PROJECT SUMMARY The United States is grappling with the urgent challenge of worsening mental and behavioral health outcomes, with over 4 million deaths from suicide, assault, and psychoactive drug use in the past four decades. These deaths, referred to as deaths of despair and violence, account for 5% of all US deaths and are increasing faster than population growth. Significant disparities exist across sociodemographic groups, with young adults, lower-income communities, and non-white populations experiencing worse outcomes, including higher rates of stress, anxiety, depression, and suicide. Climate-related stressors, such as tropical cyclones, further exacerbate mental health issues, potentially leading to increased rates of anxiety disorders, intimate partner violence, and drug use behaviors. Tropical cyclone exposure is plausibly linked to deaths of despair and violence through biological, mental, environmental, and socioeconomic impacts. Major hurricanes often result in trauma, conflict, property loss, injury, and displacement, which can lead to suicidal or violent behavior and substance misuse. As climate change intensifies, increasing the frequency and severity of tropical cyclones, disparities in mental health outcomes are expected to worsen. There are critical knowledge gaps in understanding the trends and disparities in deaths of despair and violence, the short-term impacts of tropical cyclone exposure, and the long-term effects on vulnerable populations. In this supplement, we will leverage data and methodology prepared for the parent R00 grant. To address these gaps, we will analyze comprehensive mortality data and tropical cyclone exposure records. Our team, experienced in environmental epidemiology and advanced statistical methods, will investigate the links between tropical cyclone exposure and psychological distress-related deaths. Aim 1 will characterize long-term trends and disparities in deaths of despair and violence by modelling trends in suicide, assault, and psychoactive drug- related deaths from 1982 to 2022 and analyzing disparities by age, sex, race/ethnicity, and county. Aim 2 will determine the short-term association of tropical cyclone exposure with deaths of despair and violence by estimating death rate ratios by county-month following cyclone exposure from 1988 to 2022. Aim 3 will evaluate the long-term impact of recurrent tropical cyclone exposure on these deaths and disparities by utilizing synthetic control methods to estimate long-term effects and examine impacts by Social Vulnerability Index scores. This project complements and extends the parent R00, and is consistent with NIH and Surgeon General priorities, aiming to inform public health strategies, improve disaster response, and enhance mental health resources for vulnerable communities. This research will provide the candidate with advanced skills, training and research opportunities to a graduate student training in environmental epidemiology as applied to...