelled 2.31*** (1.86, 2.88) 0.00 1.99*** (1.57, 2.51) 0.00 Parents < BA 1.19 (0.93, 1.53) 0.17 1.11 (0.87, 1.42) 0.41 Household receives public assistance 1.20 (0.84, 1.72) 0.31 1.13 (0.79, 1.62) 0.51 Delinquency (Z-score) 1.10 (1.00, 1.22) 0.06 1.03 (0.92, 1.15) 0.62 Self-rated health 1.20*** (1.07, 1.36) 0.00 1.18*** (1.05, 1.33) 0.01 Depressive symptoms 1.06* (1.01, 1.11) 0.03 1.04 (0.99, 1.10) 0.09 Neighborhood poverty rate 1.84 (0.47, 7.24) 0.38 1.48 (0.38, 5.77) 0.57 Teacher retention 0.63 (0.27, 1.46) 0.27 0.67 (0.28, 1.59) 0.36 Average class size 0.99 (0.96, 1.02) 0.42 0.99 (0.96, 1.02) 0.40 Proportion students of color 1.13 (0.63, 2.03) 0.69 1.11 (0.61, 2.01) 0.73 Proportion students testing below grade level 0.63 (0.31, 1.27) 0.20 0.64 (0.32, 1.28) 0.20 Unweighted N 14,069 14,069 14,069 14,069 Data Source: Add Health Notes: ^ p < 0.1, * p < 0.05, ** p < 0.01, *** p < 0.001 HR = hazard ratio, CI = confidence interval Table 3 contains the results from hazard models for all-cause mortality risk. In Model 1, there is suggestive evidence of a Black disadvantage in mortality risk after controlling for sex (HR = 1.25, p = 0.08). After introducing suspension/expulsion into the regressions in Model 2, the difference in mortality risk found in Model 1 all but disappears. Suspension or expulsion is associated with 2.31 times higher risk of mortality (p < 0.001). Without suspension or expulsion, the inclusion of control variables also obviates the Black-White mortality hazard ratio (Model 3). In Model 4, the fully-adjusted model, there is no significant Black-White mortality hazard, and suspension or expulsion remains a strong predictor of all-cause mortality, even net of a variety of covariates (HR = 1.99, p < 0.001). [Table 4 and Fig. 2 here] Table 4 Results from Weighted Competing-Risk Models for Internal and External-Cause Mortality vs. Survival Model 1: Internal Causes Model 2: Internal Causes Model 3: External Causes Model 4: External Causes HR 95% CI P HR 95% CI P HR 95% CI P HR 95% CI P Non-Hispanic Black (ref = Non-Hispanic White) 1.74* (1.05, 2.88) 0.03 1.61^ (0.97, 2.68) 0.07 0.65 (0.38, 1.13) 0.13 0.50^ (0.33, 0.99) 0.05 Male 1.15 (0.79, 1.68) 0.48 1.05 (0.71, 1.56) 0.79 2.53*** (1.82, 3.51) 0.00 2.16*** (1.54, 3.03) 0.00 Ever suspended or expelled 1.62* (1.12, 2.34) 0.01 2.27*** (1.62, 3.16) 0.00 Parents < BA 1.23 (0.81, 1.86) 0.34 1.17 (0.77, 1.76) 0.46 1.16 (0.83, 1.62) 0.37 1.07 (0.77, 1.47) 0.70 Household receives public assistance 1.09 (0.67, 1.76) 0.74 1.04 (0.64, 1.69) 0.88 1.33 (0.82, 2.15) 0.25 1.23 (0.76, 2.00) 0.39 Delinquency (Z-score) 1.07 (0.88, 1.30) 0.52 1.01 (0.83, 1.24) 0.90 1.13 (1.00, 1.28) 0.06 1.04 (0.90, 1.21) 0.56 Self-rated health 1.36** (1.13, 1.65) 0.00 1.35** (1.11, 1.64) 0.00 1.08 (0.92, 1.28) 0.35 1.06 (0.90, 1.25) 0.51 Depressive symptoms 1.00 (0.91, 1.10) 0.97 0.99 (0.90, 1.09) 0.84 1.10*** (1.04, 1.16) 0.00 1.08** (1.02, 1.15) 0.01 Neighborhood poverty rate 1.82 (0.30, 10.85) 0.51 1.57 (0.25, 9.64) 0.63 1.89 (0.29, 12.42) 0.51 1.45 (0.23, 9.26) 0.69 Teacher retention 0.51 (0.21, 1.28) 0.15 0.54 (0.21, 1.37) 0.20 0.79 (0.26, 2.35) 0.67 0.84 (0.27, 2.58) 0.76 Average class size 0.98 (0.93, 1.04) 0.60 0.98 (0.93, 1.05) 0.60 1.00 (0.96, 1.03) 0.81 1.00 (0.96, 1.03) 0.77 Proportion students of color 1.14 (0.49, 2.65) 0.76 1.12 (0.48, 2.63) 0.79 1.02 (0.49, 2.16) 0.95 1.00 (0.47, 2.15) 0.99 Proportion students testing below grade level 0.34 (0.10, 1.20) 0.09 0.35^ (0.10, 1.23) 0.10 1.04 (0.42, 2.55) 0.94 1.03 (0.43, 2.49) 0.94 Unweighted N 14,069 14,069 14,069 14,069 Data Source: Add Health Notes: ^ p < 0.1, * p < 0.05, ** p < 0.01, *** p < 0.001 HR = hazard ratio, CI = confidence interval In Table 4 , we turn to cause-specific analyses of competing risk models for internal- and external-cause mortality risk. In Model 1, we present results that adjust for all covariates except for suspension/expulsion. There is a wide disparity in internal-cause mortality risk during adolescence and young adulthood between Blacks and Whites, net of socioeconomic and health covariates (HR = 1.74, p = 0.03). This disparity shrinks, but does not disappear, in Model 2 after the inclusion of suspension/expulsion (HR = 1.61, p = 0.07). Exclusionary school discipline is associated with 1.62 times higher risk of internal-cause mortality (p = 0.01, Model 2), conditional on survival from other causes of death and after adjustment for covariates. In contrast to internal-cause mortality risk, Model 3 in Table 4 demonstrates that there is no Black-White disparity in external-cause mortality risk during these ages, and in fact, there may be a Black survival advantage relative to Whites (HR = 0.65, p = 0.13). In Model 4, suspension/expulsion is associated with 2.25 times higher risk of external-cause mortality relative to those who have never been suspended or expelled (p < 0.001). The Black survival advantage relative to Whites widens in Model 4 after the inclusion of exclusionary discipline and is now statistically significant at the 0.05 level (HR = 0.58). This suggests that if there was no Black-White disparity in suspension/expulsion, the risk of external-cause mortality conditional on survival from other causes may, in fact, be lower for Blacks than for Whites. The shifts in Black-White hazard ratios for all-cause and cause-specific mortality are visualized in Fig. 2 , which contains results from models before and after adjustment for Wave I covariates. Discussion Increasing premature mortality rates have garnered significant research attention since the mid-2010s. While most studies are either cross-sectional or focused on adult determinants of midlife mortality, we direct our attention to the adolescent determinants of mortality among a nationally representative cohort of adolescents from the mid-1990s who reached adulthood in the 2000s. We specifically consider exclusionary school discipline, an understudied determinant of health and wellbeing, as an important precursor to mortality risk during young adulthood and a possible mechanism through which Black-White disparities in mortality manifest over the life course. Our results demonstrate that, compared to Whites, Blacks have modestly higher all-cause mortality risk between adolescence and young adulthood. We also find strong associations between exclusionary school discipline and mortality risk from all causes of death that persist even after adjustment for a large range of adolescent covariates. Further, the inclusion of exclusionary discipline in statistical models indeed decreases the hazard ratios for mortality among Blacks compared to Whites for both internal and external causes. Taken together, results from this study contribute to the literature in three key ways. First, we provide further evidence that Black-White disparities in mortality during adolescence and young adulthood are not universal for all causes of death. Specifically, Black adolescents and young adults are at much higher risk of internal-cause mortality than Whites, while Whites are slightly more likely to die from external causes than Blacks (Table 2 ). Nationally, more than half of deaths under age 50 were from external causes in 2022 (Curtin, Tejada-Vera, and Bastian 2024), yet results from Table 2 indicate that almost 60 percent of deaths among Black respondents were from internal causes. These Black-White disparities in internal-cause mortality attenuate slightly, but remain large after accounting for covariates and exclusionary school discipline (Fig. 2 ). This internal-cause disparity is largely driven by cardiometabolic causes, cancers, and infectious diseases which together compose nearly half of all deaths in the Black subsample, compared to less than one-third of deaths in the White subsample (Table 2 ). Many members of this cohort were born around the onset of the HIV/AIDS epidemic in the early-1980s, and most reached adolescence during its peak in the early-1990s. The introduction of lifesaving technologies saved millions of lives starting in the mid-1990s, but exacerbated Black-White disparities in AIDS-related mortality due to structural inequities in health-promoting resources and access to antiretroviral therapies (Rubin, Colen, and Link 2010). Most recently, the COVID-19 pandemic once again brought the crisis of Black-White disparities premature mortality into stark relief, and highlighted the role of structural racism in generating vast amounts of preventable death (Laster Pirtle 2020 ; Bonilla-Silva 2020 ). Black-White disparities in young cardiometabolic health in the Add Health cohort are also large (Gaydosh et al. 2018 ; Richardson et al. 2021 ). The relatively high prevalence of cardiometabolic morbidity and inflammation among Black young adults not only contributes to the elevated risk of mortality from diabetes and heart disease at these ages, but also together comprise a “syndemic” of socially unequal risks for mortality from COVID-19 (Gravlee 2020 ). On the contrary, White adolescents and young adults in this cohort are more likely to die from external causes than their Black counterparts. There has been substantial attention to the rise in external-cause mortality among adults between ages 25 and 64 (Harris, Majmundar, and Becker 2021), but this study is one of few to document this pattern earlier in the life course (see Lawrence et al. 2024 ). The overrepresentation of suicide and drug poisoning in the White population shown in Table 2 is largely driving this phenomenon. These results are paradoxical given that Black adolescents report 20% higher levels of depressive symptoms—which strongly predict subsequent external-cause mortality—relative to White adolescents (Tables 1 and 4 ). This cohort came of age at the onset of the opioid epidemic in the early-2000s, during which pharmaceutical corporations marketed prescription opioid painkillers, such as OxyContin, as non-addictive treatments for chronic pain. The belief that Black Americans feel less pain than White Americans, or that Black Americans are otherwise drug-seeking, is widespread among medical practitioners in the United States, who as a result disproportionately prescribed White Americans historically unprecedented amounts of addictive opioid drugs to manage acute or chronic pain (Simpson 2021 ). The Add Health cohort is now entering midlife as the opioid epidemic accelerates in non-White populations (Gennuso et al. 2019 ). Given that drug overdose mortality rates are higher among Black Americans than White Americans after age 45, it is possible that the White disadvantage in external-cause mortality will shrink or reverse as the Add Health cohort ages (Monnat 2022 ). Second, exposure to exclusionary school discipline during adolescence is a strong predictor of subsequent mortality risk. This association exists for both internal and external causes of death, but is particularly strong for external causes, and it persists regardless of adjustment for socioeconomic, contextual, and health covariates in adolescence (Table 4 ). There are likely numerous pathways through which exclusionary school discipline may increase mortality risk. First, and perhaps most importantly, is the “school-to-prison” pipeline, whereby students who experience exclusionary school discipline are far more likely to experience arrest or incarceration than students who were not. This association between school suspension and arrest exists early in the life course and persists into adulthood. Children who were suspended before age 10 were at least twice as likely to have been arrested by age 15 relative to those who were not (Mittleman 2018 ). Exclusionary school discipline initiates or accelerates trajectories into substance use disorder that in part operate through exposure to arrest during adolescence and young adulthood (Prins et al. 2023 ). Young adults who were suspended during childhood and adolescence are also more than twice as likely to be incarcerated than those who were not (Hemez et al. 2020 ). Given the concentrated risk of mortality from suicide, homicide, and drug poisoning both during (Carson 2021 ) and after incarceration (Binswanger 2013 ), it is quite possible that the school-to-prison pipeline is operating as an important mechanism in the association between ESD and mortality risk from external causes. While likely most salient for external-cause mortality, the school-to-prison pipeline may be relevant to subsequent internal-cause mortality risk as well. Individuals who are incarcerated have a much higher burden of chronic disease morbidity than the non-incarcerated population (Binswanger, Krueger, and Steiner 2009 ). Inadequate nutrition, vigilance and victimization, poor healthcare access and quality, and loneliness may all elevate chronic stress, and thus increase the risk of mortality from chronic diseases during incarceration (Daza et al. 2020). Exposure to arrest and incarceration are also associated with increased stress-related physiological dysregulation during young adulthood, which may carry implications for mortality from acute and chronic diseases (Boen 2020 ). The havoc wreaked by the COVID-19 pandemic on incarcerated populations—who are more than three times as likely to die from the disease than the general population (Sugie et al. 2023)—also highlighted the importance of carceral environments as vectors for infectious disease transmission (LeMasters et al. 2022 ). This phenomenon has also been noted for HIV/AIDS, sexually transmitted infections, influenza, and tuberculosis (Massoglia 2008 ). Exposure to the criminal legal system is not the only mechanism connecting ESD to mortality risk. School suspension and expulsion are strongly associated with reduced educational attainment in adulthood, which likely carries implications for premature mortality from internal and external causes alike. Specifically, school suspension is associated with a significant reduction in academic performance during childhood and adolescence (Perry and Morris 2014) and a 25% reduction in the likelihood of earning a Bachelors’ degree by young adulthood (Rosenbaum 2020 ). Educational inequality in mortality is increasing in the United States, particularly from cardiometabolic and external causes (Sasson and Hayward 2019), and as such, it is quite possible that ESD during adolescence acts as an important early-life precursor to these disparities. Finally, the experience of suspension or expulsion is associated with numerous negative social experiences that may be associated with mortality risk. Exclusionary school discipline is associated with elevated depressive symptoms during adolescence and young adulthood (Angton et al. 2024 ). Students who have experienced ESD are more likely to experience friendship loss following suspension (Jacobsen 2020 ), have fewer close relationships with adults (Anyon et al. 2016), and are less likely to report participating in political and civic engagement later in life (Kupchik and Catlaw 2015 ). Social isolation and loneliness are strong predictors of mortality during middle and later-adulthood (Stokes et al. 2021 ). In another study of the Add Health cohort with mortality follow-up, social acceptance has a modest, protective effect on subsequent all-cause mortality risk, indicating that social support matters for mortality risk even in early life (Lawrence et al. 2024 ). Finally, exclusionary school discipline is associated with violence victimization in adulthood (Wolf and Kupchik 2017) which may reflect a direct risk of homicide mortality, in addition to acting as a stressor affecting cardiometabolic and immune regulation of young adults. Third, the disproportionate allocation of school suspension and expulsion towards Black students may play a role in shaping Black-White mortality disparities for both internal and external causes. Specifically, Black-White hazard ratios for all-cause mortality reduce by 11% in fully adjusted models after accounting for exclusionary school discipline ( Models 3 and 4 in Table 3 ). This attenuation exists for both internal and external causes, for which Black-White hazard ratios decline by 8% and 11%, respectively (Table 4 ). Results from Table 4 also indicate that, if Black adolescents experienced ESD at the same rate as White adolescents, the White disadvantage in external-cause mortality risk would be larger and statistically significant relative to their Black counterparts. Critically, eliminating racial disparities in exclusionary school discipline is not the only recourse to reduce Black-White disparities in mortality. Controlling for socioeconomic and health factors during adolescence in hazard models also drastically decreases both internal- and external-cause mortality risk among Blacks relative to Whites, indicating that reducing racialized material disadvantage, improving physical and mental health, and promoting educational equity during adolescence may further prove lifesaving. Limitations We acknowledge this study’s limitations. First, statistical power for more detailed analyses of mortality data is limited by the relatively small number of deaths in the Add Health cohort. Relatedly, because of cross-wave attrition and small sample sizes, we are unable to test for specific mechanisms—such as criminal legal system involvement—underlying the relationship between school suspension and expulsion and premature mortality. As the cohort ages, and as the social conditions generating risks for premature death persist, the sample of decedents will increase with each follow-up period. Second, the conclusions in this study are based on statistical associations and not on causal models. Without formal mediation techniques, we cannot assess the indirect effect of school suspension and expulsion on racial disparities in mortality. Instead, we provide longitudinal but associational evidence of the contribution of ESD to premature mortality in an aging cohort. Future research could use mediation techniques to specify the relative contribution of ESD and other social experiences to Black and White young adults’ survival. Third, we exclusively focus on factors affecting mortality risk during adolescence to prevent censoring and preserve as many cases as possible. As cases increase with each mortality follow-up, future analyses can incorporate later waves of Add Health, as well as construct time-varying measures of social, health, and behavioral exposures. Conclusion In this study, we demonstrate a strong, positive association between exclusionary school discipline and subsequent mortality risk among U.S. young adults. We also provide preliminary evidence that disproportionate school punishment among Black adolescents may elevate mortality risk relative to their White counterparts. The banishment of students for alleged or actual misbehavior sends a clear message: that those who transgress social norms, make mistakes, or occupy marginalized social positions are unworthy of inclusion in the wider society. Our results indicate that exclusionary school discipline is more than an ineffective means of promoting school safety or education: it is a practice that is strongly associated with mortality risk and, accordingly, must be reconsidered. Nearly all mortality before age 50, whether from internal or external causes, is preventable. The replacement of exclusionary school discipline with restorative practices may prove lifesaving for all young people, but particularly so for the Black adolescents that it disproportionately affects. Declarations Author Contribution S.T. wrote the main manuscript text and conducted all analyses. C.E.G. provided methodological direction. R.A.H. provided conceptual advice. All authors reviewed the manuscript. Data Availability The data underlying this article were provided by the National Longitudinal Study of Adolescent to Adult Health (Add Health) under a restricted-use data contract. Data cannot be shared by the author. More information about accessing data from Add Health may be found here: [https://addhealth.cpc.unc.edu/data/#restricted-use](https:/addhealth.cpc.unc.edu/data) . References Advancement Project. (2000). Opportunities Suspended: The Devastating Consequences of Zero Tolerance and School Discipline. A National Summit on Zero Tolerance . The Civil Rights Project at Harvard University. Allensworth, E., & Ponisciak, S. (2009). and Christopher Mazzeo. The Schools Teachers Leave. Consortium on Chicago School Research . Allgood, K. L., Fleischer, N. L., Assari, S., Morenoff, J., & Needham, B. L. (2024). School Segregation During Adolescence Is Associated with Higher 30-Year Cardiovascular Risk of Black but Not White Young Adults. Journal of Racial and Ethnic Health Disparities . 10.1007/s40615-024-02135-5 Angton, A., Niño, M., & Tsuchiya, K., and Shauna Morimoto (2024). The Long-Term Consequences of School Suspension and Expulsion on Depressive Symptoms. Advances in Life Course Research , 61 , 100631. 10.1016/j.alcr.2024.100631 Anyon, Y., & Zhang, D., and Cynthia Hazel (2016). Race, Exclusionary Discipline, and Connectedness to Adults in Secondary Schools. American Journal of Community Psychology , 57 (3–4), 342–352. 10.1002/ajcp.12061 Arias, E., & Xu, J. (2025). and Kenneth Kochanek. United States Life Tables, 2022. National Vital Statistics Reports 74(2). https://www.cdc.gov/nchs/data/nvsr/nvsr74/nvsr74-02.pdf Beckett, K., and Naomi Murakawa (2012). Mapping the Shadow Carceral State: Toward an Institutionally Capacious Approach to Punishment. Theoretical Criminology , 16 (2), 221–244. 10.1177/1362480612442113 Binswanger, I. A., Krueger, P. M., & Steiner, J. F. (2009). Prevalence of Chronic Medical Conditions among Jail and Prison Inmates in the USA Compared with the General Population. Journal of Epidemiology & Community Health , 63 (11), 912–919. 10.1136/jech.2009.090662 Binswanger, I. A. (2013). Mortality After Prison Release: Opioid Overdose and Other Causes of Death, Risk Factors, and Time Trends From 1999 to 2009. Annals of Internal Medicine , 159 (9), 592. 10.7326/0003-4819-159-9-201311050-00005 Boen, C. E. (2020). Criminal Justice Contacts and Psychophysiological Functioning in Early Adulthood: Health Inequality in the Carceral State. Journal of Health and Social Behavior , 61 (3), 290–306. 10.1177/0022146520936208 Boen, C. E., Kozlowski, K., & Tyson, K. D. (2020). Toxic’ Schools? How School Exposures during Adolescence Influence Trajectories of Health through Young Adulthood. SSM - Population Health , 11 , 100623. 10.1016/j.ssmph.2020.100623 Bonilla-Silva, E. (1997). Rethinking Racism: Toward a Structural Interpretation. American Sociological Review , 62 (3), 465. 10.2307/2657316 Bonilla-Silva, E. (2020). Color-Blind Racism in Pandemic Times. Sociology of Race and Ethnicity , 233264922094102 . 10.1177/2332649220941024 Bonilla-Silva, E. (2022). Racism without Racists: Color-Blind Racism and the Persistence of Racial Inequality in America . Sixth edition. Lanham Boulder New York London: Rowman & Littlefield. Bor, J., Stokes, A. C., Raifman, J., Venkataramani, A., Bassett, M. T., & Himmelstein, D. (2023). and Steffie Woolhandler. Missing Americans: Early Death in the United States—1933–2021 edited by S. Galea. PNAS Nexus 2(6):pgad173. 10.1093/pnasnexus/pgad173 Braudt, D. B., Elizabeth, M., Lawrence, A. M., Tilstra, R. G., Rogers, & Hummer, R. A. (2019). Family Socioeconomic Status and Early Life Mortality Risk in the United States. Maternal and Child Health Journal , 23 (10), 1382–1391. 10.1007/s10995-019-02799-0 Brown, T. H., and Patricia Homan (2024). Structural Racism and Health Stratification: Connecting Theory to Measurement. Journal of Health and Social Behavior , 65 (1), 141–160. 10.1177/00221465231222924 Carbonaro, W., Lauen, D. L., & Levy, B. L. (2023). Does Cumulative Exposure to High-Poverty Schools Widen Test-Score Inequality? Sociology of Education , 96 (2), 81–103. 10.1177/00380407221147889 Carson, E., & Ann (2021). Mortality in Local Jails, 2000–2018 – Statistical Tables. Statistical Tables 3 6. Cholewa, B., Hull, M. F., & Babcock, C. R., and Alexandre D. Smith (2018). Predictors and Academic Outcomes Associated with In-School Suspension. School Psychology Quarterly , 33 (2), 191–199. 10.1037/spq0000213 Crosnoe, R., and Monica Kirkpatrick Johnson (2011). Research on Adolescence in the Twenty-First Century. Annual Review of Sociology , 37 (1), 439–460. 10.1146/annurev-soc-081309-150008 Cunningham, T. J., Janet, B., Croft, Y., Liu, H., Lu, P. I., Eke, & Giles, W. H. (2017). Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015. MMWR Morbidity and Mortality Weekly Report , 66 (17), 444–456. 10.15585/mmwr.mm6617e1 Curtin, S. (2024). Betzaida Tejada-Vera, and Bringham Bastian. Deaths: Leading Causes for 2022 . 73:10. National Vital Statistics Reports. Washington, D.C.: Center for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/164020/cdc_164020_DS1.pdf Daza, S., & Palloni, A., and Jerrett Jones (2020). The Consequences of Incarceration for Mortality in the United States. Demography , 57 (2), 577–598. 10.1007/s13524-020-00869-5 Duarte, C. P., Moses, C., Brown, M., Kajeepeta, S., Prins, S. J., & Scott, J., and Mahasin S. Mujahid (2023). Punitive School Discipline as a Mechanism of Structural Marginalization with Implications for Health Inequity: A Systematic Review of Quantitative Studies in the Health and Social Sciences Literature. Annals of the New York Academy of Sciences , 1519 (1), 129–152. 10.1111/nyas.14922 Dunning-Lozano, J. L. (2018). School Discipline, Race, and the Discursive Construction of the ‘Deficient’ Student. Sociological Spectrum , 38 (5), 326–345. 10.1080/02732173.2018.1532364 Dwyer-Lindgren, L., Kendrick, P., Kelly, Y. O., Baumann, M. M., Compton, K., Brigette, F., Blacker, F., Daoud, Z., Li, F., Mouhanna, H., Nassereldine, C., Schmidt, D. O., Sylte, S. I., Hay, G. A., Mensah, A. M., Nápoles, E. J., Pérez-Stable, C. J. L., Murray, & Mokdad, A. H. (2023). Cause-Specific Mortality by County, Race, and Ethnicity in the USA, 2000–19: A Systematic Analysis of Health Disparities. The Lancet , 402 (10407), 1065–1082. 10.1016/S0140-6736(23)01088-7 Elder, G. H., & Johnson, M. K. (2003). and Robert Crosnoe. The Emergence and Development of Life Course Theory. Pp. 3–19 in Handbook of the Life Course , Handbooks of Sociology and Social Research , edited by J. T. Mortimer and M. J. Shanahan. Boston, MA: Springer US. Friedman, J. R., & Tiako, M. J. N., and Helena Hansen (2024). Understanding and Addressing Widening Racial Inequalities in Drug Overdose. American Journal of Psychiatry , 181 (5), 381–390. 10.1176/appi.ajp.20230917 Fuchs, V. R. (2016). Black Gains in Life Expectancy. Journal Of The American Medical Association , 316 (18), 1869. 10.1001/jama.2016.14398 Gaydosh, L., Schorpp, K. M., Chen, E., & Miller, G. E. (2018). and Kathleen Mullan Harris. College Completion Predicts Lower Depression but Higher Metabolic Syndrome among Disadvantaged Minorities in Young Adulthood. Proceedings of the National Academy of Sciences 115(1):109–14. 10.1073/pnas.1714616114 Gee, G. C., Hing, A., Mohammed, S., Tabor, D. C., & Williams, D. R. (2019). Racism and the Life Course: Taking Time Seriously. American Journal of Public Health , 109 (S1), S43–47. 10.2105/AJPH.2018.304766 Gennuso, K. P., Courtney, K., Blomme, M. L., Givens, E. A., & Pollock, and Anne M. Roubal (2019). Deaths of Despair(Ity) in Early 21st Century America: The Rise of Mortality and Racial/Ethnic Disparities. American Journal of Preventive Medicine , 57 (5), 585–591. 10.1016/j.amepre.2019.06.018 Geronimus, A. T., Bound, J., & Colen, C. G. (2011). Excess Black Mortality in the United States and in Selected Black and White High-Poverty Areas, 1980–2000. American Journal of Public Health , 101 (4), 720–729. 10.2105/AJPH.2010.195537 Goosby, B. J., and Katrina M. Walsemann (2012). School Racial Composition and Race/Ethnic Differences in Early Adulthood Health. Health & Place , 18 (2), 296–304. 10.1016/j.healthplace.2011.10.002 Gould, M. S. (1996). Psychosocial Risk Factors of Child and Adolescent Completed Suicide. Archives of General Psychiatry , 53 (12), 1155. 10.1001/archpsyc.1996.01830120095016 Graham, C., Hummer, R. A., & Halpern, C. T. (2025). Gazing into the Crystal Ball: Do Adolescent Survival Expectations Predict Premature Mortality Risk in the United States? Social Science & Medicine , 364 , 117548. 10.1016/j.socscimed.2024.117548 Gravlee, C. C. (2020). Systemic Racism, Chronic Health Inequities, and COVID-19: A Syndemic in the Making? American Journal of Human Biology , 32 (5), e23482. 10.1002/ajhb.23482 Hanson, A. L. (2005). Have Zero Tolerance School Discipline Policies Turned into a Nightmare? The American Dream’s Promise of Equal Educational Opportunity Grounded in Brown v. Board of Education. UC Davis Journal of Juvenile Law and Policy , 9 (2), 289–379. Hargrove, T. W. (2024). Mental Health across the Early Life Course at the Intersection of Race, Skin Tone, and School Racial Context. Social Forces , 102 (4), 1398–1423. 10.1093/sf/soad126 Harper, S., Riddell, C. A., & King, N. B. (2021). Declining Life Expectancy in the United States: Missing the Trees for the Forest. Annual Review of Public Health , 42 (1), 381–403. 10.1146/annurev-publhealth-082619-104231 Harris, K. M., Halpern, C. T., Whitsel, E. A., Jon, M., Hussey, Ley, A., Killeya-Jones, J., & Tabor, and Sarah C. Dean (2019). Cohort Profile: The National Longitudinal Study of Adolescent to Adult Health (Add Health). International Journal of Epidemiology , 48 (5), 1415–1415k. 10.1093/ije/dyz115 Harris, K., Mullan, M. K., Majmundar, & Becker, T. (Eds.). (2021). High and Rising Mortality Rates Among Working-Age Adults . National Academies. Hemez, P., Brent, J. J., & Mowen, T. J. (2020). Exploring the School-to-Prison Pipeline: How School Suspensions Influence Incarceration During Young Adulthood. Youth Violence and Juvenile Justice , 18 (3), 235–255. 10.1177/1541204019880945 Hummer, R. A. (2023). Race and Ethnicity, Racism, and Population Health in the United States: The Straightforward, the Complex, Innovations, and the Future. Demography , 60 (3), 633–657. 10.1215/00703370-10747542 Hummer, R. A., & Lariscy, J. T. (2011). Educational Attainment and Adult Mortality. Pp. 241–61 in International Handbook of Adult Mortality . Vol. 2, International Handbooks of Population , edited by R. G. Rogers and E. M. Crimmins. Dordrecht: Springer Netherlands. Jacobsen, W. C. (2020). School Punishment and Interpersonal Exclusion: Rejection, Withdrawal, and Separation from Friends. Criminology , 58 (1), 35–69. 10.1111/1745-9125.12227 Jylhä, M. (2009). What Is Self-Rated Health and Why Does It Predict Mortality? Towards a Unified Conceptual Model. Social Science & Medicine , 69 (3), 307–316. 10.1016/j.socscimed.2009.05.013 Kershaw, K. N., Rafferty, J., Petito, L. C., & Khan, S. S. (2021). Age-Specific Racial Disparities in Mortality From Infancy to Older Adulthood. Journal of the American College of Cardiology , 78 (8), 854–855. 10.1016/j.jacc.2021.06.029 Kramer, M. R., Valderrama, A. L., & Casper, M. L. (2015). Decomposing Black-White Disparities in Heart Disease Mortality in the United States, 1973–2010: An Age-Period-Cohort Analysis. American Journal of Epidemiology , 182 (4), 302–312. 10.1093/aje/kwv050 Kupchik, A., & Catlaw, T. J. (2015). Discipline and Participation: The Long-Term Effects of Suspension and School Security on the Political and Civic Engagement of Youth. Youth & Society , 47 (1), 95–124. 10.1177/0044118X14544675 Lacoe, J., and Matthew P. Steinberg (2019). Do Suspensions Affect Student Outcomes? Educational Evaluation and Policy Analysis , 41 (1), 34–62. 10.3102/0162373718794897 Laster Pirtle, W. N. (2020). Racial Capitalism: A Fundamental Cause of Novel Coronavirus (COVID-19) Pandemic Inequities in the United States. Health Education & Behavior , 47 (4), 504–508. 10.1177/1090198120922942 Lawrence, E., Rogers, R. G., & Hummer, R. A. (2024). Sex Differences in U.S. Adolescent and Young Adult Mortality. Population Research and Policy Review , 43 (6), 73. 10.1007/s11113-024-09916-0 Lawrence, E., Trani, E. A., Anthony, K. M., Hummer, R. A., Jensen, T., Tuder, S., Loehr, L. R., Harris, K. M., & Whitsel, E. A. (2024). Data Resource Profile: Add Health Mortality Outcomes Surveillance. International Journal of Epidemiology , 53 (5), dyae121. 10.1093/ije/dyae121 Leban, L., and Marlow Masterson (2022). The Impact of Childhood School Suspension on Dropout and Arrest in Adolescence: Disparate Relationships by Race and Adverse Childhood Experiences. Criminal Justice and Behavior , 49 (4), 550–569. 10.1177/00938548211041387 LeMasters, K., Brinkley-Rubinstein, L., Maner, M., Peterson, M., & Nowotny, K., and Zinzi Bailey (2022). Carceral Epidemiology: Mass Incarceration and Structural Racism during the COVID-19 Pandemic. The Lancet Public Health , 7 (3), e287–e290. 10.1016/S2468-2667(22)00005-6 LeMasters, K., Touma, A. S. D. A. F., & Andrabi, N., Lauren Brinkley-Rubinstein, and Carmen Gutierrez (2024). The Physiological Toll of Arrests: An Examination of Arrest History on Midlife Allostatic Load. Annals of Epidemiology , 96 , 1–12. 10.1016/j.annepidem.2024.05.007 Levine, R. S., Rust, G. S., Pisu, M., Agboto, V., Peter, A., Baltrus, Nathaniel, C., Briggs, R., Zoorob, P., Juarez, P. C., Hull, I., Goldzweig, & Hennekens, C. H. (2010). Increased Black–White Disparities in Mortality After the Introduction of Lifesaving Innovations: A Possible Consequence of US Federal Laws. American Journal of Public Health , 100 (11), 2176–2184. 10.2105/AJPH.2009.170795 Louie, P., Reed, T., & DeAngelis (2024). Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans. Social Forces , 102 (3), 817–838. 10.1093/sf/soad112 Maag, J. W. (2012). School-Wide Discipline and the Intransigency of Exclusion. Children and Youth Services Review , 34 (10), 2094–2100. 10.1016/j.childyouth.2012.07.005 Macinko, J., & Elo, I. T. (2009). Black-White Differences in Avoidable Mortality in the USA, 1980–2005. Journal of Epidemiology & Community Health , 63 (9), 715–721. 10.1136/jech.2008.081141 Malat, J., Sarah Mayorga-Gallo, and, & Williams, D. R. (2018). The Effects of Whiteness on the Health of Whites in the USA. Social Science & Medicine , 199 , 148–156. 10.1016/j.socscimed.2017.06.034 Mallett, C. A. (2016). The School-to-Prison Pipeline: A Critical Review of the Punitive Paradigm Shift. Child and Adolescent Social Work Journal , 33 (1), 15–24. 10.1007/s10560-015-0397-1 Martinez, R. A. M., Andrabi, N., Goodwin, A. N., Wilbur, R. E., & Smith, N. R., and Paul N. Zivich (2023). Conceptualization, Operationalization, and Utilization of Race and Ethnicity in Major Epidemiology Journals, 1995–2018: A Systematic Review. American Journal of Epidemiology , 192 (3), 483–496. 10.1093/aje/kwac146 Martínez-Alés, G., Jiang, T., Keyes, K. M., & Gradus, J. L. (2022). The Recent Rise of Suicide Mortality in the United States. Annual Review of Public Health , 43 (1), 99–116. 10.1146/annurev-publhealth-051920-123206 Massoglia, M. (2008). Incarceration as Exposure: The Prison, Infectious Disease, and Other Stress-Related Illnesses. Journal of Health and Social Behavior , 49 (1), 56–71. 10.1177/002214650804900105 Masters, R. K., Laudan, Y., Aron, & Woolf, S. H. (2024). Life Expectancy Changes During the COVID-19 Pandemic, 2019–2021: Highly Racialized Deaths in Young and Middle Adulthood in the United States as Compared With Other High-Income Countries. American Journal of Epidemiology , 193 (1), 26–35. 10.1093/aje/kwad180 Masters, R. K., Robert, A., Hummer, D. A., Powers, A., Beck, S. F., & Lin, and Brian Karl Finch (2014). Long-Term Trends in Adult Mortality for U.S. Blacks and Whites: An Examination of Period- and Cohort-Based Changes. Demography , 51 , 2047–2073. Masters, R. K., Bruce, G., Link, & Phelan, J. C. (2015). Trends in Education Gradients of ‘Preventable’ Mortality: A Test of Fundamental Cause Theory. Social Science & Medicine , 127 , 19–28. 10.1016/j.socscimed.2014.10.023 McFarland, M. J., Geller, A., & McFarland, C. (2019). Police Contact and Health among Urban Adolescents: The Role of Perceived Injustice. Social Science & Medicine , 238 , 112487. 10.1016/j.socscimed.2019.112487 Metzl, J. M. (2019). Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland . Basic Books. Mittleman, J. (2018). A Downward Spiral? Childhood Suspension and the Path to Juvenile Arrest. Sociology of Education , 91 (3), 183–204. 10.1177/0038040718784603 Monnat, S. M. (2022). Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999–2020. The ANNALS of the American Academy of Political and Social Science , 703 (1), 50–78. 10.1177/00027162231154348 Mowen, T., and John Brent (2016). School Discipline as a Turning Point: The Cumulative Effect of Suspension on Arrest. Journal of Research in Crime and Delinquency , 53 (5), 628–653. 10.1177/0022427816643135 Niño, M., & Angton, A., Kathryn Norton-Smith, and Kayla Allison (2024). The Long Arm of School Punishment: The Role of School Suspension on Self-Rated Health from Adolescence to Midlife. Socius: Sociological Research for a Dynamic World , 10 , 23780231241284942. 10.1177/23780231241284942 Novak, A., and Marvin Krohn (2021). Collateral Consequences of School Suspension: Examining the ‘Knifing off’ Hypothesis. American Journal of Criminal Justice , 46 (5), 728–747. 10.1007/s12103-020-09579-5 Owens, J., & McLanahan, S. S. (2020). Unpacking the Drivers of Racial Disparities in School Suspension and Expulsion. Social Forces , 98 (4), 1548–1577. 10.1093/sf/soz095 Patterson, E. J., Becker, A., & Baluran, D. A. (2022). Gendered Racism on the Body: An Intersectional Approach to Maternal Mortality in the United States. Population Research and Policy Review , 41 (3), 1261–1294. 10.1007/s11113-021-09691-2 Payne, A., & Ann, and Kelly Welch (2016). The Centrality of Schools in the Lifecourse: The Case for Focusing on School-Related Influences in Developmental Theory and Research. Deviant Behavior , 37 (7), 748–760. 10.1080/01639625.2015.1071134 Pearlin, L. I., Schieman, S., & Fazio, E. M., and Stephen C. Meersman (2005). Stress, Health, and the Life Course: Some Conceptual Perspectives. Journal of Health and Social Behavior , 46 (2), 205–219. 10.1177/002214650504600206 Perera, R., & Melissa Kay, D. (2023). Survey: Understanding How US Public Schools Approach School Discipline . Brookings Institution. https://policycommons.net/artifacts/4140050/survey/4948163/ Perry, B. L., and Edward W. Morris (2014). Suspending Progress: Collateral Consequences of Exclusionary Punishment in Public Schools. American Sociological Review , 79 (6), 1067–1087. 10.1177/0003122414556308 Pettit, B., and Carmen Gutierrez (2018). Mass Incarceration and Racial Inequality. American Journal of Economics and Sociology , 77 (3–4), 1153–1182. 10.1111/ajes.12241 Phelan, J. C., & Link, B. G. (2015). Is Racism a Fundamental Cause of Inequalities in Health? Annual Review of Sociology , 41 (1), 311–330. 10.1146/annurev-soc-073014-112305 Phelan, J. C., Bruce, G., Link, A., Diez-Roux, I., Kawachi, & Levin, B. (2004). Fundamental Causes’ of Social Inequalities in Mortality: A Test of the Theory. Journal of Health and Social Behavior , 45 (3), 265–285. 10.1177/002214650404500303 Polos, J. A., Stephanie, M., Koning, T. W., Hargrove, Kiarri, N., & Kershaw, and Thomas W. McDade (2022). Structural Racism in School Contexts and Adolescent Depression: Development of New Indices for the National Longitudinal Study of Adolescent to Adult Health and Beyond. SSM - Population Health , 19 , 101237. 10.1016/j.ssmph.2022.101237 Porter, L. C., and Laura M. DeMarco (2019). Beyond the Dichotomy: Incarceration Dosage and Mental Health. Criminology , 57 (1), 136–156. 10.1111/1745-9125.12199 Prins, S. J., Ruth, T., Shefner, S., Kajeepeta, N., Levy, P., & Esie, and Pia M. Mauro (2023). Longitudinal Relationships among Exclusionary School Discipline, Adolescent Substance Use, and Adult Arrest: Public Health Implications of the School-to-Prison Pipeline. Drug and Alcohol Dependence , 251 , 110949. 10.1016/j.drugalcdep.2023.110949 Reingle Gonzalez, J. M., Christopher, P., Salas-Wright, N. M., Connell, Katelyn, K., Jetelina, S. J., Clipper, & Businelle, M. S. (2016). The Long-Term Effects of School Dropout and GED Attainment on Substance Use Disorders. Drug and Alcohol Dependence , 158 , 60–66. 10.1016/j.drugalcdep.2015.11.002 Richardson, L., Goodwin, A. N., & Hummer, R. A. (2021). Social Status Differences in Allostatic Load among Young Adults in the United States. SSM - Population Health , 15 , 100771. 10.1016/j.ssmph.2021.100771 Rogers, R. G., Lawrence, E. M., & Hummer, R. A., and Andrea M. Tilstra (2017). Racial/Ethnic Differences in Early-Life Mortality in the United States. Biodemography and Social Biology , 63 (3), 189–205. 10.1080/19485565.2017.1281100 Ronfeldt, M., & Loeb, S., and James Wyckoff (2013). How Teacher Turnover Harms Student Achievement. American Educational Research Journal , 50 (1), 4–36. 10.3102/0002831212463813 Rosenbaum, J. (2020). Educational and Criminal Justice Outcomes 12 Years After School Suspension. Youth & Society , 52 (4), 515–547. 10.1177/0044118X17752208 Rosenbaum, J. E. (2020). School Suspension Predicts Trichomoniasis Five Years Later in a Matched Sample. Bmc Public Health , 20 (1), 88. 10.1186/s12889-020-8197-8 Rubin, M. S., Cynthia, G., Colen, & Link, B. G. (2010). Examination of Inequalities in HIV/AIDS Mortality in the United States From a Fundamental Cause Perspective. American Journal of Public Health , 100 (6), 1053–1059. 10.2105/AJPH.2009.170241 Sasson, I. (2016). Trends in Life Expectancy and Lifespan Variation by Educational Attainment: United States, 1990–2010. Demography , 53 (2), 269–293. 10.1007/s13524-015-0453-7 Sasson, I., and Mark D. Hayward (2019). Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010–2017. Journal Of The American Medical Association , 322 (8), 756. 10.1001/jama.2019.11330 Sawyer, S. M., Rima, A., Afifi, Linda, H., Bearinger, S. J., Blakemore, B., Dick, A. C., Ezeh, & Patton, G. C. (2012). Adolescence: A Foundation for Future Health. The Lancet , 379 (9826), 1630–1640. 10.1016/S0140-6736(12)60072-5 Schollenberger, T. (2013). Racial Disparities in School Suspension and Subsequent Outcomes: Evidence from the National Longitudinal Survey of Youth 1997 . UCLA Civil Rights Project. Schwandt, H., Currie, J., Bär, M., Banks, J., Bertoli, P., Bütikofer, A., Cattan, S., Chao, B. Z. Y., Costa, C., González, L., Grembi, V., Huttunen, K., René Karadakic, Lucy Kraftman, Sonya Krutikova, Stefano Lombardi, Peter Redler, Carlos Riumallo-Herl, Ana Rodríguez-González, Kjell G. Salvanes, Paula Santana, Josselin Thuilliez, Van Doorslaer, E., Van Ourti, T., & Winter, J. K. (2021). Bram Wouterse, and Amelie Wuppermann. Inequality in Mortality between Black and White Americans by Age, Place, and Cause and in Comparison to Europe, 1990 to 2018. Proceedings of the National Academy of Sciences 118(40):e2104684118. 10.1073/pnas.2104684118 Schwartz, G., & Wave, I. (2023). & II School Desegregation Disparities. Chapel Hill, NC. doi: https://addhealth.cpc.unc.edu/wp-content/uploads/docs/restricted_use/Wave-I-II-School-Desegregation-Disparities.zip Simpson, K. (2021). The Racial Tension Between Underprescription and Overprescription of Pain Medication Amid the Opioid Epidemic. NYU Review of Law and Social Change , 45 , 129. Skiba, R. J., and Kimberly Knesting (2002). Zero Tolerance, Zero Evidence: An Analysis of School Disciplinary Practice. Zero tolerance: Can suspension and expulsion keep school safe? New directions for youth development, No. 92 (pp. 17–43). Jossey-Bass/Wiley. StataCorp (2021). Stata Statistical Software: Release 17. Stokes, A. C., Xie, W., Lundberg, D. J., Glei, D. A., & Weinstein, M. A. (2021). Loneliness, Social Isolation, and All-Cause Mortality in the United States. SSM - Mental Health , 1 , 100014. 10.1016/j.ssmmh.2021.100014 Strassle, P. D., Mathew, M., Baumann, Y. O., Kelly, Z., Li, C., Schmidt, D. O., Sylte, K., Compton, G. J., Bertolacci, W. L. M. K., Daoud, F., Naghavi, M., Rodriquez, E. J., Mensah, G. A., Murray, C. J. L., Mokdad, A. H., Dwyer-Lindgren, L., & Eliseo, J. Pérez-Stable. 2025. Homicide Rates Across County, Race, Ethnicity, Age, and Sex in the US: A Global Burden of Disease Study. JAMA Network Open 8(2):e2462069. 10.1001/jamanetworkopen.2024.62069 Sugie, N. F., Turney, K., Reiter, K., Tublitz, R., Kaiser, D., & Goodsell, R. Erin Secrist, Ankita Patil, and Monik Jiménez. 2023. Excess Mortality in U.S. Prisons during the COVID-19 Pandemic. Science Advances 9(48):eadj8104. 10.1126/sciadv.adj8104 Tehranifar, P., Goyal, A., Phelan, J. C., Link, B. G., Liao, Y., & Desai, X. F. M., and Mary Beth Terry (2016). Age at Cancer Diagnosis, Amenability to Medical Interventions, and Racial/Ethnic Disparities in Cancer Mortality. Cancer Causes & Control , 27 (4), 553–560. 10.1007/s10552-016-0729-2 Thiébaut, A. C. M., and Jacques Bénichou (2004). Choice of Time-scale in Cox’s Model Analysis of Epidemiologic Cohort Data: A Simulation Study. Statistics in Medicine , 23 (24), 3803–3820. 10.1002/sim.2098 Tilstra, A. M., Gutin, I., Dollar, N. T., Rogers, R. G., & Hummer, R. A. (2022). Outside the Skin’: The Persistence of Black–White Disparities in U.S. Early-Life Mortality. Demography , 59 (6), 2247–2269. 10.1215/00703370-10346963 Tilstra, A. M., Daniel, H., Simon, & Masters, R. K. (2021). Trends in ‘Deaths of Despair’ Among Working-Aged White and Black Americans, 1990–2017. American Journal of Epidemiology , 190 (9), 1751–1759. 10.1093/aje/kwab088 Trani, E. A., Hill, M. J., Anthony, K., Lawrence, E., Loehr, L., & Hummer, R. (2024). and Eric Whitsel. Mortality Outcomes Surveillance, Part I: Ascertaining Decedents (2022 Update). 10.17615/ZBE9-RH36 Trani, E. A., Laura, R., Loehr, E. M., Lawrence, R. A., Hummer, E. A., & Whitsel (2023). and Mary Jane Hill. Mortality Outcomes Surveillance, Part I: Ascertaining Decedents (2021 Update) . The University of North Carolina at Chapel Hill University Libraries. 10.17615/8S1B-QD86 United States Department of Education (2022). Suspensions and Expulsions in Public Schools . Focus on Student Discipline. Office of Civil Rights. https://www.ed.gov/sites/ed/files/about/offices/list/ocr/docs/suspensions-and-expulsion-part-2.pdf Weaver, V. M. (2007). Frontlash: Race and the Development of Punitive Crime Policy. Studies in American Political Development , 21 (2), 230–265. 10.1017/S0898588X07000211 Williams, D. R. (2018). Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-Related Stressors. Journal of Health and Social Behavior , 59 (4), 466–485. 10.1177/0022146518814251 Wolf, E. R., Frederick, P., Rivara, Colin, J., Orr, A., Sen, D. A., Chapman, & Woolf, S. H. (2024). Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth. Journal Of The American Medical Association , 331 (20), 1732. 10.1001/jama.2024.3908 Wolf, K. C., and Aaron Kupchik (2017). School Suspensions and Adverse Experiences in Adulthood. Justice Quarterly , 34 (3), 407–430. 10.1080/07418825.2016.1168475 World Health Organization. (2007). International Statistical Classification of Diseases and Related Health Problems, 10th Revision . WHO. Wrigley-Field, E. (2020). US Racial Inequality May Be as Deadly as COVID-19. Proceedings of the National Academy of Sciences 117(36):21854–56. 10.1073/pnas.2014750117 Wrigley-Field, E. (2025). Three Ways of Looking at Black–White Mortality Differences in the United States. Annual Review of Sociology . 10.1146/annurev-soc-031021-105213 Additional Declarations No competing interests reported. Supplementary Files PRPRAppendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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12:57:51","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":325945,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8079204/v1/433cf3556a2f2637636386a1.html"},{"id":97353784,"identity":"d7664d89-0344-462e-9432-17c6c9cec317","added_by":"auto","created_at":"2025-12-03 12:57:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":395366,"visible":true,"origin":"","legend":"\u003cp\u003eWeighted Kaplan-Meier Survival Curves by (A) Suspension/Expulsion History at Wave I and (B) Race/Ethnicity\u003c/p\u003e\n\u003cp\u003eNote:\u003cstrong\u003e \u003c/strong\u003eshaded area indicates 95% confidence interval\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8079204/v1/55f1fba18ebf325cad0cdee2.png"},{"id":97371321,"identity":"7c244119-70fa-4ede-aa43-19a1dc98b053","added_by":"auto","created_at":"2025-12-03 16:28:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":105604,"visible":true,"origin":"","legend":"\u003cp\u003eBlack-White Disparities in Mortality Hazard during Adolescence and Young Adulthood by Cause of Death and Model Specification\u003c/p\u003e\n\u003cp\u003eNote: error bars indicate 95% confidence intervals\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8079204/v1/988156d47ccc40a3b2ebfafc.png"},{"id":97373216,"identity":"06115c33-c743-42ec-9275-b2fc688341f3","added_by":"auto","created_at":"2025-12-03 16:34:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2012686,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8079204/v1/74298ae9-31bd-43b5-b124-b67c0c294916.pdf"},{"id":97353790,"identity":"7b26ad7c-4534-4948-aaf6-085a6d71ee2d","added_by":"auto","created_at":"2025-12-03 12:57:51","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14995,"visible":true,"origin":"","legend":"","description":"","filename":"PRPRAppendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-8079204/v1/168a8691b42cd3462084469f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exclusionary School Discipline and Black-White Disparities in Mortality through Early-Midlife","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOver the past two decades, mortality rates during early and midlife have increased markedly in the United States (Bor et al. 2023). Despite progress in reducing disparities during the 21\u003csup\u003est\u003c/sup\u003e century, Black Americans continue to die at much higher rates than White Americans (Arias, Xu, and Kochanek 2025). Black-White disparities in all-cause mortality are largest under age 64 years, and are particularly wide among adolescents and young adults (Rogers et al. 2017). For many causes, Black-White mortality disparities during adolescence and early adulthood have increased in recent years (Schwandt et al. 2021; Wolf et al. 2024). These enduring Black-White disparities in mortality account for thousands of excess deaths per year and signal that current efforts to eliminate racial health inequities are inadequate (Wrigley-Field 2020). Despite being far too common and largely preventable, surprisingly little research investigates the social determinants of Black-White mortality disparities before midlife.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the same time, a small but growing body of literature investigates adolescent social exposures as important precursors to subsequent adult mortality risk (Lawrence, Rogers, and Hummer 2024; Graham, Hummer, and Halpern 2025). Adolescence is a sensitive period in human development during which social exposures matter greatly for identity formation, subsequent life chances, and later life health (Harris 2010; Sawyer et al. 2012). It is also a time when racially-unequal exposure to social stressors may be particularly salient antecedents to Black-White inequities in survival (Gee et al. 2019).\u003c/p\u003e\n\u003cp\u003eIn particular, adolescents spend a considerable amount of time in schools. Accordingly, a growing body of literature has emphasized the critical role of early-life educational environments as precursors to later-life wellbeing (Boen 2020; Hargrove 2024; Payne and Welch 2016). Exclusionary school discipline—the practice of using suspension or expulsion as punishments for school policy violations—has gained research attention in recent years as a potential explanation for racial disparities in adverse health and social outcomes across the life course (e.g., Duarte et al. 2023; Leban and Masterson 2022). Exclusionary discipline is ubiquitous, highly racially unequal, yet understudied as a determinant of health. Five million youth are exposed to exclusionary discipline each year, more than a third of whom are Black (United States Department of Education 2022). There are wide Black-White disparities in suspension or expulsion for children as young as five years old (Owens and McLanahan 2020). By the end of their K-12 school career, over 35 percent of students have been suspended at least once, a figure that rises to 45 percent for Black girls and 67 percent for Black boys (Schollenberger 2013). Despite mounting evidence of the inefficacy of exclusionary discipline in improving student achievement or deterring classroom disruptions (Maag 2012; Perry and Morris 2014), the majority of public schools currently mandate suspension or expulsion for code of conduct violations (Perera and Dilberty 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBuilding on both the Black-White mortality literature and the adolescent school disciplinary literature, this paper first seeks to document U.S. Black-White disparities in mortality through early-midlife in a nationally representative cohort. Second, we interrogate whether school suspension and expulsion are associated with subsequent mortality risk, and if so, to what extent this exposure may account for racial disparities in mortality. Together, we aim to shed new light on racial disparities in early adult mortality by focusing on adolescent processes that unfold in the context of schools.\u0026nbsp;\u003c/p\u003e"},{"header":"Background","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eRacism as a Fundamental Cause of Disparities in Early-Life Mortality\u003c/h2\u003e\u003cp\u003eFor as long as life expectancy has been measured in the United States, Black Americans have, on average, lived shorter lives than White Americans (Hummer \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In 2022, life expectancy at birth among Black Americans was 72.8 years, compared to 77.5 years among White Americans (Arias, Xu, and Kochanek 2025). Before the COVID-19 pandemic, during which Black Americans lost nearly twice as many years of life expectancy as White Americans (Masters, Aron, and Woolf 2024), considerable progress had been made in reducing Black-White disparities in mortality (Dwyer-Lindgren et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This progress was in part attributable to reductions in premature mortality among Black Americans due to improving socioeconomic conditions and reductions in certain acute and chronic diseases such as HIV/AIDS and cardiovascular disease (Fuchs \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Harper, Riddell, and King \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Masters et al. \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), but also due to rising mortality rates among middle-aged Whites in recent years (Sasson \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStructural racism is a fundamental cause of Black-White disparities in mortality in the United States (Phelan and Link \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). By \u0026ldquo;structural racism,\u0026rdquo; we refer to the interconnected web of racially discriminatory systems in multiple domains (e.g., housing, employment, education, and the criminal legal system) that create and maintain racialized subordination by disproportionately allocating resources to those in racially privileged groups, at the expense of those in racially minoritized groups (Brown and Homan 2024). Structural racism has persisted and transformed over time, from chattel enslavement, to Jim Crow, to the \u0026ldquo;colorblind\u0026rdquo; racism of the post-Civil Rights era (Bonilla-Silva \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1997\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). A core tenet of fundamental cause theory is the consistent operation of the fundamental cause over time, for a variety of health phenomena, and in spite of innovations in health-promoting resources (Phelan et al. \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). It follows, then, that the endurance of structural racism contributes to persistent Black-White disparities in mortality over time, in spite of changing population health threats and across a wide range of causes of death (Geronimus, Bound, and Colen \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Kramer, Valderrama, and Casper \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Tilstra et al. \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFundamental cause theory also contends that the more \u0026ldquo;preventable\u0026rdquo; a cause of disease or death is, whether by medical or social interventions, the larger the disparity will be, owing to the inequitable allocation of these health-promoting resources between racially privileged and racially disadvantaged groups (Levine et al. \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Macinko and Elo \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Tehranifar et al. \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Given that mortality under age 50 years is widely preventable for most causes of death, it is unsurprising that Black-White disparities in mortality rates have historically been especially large early in the life course (Cunningham et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Indeed, Black-White all-cause mortality disparities are widest before age 55 (Kershaw et al. \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and are particularly wide among children, for whom mortality rates are 1.75 times higher among Black youth relative to White youth (Wolf et al. \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Black-White disparities in mortality during adolescence and young adulthood are also large and persistent over time (Tilstra et al. \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These disparities exist for numerous causes such as circulatory and infectious diseases, maternal mortality, and homicide (Patterson, Andr\u0026eacute;a Becker, and Baluran 2022; Wolf et al. \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Strassle et al. 2025).\u003c/p\u003e\u003cp\u003eHowever, the broad patterns of elevated early-life mortality among Blacks relative to Whites are not universal. For certain causes of death, White Americans have higher mortality rates than Black Americans at these ages. The most notable example is mortality from drug-related causes, which skyrocketed among White people, and particularly White men, during the 2010s (Tilstra, Simon, and Masters 2021). It bears mentioning that drug-related mortality among Black American young adults under age 44 surged during and after the COVID-19 pandemic, and now roughly equals that of White Americans (Friedman, Nguemeni Tiako, and Hansen 2024). Similarly, suicide and alcohol-related mortality have historically been higher among White adolescents and young adults, but have increased markedly among young Black Americans since 2019 (Mart\u0026iacute;nez-Al\u0026eacute;s et al. \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Wolf et al. \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe high mortality rates from some causes among Whites relative to Blacks exemplify the need for caution when interpreting Black-White disparities in mortality, given that the absence or reversal of a Black-White disparity does not necessarily indicate favorable outcomes among Whites (Wrigley-Field \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Nor does it automatically signal positive progress in curtailing racism\u0026rsquo;s effect on population health, given that the poor health of Whites is also in part a result of the ways that racism harms all racial groups in a racialized social system, albeit to very different extents (Malat, Mayorga-Gallo, and Williams \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Louie and DeAngelis 2024; Metzl \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eRacism, Schools, and Health Across the Life Course\u003c/h2\u003e\u003cp\u003eIn this study, we employ a life course perspective to frame the ways that educational exposures work to shape life chances and health into adulthood (Elder, Johnson, and Crosnoe 2003). Childhood and adolescence are periods during which individuals develop a sense of identity, undergo rapid physical and social transitions, and form understandings of the social world, and are thus foundational for subsequent outcomes (Crosnoe and Johnson 2011). We integrate a stress process framework into the life course perspective to contextualize how exposures to major stressors\u0026mdash;in this case, to exclusionary school discipline and its associated social consequences\u0026mdash;may negatively impact health and wellbeing into adulthood (Pearlin et al. \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe American education system is a key institution involved in the maintenance of racial inequality, and literature increasingly links racialized exposures in K-12 schools to racial inequities in health across the life course (Goosby and Walsemann 2012). Students who attended lower-resourced schools in adolescence tend to have worse mental health outcomes and elevated levels of inflammation during early adulthood (Boen, Kozlowski, and Tyson \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). High levels of structural racism within schools are associated with elevated depressive symptomatology among Black adolescents, especially Black girls, during adolescence (Polos et al. \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Black students, particularly those with the darkest skin tones, who attend majority-White schools have especially steep trajectories of depressive symptoms into midlife (Hargrove \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSchool composition is not the only educational factor shaping the future life chances of adolescents. The \u0026ldquo;punitive turn\u0026rdquo; of the 1980s and 1990s emerged in response to growing, and often overtly racist, fears of social disorder, crime, and violence that resulted in the vast and historically unprecedented expansion of the criminal legal system (Weaver \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Pettit and Gutierrez 2018). But the punitive turn did not begin and end with prisons. Beginning in the mid-1990s, \u0026ldquo;zero tolerance policies\u0026rdquo; also emerged in schools across the country (Mallett \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). These policies mandated harsh, non-negotiable, and automatic expulsions that were first designed to curb firearm use on school grounds, but later applied to an increasingly broad swath of school policy violations (Hanson \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Zero-tolerance policies operate irrespective of a student\u0026rsquo;s age, ignore precipitating circumstances leading to alleged violations, and rely on little administrative discretion in their implementation (Advancement Project \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Skiba and Knesting 2002).\u003c/p\u003e\u003cp\u003eEvidence suggests that exclusionary school discipline initiates a cascade of negative social and health outcomes in three key domains that may place adolescents and young adults at elevated risk of early adult mortality. First, school suspension and expulsion harms academic performance and is linked to lower likelihood of high school completion, which in turn negatively impacts future socioeconomic status (Cholewa et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Lacoe and Steinberg 2019). Educational attainment is a critical protective factor for stress-related health outcomes, including substance use disorder (Reingle Gonzalez et al. \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) and cardiometabolic risk (Richardson, Goodwin, and Hummer \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Additionally, an extensive literature documents that adults with less than a high school education are at elevated risk of mortality from a variety of causes, including cardiometabolic diseases, cancers, and external causes (Hummer and Lariscy \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Masters, Link, and Phelan \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In this way, reduced educational attainment may be a critical link between exclusionary school discipline and mortality.\u003c/p\u003e\u003cp\u003eSecond, the \u0026ldquo;school-to-prison pipeline\u0026rdquo; often begins with exclusionary school discipline (Hemez, Brent, and Mowen \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Mallett \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Specifically, young adults who were suspended during adolescence are at least 1.3 times more likely to have been arrested after their suspension, and 1.25 times more likely to have been incarcerated than those who were not, even after adjustment for behavioral risk factors (Rosenbaum \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). There is a dose-response relationship between frequency of suspension and likelihood of arrest (Mowen and Brent 2016). Criminal legal system involvement implies exposure to countless social stressors, including violence victimization, social stigmatization, and increased economic precarity (McFarland, Geller, and McFarland \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Williams \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Beckett and Murakawa 2012). Contact with the criminal legal system is a well-documented risk factor for a host of negative physical and mental health outcomes including depressive symptoms, stress-related physiological dysregulation, and infectious disease morbidity (Boen \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; LeMasters et al. \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Massoglia \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Porter and DeMarco 2019), as well as with subsequent mortality risk (Binswanger \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Daza, Palloni, and Jones 2020; LeMasters et al. \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThird, exclusionary discipline is associated with social stigma, strain in relationships, and reduced social integration. Specifically, students who are suspended or expelled receive stigmatizing labels, and are thus less likely to have close, prosocial relationships with their instructors and peers (Anyon, Zhang, and Hazel 2016; Jacobsen \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Novak and Krohn 2021). In addition, labels of deficiency and delinquency spill over to parents, who are often encouraged by schools to use harsher disciplinary practices against their children at home, putting further strain on the parent-child relationship (Dunning-Lozano \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven (a) the inequitable sorting of Black students into suspension or expulsion; (b) the important role that schools play in shaping adult health outcomes; and (c) the critical role of exclusionary school discipline in shaping social outcomes, it is quite possible that exclusionary school discipline is implicated in Black-White inequities in subsequent mortality risk.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eGaps in the Literature\u003c/h3\u003e\n\u003cp\u003eDespite increasing attention to Black-White patterns in rising mortality rates during young adulthood, three critical gaps in the literature remain. First, comparatively few studies interrogate the life-course determinants of premature mortality using longitudinal data, and even fewer detail the specific determinants of mortality during adolescence (Braudt et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Graham, Hummer, and Halpern \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Lawrence, Rogers, and Hummer \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Second, while a growing body of literature documents the critical function that schools play in shaping Black-White disparities in health across the life course, few investigate the specific role of exclusionary school discipline. One study of children and adolescents in New York City documents a strong association between school suspension or expulsion and suicide mortality (Gould \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). Other recent studies have documented strong relationships between exclusionary school discipline and elevated depressive symptoms (Angton et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) as well as poor self-rated health into adulthood (Ni\u0026ntilde;o et al. 2024). Still, to our knowledge, this is the first study to specifically investigate whether and to what extent exclusionary school discipline patterns mortality risk by race/ethnicity. Third, there are relatively few prospective studies that consider cause-specific mortality among adolescents and young adults. The differing profiles of cause-specific mortality between young Black and White Americans warrants cause-specific analyses when possible. In this way, the relatively scant literature on the early-life determinants of mortality indicates that our understanding of the precursors to mortality is far from complete.\u003c/p\u003e\n\u003ch3\u003eThe Current Study\u003c/h3\u003e\n\u003cp\u003eTo address these gaps in the literature, we use detailed nationally representative longitudinal data to advance address the following questions:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAre there Black-White disparities in adolescent and young adult all-cause and cause-specific mortality risk for this cohort?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIs exclusionary school discipline during early life associated with adolescent and young adult mortality risk?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do Black-White differences in adolescent and young adult mortality risk change when accounting for exclusionary school discipline?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eIn light of these questions and the literature discussed above, we hypothesize the following. First, based on a long and substantial body of literature, Black adolescents and young adults have higher mortality risk than White adolescents and young adults, particularly from internal-cause mortality. We also hypothesize that experiencing exclusionary school discipline is associated with increased subsequent mortality risk, especially from external-cause mortality. Lastly, we expect that the Black disadvantage in mortality risk will narrow after the inclusion of exclusionary discipline, both for all-cause as well as for cause-specific mortality.\u003c/p\u003e"},{"header":"Data and Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData\u003c/h2\u003e\u003cp\u003eData come from The National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative, longitudinal study of US adolescents who are now in their 30s and 40s (Harris et al. \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Add Health began with Wave I (1994\u0026ndash;1995) by administering in-school questionnaires and in-home interviews to adolescents in grades 7\u0026ndash;12 (ages 12\u0026ndash;19) based on a school-based complex clustered sampling design. The 20,745 adolescents from Wave I have been subsequently followed with for five waves between 1996 and 2018. This study uses data from the in-home and parent interviews conducted at Wave I; neighborhood contextual data at the Census tract level derived from Wave I home addresses; school administrator data from the in-school survey at Wave I; school-related contextual data at Wave I from the 1990 Census and Common Core of Data (Schwartz \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); and death record data from the National Death Index and other sources of follow-up linked to respondent identifiers through December 31, 2022 (Trani et al. \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMeasures\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003eOutcomes\u003c/h2\u003e\u003cp\u003eWe consider two outcomes in this study. The first is all-cause mortality versus survival from the date of Wave I interview until December 31, 2022. Mortality data is sourced from the Add Health Mortality Outcomes Surveillance Data file, which links decedent records to respondents in the Add Health cohort. Detailed discussion of the data linkage procedure can be found elsewhere (Trani et al. \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The Mortality Outcomes Surveillance data is comparable to other nationally-representative cohort studies with mortality follow up (Lawrence et al. \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The second outcome is cause-specific mortality versus survival by broad cause-of-death grouping (internal vs. external causes), conditional on survival from other causes of death. Internal causes of death include disease-related causes, such as heart disease and cancers. Examples of external causes include suicides, homicides, and traffic accidents. We use these broad cause of death categories to maximize statistical power, and to comply with Add Health\u0026rsquo;s deductive disclosure policies. To determine cause of death, we use data on the underlying cause of death from the Mortality Outcomes Surveillance data based on \u003cem\u003eInternational Classification of Diseases and Related Health Problems, 10th Revision\u003c/em\u003e (ICD-10) classifications (World Health Organization \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). A table of cause of death classification can be found in \u003cb\u003eAppendix Table\u0026nbsp;1.\u003c/b\u003e Of the original Add Health cohort, 706 (3.4%) people were identified as deceased by the end of 2022.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eWeighted Sample Characteristics by Race/Ethnicity, Vital Status, and Broad Cause of Death\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"15\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c3\" namest=\"c2\" rowspan=\"2\"\u003e\u003cp\u003eFull sample\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;14,069)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c5\" namest=\"c4\" rowspan=\"2\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;4,060)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;10,009)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c9\" namest=\"c8\" rowspan=\"2\"\u003e\u003cp\u003eAlive\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;13,536)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c15\" namest=\"c10\"\u003e\u003cp\u003eDied\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003eAll Causes\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;533)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003eInternal\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;223)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u003cp\u003eExternal\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;289)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge at Wave I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e15.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e16.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e16.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e15.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.63\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.71\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Hispanic White\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Hispanic Black\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeceased by 12/31/2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge at death (Among decedents)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e34.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e36.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e31.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEver suspended or expelled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.49\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.49\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.45\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.53\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWave I Controls\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents\u0026thinsp;\u0026lt;\u0026thinsp;Bachelors\u0026rsquo; degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousehold receives public assistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.27\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelinquency scale (Z-score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.20\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.29\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-rated health (1\u0026thinsp;=\u0026thinsp;excellent, 5\u0026thinsp;=\u0026thinsp;poor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.31\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.40\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepressive symptoms (0\u0026ndash;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.18\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.26\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e3.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e3.39\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeighborhood poverty rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.22\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeacher retention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage class size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e25.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e25.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e25.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e25.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProportion students of color\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProportion students testing below grade level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"15\"\u003eNotes: Data Source: Add Health.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"15\"\u003e\u003csup\u003ea\u003c/sup\u003e Two-tailed t-test between Black and White respondents significant at alpha\u0026thinsp;=\u0026thinsp;0.05,\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"15\"\u003e\u003csup\u003eb\u003c/sup\u003e two-tailed t-test between decedents and surviving Wave I respondents significant at alpha\u0026thinsp;=\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eExplanatory Variables\u003c/h3\u003e\n\u003cp\u003eThe exposure of interest is self-reported race/ethnicity (Non-Hispanic Black and Non-Hispanic White) measured at Wave I, which we operationalize to measure Black-White disparities in mortality risk. This variable is a proxy for racialized social status, a sociohistorical construct that varies across time and space (Martinez et al. \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In addition to quantifying Black-White disparities in mortality, this variable represents a confluence of racialized exposures to health risks and/or rewards (Brown and Homan 2024). Due to low numbers of deaths among respondents of other ethnoracial groups, we only include those who identify as Non-Hispanic Black or White.\u003c/p\u003e\u003cp\u003eAlso central to our investigation is the association between exclusionary school discipline (ESD) and subsequent mortality risk. We measure ESD at Wave I with a binary variable based on whether the respondent answers \u0026ldquo;Yes\u0026rdquo; to either of the following questions: \u0026ldquo;Have you ever received an out-of-school suspension?\u0026rdquo; and/or \u0026ldquo;Have you ever been expelled from school?\u0026rdquo; These questions were asked in Wave I when the respondents were as young as age 12; thus, they likely underestimate the true prevalence of ESD in this cohort. Due to attrition between Waves I and III, when the question is next asked and respondents are at least 18, we measure ESD at Wave I to preserve as many cases as possible.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCovariates\u003c/h2\u003e\u003cp\u003eWe also adjust for measures of adolescent sex, socioeconomic status, behavior, school environment, and health. We adjust for sex assigned at birth (1\u0026thinsp;=\u0026thinsp;male, 0\u0026thinsp;=\u0026thinsp;female) due to large sex disparities in early-life mortality (Lawrence et al. \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). We measure parental SES through parental education (1\u0026thinsp;=\u0026thinsp;at least one parent with less than a Bachelors\u0026rsquo; degree) and household receipt of public assistance (1\u0026thinsp;=\u0026thinsp;household received public assistance) sourced from Wave I parent interview data. We adjust for Wave I neighborhood poverty with a continuous measure of the tract-level proportion of households below the federal poverty line. To measure adolescent behavior, which may select adolescents into both ESD and heightened mortality risk, we use a standardized delinquency scale of 15 items asking the frequency in the past year with which respondents participated in behavior such as property damage, graffiti, and shoplifting.\u003c/p\u003e\u003cp\u003eTo isolate the association of ESD with mortality risk, we further adjust for measures of school socioeconomic status and disorder, which are associated with health and wellbeing in other studies using Add Health data (Boen et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). We adjust for teacher retention via the proportion of teachers who have worked at the respondent\u0026rsquo;s school for 5 years or longer. Teacher turnover is a proxy for school disorder and the availability of social support for students. Teachers are more likely to leave schools with high levels of disorder (Allensworth, Ponisciak, and Mazzeo 2009), and high levels of teacher turnover make close relationships between teachers and students more challenging (Ronfeldt, Loeb, and Wyckoff 2013). We adjust for average class size, which is another indicator of teacher burnout and school socioeconomic status: schools with large class sizes tend to have lower socioeconomic status, and teachers\u0026rsquo; material, academic, and emotional resources for students may be spread thinner. We also adjust for the proportion of students of color as a measure of school racial segregation, which is associated with poor health among adolescents (Allgood et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Finally, we adjust for the school-level proportion of students testing below grade level as a measure of school SES. This measure is not intended to capture the academic performance of students, but rather the level of material resources in a school environment, given strong and enduring socioeconomic gradients in standardized testing performance (Carbonaro, Lauen, and Levy \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These measures are each sourced from the Wave I school administrator dataset.\u003c/p\u003e\u003cp\u003eLastly, we adjust for physical and mental health during adolescence. We adjust for self-rated health, a predictor of subsequent mortality risk (Jylh\u0026auml; \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), at Wave I (1\u0026thinsp;=\u0026thinsp;excellent, 2\u0026thinsp;=\u0026thinsp;very good, 3\u0026thinsp;=\u0026thinsp;good, 4\u0026thinsp;=\u0026thinsp;fair, 5\u0026thinsp;=\u0026thinsp;poor). We treat self-rated health as a continuous measure. We also adjust for depressive symptoms during adolescence using a 5-item index adapted from the Center of Epidemiologic Studies Depression Scale (CES-D). Participants were asked how often during the past seven days they \u0026ldquo;could not shake off the blues,\u0026rdquo; \u0026ldquo;felt depressed,\u0026rdquo; \u0026ldquo;were happy,\u0026rdquo; \u0026ldquo;felt sad,\u0026rdquo; and \u0026ldquo;felt life was not worth living\u0026rdquo; (0\u0026thinsp;=\u0026thinsp;never or rarely, 1\u0026thinsp;=\u0026thinsp;sometimes, 2\u0026thinsp;=\u0026thinsp;a lot of the time, 3\u0026thinsp;=\u0026thinsp;most or all of the time). The five items were added together to create an index of depressive symptoms ranging from 0 to 15 points.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eAnalytic Sample\u003c/h2\u003e\u003cp\u003eWe include all Black and White respondents with valid Wave I sampling weights and demographic covariates (age and sex). This results in an analytic sample of 14,069 observations (533 deaths). To address missingness, we use multiple imputation with chained equations (MICE) and conduct our analyses in Stata 17 (StataCorp \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). All analyses adjust for Add Health\u0026rsquo;s complex stratified sampling design and account for variance clustering within schools (Trani et al. \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe begin with descriptive analyses, paying particular attention to patterns between key exposures\u0026mdash;race/ethnicity and exclusionary school discipline\u0026mdash;and vital status.\u003c/p\u003e\u003cp\u003eWe then use Cox proportional hazard models to investigate mortality disparities by race/ethnicity and exposure to ESD. We use age at Wave I interview as the entry point. The duration (in months) is age at death minus age at Wave I interview for decedents, and age at 12/31/2022 minus age at Wave I interview for those who survived the study period. Because the duration variable implicitly includes age, we do not adjust for age in statistical models (Thi\u0026eacute;baut and B\u0026eacute;nichou 2004).\u003c/p\u003e\u003cp\u003eWe conduct two sets of hazard models. In the first, we use all-cause mortality as the outcome of interest. In Model 1 we include race/ethnicity and sex to document sex-adjusted Black-White disparities in all-cause mortality risk. Model 2 adds exclusionary school discipline to Model 1. In Model 3, we include race/ethnicity, sex, and the array of covariates to examine whether socioeconomic, school, and behavioral factors account for any Black-White disparities in mortality risk. Finally, in Model 4, we include race/ethnicity, sex, ESD, and all covariates to present fully adjusted associations between race/ethnicity, ESD, and all-cause mortality risk.\u003c/p\u003e\u003cp\u003eIn the second set of models, we use competing-risk regressions for internal-cause and external-cause mortality conditional on survival from other causes of death. We mirror the structure of the first set of models, but for the sake of brevity, only present results from models that adjust for control variables. Thus, in Model 1, we include race/ethnicity, sex, and control variables to display Black-White disparities in internal-cause mortality risk after adjustment for covariates. In Model 2, we add exclusionary school discipline to Model 1. We repeat this procedure for external-cause mortality in Models 3 and 4.\u003c/p\u003e\u003cp\u003eTo test the proportional hazard assumptions, we interact each variable in our regressions with the duration variable in fully adjusted models (Model 4). There were no significant interaction terms between time and race/ethnicity or between time and suspension/expulsion, indicating that Cox models do not violate the proportionality assumption.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e[Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e about here]\u003c/h2\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays the risk of all-cause mortality by exclusionary discipline history (Panel A) and by race/ethnicity (Panel B). Almost immediately following the Wave I interview, a large and growing disparity in mortality risk by suspension/expulsion history emerges. By the early 40s, those who have been suspended or expelled in adolescence are more than twice as likely to have died than those who were not. Panel B shows that, although Black respondents have lower survival probability than White respondents at most ages, there is not a statistically significant difference in mortality hazard during adolescence and young adulthood at the 0.05 level.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e about here]\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows weighted descriptive statistics of the sample by race/ethnicity, vital status, and broad cause of death. Participants were an average age of 16 years at Wave I interview. The sample is 19 percent Black and 81 percent White. Around four percent of the analytic sample was deceased by 12/31/2022, with an average age at death of 34 years.\u003c/p\u003e\u003cp\u003eExclusionary school discipline is quite common, and highly unequal by race/ethnicity and by vital status. More than one quarter (28%) of the full sample had been suspended or expelled from school by Wave 1. Black adolescents were more than twice as likely to be suspended or expelled than White adolescents (49% vs. 24%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Decedents were also much more likely to have been suspended or expelled than those who survived to the end of the study period (49% vs 28%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Suspension/expulsion is particularly prevalent among those who died from external causes, of whom more than half were previously suspended or expelled from school, but is also disproportionately prevalent among internal-cause decedents.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e also demonstrates large inequalities in certain covariates by race/ethnicity and by vital status. Specifically, Black respondents were more likely live in households receiving public assistance and lived in neighborhoods with higher poverty rates than White respondents. Black respondents also attended schools with much larger proportions of non-White students than White respondents did (60% vs 18%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). White respondents reported lower levels of depressive symptoms than did Black respondents during adolescence (2.66 vs. 3.18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Almost two-thirds of all-cause decedents are males (63%), a figure that rises to more than 70 percent for external causes. There is no significant overrepresentation of males among internal-cause decedents. Decedents also reported worse health in adolescence than those who survived: external-cause decedents had higher levels of depressive symptoms in adolescence (3.39 vs. 2.74, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while internal-cause decedents had worse self-rated health (2.40 vs 2.10, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e here]\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Causes of Death by Race/Ethnicity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eNon-Hispanic Black\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eNon-Hispanic White\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnweighted count\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeighted proportion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eUnweighted count\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eWeighted proportion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll internal causes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.58*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCirculatory and metabolic causes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfectious diseases (including COVID-19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.10+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther internal causes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAll external causes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e74\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.39*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.05\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003e215\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.60\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuicide and accidental poisoning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.10**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHomicide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.13*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransport accidents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther external causes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMissing/suppressed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e365\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eData Source: Add Health\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eNotes:\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; + p\u0026thinsp;\u0026lt;\u0026thinsp;0.1 for two-tailed t-test between Black and White decedents.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eProportions may not add to 1 due to rounding.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, we present the distribution of causes of death by race/ethnicity. There are notable Black-White disparities in the relative shares of internal and external causes of death. Specifically, the majority (58%) of deaths among Black decedents are from internal causes. Black decedents are more than 1.5 times as likely to have died from internal causes than White decedents. Black decedents were more than 3 times as likely to have died from infectious diseases (including COVID-19) by early-middle adulthood than White decedents (10% vs. 3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.1), as well as from circulatory and metabolic diseases, cancers, and other internal causes, though these differences do not reach statistical significance. White decedents, on the other hand, were 1.5 times more likely to have died from external causes than Black decedents. More than 35% of deaths in the White population were from suicide and accidental poisoning, compared to 10% of deaths in the Black population (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Whites were also more likely to die from transport accidents and other external causes. A notable exception to the elevated level of external-cause mortality among Whites relative to Blacks is homicide, from which Black decedents were more than 6 times more likely to die than White decedents (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e here]\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults from Weighted Cox Proportional Hazards Models for All-Cause Mortality vs. Survival\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"17\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eModel 1:\u003c/p\u003e\u003cp\u003eRace/ethnicity and sex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eModel 2:\u003c/p\u003e\u003cp\u003eModel 1\u0026thinsp;+\u0026thinsp;suspension/expulsion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e\u003cp\u003eModel 3:\u003c/p\u003e\u003cp\u003eModel 1\u0026thinsp;+\u0026thinsp;covariates\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c17\" namest=\"c14\"\u003e\u003cp\u003eModel 4:\u003c/p\u003e\u003cp\u003eModel 3\u0026thinsp;+\u0026thinsp;suspension/expulsion\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Hispanic Black (ref\u0026thinsp;=\u0026thinsp;Non-Hispanic White)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.25^\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.98,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.78,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.71,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.64,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale (ref\u0026thinsp;=\u0026thinsp;female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.64***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.26,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.39*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(1.05,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.72***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(1.32,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.52***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(1.15,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e2.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEver suspended or expelled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.31***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(1.86,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.99***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(1.57,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e2.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents\u0026thinsp;\u0026lt;\u0026thinsp;BA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.93,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.87,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousehold receives public assistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.84,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.79,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelinquency (Z-score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(1.00,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.92,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-rated health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.20***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(1.07,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.18***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(1.05,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepressive symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.06*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(1.01,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.99,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeighborhood poverty rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.47,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e7.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.38,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e5.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeacher retention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.27,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.28,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage class size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.96,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.96,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProportion students of color\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.63,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.61,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e2.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProportion students testing below grade level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.31,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.32,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnweighted N\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14,069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14,069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e14,069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e14,069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"17\"\u003eData Source: Add Health\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"17\"\u003eNotes: ^ p\u0026thinsp;\u0026lt;\u0026thinsp;0.1, * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"17\"\u003eHR\u0026thinsp;=\u0026thinsp;hazard ratio, CI\u0026thinsp;=\u0026thinsp;confidence interval\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e contains the results from hazard models for all-cause mortality risk. In Model 1, there is suggestive evidence of a Black disadvantage in mortality risk after controlling for sex (HR\u0026thinsp;=\u0026thinsp;1.25, p\u0026thinsp;=\u0026thinsp;0.08). After introducing suspension/expulsion into the regressions in Model 2, the difference in mortality risk found in Model 1 all but disappears. Suspension or expulsion is associated with 2.31 times higher risk of mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Without suspension or expulsion, the inclusion of control variables also obviates the Black-White mortality hazard ratio (Model 3). In Model 4, the fully-adjusted model, there is no significant Black-White mortality hazard, and suspension or expulsion remains a strong predictor of all-cause mortality, even net of a variety of covariates (HR\u0026thinsp;=\u0026thinsp;1.99, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e here]\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults from Weighted Competing-Risk Models for Internal and External-Cause Mortality vs. Survival\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"17\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eModel 1: Internal Causes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eModel 2: Internal Causes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e\u003cp\u003eModel 3: External Causes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c17\" namest=\"c14\"\u003e\u003cp\u003eModel 4: External Causes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Hispanic Black (ref\u0026thinsp;=\u0026thinsp;Non-Hispanic White)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.74*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.05,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.61^\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.97,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.38,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.50^\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.33,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.79,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.71,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.53***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(1.82,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e3.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2.16***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(1.54,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e3.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEver suspended or expelled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.62*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(1.12,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2.27***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(1.62,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e3.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents\u0026thinsp;\u0026lt;\u0026thinsp;BA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.81,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.77,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.83,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.77,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousehold receives public assistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.67,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.64,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.82,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.76,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelinquency (Z-score)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.88,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.83,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(1.00,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.90,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-rated health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.36**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.13,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.35**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(1.11,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.92,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.90,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepressive symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.91,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.90,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.10***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(1.04,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.08**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(1.02,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeighborhood poverty rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.30,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.25,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.29,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e12.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.23,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e9.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTeacher retention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.21,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.21,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.26,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.27,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e2.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage class size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.93,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.93,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.96,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.96,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProportion students of color\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.49,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.48,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.49,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.47,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e2.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProportion students testing below grade level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.10,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.35^\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.10,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(0.42,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e(0.43,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e2.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnweighted N\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14,069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14,069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e14,069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e14,069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"17\"\u003eData Source: Add Health\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"17\"\u003eNotes: ^ p\u0026thinsp;\u0026lt;\u0026thinsp;0.1, * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"17\"\u003eHR\u0026thinsp;=\u0026thinsp;hazard ratio, CI\u0026thinsp;=\u0026thinsp;confidence interval\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, we turn to cause-specific analyses of competing risk models for internal- and external-cause mortality risk. In Model 1, we present results that adjust for all covariates except for suspension/expulsion. There is a wide disparity in internal-cause mortality risk during adolescence and young adulthood between Blacks and Whites, net of socioeconomic and health covariates (HR\u0026thinsp;=\u0026thinsp;1.74, p\u0026thinsp;=\u0026thinsp;0.03). This disparity shrinks, but does not disappear, in Model 2 after the inclusion of suspension/expulsion (HR\u0026thinsp;=\u0026thinsp;1.61, p\u0026thinsp;=\u0026thinsp;0.07). Exclusionary school discipline is associated with 1.62 times higher risk of internal-cause mortality (p\u0026thinsp;=\u0026thinsp;0.01, Model 2), conditional on survival from other causes of death and after adjustment for covariates.\u003c/p\u003e\u003cp\u003eIn contrast to internal-cause mortality risk, Model 3 in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e demonstrates that there is no Black-White disparity in external-cause mortality risk during these ages, and in fact, there may be a Black survival advantage relative to Whites (HR\u0026thinsp;=\u0026thinsp;0.65, p\u0026thinsp;=\u0026thinsp;0.13). In Model 4, suspension/expulsion is associated with 2.25 times higher risk of external-cause mortality relative to those who have never been suspended or expelled (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The Black survival advantage relative to Whites widens in Model 4 after the inclusion of exclusionary discipline and is now statistically significant at the 0.05 level (HR\u0026thinsp;=\u0026thinsp;0.58). This suggests that if there was no Black-White disparity in suspension/expulsion, the risk of external-cause mortality conditional on survival from other causes may, in fact, be lower for Blacks than for Whites. The shifts in Black-White hazard ratios for all-cause and cause-specific mortality are visualized in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, which contains results from models before and after adjustment for Wave I covariates.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIncreasing premature mortality rates have garnered significant research attention since the mid-2010s. While most studies are either cross-sectional or focused on adult determinants of midlife mortality, we direct our attention to the adolescent determinants of mortality among a nationally representative cohort of adolescents from the mid-1990s who reached adulthood in the 2000s. We specifically consider exclusionary school discipline, an understudied determinant of health and wellbeing, as an important precursor to mortality risk during young adulthood and a possible mechanism through which Black-White disparities in mortality manifest over the life course. Our results demonstrate that, compared to Whites, Blacks have modestly higher all-cause mortality risk between adolescence and young adulthood. We also find strong associations between exclusionary school discipline and mortality risk from all causes of death that persist even after adjustment for a large range of adolescent covariates. Further, the inclusion of exclusionary discipline in statistical models indeed decreases the hazard ratios for mortality among Blacks compared to Whites for both internal and external causes.\u003c/p\u003e\u003cp\u003eTaken together, results from this study contribute to the literature in three key ways. First, we provide further evidence that Black-White disparities in mortality during adolescence and young adulthood are not universal for all causes of death. Specifically, Black adolescents and young adults are at much higher risk of internal-cause mortality than Whites, while Whites are slightly more likely to die from external causes than Blacks (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Nationally, more than half of deaths under age 50 were from external causes in 2022 (Curtin, Tejada-Vera, and Bastian 2024), yet results from Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e indicate that almost 60 percent of deaths among Black respondents were from internal causes. These Black-White disparities in internal-cause mortality attenuate slightly, but remain large after accounting for covariates and exclusionary school discipline (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This internal-cause disparity is largely driven by cardiometabolic causes, cancers, and infectious diseases which together compose nearly half of all deaths in the Black subsample, compared to less than one-third of deaths in the White subsample (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Many members of this cohort were born around the onset of the HIV/AIDS epidemic in the early-1980s, and most reached adolescence during its peak in the early-1990s. The introduction of lifesaving technologies saved millions of lives starting in the mid-1990s, but exacerbated Black-White disparities in AIDS-related mortality due to structural inequities in health-promoting resources and access to antiretroviral therapies (Rubin, Colen, and Link 2010). Most recently, the COVID-19 pandemic once again brought the crisis of Black-White disparities premature mortality into stark relief, and highlighted the role of structural racism in generating vast amounts of preventable death (Laster Pirtle \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Bonilla-Silva \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Black-White disparities in young cardiometabolic health in the Add Health cohort are also large (Gaydosh et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Richardson et al. \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The relatively high prevalence of cardiometabolic morbidity and inflammation among Black young adults not only contributes to the elevated risk of mortality from diabetes and heart disease at these ages, but also together comprise a \u0026ldquo;syndemic\u0026rdquo; of socially unequal risks for mortality from COVID-19 (Gravlee \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOn the contrary, White adolescents and young adults in this cohort are more likely to die from external causes than their Black counterparts. There has been substantial attention to the rise in external-cause mortality among adults between ages 25 and 64 (Harris, Majmundar, and Becker 2021), but this study is one of few to document this pattern earlier in the life course (see Lawrence et al. \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The overrepresentation of suicide and drug poisoning in the White population shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e is largely driving this phenomenon. These results are paradoxical given that Black adolescents report 20% higher levels of depressive symptoms\u0026mdash;which strongly predict subsequent external-cause mortality\u0026mdash;relative to White adolescents (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This cohort came of age at the onset of the opioid epidemic in the early-2000s, during which pharmaceutical corporations marketed prescription opioid painkillers, such as OxyContin, as non-addictive treatments for chronic pain. The belief that Black Americans feel less pain than White Americans, or that Black Americans are otherwise drug-seeking, is widespread among medical practitioners in the United States, who as a result disproportionately prescribed White Americans historically unprecedented amounts of addictive opioid drugs to manage acute or chronic pain (Simpson \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The Add Health cohort is now entering midlife as the opioid epidemic accelerates in non-White populations (Gennuso et al. \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Given that drug overdose mortality rates are higher among Black Americans than White Americans after age 45, it is possible that the White disadvantage in external-cause mortality will shrink or reverse as the Add Health cohort ages (Monnat \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSecond, exposure to exclusionary school discipline during adolescence is a strong predictor of subsequent mortality risk. This association exists for both internal and external causes of death, but is particularly strong for external causes, and it persists regardless of adjustment for socioeconomic, contextual, and health covariates in adolescence (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). There are likely numerous pathways through which exclusionary school discipline may increase mortality risk. First, and perhaps most importantly, is the \u0026ldquo;school-to-prison\u0026rdquo; pipeline, whereby students who experience exclusionary school discipline are far more likely to experience arrest or incarceration than students who were not. This association between school suspension and arrest exists early in the life course and persists into adulthood. Children who were suspended before age 10 were at least twice as likely to have been arrested by age 15 relative to those who were not (Mittleman \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Exclusionary school discipline initiates or accelerates trajectories into substance use disorder that in part operate through exposure to arrest during adolescence and young adulthood (Prins et al. \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Young adults who were suspended during childhood and adolescence are also more than twice as likely to be incarcerated than those who were not (Hemez et al. \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Given the concentrated risk of mortality from suicide, homicide, and drug poisoning both during (Carson \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and after incarceration (Binswanger \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), it is quite possible that the school-to-prison pipeline is operating as an important mechanism in the association between ESD and mortality risk from external causes.\u003c/p\u003e\u003cp\u003eWhile likely most salient for external-cause mortality, the school-to-prison pipeline may be relevant to subsequent internal-cause mortality risk as well. Individuals who are incarcerated have a much higher burden of chronic disease morbidity than the non-incarcerated population (Binswanger, Krueger, and Steiner \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Inadequate nutrition, vigilance and victimization, poor healthcare access and quality, and loneliness may all elevate chronic stress, and thus increase the risk of mortality from chronic diseases during incarceration (Daza et al. 2020). Exposure to arrest and incarceration are also associated with increased stress-related physiological dysregulation during young adulthood, which may carry implications for mortality from acute and chronic diseases (Boen \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The havoc wreaked by the COVID-19 pandemic on incarcerated populations\u0026mdash;who are more than three times as likely to die from the disease than the general population (Sugie et al. 2023)\u0026mdash;also highlighted the importance of carceral environments as vectors for infectious disease transmission (LeMasters et al. \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This phenomenon has also been noted for HIV/AIDS, sexually transmitted infections, influenza, and tuberculosis (Massoglia \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eExposure to the criminal legal system is not the only mechanism connecting ESD to mortality risk. School suspension and expulsion are strongly associated with reduced educational attainment in adulthood, which likely carries implications for premature mortality from internal and external causes alike. Specifically, school suspension is associated with a significant reduction in academic performance during childhood and adolescence (Perry and Morris 2014) and a 25% reduction in the likelihood of earning a Bachelors\u0026rsquo; degree by young adulthood (Rosenbaum \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Educational inequality in mortality is increasing in the United States, particularly from cardiometabolic and external causes (Sasson and Hayward 2019), and as such, it is quite possible that ESD during adolescence acts as an important early-life precursor to these disparities.\u003c/p\u003e\u003cp\u003eFinally, the experience of suspension or expulsion is associated with numerous negative social experiences that may be associated with mortality risk. Exclusionary school discipline is associated with elevated depressive symptoms during adolescence and young adulthood (Angton et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Students who have experienced ESD are more likely to experience friendship loss following suspension (Jacobsen \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), have fewer close relationships with adults (Anyon et al. 2016), and are less likely to report participating in political and civic engagement later in life (Kupchik and Catlaw \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Social isolation and loneliness are strong predictors of mortality during middle and later-adulthood (Stokes et al. \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In another study of the Add Health cohort with mortality follow-up, social acceptance has a modest, protective effect on subsequent all-cause mortality risk, indicating that social support matters for mortality risk even in early life (Lawrence et al. \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Finally, exclusionary school discipline is associated with violence victimization in adulthood (Wolf and Kupchik 2017) which may reflect a direct risk of homicide mortality, in addition to acting as a stressor affecting cardiometabolic and immune regulation of young adults.\u003c/p\u003e\u003cp\u003eThird, the disproportionate allocation of school suspension and expulsion towards Black students may play a role in shaping Black-White mortality disparities for both internal and external causes. Specifically, Black-White hazard ratios for all-cause mortality reduce by 11% in fully adjusted models after accounting for exclusionary school discipline (\u003cb\u003eModels 3\u003c/b\u003e and \u003cb\u003e4\u003c/b\u003e in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This attenuation exists for both internal and external causes, for which Black-White hazard ratios decline by 8% and 11%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Results from Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e also indicate that, if Black adolescents experienced ESD at the same rate as White adolescents, the White disadvantage in external-cause mortality risk would be larger and statistically significant relative to their Black counterparts. Critically, eliminating racial disparities in exclusionary school discipline is not the only recourse to reduce Black-White disparities in mortality. Controlling for socioeconomic and health factors during adolescence in hazard models also drastically decreases both internal- and external-cause mortality risk among Blacks relative to Whites, indicating that reducing racialized material disadvantage, improving physical and mental health, and promoting educational equity during adolescence may further prove lifesaving.\u003c/p\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eWe acknowledge this study\u0026rsquo;s limitations. First, statistical power for more detailed analyses of mortality data is limited by the relatively small number of deaths in the Add Health cohort. Relatedly, because of cross-wave attrition and small sample sizes, we are unable to test for specific mechanisms\u0026mdash;such as criminal legal system involvement\u0026mdash;underlying the relationship between school suspension and expulsion and premature mortality. As the cohort ages, and as the social conditions generating risks for premature death persist, the sample of decedents will increase with each follow-up period. Second, the conclusions in this study are based on statistical associations and not on causal models. Without formal mediation techniques, we cannot assess the indirect effect of school suspension and expulsion on racial disparities in mortality. Instead, we provide longitudinal but associational evidence of the contribution of ESD to premature mortality in an aging cohort. Future research could use mediation techniques to specify the relative contribution of ESD and other social experiences to Black and White young adults\u0026rsquo; survival. Third, we exclusively focus on factors affecting mortality risk during adolescence to prevent censoring and preserve as many cases as possible. As cases increase with each mortality follow-up, future analyses can incorporate later waves of Add Health, as well as construct time-varying measures of social, health, and behavioral exposures.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, we demonstrate a strong, positive association between exclusionary school discipline and subsequent mortality risk among U.S. young adults. We also provide preliminary evidence that disproportionate school punishment among Black adolescents may elevate mortality risk relative to their White counterparts. The banishment of students for alleged or actual misbehavior sends a clear message: that those who transgress social norms, make mistakes, or occupy marginalized social positions are unworthy of inclusion in the wider society. Our results indicate that exclusionary school discipline is more than an ineffective means of promoting school safety or education: it is a practice that is strongly associated with mortality risk and, accordingly, must be reconsidered. Nearly all mortality before age 50, whether from internal or external causes, is preventable. The replacement of exclusionary school discipline with restorative practices may prove lifesaving for all young people, but particularly so for the Black adolescents that it disproportionately affects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.T. wrote the main manuscript text and conducted all analyses. C.E.G. provided methodological direction. R.A.H. provided conceptual advice. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data underlying this article were provided by the National Longitudinal Study of Adolescent to Adult Health (Add Health) under a restricted-use data contract. Data cannot be shared by the author. More information about accessing data from Add Health may be found here: [https://addhealth.cpc.unc.edu/data/#restricted-use](https:/addhealth.cpc.unc.edu/data) .\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdvancement Project. (2000). \u003cem\u003eOpportunities Suspended: The Devastating Consequences of Zero Tolerance and School Discipline. A National Summit on Zero Tolerance\u003c/em\u003e. The Civil Rights Project at Harvard University.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllensworth, E., \u0026amp; Ponisciak, S. (2009). and Christopher Mazzeo. The Schools Teachers Leave. \u003cem\u003eConsortium on Chicago School Research\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllgood, K. L., Fleischer, N. L., Assari, S., Morenoff, J., \u0026amp; Needham, B. L. (2024). School Segregation During Adolescence Is Associated with Higher 30-Year Cardiovascular Risk of Black but Not White Young Adults. \u003cem\u003eJournal of Racial and Ethnic Health Disparities\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40615-024-02135-5\u003c/span\u003e\u003cspan address=\"10.1007/s40615-024-02135-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAngton, A., Ni\u0026ntilde;o, M., \u0026amp; Tsuchiya, K., and Shauna Morimoto (2024). The Long-Term Consequences of School Suspension and Expulsion on Depressive Symptoms. \u003cem\u003eAdvances in Life Course Research\u003c/em\u003e, \u003cem\u003e61\u003c/em\u003e, 100631. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.alcr.2024.100631\u003c/span\u003e\u003cspan address=\"10.1016/j.alcr.2024.100631\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnyon, Y., \u0026amp; Zhang, D., and Cynthia Hazel (2016). Race, Exclusionary Discipline, and Connectedness to Adults in Secondary Schools. \u003cem\u003eAmerican Journal of Community Psychology\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(3\u0026ndash;4), 342\u0026ndash;352. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ajcp.12061\u003c/span\u003e\u003cspan address=\"10.1002/ajcp.12061\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArias, E., \u0026amp; Xu, J. (2025). and Kenneth Kochanek. United States Life Tables, 2022. \u003cem\u003eNational Vital Statistics Reports\u003c/em\u003e 74(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/data/nvsr/nvsr74/nvsr74-02.pdf\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/data/nvsr/nvsr74/nvsr74-02.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeckett, K., and Naomi Murakawa (2012). Mapping the Shadow Carceral State: Toward an Institutionally Capacious Approach to Punishment. \u003cem\u003eTheoretical Criminology\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(2), 221\u0026ndash;244. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1362480612442113\u003c/span\u003e\u003cspan address=\"10.1177/1362480612442113\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBinswanger, I. A., Krueger, P. M., \u0026amp; Steiner, J. F. (2009). Prevalence of Chronic Medical Conditions among Jail and Prison Inmates in the USA Compared with the General Population. \u003cem\u003eJournal of Epidemiology \u0026amp; Community Health\u003c/em\u003e, \u003cem\u003e63\u003c/em\u003e(11), 912\u0026ndash;919. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/jech.2009.090662\u003c/span\u003e\u003cspan address=\"10.1136/jech.2009.090662\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBinswanger, I. A. (2013). Mortality After Prison Release: Opioid Overdose and Other Causes of Death, Risk Factors, and Time Trends From 1999 to 2009. \u003cem\u003eAnnals of Internal Medicine\u003c/em\u003e, \u003cem\u003e159\u003c/em\u003e(9), 592. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7326/0003-4819-159-9-201311050-00005\u003c/span\u003e\u003cspan address=\"10.7326/0003-4819-159-9-201311050-00005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoen, C. E. (2020). Criminal Justice Contacts and Psychophysiological Functioning in Early Adulthood: Health Inequality in the Carceral State. \u003cem\u003eJournal of Health and Social Behavior\u003c/em\u003e, \u003cem\u003e61\u003c/em\u003e(3), 290\u0026ndash;306. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0022146520936208\u003c/span\u003e\u003cspan address=\"10.1177/0022146520936208\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoen, C. E., Kozlowski, K., \u0026amp; Tyson, K. D. (2020). Toxic\u0026rsquo; Schools? How School Exposures during Adolescence Influence Trajectories of Health through Young Adulthood. \u003cem\u003eSSM - Population Health\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e, 100623. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ssmph.2020.100623\u003c/span\u003e\u003cspan address=\"10.1016/j.ssmph.2020.100623\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBonilla-Silva, E. (1997). Rethinking Racism: Toward a Structural Interpretation. \u003cem\u003eAmerican Sociological Review\u003c/em\u003e, \u003cem\u003e62\u003c/em\u003e(3), 465. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2307/2657316\u003c/span\u003e\u003cspan address=\"10.2307/2657316\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBonilla-Silva, E. (2020). Color-Blind Racism in Pandemic Times. \u003cem\u003eSociology of Race and Ethnicity\u003c/em\u003e, \u003cem\u003e233264922094102\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2332649220941024\u003c/span\u003e\u003cspan address=\"10.1177/2332649220941024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBonilla-Silva, E. (2022). \u003cem\u003eRacism without Racists: Color-Blind Racism and the Persistence of Racial Inequality in America\u003c/em\u003e. Sixth edition. Lanham Boulder New York London: Rowman \u0026amp; Littlefield.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBor, J., Stokes, A. C., Raifman, J., Venkataramani, A., Bassett, M. T., \u0026amp; Himmelstein, D. (2023). and Steffie Woolhandler. Missing Americans: Early Death in the United States\u0026mdash;1933\u0026ndash;2021 edited by S. Galea. \u003cem\u003ePNAS Nexus\u003c/em\u003e 2(6):pgad173. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/pnasnexus/pgad173\u003c/span\u003e\u003cspan address=\"10.1093/pnasnexus/pgad173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBraudt, D. B., Elizabeth, M., Lawrence, A. M., Tilstra, R. G., Rogers, \u0026amp; Hummer, R. A. (2019). Family Socioeconomic Status and Early Life Mortality Risk in the United States. \u003cem\u003eMaternal and Child Health Journal\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(10), 1382\u0026ndash;1391. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10995-019-02799-0\u003c/span\u003e\u003cspan address=\"10.1007/s10995-019-02799-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown, T. H., and Patricia Homan (2024). Structural Racism and Health Stratification: Connecting Theory to Measurement. \u003cem\u003eJournal of Health and Social Behavior\u003c/em\u003e, \u003cem\u003e65\u003c/em\u003e(1), 141\u0026ndash;160. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/00221465231222924\u003c/span\u003e\u003cspan address=\"10.1177/00221465231222924\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarbonaro, W., Lauen, D. L., \u0026amp; Levy, B. L. (2023). Does Cumulative Exposure to High-Poverty Schools Widen Test-Score Inequality? \u003cem\u003eSociology of Education\u003c/em\u003e, \u003cem\u003e96\u003c/em\u003e(2), 81\u0026ndash;103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/00380407221147889\u003c/span\u003e\u003cspan address=\"10.1177/00380407221147889\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarson, E., \u0026amp; Ann (2021). Mortality in Local Jails, 2000\u0026ndash;2018 \u0026ndash; Statistical Tables. \u003cem\u003eStatistical Tables 3\u003c/em\u003e6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCholewa, B., Hull, M. F., \u0026amp; Babcock, C. R., and Alexandre D. Smith (2018). Predictors and Academic Outcomes Associated with In-School Suspension. \u003cem\u003eSchool Psychology Quarterly\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(2), 191\u0026ndash;199. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/spq0000213\u003c/span\u003e\u003cspan address=\"10.1037/spq0000213\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCrosnoe, R., and Monica Kirkpatrick Johnson (2011). Research on Adolescence in the Twenty-First Century. \u003cem\u003eAnnual Review of Sociology\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(1), 439\u0026ndash;460. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1146/annurev-soc-081309-150008\u003c/span\u003e\u003cspan address=\"10.1146/annurev-soc-081309-150008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCunningham, T. J., Janet, B., Croft, Y., Liu, H., Lu, P. I., Eke, \u0026amp; Giles, W. H. (2017). Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans \u0026mdash; United States, 1999\u0026ndash;2015. \u003cem\u003eMMWR Morbidity and Mortality Weekly Report\u003c/em\u003e, \u003cem\u003e66\u003c/em\u003e(17), 444\u0026ndash;456. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15585/mmwr.mm6617e1\u003c/span\u003e\u003cspan address=\"10.15585/mmwr.mm6617e1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurtin, S. (2024). Betzaida Tejada-Vera, and Bringham Bastian. \u003cem\u003eDeaths: Leading Causes for 2022\u003c/em\u003e. 73:10. National Vital Statistics Reports. Washington, D.C.: Center for Disease Control and Prevention. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://stacks.cdc.gov/view/cdc/164020/cdc_164020_DS1.pdf\u003c/span\u003e\u003cspan address=\"https://stacks.cdc.gov/view/cdc/164020/cdc_164020_DS1.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDaza, S., \u0026amp; Palloni, A., and Jerrett Jones (2020). The Consequences of Incarceration for Mortality in the United States. \u003cem\u003eDemography\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(2), 577\u0026ndash;598. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13524-020-00869-5\u003c/span\u003e\u003cspan address=\"10.1007/s13524-020-00869-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDuarte, C. P., Moses, C., Brown, M., Kajeepeta, S., Prins, S. J., \u0026amp; Scott, J., and Mahasin S. Mujahid (2023). Punitive School Discipline as a Mechanism of Structural Marginalization with Implications for Health Inequity: A Systematic Review of Quantitative Studies in the Health and Social Sciences Literature. \u003cem\u003eAnnals of the New York Academy of Sciences\u003c/em\u003e, \u003cem\u003e1519\u003c/em\u003e(1), 129\u0026ndash;152. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/nyas.14922\u003c/span\u003e\u003cspan address=\"10.1111/nyas.14922\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDunning-Lozano, J. L. (2018). School Discipline, Race, and the Discursive Construction of the \u0026lsquo;Deficient\u0026rsquo; Student. \u003cem\u003eSociological Spectrum\u003c/em\u003e, \u003cem\u003e38\u003c/em\u003e(5), 326\u0026ndash;345. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/02732173.2018.1532364\u003c/span\u003e\u003cspan address=\"10.1080/02732173.2018.1532364\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDwyer-Lindgren, L., Kendrick, P., Kelly, Y. O., Baumann, M. M., Compton, K., Brigette, F., Blacker, F., Daoud, Z., Li, F., Mouhanna, H., Nassereldine, C., Schmidt, D. O., Sylte, S. I., Hay, G. A., Mensah, A. M., N\u0026aacute;poles, E. J., P\u0026eacute;rez-Stable, C. J. L., Murray, \u0026amp; Mokdad, A. H. (2023). Cause-Specific Mortality by County, Race, and Ethnicity in the USA, 2000\u0026ndash;19: A Systematic Analysis of Health Disparities. \u003cem\u003eThe Lancet\u003c/em\u003e, \u003cem\u003e402\u003c/em\u003e(10407), 1065\u0026ndash;1082. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(23)01088-7\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(23)01088-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElder, G. H., \u0026amp; Johnson, M. K. (2003). and Robert Crosnoe. The Emergence and Development of Life Course Theory. Pp. 3\u0026ndash;19 in \u003cem\u003eHandbook of the Life Course\u003c/em\u003e, \u003cem\u003eHandbooks of Sociology and Social Research\u003c/em\u003e, edited by J. T. Mortimer and M. J. Shanahan. Boston, MA: Springer US.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFriedman, J. R., \u0026amp; Tiako, M. J. N., and Helena Hansen (2024). Understanding and Addressing Widening Racial Inequalities in Drug Overdose. \u003cem\u003eAmerican Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e181\u003c/em\u003e(5), 381\u0026ndash;390. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1176/appi.ajp.20230917\u003c/span\u003e\u003cspan address=\"10.1176/appi.ajp.20230917\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFuchs, V. R. (2016). Black Gains in Life Expectancy. \u003cem\u003eJournal Of The American Medical Association\u003c/em\u003e, \u003cem\u003e316\u003c/em\u003e(18), 1869. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2016.14398\u003c/span\u003e\u003cspan address=\"10.1001/jama.2016.14398\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGaydosh, L., Schorpp, K. M., Chen, E., \u0026amp; Miller, G. E. (2018). and Kathleen Mullan Harris. College Completion Predicts Lower Depression but Higher Metabolic Syndrome among Disadvantaged Minorities in Young Adulthood. \u003cem\u003eProceedings of the National Academy of Sciences\u003c/em\u003e 115(1):109\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1073/pnas.1714616114\u003c/span\u003e\u003cspan address=\"10.1073/pnas.1714616114\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGee, G. C., Hing, A., Mohammed, S., Tabor, D. C., \u0026amp; Williams, D. R. (2019). Racism and the Life Course: Taking Time Seriously. \u003cem\u003eAmerican Journal of Public Health\u003c/em\u003e, \u003cem\u003e109\u003c/em\u003e(S1), S43\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2105/AJPH.2018.304766\u003c/span\u003e\u003cspan address=\"10.2105/AJPH.2018.304766\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGennuso, K. P., Courtney, K., Blomme, M. L., Givens, E. A., \u0026amp; Pollock, and Anne M. Roubal (2019). Deaths of Despair(Ity) in Early 21st Century America: The Rise of Mortality and Racial/Ethnic Disparities. \u003cem\u003eAmerican Journal of Preventive Medicine\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(5), 585\u0026ndash;591. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amepre.2019.06.018\u003c/span\u003e\u003cspan address=\"10.1016/j.amepre.2019.06.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGeronimus, A. T., Bound, J., \u0026amp; Colen, C. G. (2011). Excess Black Mortality in the United States and in Selected Black and White High-Poverty Areas, 1980\u0026ndash;2000. \u003cem\u003eAmerican Journal of Public Health\u003c/em\u003e, \u003cem\u003e101\u003c/em\u003e(4), 720\u0026ndash;729. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2105/AJPH.2010.195537\u003c/span\u003e\u003cspan address=\"10.2105/AJPH.2010.195537\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoosby, B. J., and Katrina M. Walsemann (2012). School Racial Composition and Race/Ethnic Differences in Early Adulthood Health. \u003cem\u003eHealth \u0026amp; Place\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(2), 296\u0026ndash;304. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.healthplace.2011.10.002\u003c/span\u003e\u003cspan address=\"10.1016/j.healthplace.2011.10.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGould, M. S. (1996). Psychosocial Risk Factors of Child and Adolescent Completed Suicide. \u003cem\u003eArchives of General Psychiatry\u003c/em\u003e, \u003cem\u003e53\u003c/em\u003e(12), 1155. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archpsyc.1996.01830120095016\u003c/span\u003e\u003cspan address=\"10.1001/archpsyc.1996.01830120095016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGraham, C., Hummer, R. A., \u0026amp; Halpern, C. T. (2025). Gazing into the Crystal Ball: Do Adolescent Survival Expectations Predict Premature Mortality Risk in the United States? \u003cem\u003eSocial Science \u0026amp; Medicine\u003c/em\u003e, \u003cem\u003e364\u003c/em\u003e, 117548. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2024.117548\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2024.117548\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGravlee, C. C. (2020). Systemic Racism, Chronic Health Inequities, and COVID-19: A Syndemic in the Making? \u003cem\u003eAmerican Journal of Human Biology\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(5), e23482. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ajhb.23482\u003c/span\u003e\u003cspan address=\"10.1002/ajhb.23482\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHanson, A. L. (2005). Have Zero Tolerance School Discipline Policies Turned into a Nightmare? The American Dream\u0026rsquo;s Promise of Equal Educational Opportunity Grounded in Brown v. Board of Education. \u003cem\u003eUC Davis Journal of Juvenile Law and Policy\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(2), 289\u0026ndash;379.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHargrove, T. W. (2024). Mental Health across the Early Life Course at the Intersection of Race, Skin Tone, and School Racial Context. \u003cem\u003eSocial Forces\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e(4), 1398\u0026ndash;1423. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/sf/soad126\u003c/span\u003e\u003cspan address=\"10.1093/sf/soad126\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarper, S., Riddell, C. A., \u0026amp; King, N. B. (2021). Declining Life Expectancy in the United States: Missing the Trees for the Forest. \u003cem\u003eAnnual Review of Public Health\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(1), 381\u0026ndash;403. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1146/annurev-publhealth-082619-104231\u003c/span\u003e\u003cspan address=\"10.1146/annurev-publhealth-082619-104231\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarris, K. M., Halpern, C. T., Whitsel, E. A., Jon, M., Hussey, Ley, A., Killeya-Jones, J., \u0026amp; Tabor, and Sarah C. Dean (2019). Cohort Profile: The National Longitudinal Study of Adolescent to Adult Health (Add Health). \u003cem\u003eInternational Journal of Epidemiology\u003c/em\u003e, \u003cem\u003e48\u003c/em\u003e(5), 1415\u0026ndash;1415k. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ije/dyz115\u003c/span\u003e\u003cspan address=\"10.1093/ije/dyz115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarris, K., Mullan, M. K., Majmundar, \u0026amp; Becker, T. (Eds.). (2021). \u003cem\u003eHigh and Rising Mortality Rates Among Working-Age Adults\u003c/em\u003e. National Academies.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHemez, P., Brent, J. J., \u0026amp; Mowen, T. J. (2020). Exploring the School-to-Prison Pipeline: How School Suspensions Influence Incarceration During Young Adulthood. \u003cem\u003eYouth Violence and Juvenile Justice\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(3), 235\u0026ndash;255. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1541204019880945\u003c/span\u003e\u003cspan address=\"10.1177/1541204019880945\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHummer, R. A. (2023). Race and Ethnicity, Racism, and Population Health in the United States: The Straightforward, the Complex, Innovations, and the Future. \u003cem\u003eDemography\u003c/em\u003e, \u003cem\u003e60\u003c/em\u003e(3), 633\u0026ndash;657. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1215/00703370-10747542\u003c/span\u003e\u003cspan address=\"10.1215/00703370-10747542\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHummer, R. A., \u0026amp; Lariscy, J. T. (2011). Educational Attainment and Adult Mortality. Pp. 241\u0026ndash;61 in \u003cem\u003eInternational Handbook of Adult Mortality\u003c/em\u003e. Vol. 2, \u003cem\u003eInternational Handbooks of Population\u003c/em\u003e, edited by R. G. Rogers and E. M. Crimmins. Dordrecht: Springer Netherlands.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJacobsen, W. C. (2020). School Punishment and Interpersonal Exclusion: Rejection, Withdrawal, and Separation from Friends. \u003cem\u003eCriminology\u003c/em\u003e, \u003cem\u003e58\u003c/em\u003e(1), 35\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/1745-9125.12227\u003c/span\u003e\u003cspan address=\"10.1111/1745-9125.12227\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJylh\u0026auml;, M. (2009). What Is Self-Rated Health and Why Does It Predict Mortality? Towards a Unified Conceptual Model. \u003cem\u003eSocial Science \u0026amp; Medicine\u003c/em\u003e, \u003cem\u003e69\u003c/em\u003e(3), 307\u0026ndash;316. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2009.05.013\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2009.05.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKershaw, K. N., Rafferty, J., Petito, L. C., \u0026amp; Khan, S. S. (2021). Age-Specific Racial Disparities in Mortality From Infancy to Older Adulthood. \u003cem\u003eJournal of the American College of Cardiology\u003c/em\u003e, \u003cem\u003e78\u003c/em\u003e(8), 854\u0026ndash;855. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jacc.2021.06.029\u003c/span\u003e\u003cspan address=\"10.1016/j.jacc.2021.06.029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKramer, M. R., Valderrama, A. L., \u0026amp; Casper, M. L. (2015). Decomposing Black-White Disparities in Heart Disease Mortality in the United States, 1973\u0026ndash;2010: An Age-Period-Cohort Analysis. \u003cem\u003eAmerican Journal of Epidemiology\u003c/em\u003e, \u003cem\u003e182\u003c/em\u003e(4), 302\u0026ndash;312. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/aje/kwv050\u003c/span\u003e\u003cspan address=\"10.1093/aje/kwv050\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKupchik, A., \u0026amp; Catlaw, T. J. (2015). Discipline and Participation: The Long-Term Effects of Suspension and School Security on the Political and Civic Engagement of Youth. \u003cem\u003eYouth \u0026amp; Society\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(1), 95\u0026ndash;124. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0044118X14544675\u003c/span\u003e\u003cspan address=\"10.1177/0044118X14544675\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLacoe, J., and Matthew P. Steinberg (2019). Do Suspensions Affect Student Outcomes? \u003cem\u003eEducational Evaluation and Policy Analysis\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(1), 34\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3102/0162373718794897\u003c/span\u003e\u003cspan address=\"10.3102/0162373718794897\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaster Pirtle, W. N. (2020). Racial Capitalism: A Fundamental Cause of Novel Coronavirus (COVID-19) Pandemic Inequities in the United States. \u003cem\u003eHealth Education \u0026amp; Behavior\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(4), 504\u0026ndash;508. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1090198120922942\u003c/span\u003e\u003cspan address=\"10.1177/1090198120922942\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLawrence, E., Rogers, R. G., \u0026amp; Hummer, R. A. (2024). Sex Differences in U.S. Adolescent and Young Adult Mortality. \u003cem\u003ePopulation Research and Policy Review\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(6), 73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11113-024-09916-0\u003c/span\u003e\u003cspan address=\"10.1007/s11113-024-09916-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLawrence, E., Trani, E. A., Anthony, K. M., Hummer, R. A., Jensen, T., Tuder, S., Loehr, L. R., Harris, K. M., \u0026amp; Whitsel, E. A. (2024). Data Resource Profile: Add Health Mortality Outcomes Surveillance. \u003cem\u003eInternational Journal of Epidemiology\u003c/em\u003e, \u003cem\u003e53\u003c/em\u003e(5), dyae121. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ije/dyae121\u003c/span\u003e\u003cspan address=\"10.1093/ije/dyae121\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeban, L., and Marlow Masterson (2022). The Impact of Childhood School Suspension on Dropout and Arrest in Adolescence: Disparate Relationships by Race and Adverse Childhood Experiences. \u003cem\u003eCriminal Justice and Behavior\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(4), 550\u0026ndash;569. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/00938548211041387\u003c/span\u003e\u003cspan address=\"10.1177/00938548211041387\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeMasters, K., Brinkley-Rubinstein, L., Maner, M., Peterson, M., \u0026amp; Nowotny, K., and Zinzi Bailey (2022). Carceral Epidemiology: Mass Incarceration and Structural Racism during the COVID-19 Pandemic. \u003cem\u003eThe Lancet Public Health\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(3), e287\u0026ndash;e290. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2468-2667(22)00005-6\u003c/span\u003e\u003cspan address=\"10.1016/S2468-2667(22)00005-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeMasters, K., Touma, A. S. D. A. F., \u0026amp; Andrabi, N., Lauren Brinkley-Rubinstein, and Carmen Gutierrez (2024). The Physiological Toll of Arrests: An Examination of Arrest History on Midlife Allostatic Load. \u003cem\u003eAnnals of Epidemiology\u003c/em\u003e, \u003cem\u003e96\u003c/em\u003e, 1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.annepidem.2024.05.007\u003c/span\u003e\u003cspan address=\"10.1016/j.annepidem.2024.05.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevine, R. S., Rust, G. S., Pisu, M., Agboto, V., Peter, A., Baltrus, Nathaniel, C., Briggs, R., Zoorob, P., Juarez, P. C., Hull, I., Goldzweig, \u0026amp; Hennekens, C. H. (2010). Increased Black\u0026ndash;White Disparities in Mortality After the Introduction of Lifesaving Innovations: A Possible Consequence of US Federal Laws. \u003cem\u003eAmerican Journal of Public Health\u003c/em\u003e, \u003cem\u003e100\u003c/em\u003e(11), 2176\u0026ndash;2184. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2105/AJPH.2009.170795\u003c/span\u003e\u003cspan address=\"10.2105/AJPH.2009.170795\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLouie, P., Reed, T., \u0026amp; DeAngelis (2024). Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans. \u003cem\u003eSocial Forces\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e(3), 817\u0026ndash;838. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/sf/soad112\u003c/span\u003e\u003cspan address=\"10.1093/sf/soad112\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaag, J. W. (2012). School-Wide Discipline and the Intransigency of Exclusion. \u003cem\u003eChildren and Youth Services Review\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(10), 2094\u0026ndash;2100. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.childyouth.2012.07.005\u003c/span\u003e\u003cspan address=\"10.1016/j.childyouth.2012.07.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMacinko, J., \u0026amp; Elo, I. T. (2009). Black-White Differences in Avoidable Mortality in the USA, 1980\u0026ndash;2005. \u003cem\u003eJournal of Epidemiology \u0026amp; Community Health\u003c/em\u003e, \u003cem\u003e63\u003c/em\u003e(9), 715\u0026ndash;721. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/jech.2008.081141\u003c/span\u003e\u003cspan address=\"10.1136/jech.2008.081141\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalat, J., Sarah Mayorga-Gallo, and, \u0026amp; Williams, D. R. (2018). The Effects of Whiteness on the Health of Whites in the USA. \u003cem\u003eSocial Science \u0026amp; Medicine\u003c/em\u003e, \u003cem\u003e199\u003c/em\u003e, 148\u0026ndash;156. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2017.06.034\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2017.06.034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMallett, C. A. (2016). The School-to-Prison Pipeline: A Critical Review of the Punitive Paradigm Shift. \u003cem\u003eChild and Adolescent Social Work Journal\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(1), 15\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10560-015-0397-1\u003c/span\u003e\u003cspan address=\"10.1007/s10560-015-0397-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartinez, R. A. M., Andrabi, N., Goodwin, A. N., Wilbur, R. E., \u0026amp; Smith, N. R., and Paul N. Zivich (2023). Conceptualization, Operationalization, and Utilization of Race and Ethnicity in Major Epidemiology Journals, 1995\u0026ndash;2018: A Systematic Review. \u003cem\u003eAmerican Journal of Epidemiology\u003c/em\u003e, \u003cem\u003e192\u003c/em\u003e(3), 483\u0026ndash;496. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/aje/kwac146\u003c/span\u003e\u003cspan address=\"10.1093/aje/kwac146\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMart\u0026iacute;nez-Al\u0026eacute;s, G., Jiang, T., Keyes, K. M., \u0026amp; Gradus, J. L. (2022). The Recent Rise of Suicide Mortality in the United States. \u003cem\u003eAnnual Review of Public Health\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(1), 99\u0026ndash;116. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1146/annurev-publhealth-051920-123206\u003c/span\u003e\u003cspan address=\"10.1146/annurev-publhealth-051920-123206\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMassoglia, M. (2008). Incarceration as Exposure: The Prison, Infectious Disease, and Other Stress-Related Illnesses. \u003cem\u003eJournal of Health and Social Behavior\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(1), 56\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/002214650804900105\u003c/span\u003e\u003cspan address=\"10.1177/002214650804900105\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasters, R. K., Laudan, Y., Aron, \u0026amp; Woolf, S. H. (2024). Life Expectancy Changes During the COVID-19 Pandemic, 2019\u0026ndash;2021: Highly Racialized Deaths in Young and Middle Adulthood in the United States as Compared With Other High-Income Countries. \u003cem\u003eAmerican Journal of Epidemiology\u003c/em\u003e, \u003cem\u003e193\u003c/em\u003e(1), 26\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/aje/kwad180\u003c/span\u003e\u003cspan address=\"10.1093/aje/kwad180\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasters, R. K., Robert, A., Hummer, D. A., Powers, A., Beck, S. F., \u0026amp; Lin, and Brian Karl Finch (2014). Long-Term Trends in Adult Mortality for U.S. Blacks and Whites: An Examination of Period- and Cohort-Based Changes. \u003cem\u003eDemography\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e, 2047\u0026ndash;2073.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasters, R. K., Bruce, G., Link, \u0026amp; Phelan, J. C. (2015). Trends in Education Gradients of \u0026lsquo;Preventable\u0026rsquo; Mortality: A Test of Fundamental Cause Theory. \u003cem\u003eSocial Science \u0026amp; Medicine\u003c/em\u003e, \u003cem\u003e127\u003c/em\u003e, 19\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2014.10.023\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2014.10.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcFarland, M. J., Geller, A., \u0026amp; McFarland, C. (2019). Police Contact and Health among Urban Adolescents: The Role of Perceived Injustice. \u003cem\u003eSocial Science \u0026amp; Medicine\u003c/em\u003e, \u003cem\u003e238\u003c/em\u003e, 112487. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2019.112487\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2019.112487\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMetzl, J. M. (2019). \u003cem\u003eDying of Whiteness: How the Politics of Racial Resentment Is Killing America\u0026rsquo;s Heartland\u003c/em\u003e. Basic Books.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMittleman, J. (2018). A Downward Spiral? Childhood Suspension and the Path to Juvenile Arrest. \u003cem\u003eSociology of Education\u003c/em\u003e, \u003cem\u003e91\u003c/em\u003e(3), 183\u0026ndash;204. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0038040718784603\u003c/span\u003e\u003cspan address=\"10.1177/0038040718784603\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMonnat, S. M. (2022). Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999\u0026ndash;2020. \u003cem\u003eThe ANNALS of the American Academy of Political and Social Science\u003c/em\u003e, \u003cem\u003e703\u003c/em\u003e(1), 50\u0026ndash;78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/00027162231154348\u003c/span\u003e\u003cspan address=\"10.1177/00027162231154348\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMowen, T., and John Brent (2016). School Discipline as a Turning Point: The Cumulative Effect of Suspension on Arrest. \u003cem\u003eJournal of Research in Crime and Delinquency\u003c/em\u003e, \u003cem\u003e53\u003c/em\u003e(5), 628\u0026ndash;653. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0022427816643135\u003c/span\u003e\u003cspan address=\"10.1177/0022427816643135\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNi\u0026ntilde;o, M., \u0026amp; Angton, A., Kathryn Norton-Smith, and Kayla Allison (2024). The Long Arm of School Punishment: The Role of School Suspension on Self-Rated Health from Adolescence to Midlife. \u003cem\u003eSocius: Sociological Research for a Dynamic World\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e, 23780231241284942. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/23780231241284942\u003c/span\u003e\u003cspan address=\"10.1177/23780231241284942\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNovak, A., and Marvin Krohn (2021). Collateral Consequences of School Suspension: Examining the \u0026lsquo;Knifing off\u0026rsquo; Hypothesis. \u003cem\u003eAmerican Journal of Criminal Justice\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(5), 728\u0026ndash;747. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12103-020-09579-5\u003c/span\u003e\u003cspan address=\"10.1007/s12103-020-09579-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOwens, J., \u0026amp; McLanahan, S. S. (2020). Unpacking the Drivers of Racial Disparities in School Suspension and Expulsion. \u003cem\u003eSocial Forces\u003c/em\u003e, \u003cem\u003e98\u003c/em\u003e(4), 1548\u0026ndash;1577. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/sf/soz095\u003c/span\u003e\u003cspan address=\"10.1093/sf/soz095\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatterson, E. J., Becker, A., \u0026amp; Baluran, D. A. (2022). Gendered Racism on the Body: An Intersectional Approach to Maternal Mortality in the United States. \u003cem\u003ePopulation Research and Policy Review\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(3), 1261\u0026ndash;1294. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11113-021-09691-2\u003c/span\u003e\u003cspan address=\"10.1007/s11113-021-09691-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePayne, A., \u0026amp; Ann, and Kelly Welch (2016). The Centrality of Schools in the Lifecourse: The Case for Focusing on School-Related Influences in Developmental Theory and Research. \u003cem\u003eDeviant Behavior\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(7), 748\u0026ndash;760. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/01639625.2015.1071134\u003c/span\u003e\u003cspan address=\"10.1080/01639625.2015.1071134\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePearlin, L. I., Schieman, S., \u0026amp; Fazio, E. M., and Stephen C. Meersman (2005). Stress, Health, and the Life Course: Some Conceptual Perspectives. \u003cem\u003eJournal of Health and Social Behavior\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(2), 205\u0026ndash;219. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/002214650504600206\u003c/span\u003e\u003cspan address=\"10.1177/002214650504600206\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerera, R., \u0026amp; Melissa Kay, D. (2023). \u003cem\u003eSurvey: Understanding How US Public Schools Approach School Discipline\u003c/em\u003e. Brookings Institution. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://policycommons.net/artifacts/4140050/survey/4948163/\u003c/span\u003e\u003cspan address=\"https://policycommons.net/artifacts/4140050/survey/4948163/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerry, B. L., and Edward W. Morris (2014). Suspending Progress: Collateral Consequences of Exclusionary Punishment in Public Schools. \u003cem\u003eAmerican Sociological Review\u003c/em\u003e, \u003cem\u003e79\u003c/em\u003e(6), 1067\u0026ndash;1087. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0003122414556308\u003c/span\u003e\u003cspan address=\"10.1177/0003122414556308\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePettit, B., and Carmen Gutierrez (2018). Mass Incarceration and Racial Inequality. \u003cem\u003eAmerican Journal of Economics and Sociology\u003c/em\u003e, \u003cem\u003e77\u003c/em\u003e(3\u0026ndash;4), 1153\u0026ndash;1182. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ajes.12241\u003c/span\u003e\u003cspan address=\"10.1111/ajes.12241\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePhelan, J. C., \u0026amp; Link, B. G. (2015). Is Racism a Fundamental Cause of Inequalities in Health? \u003cem\u003eAnnual Review of Sociology\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(1), 311\u0026ndash;330. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1146/annurev-soc-073014-112305\u003c/span\u003e\u003cspan address=\"10.1146/annurev-soc-073014-112305\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePhelan, J. C., Bruce, G., Link, A., Diez-Roux, I., Kawachi, \u0026amp; Levin, B. (2004). Fundamental Causes\u0026rsquo; of Social Inequalities in Mortality: A Test of the Theory. \u003cem\u003eJournal of Health and Social Behavior\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(3), 265\u0026ndash;285. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/002214650404500303\u003c/span\u003e\u003cspan address=\"10.1177/002214650404500303\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePolos, J. A., Stephanie, M., Koning, T. W., Hargrove, Kiarri, N., \u0026amp; Kershaw, and Thomas W. McDade (2022). Structural Racism in School Contexts and Adolescent Depression: Development of New Indices for the National Longitudinal Study of Adolescent to Adult Health and Beyond. \u003cem\u003eSSM - Population Health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e, 101237. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ssmph.2022.101237\u003c/span\u003e\u003cspan address=\"10.1016/j.ssmph.2022.101237\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePorter, L. C., and Laura M. DeMarco (2019). Beyond the Dichotomy: Incarceration Dosage and Mental Health. \u003cem\u003eCriminology\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(1), 136\u0026ndash;156. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/1745-9125.12199\u003c/span\u003e\u003cspan address=\"10.1111/1745-9125.12199\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrins, S. J., Ruth, T., Shefner, S., Kajeepeta, N., Levy, P., \u0026amp; Esie, and Pia M. Mauro (2023). Longitudinal Relationships among Exclusionary School Discipline, Adolescent Substance Use, and Adult Arrest: Public Health Implications of the School-to-Prison Pipeline. \u003cem\u003eDrug and Alcohol Dependence\u003c/em\u003e, \u003cem\u003e251\u003c/em\u003e, 110949. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.drugalcdep.2023.110949\u003c/span\u003e\u003cspan address=\"10.1016/j.drugalcdep.2023.110949\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReingle Gonzalez, J. M., Christopher, P., Salas-Wright, N. M., Connell, Katelyn, K., Jetelina, S. J., Clipper, \u0026amp; Businelle, M. S. (2016). The Long-Term Effects of School Dropout and GED Attainment on Substance Use Disorders. \u003cem\u003eDrug and Alcohol Dependence\u003c/em\u003e, \u003cem\u003e158\u003c/em\u003e, 60\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.drugalcdep.2015.11.002\u003c/span\u003e\u003cspan address=\"10.1016/j.drugalcdep.2015.11.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRichardson, L., Goodwin, A. N., \u0026amp; Hummer, R. A. (2021). Social Status Differences in Allostatic Load among Young Adults in the United States. \u003cem\u003eSSM - Population Health\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e, 100771. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ssmph.2021.100771\u003c/span\u003e\u003cspan address=\"10.1016/j.ssmph.2021.100771\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRogers, R. G., Lawrence, E. M., \u0026amp; Hummer, R. A., and Andrea M. Tilstra (2017). Racial/Ethnic Differences in Early-Life Mortality in the United States. \u003cem\u003eBiodemography and Social Biology\u003c/em\u003e, \u003cem\u003e63\u003c/em\u003e(3), 189\u0026ndash;205. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/19485565.2017.1281100\u003c/span\u003e\u003cspan address=\"10.1080/19485565.2017.1281100\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRonfeldt, M., \u0026amp; Loeb, S., and James Wyckoff (2013). How Teacher Turnover Harms Student Achievement. \u003cem\u003eAmerican Educational Research Journal\u003c/em\u003e, \u003cem\u003e50\u003c/em\u003e(1), 4\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3102/0002831212463813\u003c/span\u003e\u003cspan address=\"10.3102/0002831212463813\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosenbaum, J. (2020). Educational and Criminal Justice Outcomes 12 Years After School Suspension. \u003cem\u003eYouth \u0026amp; Society\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(4), 515\u0026ndash;547. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0044118X17752208\u003c/span\u003e\u003cspan address=\"10.1177/0044118X17752208\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosenbaum, J. E. (2020). School Suspension Predicts Trichomoniasis Five Years Later in a Matched Sample. \u003cem\u003eBmc Public Health\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(1), 88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-020-8197-8\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-8197-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRubin, M. S., Cynthia, G., Colen, \u0026amp; Link, B. G. (2010). Examination of Inequalities in HIV/AIDS Mortality in the United States From a Fundamental Cause Perspective. \u003cem\u003eAmerican Journal of Public Health\u003c/em\u003e, \u003cem\u003e100\u003c/em\u003e(6), 1053\u0026ndash;1059. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2105/AJPH.2009.170241\u003c/span\u003e\u003cspan address=\"10.2105/AJPH.2009.170241\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSasson, I. (2016). Trends in Life Expectancy and Lifespan Variation by Educational Attainment: United States, 1990\u0026ndash;2010. \u003cem\u003eDemography\u003c/em\u003e, \u003cem\u003e53\u003c/em\u003e(2), 269\u0026ndash;293. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13524-015-0453-7\u003c/span\u003e\u003cspan address=\"10.1007/s13524-015-0453-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSasson, I., and Mark D. Hayward (2019). Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010\u0026ndash;2017. \u003cem\u003eJournal Of The American Medical Association\u003c/em\u003e, \u003cem\u003e322\u003c/em\u003e(8), 756. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2019.11330\u003c/span\u003e\u003cspan address=\"10.1001/jama.2019.11330\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSawyer, S. M., Rima, A., Afifi, Linda, H., Bearinger, S. J., Blakemore, B., Dick, A. C., Ezeh, \u0026amp; Patton, G. C. (2012). Adolescence: A Foundation for Future Health. \u003cem\u003eThe Lancet\u003c/em\u003e, \u003cem\u003e379\u003c/em\u003e(9826), 1630\u0026ndash;1640. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(12)60072-5\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(12)60072-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchollenberger, T. (2013). \u003cem\u003eRacial Disparities in School Suspension and Subsequent Outcomes: Evidence from the National Longitudinal Survey of Youth 1997\u003c/em\u003e. UCLA Civil Rights Project.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchwandt, H., Currie, J., B\u0026auml;r, M., Banks, J., Bertoli, P., B\u0026uuml;tikofer, A., Cattan, S., Chao, B. Z. Y., Costa, C., Gonz\u0026aacute;lez, L., Grembi, V., Huttunen, K., Ren\u0026eacute; Karadakic, Lucy Kraftman, Sonya Krutikova, Stefano Lombardi, Peter Redler, Carlos Riumallo-Herl, Ana Rodr\u0026iacute;guez-Gonz\u0026aacute;lez, Kjell G. Salvanes, Paula Santana, Josselin Thuilliez, Van Doorslaer, E., Van Ourti, T., \u0026amp; Winter, J. K. (2021). Bram Wouterse, and Amelie Wuppermann. Inequality in Mortality between Black and White Americans by Age, Place, and Cause and in Comparison to Europe, 1990 to 2018. \u003cem\u003eProceedings of the National Academy of Sciences\u003c/em\u003e 118(40):e2104684118. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1073/pnas.2104684118\u003c/span\u003e\u003cspan address=\"10.1073/pnas.2104684118\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchwartz, G., \u0026amp; Wave, I. (2023). \u0026amp; II School Desegregation Disparities. Chapel Hill, NC. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://addhealth.cpc.unc.edu/wp-content/uploads/docs/restricted_use/Wave-I-II-School-Desegregation-Disparities.zip\u003c/span\u003e\u003cspan address=\"https://addhealth.cpc.unc.edu/wp-content/uploads/docs/restricted_use/Wave-I-II-School-Desegregation-Disparities.zip\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSimpson, K. (2021). The Racial Tension Between Underprescription and Overprescription of Pain Medication Amid the Opioid Epidemic. \u003cem\u003eNYU Review of Law and Social Change\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e, 129.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSkiba, R. J., and Kimberly Knesting (2002). Zero Tolerance, Zero Evidence: An Analysis of School Disciplinary Practice. \u003cem\u003eZero tolerance: Can suspension and expulsion keep school safe? New directions for youth development, No. 92\u003c/em\u003e (pp. 17\u0026ndash;43). Jossey-Bass/Wiley.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStataCorp (2021). Stata Statistical Software: Release 17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStokes, A. C., Xie, W., Lundberg, D. J., Glei, D. A., \u0026amp; Weinstein, M. A. (2021). Loneliness, Social Isolation, and All-Cause Mortality in the United States. \u003cem\u003eSSM - Mental Health\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e, 100014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ssmmh.2021.100014\u003c/span\u003e\u003cspan address=\"10.1016/j.ssmmh.2021.100014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStrassle, P. D., Mathew, M., Baumann, Y. O., Kelly, Z., Li, C., Schmidt, D. O., Sylte, K., Compton, G. J., Bertolacci, W. L. M. K., Daoud, F., Naghavi, M., Rodriquez, E. J., Mensah, G. A., Murray, C. J. L., Mokdad, A. H., Dwyer-Lindgren, L., \u0026amp; Eliseo, J. P\u0026eacute;rez-Stable. 2025. Homicide Rates Across County, Race, Ethnicity, Age, and Sex in the US: A Global Burden of Disease Study. \u003cem\u003eJAMA Network Open\u003c/em\u003e 8(2):e2462069. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2024.62069\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2024.62069\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSugie, N. F., Turney, K., Reiter, K., Tublitz, R., Kaiser, D., \u0026amp; Goodsell, R. Erin Secrist, Ankita Patil, and Monik Jim\u0026eacute;nez. 2023. Excess Mortality in U.S. Prisons during the COVID-19 Pandemic. \u003cem\u003eScience Advances\u003c/em\u003e 9(48):eadj8104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1126/sciadv.adj8104\u003c/span\u003e\u003cspan address=\"10.1126/sciadv.adj8104\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTehranifar, P., Goyal, A., Phelan, J. C., Link, B. G., Liao, Y., \u0026amp; Desai, X. F. M., and Mary Beth Terry (2016). Age at Cancer Diagnosis, Amenability to Medical Interventions, and Racial/Ethnic Disparities in Cancer Mortality. \u003cem\u003eCancer Causes \u0026amp; Control\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(4), 553\u0026ndash;560. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10552-016-0729-2\u003c/span\u003e\u003cspan address=\"10.1007/s10552-016-0729-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThi\u0026eacute;baut, A. C. M., and Jacques B\u0026eacute;nichou (2004). Choice of Time-scale in Cox\u0026rsquo;s Model Analysis of Epidemiologic Cohort Data: A Simulation Study. \u003cem\u003eStatistics in Medicine\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(24), 3803\u0026ndash;3820. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/sim.2098\u003c/span\u003e\u003cspan address=\"10.1002/sim.2098\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTilstra, A. M., Gutin, I., Dollar, N. T., Rogers, R. G., \u0026amp; Hummer, R. A. (2022). Outside the Skin\u0026rsquo;: The Persistence of Black\u0026ndash;White Disparities in U.S. Early-Life Mortality. \u003cem\u003eDemography\u003c/em\u003e, \u003cem\u003e59\u003c/em\u003e(6), 2247\u0026ndash;2269. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1215/00703370-10346963\u003c/span\u003e\u003cspan address=\"10.1215/00703370-10346963\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTilstra, A. M., Daniel, H., Simon, \u0026amp; Masters, R. K. (2021). Trends in \u0026lsquo;Deaths of Despair\u0026rsquo; Among Working-Aged White and Black Americans, 1990\u0026ndash;2017. \u003cem\u003eAmerican Journal of Epidemiology\u003c/em\u003e, \u003cem\u003e190\u003c/em\u003e(9), 1751\u0026ndash;1759. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/aje/kwab088\u003c/span\u003e\u003cspan address=\"10.1093/aje/kwab088\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTrani, E. A., Hill, M. J., Anthony, K., Lawrence, E., Loehr, L., \u0026amp; Hummer, R. (2024). and Eric Whitsel. Mortality Outcomes Surveillance, Part I: Ascertaining Decedents (2022 Update). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17615/ZBE9-RH36\u003c/span\u003e\u003cspan address=\"10.17615/ZBE9-RH36\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTrani, E. A., Laura, R., Loehr, E. M., Lawrence, R. A., Hummer, E. A., \u0026amp; Whitsel (2023). and Mary Jane Hill. \u003cem\u003eMortality Outcomes Surveillance, Part I: Ascertaining Decedents (2021 Update)\u003c/em\u003e. The University of North Carolina at Chapel Hill University Libraries. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17615/8S1B-QD86\u003c/span\u003e\u003cspan address=\"10.17615/8S1B-QD86\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnited States Department of Education (2022). \u003cem\u003eSuspensions and Expulsions in Public Schools\u003c/em\u003e. Focus on Student Discipline. Office of Civil Rights. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ed.gov/sites/ed/files/about/offices/list/ocr/docs/suspensions-and-expulsion-part-2.pdf\u003c/span\u003e\u003cspan address=\"https://www.ed.gov/sites/ed/files/about/offices/list/ocr/docs/suspensions-and-expulsion-part-2.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeaver, V. M. (2007). Frontlash: Race and the Development of Punitive Crime Policy. \u003cem\u003eStudies in American Political Development\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(2), 230\u0026ndash;265. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/S0898588X07000211\u003c/span\u003e\u003cspan address=\"10.1017/S0898588X07000211\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliams, D. R. (2018). Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-Related Stressors. \u003cem\u003eJournal of Health and Social Behavior\u003c/em\u003e, \u003cem\u003e59\u003c/em\u003e(4), 466\u0026ndash;485. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0022146518814251\u003c/span\u003e\u003cspan address=\"10.1177/0022146518814251\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWolf, E. R., Frederick, P., Rivara, Colin, J., Orr, A., Sen, D. A., Chapman, \u0026amp; Woolf, S. H. (2024). Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth. \u003cem\u003eJournal Of The American Medical Association\u003c/em\u003e, \u003cem\u003e331\u003c/em\u003e(20), 1732. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2024.3908\u003c/span\u003e\u003cspan address=\"10.1001/jama.2024.3908\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWolf, K. C., and Aaron Kupchik (2017). School Suspensions and Adverse Experiences in Adulthood. \u003cem\u003eJustice Quarterly\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(3), 407\u0026ndash;430. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/07418825.2016.1168475\u003c/span\u003e\u003cspan address=\"10.1080/07418825.2016.1168475\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2007). \u003cem\u003eInternational Statistical Classification of Diseases and Related Health Problems, 10th Revision\u003c/em\u003e. WHO.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWrigley-Field, E. (2020). US Racial Inequality May Be as Deadly as COVID-19. \u003cem\u003eProceedings of the National Academy of Sciences\u003c/em\u003e 117(36):21854\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1073/pnas.2014750117\u003c/span\u003e\u003cspan address=\"10.1073/pnas.2014750117\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWrigley-Field, E. (2025). Three Ways of Looking at Black\u0026ndash;White Mortality Differences in the United States. \u003cem\u003eAnnual Review of Sociology\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1146/annurev-soc-031021-105213\u003c/span\u003e\u003cspan address=\"10.1146/annurev-soc-031021-105213\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"exclusionary school discipline, Black-White disparities, life course, mortality","lastPublishedDoi":"10.21203/rs.3.rs-8079204/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8079204/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn the U.S., Black Americans live significantly shorter lives than White Americans. Prior research has named inequitable social exposures as critical determinants of the Black survival disadvantage during middle- and later-adulthood. Other work documents that unequal educational experiences are precursors to Black-White health disparities later in life. Still, no studies have linked educational exposures to racial disparities in subsequent mortality risk during adolescence and young adulthood. To that end, we use the National Study of Adolescent to Adult Health (Add Health) and Cox proportional hazard models to document the extent of Black-White disparities in all-cause and cause-specific mortality through young adulthood for a nationally representative cohort of Americans who were adolescents in the mid-1990s. We examine whether racially unequal exposure to exclusionary school discipline during adolescence accounts for any of this disparity. Results indicate a strong, positive associations between exclusionary school discipline and mortality from both internal (HR\u0026thinsp;=\u0026thinsp;1.62) and external (HR\u0026thinsp;=\u0026thinsp;2.27) causes of death, even after adjustment for socioeconomic and health covariates. We also find that Black-White disparities in mortality are heterogenous by cause of death: there is a large Black disadvantage in internal-cause mortality (HR\u0026thinsp;=\u0026thinsp;1.74) and a modest Black advantage in external-cause mortality (HR\u0026thinsp;=\u0026thinsp;0.65). Accounting for exclusionary school discipline in statistical models attenuates the Black-White hazard ratios for both internal and external causes of death. Our fundings underscore the critical need to reform exclusionary disciplinary practices to reduce premature mortality in the United States, particularly among Black Americans.\u003c/p\u003e","manuscriptTitle":"Exclusionary School Discipline and Black-White Disparities in Mortality through Early-Midlife","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-03 12:57:46","doi":"10.21203/rs.3.rs-8079204/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5ee1681c-682f-4e28-a418-b3683411f4d4","owner":[],"postedDate":"December 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-21T18:38:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-03 12:57:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8079204","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8079204","identity":"rs-8079204","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}