>>WELCOME TO THE 14th MATILDA WHITE HONORS. WE'VE GATHERED TOGETHER EACH SPRING FOR 14 YEARS TO HONOR A DISTINGUISHED LECTURER FOR THEIR CONTRIBUTIONS TO THE FIELD. THAT BEGAN 14 YEARS AGO AND LAST YEAR WAS TONY ANTONUCCI AND THIS YEAR WE ADD ANN CASE TO THAT DISTINGUISHED GROUP OF RESEARCHERS WHO HAVE DONE EXCELLENT WORK AND FOR THE LAST YEAR WE ADDED TO THE HONORS PROGRAM, EARLIER STAGE INVESTIGATOR PAPER AWARDS. SO AMONG THE HUNDREDS OF APPLICATIONS WE GET EACH YEAR FOR PAPERS PUBLISHED BY EARLY STAGE INVESTIGATORS PUBLISHED IN 2020, WE'VE SELECTED FOUR THIS YEAR AND IN A MINUTE I'LL TURN IT OVER TO BILL ELWOOD WHO HAS LED THAT SELECTION COMMITTEE TO INTRODUCE THEM AND MODERATE THAT PART OF THE PRESENTATION WE ALSO EVERY YEAR OF COURSE HONOR MATILDA WHITE RILEY. FOR THOSE WHO DON'T KNOW, FIRST OF ALL, BY THE WAY, I'M BILL RILEY. I FORGET TO INTRODUCE MYSELF SOMETIMES AND NO RELATION TO HER. MATILDA CAME TO THE NATIONAL INSTITUTES OF AGING IN THE LATE '70s, EARLY '80s AND BEGAN WHAT NOW THE DIVISION OF BEHAVIORAL AND SOCIAL AND UNTIL OBSSR WAS CREATED IN 1995, SHE ESSENTIALLY SERVED AS THE DE FACTO ASSOCIATE DIRECTOR FOR BEHAVIORAL AND SOCIAL SCIENCES AND ESSENTIALLY MOSTLY WHAT OBSR DOES AND LEADING A NUMBER OF INITIATIVES INCLUDING THE NATIONAL ACADEMY'S REPORT IN THE EARLY 1980s THAT LED TO THE INCLUSION OF BEHAVIORAL AND SOCIAL SCIENCES IN THE BIOMEDICAL RESEARCH ENTERPRISE AND WE HONOR HER AND HER WORK AT THE NIH AND WELL BEFORE AND LARGE AFTER AND THERE'S A LARGE CADRE OF STUDENTS THAT FOLLOW IN HER FOOTSTEPS AS WELL. I'LL TURN IT OVER TO BILL EL WOOD. HE LED THE COMMITTEE FOR THE INVESTIGATOR PAPER AWARDS. >> I'M BILL ELWOOD FROM THE OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH. DR. M. RILEY CAME TO THE NIH WHEN AT AGE 68 MANY PEOPLE WOULD HAVE THOUGHT OF RETIRING AND SHE WAS A TREMENDOUS FORCE AT NIH FOR 20 YEARS. HAS A LEGACY WE CONTINUE TO HONOR. SIX YEARS AGO WAS OBSSRs 20th ANNIVERSARY. WE WANTED TO EXTEND OUR PROGRAM IN RECOGNITION OF THOSE 20 YEARS SO WE LOOKED TO DR. RILEY'S LEGACY BECAUSE AT 88 WHEN SHE LEFT NIH AGAIN SHE DID NOT RETIRE, SHE WENT BACK TO HER PROFESSORSHIP AT BOGMAN COLLEGE WHERE SHE CONTINUED TO PUBLISH AND RESEARCH AND TEACH AND MENTOR STUDENTS AND SO WHAT BETTER WAY TO EXTEND HER LEGACY BUT TO MENTOR EARLY STAGE INVESTIGATORS. THERE'S SOCIAL PHENOMENON RELATIVE TO HEALTH AND A COMMITTEE OF SCIENTISTS FROM ACROSS THE AGENCY RANK THE ARTICLES BASED ON VISION OF EXCELLENCE SHE PUBLISHED HERSELF YEARS AGO AND THEY'RE RANKED ON THE PAPER'S IMPACT ON THEORY AND/OR METHOD. INTEGRATION OF THE INDIVIDUAL AND SOCIAL SYSTEMIC INFLUENCES AND THE INTEGRATION OF SCIENTIFIC DISCIPLINES. OUR TIME TOGETHER IS LIMITED AND APPRECIATI APPRECIATION--PRECIOUS BUT IF YOU LOOK IN THE CHAT BOX YOU CAN SEE THE SPEAKERS' BIOGRAPHY AND WHERE YOU REGISTERED AND I'LL GIVE THE TITLE AND AFFILIATIONS. LET'S BEGIN WITH DR. KAITLYN LAWRENCE WITH THE NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES. >> THANK YOU SO MUCH. GOOD AFTERNOON. MY NAME IS KAITLYN LAWRENCE. TODAY I'M PLEASED TO SHARE MY WORK ON NEIGHBORHOOD DEPRIVATION AND EPIGENETIC AGING. AMONG AMERICAN MEN BORN IN 1920 THOSE IN THE HIGHEST INCOME LEVEL LIVES FIVE YEARS LONGER THAN THOSE IN THE LOWEST. BY COMPARISON, THE MEN BORN 20 YEARS LATER IN 1940, THIS DIFFERENTIAL EXPANDED TO 12 YEARS. SOCIO ECONOMIC STATUS OR SES IS A COMPOSITE MEASURE OF AN INDIVIDUAL'S ECONOMIC OR SOCIOLOGICAL STANDING. THE DEFINITION VARIES ACROSS THE LITERATURE BUT COMMON MEASURES ARE EDUCATION, INCOME, EMPLOYMENT OR STATUS AND IT COULD BE MEASURED AT THE INDIVIDUAL AND NEIGHBORHOOD LEVELS AND THERE'S AN INCREASING INTEREST IN HOW NEIGHBORHOODS PLAY A ROLE. A PROMINENT LEVEL IS NEIGHBORHOOD DEPRIVATION WHICH REPRESENTS AN AREA WITH A HIGH CONCENTRATION OF LOW SOCIO ECONOMIC HOUSEHOLDS. SO NEIGHBORHOOD DEPRIVATION HAS BEEN STRONGLY LINKED WITH AGE RELATED DISEASES INCLUDING REDUCED LIFE EXPECTANCY AND CAUSE OF MORTALITY. IT'S IMPORTANT TO NOTE THESE HAVE SHOWN TO BE INDEPENDENT OF SOCIO ECONOMIC STATUS AND THERE'S SOMETHING PLAYING A UNIQUE ROLE IN IMPACTING THE HEALTH. THERE'S PSYCHOLOGICAL STRESS, ENVIRONMENTAL TOXICANTS AND BEHAVIORS THROUGH THE ENVIRONMENT, FOOD DESERTS AND REDUCED ACCESS TO MEDICAL CARE. HOWEVER, LITTLE IS KNOWN ABOUT THE BIOLOGICAL MECHANISMS UNDERLYING THE RELATIONSHIP. THERE IS EVIDENCE THAT NEIGHBORHOOD TRAITS INFLUENCE OUR BIOLOGY. A PROMINENT THEORY IS ACCELERATED CHROMOSOME TELEMERES ARE ASSOCIATED WITH DISEASES BUT NEWLY DEVELOPED MEASURES CALLED EPIGENETIC CLOCKS HAVE REPORTED BIOLOGICAL AGING THAN EXISTING METRICS. SO EPIGENETIC CLOCKS THESE USE DNA METHYLATION TO LOCATIONS ON THE DNA STRAND. WE KNOW THE SITES AT THE FIFTH CARBON OF THE CYTOSINE AND DNA METHYLATION CHANGES WITH AGE. IT'S RECENTLY BEEN ASSOCIATED WITH A RANGE OF ENVIRONMENTAL EXPOSURES PROMINENTLY CIGARETTE SMOKING AS WELL AS A RANGE OF DISEASE OUTCOMES AND EPIGENETIC CLOCKS USE DIFFERENT SETS OF DNA METHYLATION ACROSS THE GENOME TO PREDICT BIOLOGIC AGE SO THE THEORY IS SIMILAR TO ALL OTHER BIOLOGIC AGE PREDICTORS AND THAT'S THEY CAPTURE DISEASE AND MORTALITY RISK NOT MEASURED BY CHRONOLOGIC AGE. THIS IS ESTIMATED BY DIFFERENCES OR RESIDUALS BETWEEN AGE PREDICTED AT A GIVEN EPIGENETIC CLOCK AND A PERSON'S CHRONOLOGIC OR EXPECTED AGE WITH THE BLACK DASHED LINE. SO WITH EPIGENETIC CLOCKS THESE RESIDUALS ARE CALLED AGE ACCELERATION AND CAN BE POSITIVE. IF THEY'RE POSITIVE THEY REPRESENT AN INCREASE IN DISEASE OR MORTALITY RISK. THEY CAN BE NEGATIVE REPRESENTING DECREASED RISK. SO MULTIPLE CLOCK METHODOLOGIES HAVE BEEN PUBLISHED BUT THERE'S NO GOLD STANDARD CENSUS THOUGH THEY HAVE EVOLVED OVER TIME AND CAN GENERALLY BE GROUPED INTO TWO GROUPS. THE FIRST IS FIRST GENERATION CLOCKS AND THESE WERE DESIGNED TO BE CHRONOLOGIC AGE PREDICTORS AS SOME OF THE PROMINENT CLOCKS IN THE GROUP ARE LISTED AND THERE'S SECOND GENERATION AND THERE'S PHENOAGE AND GRIM AGE AND NO STUDIES HAVE ASSESSED SECOND GENERATION CLOCKS WITH RESPECT TO THE TRAITS. WITH THE NEIGHBORHOOD PREDICTORS WE SOUGHT TO EVALUATE THE ASSOCIATION BETWEEN NEIGHBORHOOD DEPRIVATION AND EPIGENETIC CLOCK METRICS. WE USED DATA FROM THE SISTER STUDY A LARGE PERSPECTIVE COHORT COMPRISING 51,000 WOMEN LIVING IN THE U.S. AGED AT 35 TO 74 AT ENROLLMENT AND HAD A SISTER WITH BREAST CANCER BUT DIDN'T THEM SELVES AND ENROLLED WAS FROM 2003 TO 2009 AND THEY COLLECTED DEMOGRAPHICS, RESIDENTIAL FACTORS AND LIFESTYLE AND SOCIO ECONOMIC AND ANTHROPOREMETRIC EXAMPLES AND FOR THIS ANALYSIS WE USED DATA FROM CASE COHORT SAMPLE RESTRICTED TO NON-HISPANIC WHITE WOMEN WITH AN EXAMPLE FOR USE AFTER EXCLUDING THOSE WITH MISSING INFORMATION AND LOW-QUALITY DNA METHYLATION WE HAD 2,632 PARTICIPANTS. DNA METHYLATION WAS MEASURED FROM EXTRACTED GENOME IC DNA FROM THE SAMPLES OBTAINED AND ANALYZ ANALYZED. WE USED FROM THE AREA DEPRIVATION INDEX FROM THE YEAR 2000. THIS INDEX WAS PUBLISHED BY DR. AMY KIND FROM THE UNIVERSITY OF WISCONSIN A SOCIO ECONOMIC INDEX THAT RATES IT AT THE CENSUS BLOCK GROUP LEVEL. IT HAS A HIGHER SPATIAL RESOLUTION THAN THE CENSUS TRACK TYPICALLY USED TO MEASURE DEPRIVATION IN OTHER STUDIES. SO THE INDEX REPRESENTS NATIONWIDE PERCENTILES BETWEEN 1 AND 100 AND 100 REPRESENTS HIGH DEPRIVATION AND IF YOU LOOK AT THE MAP THAT'S SEEN IN RED. WE LINKED THIS EXTERNAL INDEX TO PARTICIPANTS GEOCODED HOME ADDRESSES. FOR STATISTICAL ANALYSIS WE ESTIMATE THE MEAN DIFFERENCES AND CONFIDENCE INTERVALS BETWEEN OUR NEIGHBORHOOD DEPRIVATION INDEX AND FOUR EPIGENETIC METRICS USING LINEAR REGRESSION AND USED THE CASE COHORT AND EACH CLOCK METRIC WAS CONVERTED FOR COMPARABILITY ACROSS THE CLOCKS. THIS SHOWED THE QUARTILES OF NEIGHBORHOOD DEPRIVATION. OUR KEY FINDING WAS THOSE WITH THE GREATEST NEIGHBORHOOD DEPRIVATION HAD HIGHER EPIGENETIC AGE ACCELERATION COMPARED TO THOSE WITH THE LOWEST AND SAME FOR HANNUM AGE AND PHENOAGE BUT NOT THE SAME WITH THE HORVATH CLOCK. SECOND GENERATION CLOCKS WERE SHOWN TO EXHIBIT THE STRONGEST ASSOCIATIONS WITH THE P TEST FOR TRENDS LESS THAN .001. TO GIVE YOU AN IDEA, GRIM AGE WERE THE HIGHEST QUARTILE WE SAW A THREE-MONTH AGE ACCELERATION COMPARED TO THOSE IN THE QUARTILE OF NEIGHBORHOOD DEPRIVATION. IN SUMMARY, WE FOUND SECOND GENERATION CLOCKS AS A REMINDER THESE WERE CREATED FOR DISEASE MORTALITY AND PREDICTORS. THESE WERE HIGHLY SENSITIVE TO NEIGHBORHOOD DEPRIVATION AND OUR FINDINGS SUPPORT AND CONTRIBUTE TO THE KNOWLEDGE OF NEIGHBORHOOD DEPRIVATION AND AGE-RELATED DISEASES. I THINK OUR STUDY ADDS VALUE TO THE LITERATURE BECAUSE IT SHOWS EVIDENCE NEIGHBORHOOD DEPRIVATION IS MEASURED TO BIOLOGIC CHANGE WITH CAPABILITIES FOR PREDICTING AGE. I'D LIKE TO CLOSE WITH A BRIEF DISCUSSION OF THE STUDY LIMITATIONS AND FUTURE DIRECTIONS WE HAVE. YOU MAY HAVE NOTICED WE HAVE ASSESSED A GROUP OF NON-HISPANIC WHITE WOMEN AND HAVE CURRENT PLANS TO EVALUATE THIS ASSOCIATION IN A MORE DIVERSE SAMPLE. OUR SAMPLE WAS ALSO LIMITED TO PARTICIPANTS WITH HIGHER SOCIO ECONOMIC STATUS AND HAVE PLANS TO REPLICATE THE STUDY IN A DIFFERENT COHORT WITH MORE DIVERSE SOCIO STATUS BACKGROUNDS AND FINALLY WE LOOKED AT NEIGHBORHOOD DEPRIVATION BROADLY BUT INTERESTED IN EXPLORING GREEN SPACE, SOCIAL FACTORS COMPRISING THE NEIGHBORHOOD ENVIRONMENT IN RELATION TO EPIGENETIC AGING. I'D LIKE TO GIVE A BIG THANKS TO MY PRIMARY MENTOR AS WELL AS MY COLLABORATORS LISTED HERE. OF COURSE THE MATILDA WHITE RILEY COMMITTEE FOR THE WONDERFUL OPPORTUNITY AND GREAT HONOR AND MY FUNDING THROUGH NIEHS. IF YOU HAVE QUESTIONS FEEL FREE TO REACH OUT WITH MY E-MAIL LISTED HERE. THANK YOU. >> GREAT JOB. AND IF ANYONE IN OUR AUDIENCE HAS QUESTIONS FOR OUR ESIs, PLEASE FEEL FREE TO TYPE THEM IN THE CHAT BOX TO ALL IF AND WHEN THEY COME UP TO ENSURE ALL OUR ESIs HAVE EQUAL AMOUNTS OF TIME TO PRESENT WE'LL HAVE QUESTION AND ANSWERS AFTER THE LAST PRESENTATION. WE'LL HAVE DR. LI NIU AT THE ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI. >> THANK YOU FOR THE INTRODUCTION. IT'S MY GREAT HONOR TO RECEIVE THE EARLY STAGE INVESTIGATOR AWARD FROM NIH OBSSR. TODAY I'LL PRESENT MY RESEARCH INVESTIGATING CHILDHOOD MALTREATMENT AND SEXUAL RISK BEHAVIOR TRAJECTORIES AMONG RACIAL/ETHNIC MINORITIES. FIRST, STUDY BACKGROUND. ACCORDING TO CHILD PROTECTIVE SERVICES, NINE IN EVERY 1,000 WERE MALTREATED. THOSE RATES ARE HIGHER IN HOUSEHOLDS FROM LOWER INCOME AND MINORITIES AND WHEN THEY WERE ASKED TO REPORT 59% REPORTED HAVING EXPERIENCED SOME FORM OF CHILD MALTREATMENT. IT INCLUDES CATS OF ABUSE, PHYSICAL, EMOTIONAL AND SEXUAL ABUSE AS WELL AS CATEGORIES OF NEGLECT INCLUDING PHYSICAL NEGLECT. IT'S TYPES OF MALTREATMENT THAT CO-OCCUR AND 65% RECORDED EXPERIENCING A COMBINATION OF TWO OR MORE TYPES OF MALTREATMENT. CHILD MALTREATMENT HAVE PROFOUND COGNITIVE, PSYCHOLOGICAL AND HEALTH CONSEQUENCES. THIS CAN MANIFEST IN SEXUAL BEHAVIORS DURING ADOLESCENCE WHICH IS A KEY PERIOD OF SEXUAL DEVELOPMENT AND EXPLORATION. RESEARCH HAS LINKED CHILD MALTREATMENT IN PARTICULAR SEX ABUSE TO SEXUAL RISK BEHAVIORS INCLUDING EARLY SEXUAL ONSET AND, UNPROTECTED SEX, MULTIPLE SEXUAL PARTNERS. MALTREATMENT CAN DEVELOP THROUGH PATHWAYS INCLUDING IMPAIRED STRESS RESPONSE SYSTEMS, EARLY PUBERTY, AS WELL AS PSYCHOLOGICAL PATHWAYS INCLUDING ATTACHMENT PROBLEMS, POST-TRAUMATIC STRESS DISORDER AND LOW SELF-EFFICACY AND WE KNOW THAT SEXUAL RISK BEHAVIOR TYPICALLY INCREASES AT THIS STAGE OF EXPLORATION AND CHANGING RELATIONSHIPS AND THEN IT DECREASES AS YOUTH FORM MORE COMMITTED AND LONGER TERM RELATIONSHIPS. TO MOST PEOPLE THIS BEHAVIORS ARE LIMITED TO ADOLESCENTS. HOWEVER, SOME HAVE CHALLENGES NAVIGATING THROUGH THIS DEVELOPMENT TASK. THEIR SEXUAL RISK BEHAVIOR MAY CONTINUE TO INCREASE THROUGHOUT ADOLESCEN ADOLESCENCE. SO IN THIS STUDY I ANSWERED TWO KEY QUESTIONS. WHAT ARE PROFILES OF MALTREATMENT CONSIDERING TYPES, FREQUENCY AND CO-OCCURRENCE AND THEN ARE MALTREATMENT PROFILES ASSOCIATED WITH DIFFERENT TRAJECTORIES OF SEXUAL RISK BEHAVIORS IN ADOLESCENCE. WE USED DATA FROM A LONGITUDINAL STUDY OF 882 ADOLESCENT GIRLS OF COLOR ATTENDING AN ADOLESCENT HEALTH CLINIC IN NEW YORK CITY. PARTICIPANT WERE BETWEEN 15 AND 21 YEARS UP TO AGE 25. THE MAJORITY OF THE PARTICIPANTS WERE FROM RACIAL MINORITY BACKGROUNDS AND ALSO LOW INCOME FAMILIES. FOR THE MEASURES, CHILD MALTREME -- MALTREATMENT WAS VALIDATED WITH A QUESTIONNAIRE AND SCORES WERE CALCULATED FOR EACH OF THE FIVE ABUSE AND NEGLECT TYPE AND AT THE STUDY VISIT PARTICIPANTS REPORTED ON SIX BEHAVIORS INCLUDING NOT USE CONDOM AND SEX INVOLVING ALCOHOL AND IN RETURN FOR MONEY OR WITH A PARTNER FIVE YEARS OR OLDER. WE USED A SET OF COVARIATES WITH DEMOGRAPHICS, DEPRESSION AND BODY MASS INDEX. WE DID AN ANALYSIS WE USED LATENT PROFILE ANALYSIS TO IDENTIFY MALTREATMENT PROFILES AND USED GROWTH CURVE MODELS TO DETERMINE HOW THEY'RE ASSOCIATED WITH AGE-BASED CHANGES IN SEXUAL RISK BEHAVIOR AROUND 13 TO 23 YEARS. OUR STUDY SHOWS FOUR MALTREATMENT PROFILES. IN THIS FIGURE THE FOUR PROFILE SHOWN ON THE AXIS THEN THE Y AXIS SHOWS HOW HIGH EACH SCORED ON EACH OF THE FIVE ABUSE AND NEGLECT SUB SCALES. LETTERS L AND S INTERPRET SEVERITY OF EXPOSURE. WE FOUND THAT 76% OF THE SAMPLE EXPERIENCED NONE TO LOW MALTREATMENT. 15% REPORTED MODERATE EMOTIONAL NEGLECT. 3% REPORTED SEVERE PHYSICAL AND EMOTIONAL ABUSE WITH CO-OCCURRING SEXUAL ABUSE AND NEGLECT AND FINALLY 6% REPORTED SEVERE SEXUAL ABUSE AS WELL AS OTHER TYPES OF ABUSE. WE THEN USED THIS IDENTIFY PROFILES TO ESTIMATE OF SEXUAL RISK BEHAVIOR AS WE CAN SEE IN THE UNCONDITIONAL GROWTH MODEL THE PARTICIPANTS HAVE AN AVERAGE OF ONE SEXUAL RISK BEHAVIOR ON AVERAGE. THERE'S A LINEAR INCREASE OF .35 MORE RISK BEHAVIORS PER YEAR AND WE SEE THAT GROWTH DECELERATED OVER TIME. IN THE CONDITIONAL MODEL WE SEE COMPARED TO THE LOW MALTREATMENT PROFILE GIRLS WHO WERE EXPOSED TO EMOTIONAL NEGLECT IN THE YELLOW BOX REPORTED MORE SEXUAL RISK BEHAVIOR THAN A REFERENCE GROUP. THE TOOLBOX SHOWS A GROUP OF SEXUALLY ABUSED GIRLS WHO ALSO EXPERIENCED ALL OTHER TYPES OF ABUSE REPORTED HIGHER SEXUAL RISK BEHAVIOR AS WELL AS A FASTER INCREASE OVER TIME COMPARED TO THE REFERENCE GROUP. THIS PATTERN REMAINED AFTER ADJUSTING FOR DEMOGRAPHIC CHARACTERISTICS, DEPRESSION, AGE AND BODY MASS INDEX. IN SUMMARY OUR DATA HAD FOUR MALTREATMENT PROFILES OF RACIAL, ETHNIC, MINORITY FEMALE ADOLESCENTS. OUR FINDINGS HIGHLIGHTED THE CRITICAL ROLE OF UNDERLYING MALTREATMENT IN SUBSEQUENT AND LOSS OF THE EMOTIONAL RESPONSIVENESS MAY LEAD TO INSECURE ATTACHMENT AND LOW SELF-EFFICACY WHICH THEN PRECIPITATE THE ONSET OF RISKY PATTERN OF SEXUAL BEHAVIOR DURING ADOLESCENCE. IN SEXUALLY ABUSED GIRLS ALSO EXPERIENCED OTHER TYPES OF ABOWS. OUR FINDING IS CONSISTENT WITH THE LITERATURE SUGGESTING THESE VICTIMS HAVE WORSE OUTCOMES AND CONSISTENT WITH THE LARGER LITERATURE ON IMPACT OF SEXUAL ABUSE. SEXUALLY ABUSED GIRLS MAKE UNIQUE RISK FACTORS INCLUDING FEELINGS OF PHYSICAL AND COGNITIVE ISSUES AND STIGMA LEADING THEM TO BE VULNERABLE ON SEXUAL BEHAVIOR AND IT'S A SERIOUS HEALTH ISSUE. UNDERSTANDING HETEROGENEITY WITHIN THE MALTREATED POPULATION CAN FORM TARGETED INTERVENTIONS. FOR EXAMPLE, IN CLINICAL AND RESEARCH SETTINGS, BETTER AND MORE COMPREHENSIVE TOOLS ARE NEEDED TO IDENTIFY MALTREATMENT EXPOSURE AND THEIR AFFECTS. ALSO EFFECTIVE HOUSING INTERVENTIONS NEED TO OCCUR PARTICULARLY AMONG YOUTH WITH A HISTORY OF MALTREATMENT. GIVEN THAT SEXUALLY ABUSED GIRLS HAVING THE WORSE OUTCOMES WILL BENEFIT FROM ADDITIONAL MENTAL AND HEALTH SERVICE TO MITIGATE THE AFFECTS TO AVOID PATTERNS OF SEXUAL RISK TRAJECTORIES. I'M INTERESTED IN EXAMINING UNIQUE FINDING ASSOCIATED WITH PROFILES OF CHILD MALTREATMENT INCLUDING PEER EXPOSURE, STRESS AND I PLAN TO EXPLORE HOW PROTECTIVE FACTORS SUCH AS SUPPORTIVE NEIGHBORHOOD AND SCHOOL ENVIRONMENT MAY HELP MITIGATE THE IMPACT OF CHILD MALTREATMENT. FINALLY, I'M INTERESTED IN SEEING HOW THIS AFFECT THIS DEVELOPMENT ACROSS THE SPAN OF ADOLESCENCE. I WOULD LIKE TO THANK MY AMAZING MENTORS FOR THEIR SUPPORT I THANK MY WONDERFUL CO-AUTHORS FOR THEIR PASSION AND EXTENSIVE KNOWLEDGE AND EXPERTISE AND SPECIAL THANKS TO THE FUNDER FOR MAKING THIS WORK POSSIBLE. THANK YOU SO MUCH FOR YOUR TIME AND ATTENTION. >> IF YOU HAVE QUESTIONS FOR DR. YUI TYPE THEM IN THE BOX AND I'LL POSE THEM LATER TO THE ENTIRE GROUP. NOW, INOW, I'D LIKE TO PRESENTNYUI TYPE THEM IN THE BOX AND I'LL POSE THEM LATER TO THE ENTIRE GROUP.NOW, I'D LIKE TO PRESENTI TYPE THEM IN THE BOX AND I'LL POSE THEM LATER TO THE ENTIRE GROUP.NOW, I'D LIKE TO PRESENT YOU DR. GOODWIN AT NORTHEASTERN UNIVERSITY COLLEGE. >> THANK YOU FOR THE HONOR AND FOR THE OPPORTUNITY TO SHOW THE WORK TODAY MYSELF AND COLLEAGUES ARE DOING TRY TO PREDICT CHALLENGING BEHAVIORS IN INDIVIDUALS WITH AUTISM USING WEARABLE BIOSENSORS AND MACHINE CLASSIFIERS. AGGRESSIVE BEHAVIOR WITH YOUTH FROM AUTISM CAN COMPROMISE THE ABILITY TO ENGAGE IN EDUCATIONAL AND OTHER ACTIVITIES EXACERBATING MORBIDITY AND COSTS FOR THOSE INDIVIDUALS AND FAMILIES. AS MANY AS AS TWO-THIRDS WITH YOUTH WITH AUTISM DISPLAY AGGRESSION. AGGRESSION CAN PRESENT SAFETY RISKS FOR THE INDIVIDUAL WITH AUTISM AND OTHERS IN THE ENVIRONMENT AND FAMILIES REPORT AGGRESSION INCREASES THEIR STRESS, THEIR ISOLATION AND THEIR FINANCIAL BURDEN AND CAN DECREASE AVAILABLE SUPPORT OPTIONS. IN ADDITION TO FAMILIES, WE HAVE REPORTS THAT THERE'S HIGHER STAFF BURNOUT AND CLAIMS FOR INSURANCE COMPENSATORY PAYMENT. IT'S ALSO DIFFICULT FOR CARE PROVIDERS. THIS IS IMPAIRING IN THE 30% TO 40% OF YOUTH WITH AUTISM MINIMALLY VERBAL. THEIR INABILITY TO SELF-REPORT STRESS CAN SEEM TO OCCUR WITHOUT WARNING AND SOMETIMES LONG AFTER ANY OBSERVABLE TRIGGER. THE FIGURE ON THE RIGHT IS REALLY OUR CONCEPTUAL MODEL. INSTEAD OF THINKING OF THIS BEHAVIOR AS ESCAPE OR AVOIDANT OR OPPOSITIONAL OR DEFIANT OR FORENSIC, WE WOULD LIKE TO RECONCEPTUALIZE THIS MORE AS STRESS COPING AND EMOTIONAL DYSREGULATION. SUCH AS IF SOMETHING TRIGGERS AN INDIVIDUAL WITH AUTISM TO EXPERIENCE DISTRESS WE'RE HYPOTHESIZING THAT HAS PHYSIOLOGICAL AROUSAL IF ONE CAN REGULATE THAT EXPERIENCE THEY HAVE NO REASON TO RETURN TO AGGRESSION AND RETURN TO EQUAL LIB RUM AND YOU CAN SEE A NEGATIVE FEEDBACK LOOP WHERE IN AROUSAL INCREASES AGGRESSION AND AGGRESSION INCREASES AROUSAL AND THE SITUATION GETS WORSE. AUTISM IS PREVALENT AND HAVE LITTLE KNOWLEDGE AND TREATMENT OPTIONS FOR INDIVIDUALS WITH AUTISM MORE SEVERAL IMPACTED. THOSE NON VERBAL AND HAVE INTELLECTUAL DISABILITY AND ENGAGE IN CHALLENGING BEHAVIORS. THERE'S UNDER REPRESENT FROM THE SEGMENT OF THE SPECTRUM IN LARGE DATA REPOSITORIES. WE HAVE HAD A UNIQUE OPPORTUNITY TO RECRUIT FROM THE AUTISM END-PATIENT COLLECTION. THIS IS AN INITIATIVE FUNDED BY THE SIMONS FOUNDATION AND MARKS FAMILY FOUNDATION WHICH IS PROVIDING SUPPORT FOR A VARIETY OF DIFFERENT SPECIALIZED PSYCHIATRIC PATIENT UNITS WITH HIGH REFERRAL RATES WITH INDIVIDUALS WITH AUTISM WHERE WE CAN IMPLEMENT A STANDARD DATA COLLECTION INFRASTRUCTURE THAT LETS US GATHER LARGE AMOUNTS OF STANDARDIZED DATA TO BETTER UNDERSTAND THIS UNDER STUDIED SEGMENT OF THE UNDER STUDIED POPULATION. FOR THE WORK I AM PRESENTING TODAY, I THINK THE IN-PATIENT SETTING IS AN IDEAL PLATFORM FOR US TO SAFELY AND SYSTEMATICALLY IDENTIFY MECHANISMS THAT MAY BE UNDERLYING EMOTIONAL AND BEHAVIORAL SYMPTOMS AND MAY INFORM INTERVENTION. THE FACT THAT WE ARE COLLECTING THIS DATA IN SITU IN REAL WORLD SETTING HELPS INCREASE THE SAFETY GIVEN THE STAFF AND CONTROL OVER ENVIRONMENTAL FACTORS BUT ALSO LIKELY TO BETTER GENERALIZE TO REAL WORLD SETTINGS BECAUSE THAT'S WHERE THE RESEARCH IS TAKING PLACE. WE'RE USING TWO PRIMARY SOURCES OF INFORMATION. PARTICIPANTS IN THE STUDY THE END PATIENTS ARE WEARING A BIO SENSOR AND IT'S WIRELESS RISK WARN IT RECORDS MEASURES OF CARDIOVASCULAR AROUSAL AND MEASURES THREE AXISAL SELL RATION TO GIVE A SENSE OF MOTOR AND PHYSICAL ACTIVITY AND MEASURES TEMPERATURE AND HEAT FLUX GIVING YOU SKIN SURFACE TEMPERATURE AND THEN RECORDS ELECTRODERMAL ACTIVITY OR SKIN CONDUCTANTS A MEASURE OF AROUSAL. AT THE SAME TIME A RESEARCH ASSISTANT OBSERVING THE STUDY PARTICIPANTS AND THE CLINICIANS SUPPORTING THEM HAVE A MOBILE APPLICATION WHERE THEY CAN RECORD ON SET AND OFF SET OF AGGRESSION AND SELF INJURYIOUS BEHAVIOR AND IT ENABLES TO LOOK AT ONSET AND DURATION OF THE BEHAVIORS AND ACCOMPANYING PHYSIOLOGICAL ACTIVITY BEFORE AND AFTER AN INDICATION OF THE BEHAVIORS. GIVEN PREVAILING LITERATURE IN BIPOLAR DISORDER AND ANTISOCIAL BEHAVIOR THAT HAVE THEORIES OF AUTISM THAT INCREASED ANXIETY OR AROUSAL MAY BE RELATED TO CHALLENGING BEHAVIORS. WE HAVE HYPOTHESIZED PHYSIOLOGICAL AROUSAL PRECEDES AGGRESSIVE BEHAVIOR AND WE WANT TO TEST WHETHER THE PROXIMAL ONSET CAN BE DETECTED USING THE WEARABLE BIO SENSORS AND MACHINE LEARNINGAGE -- LEARNING ALGORITHMS. THE PAPER IS FROM ONE CLINICAL SITE FROM MAINE HEALTH. THERE WERE 20 STUDY PARTICIPANTS WITH AUTISM. WE WERE ABLE TO GATHER AND THE DURATION WAS 27 EPISODES IN A FOUR HOUR PERIOD LASTING ABOUT 30 SECONDS EACH OBSERVED BY THE RESEARCH ASSISTANT. THE STUDY ON THE LEFT IS OUR FIRST ATTEMPT OF ANALYZING THIS DATA IN THE NF20 AND USING LOGISTIC REGRESSION USING A 15 SECOND SLIDING WINDOW LOOKING FOR VARIABILITY AND SIGNAL IN TIME LEADING UP TO THE CHALLENGING BEHAVIOR. WE USED REGULARIZED REGRESSION IN A POPULATION MODEL WHERE DATA IS TRAINED AND TESTED WITH INDIVIDUALS AND THEN AN INDIVIDUAL MODEL WHEREIN WE TRAIN AND TEST ON ONE INDIVIDUAL'S DATA AND TEST IN THE FUTURE. WE FOUND THAT THREE MINUTES OF PRIOR SENSE DATA PREDICTED ONE MINUTE IN THE FUTURE WITH 71% ACCURACY AND THREE MINUTES IN THE PAST PREDICTED WITH 84% ACCURACY WHEN WE USED UPDATED MODELS. THE PAPER CONSIDERED FOR DISCONSIDERATION USED SUPPORT VECTOR MACHINES AND WE WERE ABLE TO DEMONSTRATE THAT TWO TO THREE MINUTES OF PRIOR DATA ENABLED US TO MAKE A PREDICTION THREE MINUTES IN THE FUTURE WITH 98% ACCURACY WHETHER A POPULATION OR INDIVIDUAL MODEL WAS USED. IT YIELDS PREDICTION PERFORMANCE SO 98% PREDICTION ACCURACY VERSUS 84% IN THE LOGISTIC REGRESSION. THE POPULATION INDIVIDUAL SUPPORT MACHINE MODELS PRESENTED SIMILAR PERFORMANCE WHICH WAS NOT THE CASE IN LOGISTIC REGRESSION. THERE WAS BETTER ACCURACY IN PERSON-DEPENDENT THAN GENERALIZED AND THE GENERALIZED CLASSIFIER WOULD HAVE POTENTIALLY MORE GENERALIZABILITY THAN PERSON-DEPENDENT TRAINING AND THAT'S BETTER THAN THE LOGISTIC REGRESSION. IT ALSO DEMONSTRATED WE CAN MAKE PREDICTS SO THREE MINUTES IN THE FUTURE VERSUS ONLY ONE MINUTE WITH LOGISTIC REGRESSION. THERE'S PROMISE PREDICTING REGRESSION IN AUTISM AND A FEEL AND MY COLLABORATORS FEEL THIS LAYS THE GROUND WORK FOR EXPANDING DATA COLLECTION ON PRECURSOR BEHAVIORS ASSOCIATED WITH AGGRESSION AND UNDERSTANDING WHAT INTEREST THE TRIGGERS THAT PRECEDE PHYSIOLOGY THAT PRECEDES BEHAVIOR AND FUTURE DEVELOPMENT OF JUST IN TIME ADAPTIVE INTERVENTION MOBILE HEALTH SYSTEMS WHERE WE MAY BE ABLE TO ENABLE NEW OPPORTUNITIES FOR INTERVENTION PRIOR TO BEFORE A DISTRESS TO PREEMPTIVE INSTEAD OF CONSEQUENTIAL INTERVENTIONS MORE TYPICAL IN THE FIELD CURRENTLY AND WITH INPUT WITH PARENTS AND PROVIDERS YOU CAN DISPLAY REAL TIME RISK AND PROMPT FOR DE-ESCALATION WHERE IT OCCURS AND COMBINING WITH TREATMENT MODEL TO SEE IF IT FURTHER ENHANCES REGRESSION REDUCTION. MANY HAVE SIDE EFFECTS ASSOCIATED WITH MEDICATIONS. SEEING IF WE CAN ENABLE PREEMPTIVE AND BEHAVIORAL INTERVENTIONS THAT HAVE FEWER SIDE EFFECTS BUT MIGHT BE SIMILAR OR MORE EFFICACIOUS WOULD BE A WORTHWHILE PURSUIT. WE ALSO THINK UNCOVERING PHYSIOLOGICAL PROFILES RELATING TO AGGRESSION IN NATURALISTIC SETTINGS MAY ENHANCE CLINICAL TRIALS IN PRECISION MEDICINE IN A VARIETY OF WAYS TO PRODUCE DIGITAL BIOMARKER TO BETTER DEFINE ENDO PHENOTYPES AND TO HELP DETERMINE IF PHARMACEUTICALS SIMPLY ACT AS A SEDATIVES THAN PHYSICAL AROUSAL WITH AGGRESSION. WE'RE ACTIVELY CONTINUING THE LINE OF RESEARCH AND WE HAVE A SYSTEM WE ARE SOON TO FIELD TRIAL WHERE WE CAN PUSH REAL TIME AGGRESSION TO A MOBILE PHONE TO THE CLINICIAN AND WE'RE GOING TO DO A MIND TRIAL WHERE 50% OF THOSE WILL COME FROM THE CLASSIFIER AND WE WANT TO SEE WHAT IS THE AFFECT OF THE ALERTS ON BEHAVIOR OBSERVED IN THE STUDY PARTICIPANTS. IN THE FUTURE IF EFFICACIOUS WE COULD ASK CAREGIVERS TO MONITOR THE ALERTS AND INITIATE DE-ESCALATION OR EMOTION INTERVENTIONS BEFORE THEY OCCUR. STARTING IN THE END PATIENT BUT UPON DISCHARGE MOVING THIS OUT TO OUT PATIENT AND SEE HOW WELL PARENTS CAN REACT TO SUPPORT THEIR CHILDREN. EXPANDING FROM AGGRESSION TO ALSO LOOK AT SELF-INJURIOUS BEHAVIOR AND EMOTION DYSREGULATION WITHOUT AGGRESSION AS A MULTI-CLASS REGRESSION AND OUR FINDINGS IS WE HAVE 80% ACCURACY THREE MINUTES OUT HOLDING IN THE END OF 70 FOR ALL THREE CLASSES OF BEHAVIOR. GRESSION AND THERE'S I RUNNING COUNTER OF A PROBABILITY OF AN EVENT NOT ONLY SAYING IT'S LIKELY WITHIN THE NEXT THREE-MINUTE INTERVAL BUT AS ONE GETS CLOSER TO ENGAGING IN THIS BEHAVIOR AND THE PROBABILITY. I'M GRATEFUL FOR THE FAMILIES AND PARTICIPANTS IN THE STUDY. AND ALSO THE ADMINISTRATIVE STAFF AND RESEARCH STAFF AND PRIMARY INVESTIGATORS AT THE UNIVERSITY OF PITTSBURGH AND MAINE MEDICAL AND A WANT TO THANKS FUND FROM THE DEPARTMENT OF DEFENSE AND NATIONAL SCIENCE FOUNDATION, NIDCD, SCIENCE FOUNDATION AND OTHERS THANK YOU FOR YOUR ATTENTION. >> THANK YOU FOR A GREAT PRESENTATION, MATTHEW. IF YOU HAVE QUESTIONS SEND THEM IN AND THANK YOU TO THOSE WHO SENT THEM IN. AND NOW STEPHANIE WILSON AT SOUTHERN METHODIST UNIVERSITY PROFESSOR OF PSYCHOLOGY. WELCOME. THIS IS ON SPOUSAL BEREAVEMENT AFTER DEMENTIA CARE GIVING. LOSING A SPOUSE CAN INCREASE RISK OF EARLIER DEATH THIS IS SOMETHING WE'VE KNOWN FOR YEARS WHETHER IT'S MORTALITY OR CARDIOVASCULAR DISEASE RELATED OR INFECTIOUS DISEASE RELATED OR CARDIOVASCULAR EVENTS. WE KNOW THE PERIOD SEVERAL MONTHS AFTER ONE LOSES A SPOUSE IS A RISKIER TIME. THIS WAS DISCOVERED IN THE '70s AND 80s AND SPLASHED THE HEADLINES OF THE WIDELY READ JOURNALS AND CONTINUED TO INTRIGUE RESEARCHERS ACROSS MANY DIFFERENT SCHOOLS AND IMMUNE PEOPLE HAD POORER YUM FUNCTION THAN A NON-BEREAVED CONTROLS THE LITERATURE IS NOT PAYING AS MUCH AS ATTENTION TO THE CONTEXT OF THE DEATH. WHEN YOU HEAR THE TERM BEREAVEMENT I WONDER WHAT IS CONJURED IN YOUR MIND. IS IT A SUDDEN LOSS, HEART ATTACK, SURGICAL COMPLICATIONS AN ACCIDENT, MAYBE? DEATH FROM ALZHEIMER'S HAS INCREASED 145% SO THE LIKELIHOOD IS HIGH AND INCREASING THAT PEOPLE ARE EXPERIENCING SPOUSAL BEREAVEMENT AFTER SERVING IN A CARE GIVING RIDE AND IN SOME CASES IN DECLINE DIFFERENT FROM THE EXPERIENCE OF A MORE SUDDEN DEATH. THERE'S A LANDMARK PAPER IN TERMS OF THE DEPRESSIVE SYSTEMS AND BEREAVEMENT WE'RE SEEING A GREAT CHARACTERIZATION OF PSYCHOSOCIAL EXPERIENCE OF CAREGIVERS AND THIS WAS ON A SCALE WHERE 16 IS THE CLINICAL CUT OFF. WE CAN SEE CAREGIVERS AT THE POINT OF BEREAVEMENT ARE SEVERAL POINTS ABOVE THAT CLINICAL CUT OFF AND QUICKLY RECOVER OVER THE COURSE OF THE FIRST SEVERAL WEEKS. FOR CAREGIVERS THERE'S TWO PROCESSES GOING ON. FIRST THE EXPERIENCE OF CARE GIVING, THE EXPERIENCE OF DECLINE AND PERHAPS ANTICIPATORY GRIEF AND THE EXPERIENCE OF THE PHYSICAL LOSS AND WHAT WE HAVE CAN BE VERY DIFFICULT IN THE BEREAVEMENT WORK SO YOU CAN CAPTURE PEOPLE BEFORE THE PHYSICAL LOSS AND WHAT WE HAVE IN TERMS OF IMMUNE DATA IS THIS SUBSEQUENT TRAJECTORY THAT HAPPENS AFTER THE LOSS. REALLY THE MEANING OF THE TREND ESPECIALLY FOR CAREGIVERS AND THOSE HAVING DEMENTIA EXPERIENCE BEFORE HAND DEPENDS ON WHAT CAME BEFORE IT. THERE'S NO RISE AND NO ANTICIPATORY UPTICK AND THERE'S SUDDEN REACTION OF DISTRESS THAT'S MARKED WITH A SLOW AND INCOMPLETE RECOVERY OVER TIME. THERE AN INDICATION OF IMMEDIATE RELIEF OR A COMBINATION. THERE IS AN ESCALATION OF STRESS AS THE DEATH APPROACHES AND MODEST REACTION IN TERMS OF PHYSICAL LOSS FOLLOWED BY RECOVERY. THE STUDY WAS INTERESTED IN EXAMINING IMMUNE FUNCTION IN SELF-RATED HEALTH AS A RELEVANT COROLLARY BEFORE AND AFTER SPOUSAL CARE AND WE WERE INTERESTED IN IDENTIFYING A POTENTIALLY MODIFIABLE PROTECTIVE FACTOR. WE IDENTIFIED SOCIAL INTEGRATION AND NETWORK AS A FACTOR AND COLLEAGUE IDENTIFIED THIS AS A STRONGER FACTOR THAN ABSTAIN FROM SMOKING, BEING PHYSICALLY ACTIVE AND MAINTAINING BMI IN TERMS OF MAGNITUDE OF PROTECTION AGAINST MORTALITY. THE DATA CAME FROM A LARGER LONGITUDINAL STUDY OF CAREGIVERS WHO EXPERIENCED BEREAVEMENT IN THE COURSE OF THE STUDY. THEY HAD TO HAVE EXPERIENCE BEREAVEMENT AND HAD TO HAVE THREE ANNUAL DATA POINTS IN THE COURSE OF THAT AND RESULTED IN DATA IN LOSS AND 52 CAREGIVERS. THEY WERE ON AVERAGE AGE 70 RANGE FROM 50 TO 88 AND MOST WERE FEMALE AS IS TRUE OF THE LARGER CARE GIVING POPULATION. MOST WERE WHITE AND MOST WERE EDUCATED. THEY PROVIDED ASSESSMENT OF THE INTEGRATION AND THE NUMBER OF PEOPLE WHOM THEY HAD CONTACTS DID IT AS A MEASURE OF SOCIAL NETWORK SIZE AND FOCUSSING ON PRE-BEREAVEMENT NETWORK SIZES HERE AND AN ASSESSMENT OF HEALTH, POOR, FAIR, GOOD, EXCELLENT AND A MEASURE THAT IS SENSITIVE BOTH TO PHYSICIAN DIAGNOSED ILLNESSES AND TO PRE-CLINICAL CHANGES IN HEALTH WHICH MAKES IT A GOOD MEASURE FOR US. THE MEASURE OF IMMUNE FUNCTION IS THE BLASTOGENIC RESPONSE TO TWO MITOGENS THIS IS IMMUNE SELLS OF LYMPHOCYTE PROLIFERATION AND A MEASURE OF IMMUNE FUNCTION AND RESPONSE TO A CHALLENGE AND HIGHER LEVELS INDICATE A MORE ROBUST AS STRONG OR MORE FAVORABLE IMMUNE RESPONSE. WE LOOK AT MODEL TO BREAK UP THE HEALTH TRAJECTORIES IN PRE-LOSS AND POST-LOSS AND EXAMINED THREE MAJOR COMPONENTS OF THE MODELS. FIRST IS THE DEGREE TO WHICH EACH SLOPE WAS DIFFERENT FROM ZERO SO WE'RE ASSESSING WHETHER IT'S SIGNIFICANTLY POSITIVE OR NEGATIVE WHETHER THEY WERE DIFFERENT FROM EACH OTHER WHETHER THEY THERE WAS A SIGNIFICANT TURNING POINT IN THE COURSE OF HEALTH. AND WHETHER THERE WAS A SIGNIFICANT DISCONTINUITY A DROP OR UPTAKE AT THE POINT OF PHYSICAL LOSS. SO WHAT WE FOUND IN TERMS OF AVERAGE TRAJECTORIES CAREGIVERS TENDED TO DECLINE IN HOW WELL THEY FELT AS THE LOSS APPROACHED BUT THERE WAS AN IMMEDIATE REBOUNDING THAT HAPPENED AT THE POINT OF THE LOSS AND LEVELLING OFF FROM THERE. THIS INCREASE IS ABOUT 33%. THE RESTORED CAREGIVERS HEALTH TO WHAT THEY DESCRIBED AS GOOD. WE COVARIED FOR BMI, SEX AND CHRONIC CONDITIONS. WHEN WE BREAK IT DOWN BY SOCIAL NETWORKS THEY'RE SIMILAR UNTIL AFTER THE DEATH WHEN THEY BEGIN TO DIVERGE. THEY MANAGE TO MAINTAIN NETWORKS PRIOR TO BEREAVEMENT ABOUT 30 TIES OR SO IN THE NETWORK. THEY CONTINUED TO STEADILY IMPROVE IN HOW HEALTHY THEY FELT AND IMPROVING BEYOND WHAT THEY EXPERIENCED IN THE TWO YEARS PRIOR. THOSE WITH SMALLER NETWORKS 12 TIES DID NOT EXPERIENCE SUCH CONTINUED BENEFITS AFTER THE LOSS. WE SAW SIMILAR DECLINES IN IMMUNE FUNCTION ON AVERAGE THAT PARALLELED THAT TREND BEFORE THE LOSS IN SELF-RATED HEALTH WE SAW BUT RATHER THAN A SUDDEN IMPROVEMENT WE SAW A SUDDEN DETRIMENT IN THE INITIAL PERIOD AND SLOWER DECLINE AND THE DWE CLAIM THAT FOLLOWED -- DECLINE THAT FOLLOWED SLOWED AND THE TRAJECTORIES FOR PHA WERE SIMILAR SO WE'RE JUST FOCUSSING ON THE DATA BECAUSE THEY LOOK SIMILAR. WE SEE THE IMMUNE FUNCTION DROP IS DRIVEN BY THOSE WITH LARGER NETWORKS. SO THIS TIME LIMITED DROP SEEMS TO REFLECT PERHAPS ENOR TIF -- ENORMATIVE RESPONSE AND THE RISK IS CONDENSED WITH ROBUST SOCIAL RESOURCES AND ISOLATED CAREGIVERS SHOW NO IMMUNE RESPONSE WITH THE LOSS OF THEIR SPOUSE BUT STEEP AND STEADY DECLINES ACROSS THE ENTIRE PERIOD. IN CONCLUSION IT LOOKS AT TRAJECTORIES OF IMMUNE FUNCTION IN SELF-RATED HEALTH BEFORE AND AFTER BEREAVEMENT AND THAT PERIOD LEADING UP TO THE LOSS WE DID DETECT DECLINES IN BOTH IMMUNE FUNCTION AND SELF-RATED HEALTH WHICH MAY PLAY INTO GRIEF OR IMMUNE FUNCTION OR A MIX AND THESE WERE DISTINGUISHED BY NETWORKS BEFORE THE LOSS. HAVING A LARGER SOCIAL NETWORK BEFORE THE LOSS MITIGATED THIS AND INTERESTINGLY THE SUDDEN DROP IN IMMUNE FUNCTION OCCURRED WITH THOSE WITH MORE SOCIAL RESOURCES IT MAY POINT TO WHAT IS ENOR TIF RESPONSE TO BEREAVEMENT BUT SORE SOCIALLY ISOLATED CAREGIVERS THE GREATEST DECLINES HAPPENED OUTSIDE THAT BEREAVEMENT WINDOW WHICH SUGGESTS WE SHOULD WIDEN OUR MEASUREMENT WINDOW TO CAPTURE THE FULL VIEW OF THE PROCESS AMONG VULNERABLE CAREGIVERS IN PARTICULAR. IT LOOKED AT BEREAVEMENT AND THE NECESSITY OF COLLECTING DATA TO MAKE SENSE OF THE TRAJECTORIES WITH IN PERSON AND TAKING INTO ACCOUNT THE CAUSE OF DEATH AND CAREGIVER ROLE. ULTIMATELY WE MAY BE ATTRIBUTING LINGERING AAFFECTS AND MAY LOOK AT A MIXTURE IN A GIVEN SAMPLE AND THE RISK WINDOW MAY BE ASSOCIATED WITH A LONGER DEATH PROCESS THAT MAY OCCUR BEFORE THE PHYSICAL LOSS FOR CAREGIVERS. THIS WORK IS SITUATED WITHIN THE LARGER PROGRAM OF RESEARCH THAT SEEKS TO INTEGRATE THEORETICAL PERSPECTIVES FROM LIFE SPAN DEVELOPMENT AND HEALTH PSYCHOLOGY TO UNDERSTAND CLOSE RELATIONSHIP AFFECTS OF HEALTH. HERE BEREAVEMENT APPEARS TO REPRESENT A SENSITIVE PERIOD WHERE SOCIAL TIES ARE IMPORTANT FOR THE COURSE OF FORMER CAREGIVERS' LONG TERM HEALTH AND WE LOOKED AT THE INTERSECTION OF SOCIAL AND EMOTIONAL AGING AND BIOLOGICAL AGING OF ADULT COUPLES OF ALL AGES AND INTERESTED IN TRACING HOW THESE PLAY OUT IN DIADS USING ADVANCED STATISTICAL METHODS AND ULTIMATELY I AIM TO IDENTIFY TARGETS FOR PREVENTION AND INTERVENTION THAT ALLO -- ALLOW US TO MAXIMIZE OUR HEALTHY YEARS. THANKS VERY MUCH TO MY CO-AUTHORS. MANY THANKS TO MY GRADUATE AND POST-DOC MENTOR AND TO THE NIH FOR THE WONDERFUL FUNDING SUPPORT. PLEASE VISIT MY WEBSITE HERE OR FEEL FREE TO SEND ME AN E-MAIL AT THE BELOW E-MAIL ADDRESS. THANK YOU VERY MUCH. >> THANK YOU. CAN YOU BRING UP ALL OF OUR ESIs ON VIDEO AND VOICE, PLEASE. I HOPE IF YOU DON'T MIND IF I START THE FIRST QUESTION WITH YOU. DID SOCIAL NETWORK SIZE CHANGE AS A FUNCTION OF BEREAVEMENT? >> SOCIAL NETWORK SIZE CHANGED AS A FUNCTION OF THE LOSS. SOCIAL NETWORKS SHRUNK AS THE PHYSICAL LOSS APPROACHED AND REBOUNDED THEREAFTER. WE LOOKED AT THIS SEPARATELY PRE AND POST SOCIAL NETWORK SIZE AND ACTUALLY FOUND OUT SURPRISINGLY POST-LOSS SOCIAL NETWORK SIZES DIDN'T ADD PREDICTIVE VALUE BEYOND PRE-LOSS SOCIAL NETWORK SIZE. TO UNDERSTAND THE TRAJECTORIES IT'S IMPORTANT TO HAVE THE INFORMATION BEFORE AND ALSO POSSIBLY SUGGESTS THAT BEFORE BEREAVEMENT IS A GOOD TIME TO INTERVENE WITH LONG-TERM BENEFIT. >> I APPRECIATED YOUR WORK AND A WONDER IF YOUR FINDINGS, WHICH ARE SIMILAR TO OTHERS ARE SUFFICIENTLY REPLICATED TO BE SHARED WITH DEMENTIA SPOUSES AND OTHER CLOSE CAREGIVERS OR ARE WE JUST NOT THERE YET? WE'RE SHOWING A DEGREE OF RECOVERY WITH IMMUNE PUBLIC HEALTH AND SELF-RATED HEALTH THAT HASN'T BEEN SEEN. WE'VE SEEN THERE'S GREAT RESILIENCE AMONG CAREGIVERS AFTER THE PHYSICAL LOSS. THERE'S A SUBSET OF CAREGIVERS AT RISK FOR LONG-TERM ADJUSTMENT PROBLEMS AND I WOULD AS A CONSERVATIVE SCIENTIST I'D LIKE TO SEE THE WORK REPLICATED BUT IT DOES FIT WITH THE LARGER NARRATIVE IT'S POSSIBLE TO RECOVER AND THAT'S A GOOD THING. WE'RE NOT LOOKING AT DISPARITIES BETWEEN CAREGIVERS AND NON-CAREGIVERS AND THAT'S IMPORTANT TO DO ALONGSIDE BECAUSE OTHER WORK HAS SHOWN THOUGH WE'RE SHOWING THIS RECOVERY THAT CAN BE LINGERING HEALTH DETRIMENTS SUGGESTING IT MAY NOT BE A FULL RECOVERY BUT CERTAINLY IN TERMS OF IDENTIFYING THESE POSSIBLY MODIFIABLE PROTECTIVE FACTORS I THINK CERTAINLY COULDN'T HURT TO TRY TO WORK WITH COMMUNITIES AND CAREGIVERS TO BOLSTER THE SOCIAL RESOURCES. >> EXCELLENT. >> THANK YOU FOR THE THOROUGH ANSWER AND LETTING ME PUT YOU ON THE SPOT. YOU TALKED ABOUT YOUR FUTURE AND MORE DIVERSE SAMPLE. I WONDER HOW YOU MIGHT EXPECT RESULT TO DIFFER. >> WE'RE TALKING ABOUT MEASURING SOCIAL FACTORS HERE SO WHEN WE THINK ABOUT THOSE WE'RE THINKING ABOUT RACE AND INDIVIDUAL LEVEL SCFs. IN THIS PARTICULAR POPULATION WHICH WAS SAMPLED FOR THE REASON TO DETECT RISK FACTORS ASSOCIATED WITH BREAST CANCER, WE ACTUALLY HAD LIMITED SAMPLE AS I MENTIONED AND I THINK IF WE WIDEN THE GROUP OF PEOPLE WE'RE LOOKING AT WE CAN PRECEDE HIGHER EFFECT SIZES OR EXPLORE INTERACTIONS BETWEEN LOWER SOCIO ECONOMIC STATUS AT AN INDIVIDUAL LEVEL MIXED IN WITH NEIGHBORHOOD EFFECTS SEPARATELY. I THINK IT WOULD BE HELPFUL TO LOOK AT JOINT AFFECTS WITH RACE AND ETHNICITY AS WELL BECAUSE THEY'RE CORRELATIVE WITH STRESS AND OTHER SOCIAL FACTORS THAT CAN NEGATIVELY INFLUENCE HEALTH AND AGING. >> THE IDEA WAS TO DETECT DIFFERENCES IN BREAST CANCER CASES RELATED TO A SLEW OF ENVIRONMENTAL AND OTHER FACTORS. IN ORDER TO DO THAT, THEY DESIGNED THE STUDY SPECIFICALLY TO SAMPLE WOMEN AT HIGHER RISK GIVEN THEY HAVE A SISTER WITH BREAST CANCER BUT NOT THEMSELVES AND LOOK AT EPIGENETIC AGING AND LOOKED AT FACTORS IN THE COHORT AND WAS A GREAT FIRST PASS LOOKING AT THIS EXPLORATORY ASSOCIATION BUT AGAIN I THINK THERE'S SOME GENERALIZABILITY ISSUES WHERE WE CAN TRY TO REM CASE THIS ACROSS OTHER COHORTS THAT ARE MORE REPRESENTATIVE. >> >> YOU PUT A QUESTION IN THE CHAT BOX FOR KAITLYN. WOULD YOU LIKE TO ASK THAT YOURSELF? >> YES, PLEASE. >> HOW DID YOU HANDLE WITH THE DURATION OF LIVING IN THE NEIGHBORHOOD DID YOU HAVE MOBILITY DATA? WE HAVE SOME MOBILITY DATA AND THAT'S INTERESTING IN A CAUSAL ASSUMPTION. THIS IS USING DATA WITHOUT LIMITATION AND IN THAT SENSE I WOULD CONSIGN IT STUDY. WE DID LOOK AT A SENSITIVITY ANALYSIS. I DON'T THINK WE PUBLISHED IT BUT WE LOOKED AT WOMEN WHO HAD LIVED IN THEIR HOME FOR MORE THAN AT LEAST 10 YEARS OR LONGER AND WE DIDN'T SEE SUBSTANTIVE CHANGES IN THE AFFECTS. ALSO, BECAUSE THIS WAS A HIGHER LEVEL SES GROUP THEY WERE MORE RESIDENTIALLY STABLE AND WE SEE WOMEN IN THIS GROUP DON'T REALLY MOVE OVER TIME AND THAT WOULD BE A CHALLENGE FOR FOLLOWING OTHER MORE DIVERSE COHORT WHO'S STRUGGLE WITH HOUSING STABILITY AND TRYING TO LOOK AT TRAJECTORIES OF NEIGHBORHOOD DEPRIVATION OVER THE COURSE OF A LARGER PERIOD OF SOMEONE'S LIFE. THANK YOU FOR THE QUESTION. >> I'D LIKE TO TELL OUR PARTICIPANTS TO CONTINUE POSTING IN THE CHAT BOX. MALTREATED GIRLS FACE SO MANY CHALLENGES IN PUBERTY WITH SOCIAL AND PHYSICAL AND BIOLOGICAL CHANGES. HOW HAVE YOU CONSIDERED THE ROLE OF PUBERTAL TRANSITION IN YOUR WORK. >> WE INCLUDES DIFFERENT AGES AND PUBERTAL CONSIDERATION CAN PLAY MANY MEANINGFUL ROLES IN THE PROCESS. THE LITERATURE DOES SUGGEST CHILDHOOD ABUSE AND NEGLECT CAN TRIGGER AND PRECIPITATE EARLY TIMING IN GIRLS. AND SOCIAL CHANGES CAN BE STRESSFUL FOR ADOLESCENTS SO THOSE SUSCEPTIBLE TO MALTREATMENT MAY FIND IT DIFFICULT TO TRANSITION AND IN ONE STUDY WE CONDUCTED WITH THIS CURRENT DATA SET WE FOUND EARLIER PUBERTAL TIMING AMPLIFIED THE MALTREATMENT AND SEXUALLY TRANSMITTED INFECTION. WE FOUND MALTREATED GIRLS WHO MAKE AN EARLY TRANSITION TO PUBERTY HAVE THE WORSE SEXUAL HEALTH OUTCOMES. SO PUBERTAL TRANSITION AND MALTREATMENT AND SEXUAL HEALTH ARE COMPLEX RELATIONSHIP IS SOMETHING AND I HOPE TO MAKE MORE RESEARCH TO FURTHER UNDERSTAND THE RELATIONSHIPS. >> YOU AND KAITLYN MENTIONED YOUR EARRING -- EAGERNESS TO HAVE LARGER DATA SETS. DO YOU KNOW OF SPECIFIC DATA SETS ALREADY SYNTHESIZE OR COULD BE TO HELP ANSWER YOUR RESEARCH QUESTIONS? >> THE ADOLESCENT BRAIN COGNITIVE STUDY FUNDED BY NIH I THINK THAT WOULD BE A WONDERFUL DATA SET THAT MAY BE USED TO INVESTIGATE COMPLEX QUESTIONS AND THEY'LL TRACK THE DEVELOPMENT THROUGHOUT ADOLESCENCE. I'D BE CURIOUS TO SEE IF THE SAME MALTREATMENT PROFILES EXIST UP THIS SAMPLE AND ACROSS AIR BALL GROUPS AND LOOK AT -- RACIAL GROUPS AND IF TE PROFILES WOULD BE DIFFERENT ACROSS GROUPS. THAT WOULD BE SUPER INTERESTING. >> THANKS. I'LL MAKE A NOTE UNLESS SOMEBODY WANTS TO HIT YOU UP DIRECTLY WE'LL TRY TO MAKE THAT CONTACT FOR YOU. MATTHEW, WE'VE NEGLECTED YOU LONG ENOUGH AND YOU TALKED ABOUT THE CLINICAL IMPLICATION FOR YOUNG PEOPLE WITH AUTISM. DID YOU HAVE ADDITIONAL THOUGHTS ON HOW THE SYSTEM COULD BE SCANN EXPANDED TO IN-PATIENT CARE. >> I THINK ABOUT THE RESEARCH HAVING THREE LANES. WE'RE IN THE MIDDLE LANE WHICH IS IMMINENT BEHAVIOR CAN BE DETECTED HOW CAN THEY READY THEMSELVES AND READY THE ENVIRONMENT PRIOR TO ENGAGEMENT IN THE EVENT. MAKE THEM PROACTIVE INSTEAD OF REACTIVE. IT'S A HIGHLY HETEROGENOUS CHANGES AND I THINK WE CAN PRE DETECT THE PHYSIOLOGY BUT THE MYRIAD OF CAUSAL FACTORS CHANGING PHYSIOLOGY AND THE VARIETY OF DIFFERENT INTERVENTIONS ONE COULD TRY TO PREEMPT THE BEHAVIOR ARE VARIABLE. WE NEED TO UNDERSTAND THE POPULATION BETTER AND IF FAMILIES ARE RETEENLY -- ROUTINELY USING THIS AND THEN START TO LAYER ON ADDITIONAL SOURCES OF DATA COLLECTION TO UNDERSTAND UNDERSTAND WHAT MAY BE THE ANTECEDENT INPUTS AND MOST OF US WHEN A BAY BEHAVIOR OCCURS WE LOOK AROUND AND MAYBE IF IT'S TOO CROWDED OR NOT ENGAGED OR ENGAGED IN A DIFFICULT TASK OR MAYBE THEY DIDN'T SLEEP AND THIS POPULATION CAN'T TELL YOU THE SOURCE OF DISTRESS. AND WE MAY BE ABLE TO START PARSING SOME GROUP WITH AUTISM TO IDENTIFY THE CAUSAL INPUT THAT'S DRIVING THE CHANGE IN PHYSIOLOGY AND BEHAVIOR. THEN I'D LOVE TO WORK WITH HEALTH CARE PROVIDERS. IF YOU HAVE ONE MINUTE OR THREE MINUTES IF YOU'VE GOT FIVE MINUTES WHAT CAN BE DEPLOYED AT THE TIME SCALE AND SAMPLE THEM SO IT'S NOT A DAYS, WEEKS, MONTHS, YEARS OF TRIAL AND ERROR ON THE PART OF CLINICIAN BUT YOU HAVE AN EARLY INDICATION GIVEN THE PROFILE OF THIS CHILD LOOKING TO SUBTYPE HETEROGENEOUS POPULATION THEY MAY BE INTERVENTIONS GIVEN TO HOW THE CHILD RESPONSE TO DIFFERENT INTERVENTION APPROACHES. WHILE I STILL SEE THAT ALL BEING CLINICALLY RELEVANT MAY HELP BETTER UNDERSTAND AUTISM AS NOT A SINGLE DISORDER BUT SHARED OF CLASS COMMONALITIES WITH INDIVIDUAL DIFFERENCE. >> I HAVE TO FOLLOW UP AND YOU SEE YOU TAKING NOTES. MAYBE WE'LL TAKE A BREAK AT 2:30 BEFORE WE CONTINUE. BACK TO YOU, DR. G. YOU MENTIONED THE STICKY DATA AND MULTIPLE LANES AND NIH IS VERY INTERESTED IN MOBILE HEALTH SMART CONNECTED HEALTH BOTH AGENCIES ARE INTERESTED IN A.I. AND IN PATIENT CARE AND FAMILIES AND HEALTH CARE PROVIDERS. WITH THE STICKY DATA SOME IS COLLECTED. SOME IS ELECTRONIC HEALTH RECORDS AND THE POSSIBILITY OF LEGAL CONSIDERATIONS IS MIND BLOWING. I WONDER IF AND WHAT YOUR TEAM HAVE THOUGHT ABOUT THAT. >> I THINK WE'RE PROVIDING AN AFFORDANCE VALUABLE TO HEALTH CARE PROVIDER AND THE WAY WE DESIGN THE SYSTEM AND HOW WE INTEND IT TO BE USED I THINK WE START TO GET INTO GRAY AREA AFFECTS IF PEOPLE ARE USING THIS INFORMATION TO DISCRIMINATE AGAINST INDIVIDUALS FOR WHOM YOU THINK IS A BEHAVIOR IS COMING. THEY'RE PROBABILISTIC AND THEY'LL BE FALSE POSITIVES AND NEGATIVES. WHAT I THINK WE AS A WHOLE COMMUNITY CAN THINK ABOUT IS THE UTILITY OF THE SYSTEM AND I DON'T WANT A FAMILY TO FALSELY BELIEVE THEY TAKE THEIR EYES OFF THE CHILD AND IT TURNS OUT IT WAS A FALSE NEGATIVE AND THE CHILD IS EXPOSING THEMSELVES TO HARM OR OTHER PEOPLE BECAUSE THERE WAS TOO MUCH FAITH PUT IN THE SYSTEM OF BEING ACCURATE ALL THE TIME. NO SYSTEM IS ACCURATE ALL THE TIME. YOU SEE HOW WE DO WITH MEET -- METROLOGY AND STOCK MARKETS AND I DON'T HAVE AN ANSWER OTHER THAN TO SAY WE ALL NEED TO BE VERY AWARE. IT CAN BE EXPLOITED FOR NON-BENEFICIAL REASONS AND NEED TO BE CLEAR IN OPTING INTO THIS THE BURDEN IS ON THE USER ON WHAT IT CAN AND CAN'T DO WELL AND THE BENEFIT OUTWEIGHS THE POTENTIAL RISK IN A SENSE IT SHOULD BE PUT IN THE WORLD AND USED RESPONSIBLY. IT WILL TAKE US AS A COMMUNITY TO ANTICIPATE HOW PEOPLE MAY VIOLATE THAT USE AND TRY TO CREATE STANDARDS OR SYSTEM USAGE CREATE THAT. IT'S VERY IMPORTANT. >> YOU MENTIONED IT AND SAW IT IN THE CHAT BOX OUR DIRECT BILL RILEY ONCE TREATED CHILDREN WITH AUTISM AND IT'S A GREAT BENEFIT TO HAVE A WARNING TO INTERVENE PREEMPTIVELY. >> I'M GLAD YOU SAID THAT AND A WON'T CHALLENGE THE GROUP BUT IF I WERE TO COUNT OUT THREE MINUTES WORTH OF SECONDS IT'S QUITE A BIT OF TIME TO DO SOMETHING THOUGH IT SOUNDS SHORT AND BILL I WANT TO TELL YOU TOO I WAS AN EARLY TRAINEE OF THE MHEALTH TRAINING INSTITUTE. THAT'S WHERE I FIRST MET YOU. THIS PROJECT CONCEPT EMERGED IN PART DURING THAT WEEK LONG TRAINING TO IT'S KIND OF A SWEET HOMECOMING I GET TO SHARE THIS WORK WITH YOU TODAY. >> THEN THE TRAINING WAS WELL WORTH IT. WELL DONE. >> THANK YOU. >> DID YOU ALL HAVE ANY QUESTIONS FOR ONE ANOTHER? >> I WAS CURIOUS AS SOMEONE PUSHING THE FRONTIER OF THE AREA. CAN YOU TALK ABOUT THE DEVICES AND THE PRECISION OF THAT. >> WE HAVE OVERLAPPING INTERESTS. I WOULD NOT BE SURPRISED IF WE A CONVERSATION OFFLINE ABOUT OUR RESPECTIVE AREAS. THEY'RE NOT INTEGRATED. THAT WOULD BE THE NEXT STEP IN ORDER FOR US TO SIMULATE IT AND WHAT WE DO IN BOTH SYSTEMS WE POINT IT TO TIME SO THEY'RE USING ATOMIC CLOCK AND WE HAVE VERY LITTLE DRIFT IN ATOMIC CLOCK AND WE'RE ASSOCIATING THE DATA AND THEY'RE COLLECTED SEPARATELY BUT BEING WRITTEN TO THE SAME DATA SET WITH THE SAME TRIGGER THAT'S HOW WE PULL IT UP. WE WOULD HAVE IDEAS FOR THE BACKGROUND WHEN YOU TURN ON THE BIO SENSOR SO YOU CAN SHAKE IT AND SEE ACCELERATE CHANGES AND SAME IN THE DATA COLLECTION SESSION. THAT WAY YOU CAN VERY MUCH SEE IF THERE'S DRIFT ON TIME AND WHAT YOU SEE IN THE SENSOR DATA AND IT'S A PROMPTING AREA FOR FUTURE DEVELOPMENT IF WE CAN GET HARD COATED TIME STOP OF A SENSOR AND EMA PROGRAM AND I SAY THIS ONE FOR PREVENTING DRIFT AND I THINK THERE COULD BE GREAT UTILITY OF CONTEXT DEPENDENT OPS FOR E JOURNALLING. TO SAY IF YOU COULD GENERATE A QUESTION FOR A RESPOND ENT WHEN IT'S CHANGE FROM A PRECEDING STATE, BEING ABLE TO ASK SOMEONE IN THAT MOMENT WHAT ARE YOU FEELING OR WHAT ARE YOU DOING OR WHO ARE YOU WITH? I SAY THIS BECAUSE WE KNOW QUITE WELL HUMANS HAVE A HARD TIME WITH RECALL BIAS. IN PERFECT MEMORY OF THE PAST WE TEND TO CARRY FORWARD THE MOST RECENT. THE MORE TIME YOU HAVE TO THINK ABOUT THIS AND LONGER DELAY WHEN YOU EXPERIENCE IT THE MORE TOP-DOWN PROCESSING WHICH MAY GIVE A DIFFERENT ANSWER THAN ONE WAS FEELING IN THE MOMENT. I LIKE THE QUESTION BECAUSE I THINK IF WE CAN FIND A GOOD SOLUTION TO HAVE GOOD TIMING INFORMATION BETWEEN HOW THE BODY'S RESPONDING AND HOW SOMEONE IS RESPONDING, TANE AN OPPORTUNITY TO GET MORE IN SITU MOMENT DATA. >> THANK YOU SO MUCH. I'D LOVE TO CONTINUE THE CONVERSATION OFFLINE. >> THANK YOU. >> DOES ANYONE ELSE HAVE A QUESTION FOR ONE ANOTHER? IF NOT, I HAVE ONE FOR EACH OF YOU AS YOU APPEAR ON MY SCREEN, KAITLYN, STEPHANIE, MATTHEW, LI, ALL FOUR OF YOUR STUDIES INTEGRATE ED, PSYCHO NEURAL AND ENDOCRINOLOGY AND MATTHEW I ALREADY PICKED ON YOU AND LI, YOU TALK ABOUT BIO, SOCIAL MEASURES I WONDER HOW YOUR HYPOTHESES LED TO MULTIPLE KINDS OF DATA, HOW DIFFICULT IT IS. WHAT DO YOU NEED TO COME UP WITH SUCH INTEGRATIVE AWARD-WINNING SCIENCE. >> THAT'S A VERY WONDERFUL AND CHALLENGING QUESTION. AND LOOK AT THE GENOMIC INFORMATION AVAILABLE AND THE CUTTING EDGE WORK AND THE ABILITY OF A FELLOW TO LOOK AT DNA METHYLATION AND BRING MY OWN INTERESTS IN GENERAL SOCIAL FACTORS IN PUBLIC HEALTH AND THE BREAD AND BUTTER HOW I WAS TRAINED AS SOMEONE WHO HAD A DEGREE IN PUBLIC HEALTH. IT'S A WONDERFUL OPPORTUNITY AND I ATTRIBUTE IT TO THAT AND I HAVE TO SAY IT'S BEEN AN AMAZING LEARNING PROCESS AND REALLY COLLABORATION IS KEY AND WE LOOK TO THOSE IN THE FIELD TO CROSS POLLINATE AND HAVE INTERDISCIPLINARY WORK DONE AND IS THE MOST FRUITFUL FOR SCIENCE. YOU HAVE PEOPLE WITH DIFFERENT KNOWLEDGE COMING TOGETHER AND THE WORK WAS INTERDISCIPLINARY WORK WE'RE WORKING TOWARDS THE SAME GOAL OF HEALTH AND WELLNESS AT THE NIH AND INTERDISCIPLINARY WORK HELPS US DO THAT. >> STEPHANIE. >> I AGREE ABOUT THE NEED FOR COLLABORATION AND NIH FOSTERING THAT ENABLED MY PROJECT AS WELL. IT WAS THE INTEGRATION OF MY POST-DOC MENTORS AND COULDN'T HAVE DONE THAT IN A SHORT PERIOD THAT OUR MENTORS HAVE AND THE NIH PROMOTES AND INTEGRATING THAT WITH THE TRAINING I'D HAD IN HI GRADUATE STUDIES AND -- MY GRADUATE STUDIES AND THE PERSPECTIVE I BROUGHT GENERATED NEW QUESTIONS LOOKING AT THE DATA IN A DIFFERENT WAY. I ALSO THINK IT'S REALLY IMPORTANT TO BRIDGE DISCIPLINES. THE QUESTION WAS A RESULT OF TAKING TWO WELL DEVELOPED LITERATURE GOING ON FOR 40 YEARS AND HAS A WELL CHARACTERIZED TRADITION AND BRIDGING IT WITH TO THE CARE GIVING LITERATURE WITH A LONG AND NUANCED TRADITION. HERE WE ARE AT THE INTERSECTION OF THOSE TWO AND NEEDING TO UNDERSTAND THE EXPERIENCE OF BEREAVEMENT FOR CAREGIVERS BECAUSE THAT'S BECOMING ONE OF OUR PREDOMINANT CONTEXTS. IT'S IMPORTANT TO TAKE AN INTERDISCIPLINARY VIEW BECAUSE THAT'S WHERE THE NEW AND EXCITING QUESTION NOWADAYS. >> THANK YOU. WHAT I WOULD ADD IS IT HELPS IF YOU ALSO PICK A RESEARCH AREA OF PREVALENT PUBLIC HEALTH ISSUE. MY ENGAGEMENT HAS PROBABLY BEEN RICHER AND MORE SUCCESSFUL BECAUSE WE KNOW WHAT SUCCESS LOOKS LIKE. IT'S NOT AN ARTICLE BECAUSE MOST PARENTS DON'T READ ARTICLES AND AFFECTING CHANGE IN AN UNDERSTOOD AND UNDER RESOURCED POPULATION. IT ALIGNS WELL WITH OUR SCHOLARLY REWARD BUT THE TRANSLATIONAL NATURE YOU'RE AFFECTING PUBLIC HEALTH GETS THEIR ATTENTION AND WORKING LARD TO ACHIEVE BECAUSE THEY KNOW THERE'LL BE A BENEFIT TO SOCIETY. WHEN YOU GET IN THE SCIENCE WHAT YOU THINK IS EASY IS HARD FOR THEM AND WHAT THEY THINK IS HARD WE THINK IS EASY AND THERE'S A LOT OF TRANSLATING THAT HAS TO HAPPEN. IF YOU STICK THROUGH IT AND INTELLECTUALLY CURIOUS YOU'LL LEARN IT AND START TO APPLY IT AND THE REWARDS CAN BE GREAT WHEN YOU SEE IT CAN AFFECT MANY PEOPLE'S LIVES POSSIBLY. >> SINCE YOU MENTIONED LEARNING OTHER PEOPLE'S DISCIPLINES, SHAMELESS PLUG FOR AN MID-CAREER AWARD. WE HAVE HALF A DOZEN I.C. PARTNERS ON THAT THAT STRESSLY BUYS AND ALLOW TIME TO TRAIN IN CROSS-DISCIPLINARY AREAS AND BUILD THE RELATIONSHIPS THAT DON'T NECESSARILY HAPPEN SERENDIPITOUSLY. >> I WANT TO PUT IN A PLUG FOR THE MHEALTH TRAINING INSTITUTE BECAUSE THAT'S SOMETHING NIH OFFERS AND I FOUND IT HUGELY BENEFICIAL EARLY IN MY CAREER. >> THANKS. LI. >> THANK YOU FOR THIS WONDERFUL QUESTION. I TOTAL WILL -- TOTALLY AGREE ABOUT THE INTERDISCIPLINARY WORK AND A LOT OF THE TOPICS WE STUDY FOR EXAMPLE MALTREATMENT AND RISK IT'S IMPORTANT TO BUILD A RELATIONSHIP BETWEEN THE RESEARCHER AND PARTICIPANTS SO FOR THAT I THANK MY STUDY TEAM WHO ARE BUILDING THIS TRUSTING RELATIONSHIP WITH STUDY PARTICIPANTS. >> ASK OUR ORGANIZER ABOUT THE BREAK BUT A COUPLE MENTIONED HOW WE EXPLAIN WORK TO OUR PARENTS WHO MAY NOT HAVE BEEN RECEIVED AS MUCH AS EDUCATION AS MUCH AS WE HAVE BEEN PRIV LEDGED TO HAVE -- PRIVILEGED AS WE HAVE HAD. I RELATE TO THAT AND ALL OF YOU. I'M SURE THEY'RE PROUD YOU WORK EVERY DAY TO IMPROVE THE HEALTH AND WELL BEING OF YOUR FELLOW HUMAN BEINGS AND YOU REPRESENT THE MANY DISCIPLINES AND MANY ESIs WHO SMILTED THIS YEAR. I APPRECIATE YOUR WORK AND YOUR ACADEMIC EXCELLENCE SO MUCH AND ON BEHALF OF ALL OF US AT NIH, THANK YOU AND CONGRATULATIONS AGAIN. WHEN WE'RE ABLE TO GET TO THE OFFICE WE WILL SEND YOU CERTIFICATES SIGNED BY DR. RILEY SO YOU CAN PUT IT IN OFFICES SOME OF US CAN GET TO AND SOME OF US HAVE YET TO DO SO. THANK YOU ALL AGAIN. I'M HITTING MY -- IF WE WERE ON CAMPUS YOU'D BE HEARING A GREAT DEAL OF APPLAUSE NOW SO INSTEAD I HIT MY APPLAUSE ICON AND WE'LL TURN THINGS OVER TO BEFORE MARK DENNIS TO TELL US ABOUT NEXT STEPS. MARK. >> THE NEXT STEPS ARE A BREAK FOR A FEW MINUTES AND THEN AT 3:10 WE'LL START WITH THE KEY NOTE LECTURE, DR. ERICA SPOTTS WILL MODERATE AND DR. ANNE CASE WILL GIVE HER PRESENTATION AND HERS IS DEATH BY DEGREE U.S. MORTALITY IN THE 21st CENTURY. WE'LL RESUME AT 3:10. I'M GOING TO INTRODUCE ERICA SPOTTS WHO LED IN THE MATILDA WHITE. >> GOOD AFTERNOON. I'M FROM OBSSR AND THE CHAIR OF THE MATILDA WHITE RILEY DISTINGUISHED LECTURE COMMITTEE. WELCOME. THE RECIPIENT THROUGH RESEARCH AND CAREER THAT'S ADVANCED BEHAVIORAL AND SOCIAL SCIENTIFIC KNOWLEDGE WITHIN NIH'S MISSION. THE RECIPIENTS ALSO FOLLOWS THE VISION THROUGH EXPANDED CONCEPTUALIZATION OF COGNITIVE AND EXECUTIVE FUNCTIONING OF LIFE THROUGH RESEARCH THAT IMPROVES THE LIVES OF PEOPLE IN SOCIETY AND LOOKS AT INTERACTIONS BETWEEN GENES AND THE BUILT NATIONAL AND SOCIAL ENVIRONMENT AND THE UTILITY OF THE KNOWLEDGE FOR CLINICAL PRACTICE AND LIFE COURSE PERSPECTIVES ON DEVELOPMENT, HEALTH AND WELL BEING OF INDIVIDUALS AND METHODS IN THE ADVANCEMENT OF KNOWLEDGE ON WELL BEING THE RECIPIENT IS SELECTED BY COMMITTEE I'D NOW LIKE TO THANK. THIS YEAR'S COMMITTEE -- [LISTING NAMES] THE COMMITTEE READS THEM AND THEM NOMINATES. THANK YOU FOR THEIR SERVICE AND THOUGH SHE PROBABLY NEEDS LITTLE INTRODUCTION, IT'S WITH GREAT PLEASURE I PRESENT THIS YEAR'S MATILDA WHITE RILEY'S LECTURER AND SHE IS A RESEARCH ASSOCIATE OF THE ECONOMIC RESEARCH AND FELLOW OF THE ECONO METRICS SOCIETY AND NATIONAL ACADEMY OF MEDICINE AND AMERICAN ACADEMY OF ARTS AND SCIENCES AND THE PHILOSOPHICAL SOCIETY. SHE HAS A NEW YORK TIMES AND WALL STREET BEST SELLER AND SHORT LISTED FOR THE MACKENZIE AWARD OF YEAR. IF WE WERE IN PERSON I'D ASK HER TO COME TO THE PODIUM TO RECEIVE HER AWARD. WE'LL HAVE A PLAQUE WE'LL HAVE SENT TO HER. GIVEN THE CURRENT CIRCUMSTANCES KNOW SHE'LL RECEIVE HER AWARD AS SOON AS WE'RE ABLE. I'LL ASK HER TO BEGIN THE PRESENTATION. THANK YOU FOR JOINING US TODAY. >> THANK YOU FOR THIS GREAT HONOR. I THINK DR. WHITE RILEY WOULD BE PLEASED WITH THE EARLIER PRESENTATIONS. CONGRATULATION TO THE EARLY STAGE INVESTIGATORS I WAS BLOWN AWAY. I WAS GLAD I COULD SEE THEM THIS AFTERNOON AND WHEN I LOOKED AT THE LIST OF PEOPLE WHO RECEIVE THE AWARD IN THE PAST, IT CONTAINS MANY OF MY HEROES. I'M HONORED TO AND HUMBLED TO ACCEPT THIS AWARD. I'M GOING TO SHOW MY SCREEN. I'LL BE TALKING ABOUT MOSTLY ABOUT WORK I'VE BEEN DOING WITH MY CO-AUTHOR WHERE WE PUT IN A SERIES OF PAPERS. THE FIRST I CULMINATED INTO A BOOK I'LL TALK A BIT ABOUT IN WHAT'S HAPPENED TO MIDLIFE MORTALITY IN THE U.S. THIS RESEARCH HAS BEEN GENEROUSLY FUNDED BY THE NIH AND I WANT TO SAY THROUGHOUT MY CAREER I HAVE BEEN FUNDED BY THE NIH AND THE FACT THERE WERE PEOPLE AT THE NIH WHO BELIEVED IN ME AND MY RESEARCH MADE AN ENORMOUS DIFFERENCE IN MY CAREER PATH. I'M INCREDIBLY GRATEFUL FOR THE FUNDING I'VE RECEIVED. RIGHT AT THE BEGINNING OF THE NATIONAL EMERGENCY IN MARCH OF LAST YEAR TO GIVE YOU A SHORT OVERVIEW, EVEN BEFORE THE ARRIVAL OF COVID-19, THE LIVES OF AMERICANS WHO DO NOT HOLD A BACHELOR'S DEGREE, WHICH ARE TWO-THIRDS OF PEOPLE IN THE U.S. AGED 25 TO 64, THEIR LIVES WERE ALREADY COMING APART. IN THE BOOK WE DOCUMENT WHAT THAT MEANS IN TERMS OF DESPAIR AND EXCESS MORTALITY AND WE'LL DISCUSS THE ROLE ON FORCES WE THINK ARE PRIVATE. WHAT YOU'LL SEE IN THE COURSE OF THE NEXT 15 MINUTES OR SO IS A COLLEGE DEGREE IS INCREASINGLY IMPORTANT TO THIS LIFE IN THIS SOCIETY. SES USING AIR QUOTES HERE, AND THERE'S BEEN A MARKER AND THINK THROUGH THE MECHANISMS THROUGH IT CAN DRIVE LIVES. AND TO START I WANT TO TELL YOU THE 20th CENTURY WAS A TIME OF GREAT PROGRESS IN TERMS OF MORTALITY. THERE IS MEDICAL EVENTS. THERE WAS CLEAN WATER. THERE WERE AMAZING CHANGES AND YOU CAN SEE THOSE IF YOU LOOK AT FOR EXAMPLE, THIS IS LOOKING AT MORTALITY RATES FOR MEN AND WOMEN AGED 25 TO 54. THESE ARE DEATHS PER 100,000 PEOPLE AT RISK AND THE DEATH RATES ARE THOSE TODAY. AND YOU CAN SEE THE DEATH RATE IN THE AGE GROUP AND 1500 PER 100,000 AND YOU SEE THE CHANGE BY THE END OF THE CENTURY. THE 1918 FLU EPIDEMICS AND OTHER EPIDEMICS THAT TOOK THEIR TOLL AND YOU SEE THE PLATEAU AROUND 1960 PEOPLE IN THEIR 40s AND 50s SMOKED LIKE CHIMNEYS IN THEIR 20s AND WERE DYING OF LUNG CANCER AND HEART DISEASE. TWO THINGS HAPPENED. ONE, THERE WAS BEHAVIORAL CHANGE AND PEOPLE STOPPED SMOKING IN BIG NUMBERS AND TWO THE MEDICAL ADVANCE AND ON THE MARKET CAME EXPENSIVE ADVERTISEMENTS AND PEOPLE STOPPED DROPPING DEAD OF CORONARY AND CARDIOVASCULAR DISEASE AND PROGRESS CONTINUED AT 2% A YEAR AND WE GOT LULLED INTO THINKING THAT PROCESS WAS GOING CONTINUE. WHAT HAPPENED IN OTHER RICH COUNTRIES IS THE PROGRESS DID CONTINUE. THIS IS AGE-ADJUSTED MORTALITY FOR MEN 45 TO 54 AND OTHER ENGLISH SPEAKING COUNTRIES AND THE RICH COUNTRIES OF EUROPE AND BASED ON MORTALITY DECLINE CONTINUED AT 2% A YEAR. THEN IN THE U.S. WE DECIDED -- >> DR. CASE, WE SEE GRAY BOXES ON YOUR SCREEN. APPARENTLY IF YOU DO CONTROL, ALT, SHIFT 8 THEY'LL GO AWAY. >> I THINK WE SHOULD GO AHEAD. THEY'RE AROUND THE OUTSIDE OF THE SCREEN. >> MOST EVERYTHING I'LL STAY, I'LL SAY IN WORDS BUT THE GRAPHS GIVE THEM MORE POWER. WE'LL PROCEED AND SEE HOW IT GOES. IN THE U.S., HISPANICS MORTALITY OVER THIS PERIOD FALL 2% A YEAR. THEIR MORTALITY RATES LOOKED A LOT LIKE PEOPLE IN GREAT BRITAIN AND FOR AFRICAN AMERICANS WHOSE MORTALITY RATES ARE HIGHER THAN WHITES CONTINUE TO BE HIGHER THAN WHITES OVER THIS PERIOD THEIR MORTALITY WAS DECLINING AT 2.5% A YEAR. THE ODD GROUP OUT WAS NON-WHITE HISPANICS WHO FLAT LINED AT BEST. A GAP OPENED UP BETWEEN MORTALITY RATES IN THE U.S. IN MID LIFE AND MORTALITY RATES AND OTHER RICH COUNTRIES OF THE WORLD. WHEN WE STARTED THIS WAS ODD THE MOST PRIVILEGED GROUP, THAT HAS THE MOST EDUCATION AND MOST WEALTH IS THE GROUP SEEING THEIR MORTALITY START FALLING AND START TO RISE. WE THOUGHT THAT WOULD BE THE PLACE WE'D START TO DIG. WHAT HAPPENED SINCE WE START THE WORK MORE YEARS HAVE PASSED AND UNFORTUNATELY FOR THE HISPANIC NON-BLACK GROUP MORTALITY BEGAN TO RISE. THIS WAS LARGELY DUE TO FENTANYL HEAVY DUTY OPIOID USED IN HOSPITALS BUT BECAME A STREET DRUG. IT IS DEADLY. IT MIXES WITH HEROIN AND COCAINE AND A LITTLE TOO MUCH CAN BE THE END. WE CAN RETURN TO QUESTIONS AND ANSWERS. THE QUESTION IS IT A BIG DEAL THAT MORTALITY STARTS FALLING FOR WHITES? WELL, IT'S A BIG ENOUGH DEAL LIFE EXPECTANCY FELL IN THE U.S. FOR THREE YEARS STRAIGHT FROM 2014 TO 2017. REMEMBER, THIS IS ALL PRECOVID. A DECLINE HAPPENED IN THE U.S. FOR A CENTURY. THERE WAS ALSO THE 1918 FLU EPIDEMIC AND MORE TAL RATE -- MORTALITY RATE FOR THE ELDERLY AND CHILDREN CONTINUED TO FALL BUT WHAT HAPPENED IN MIDLIFE WAS A BIG ENOUGH EVENT IT TURNED LIFE EXPECTANCY THE WRONG WAY. PART IS DUE TO THE FACT WE STOPPED MAKING PROGRESS AGAINST HEART DISEASE. HEART DISEASE WITH US OUR ENGINE OF PROGRESS IN THE LAST PART OF THE 20th CENTURY IF WE CONTINUED TO MAKE PROGRESS AGAINST HEART DISEASE ALL CAUSE MORTALITY WOULD NOT HAVE TURNED THE WRONG WAY. IT FLAT LINED AND WE CAN RETURN TO THAT IN Q&A. THE THREE CAUSES THAT WERE RISING WERE FROM SUICIDE AND DRUG OVERDOSE AND ALCOHOL AND LIVER DISEASE. IF YOU CAN SEE THE SCREEN YOU WOULD SEE THE CONCENTRATIONS ARE PEOPLE WITH A B.A. OR MORE THERE WERE SMALL INCREASES IN EACH CAUSE OF DEATH BUT WE FIND THAT COLLEGE DEGREE IS A MEANINGFUL DIVIDING LINE. SINCE 1989, EDUCATION'S BEEN RECORDED ON THE STANDARD U.S. DEATH CERTIFICATE. WE HAVE LIKE 73 MILLION RECORDS FOR ADULTS AGED 25 AND ABOVE AN YOU LOSE MOST THE ANALYSIS. YOU'RE LOOKING AT AN AGE GROUP HISPANICS 50 TO 44 BUT NOT JUST FOR PEOPLE PART OF MIDLIFE. IT TURNS OUT FOR EVERY FIVE YEAR AGE GROUP FROM 25 TO 29-YEAR-OLDS AND 60 TO 64-YEAR-OLDS YOU SEE A TRAUMATIC INCREASE IN WHAT WE CALL DEATHS OF DESPAIR AND ALMOST NO CHANGE FOR PEOPLE WITH A COLLEGE DEGREE. NOW, YOU PUT THESE TOGETHER IN A LOT OF THE WORK FOR MANY REASONS. IT'S ALMOST DEATH BY ONE'S OWN HAND. THEY'RE ALL DISPLAY A PARTICULAR AMOUNT OF DESPAIR. IT'S HARD TO KNOW WHETHER OR NOT A DRUG OVERDOSE WAS INTENTIONAL OR AN ACCIDENT. WAS IT INTENTIONAL OR AN ACCIDENT AND SOMEBODY HAD TO MAKE THAT DECISION AND THOSE PROBLEMS SOMEWHAT DISAPPEAR. IN 2019 THE LAST YEAR IN WHICH WE HAVE DATA THERE WERE 164,000 DEATHS IN THE U.S. BY ALCOHOL AND SUICIDE. THAT'S UP FROM 65,000 DEATHS IN 1995. WE KNOW RELATIVE TO COVID THOSE NUMBERS DON'T SEEM VERY LARGE PERHAPS BUT THEY SEEM LARGE TO ME. HOPEFULLY ONCE WE HAVE ENOUGH VACCINES OUT THERE IN THE ARMS OF PEOPLE AND LOOKING AT COVID IN THE REARVIEW MIRROR THERE'S NO VACCINE THAT WILL STOP PEOPLE FROM TAKING THEIR LIVES IN THESE WAYS. WHEN PEOPLE GOT TO RETIREMENT AGE MAYBE THESE DEATHS OF DESPAIR WOULD GO AWAY BUT UNFORTUNATELY IF YOU CAN SEE THE SLIDE, PEOPLE AGE 65 TO 69, WE BY GIN -- BEGIN TO SEE THE SAME PHENOMENON OF PEOPLE WITHOUT A B.A. AND WITHOUT. INSTEAD OF LOOKING BY AGE GROUP IT'S MORE USEFUL TO THINK BY BIRTH COHORT. IF YOU LOOK AT PEOPLE WITHOUT A B.A. IMPORTANT IN A PARTICULAR BIRTH YEARS AND IT SHOWS 55 AND ONWARD, IF YOU WERE IN BORN IN 1940 YOUR RISK OF DYING ONE OF THESE IT'S NOT CHANGED MUCH AND FLAT LINED. THERE'S A LITTLE BIT OF DATA BETWEEN THE COHORT BORN 1945 BUT WHEN YOU GET TO THE COHORT OF 1950, AT ANY GIVEN AGE, THE HIGHER RISK OF DYING FROM ONE OF THESE DEATHS OF DESPAIR HIGHER STILL IN 55 AND BORN IN 1960. THERE'S AN ARROW THAT SHOWS THE DIFFERENCE IN YOUR LAID 40s OF SOMEONE BORN IN 1945 AND RISK BETWEEN 1970 AND IT'S THREE TIMES THE RISK. IT'S MOST JUST BABY BOOMERS WHERE IT WAS THE SUMMER OF LOVE IN 1968 AND THEY ALL TOOK DRUGS AND EXIT STAGE RIGHT, EVERYTHING'S GOING TO BE OKAY. IT GETS WORSE FOR GEN X AND GEN Y AND WORSE FOR MILLENNIALS. I CAN SHOW YOU THIS SEPARATELY FOR ALCOHOL AND SUICIDE. ALL THREE OF THEM SHOW THE SAME PATTERN OF THINGS GETTING WORSE FOR PEOPLE BORN LATER. IF WE COMPARE PEOPLE WITH AND WITHOUT A BACHELOR'S DEGREE, IT LOOKS LIKE THEY LIVE IN DIFFERENT UNIVERSES. THIS IS A PHENOMENON HITTING PEOPLE WITHOUT A B.A. I CAN SAY IF YOU DIVIDE THIS UP INTO HIGH SCHOOL, SOME COLLEGE, B.A. OR MORE, THE PEOPLE WITH SOME COLLEGE LOOK VERY MUCH LIKE THE PEOPLE WITH A HIGH SCHOOL DEGREE OR LESS NOT WITH A B.A. OR MORE. THIS DIVIDING LINE SEEMS LIKE A PRETTY CLEAR ONE TO US. THIS TOOK US BACK TO IN THE 1980s DURKHEIM TALKED ABOUT THIS WITH NOT ENOUGH SOCIAL INTEGRATION AND MORE SOCIAL REGULATION AND THE KIND OF UPHEAVAL THE WHITE WORKING CLASS SAW AFTER 1970 COULD BE RESPONSIBLE FOR WHAT WE'RE SEEING NOW TODAY. WHAT DO WE KNOW ABOUT WHO'S DYING? THIS PHENOMENON IS GEOGRAPHICALLY WIDESPREAD. EVERY STATE SAW INCREASES BETWEEN 2000 AND 2018 IN DEATHS. WEST VIRGINIA IS HAVING A HORRIBLE TIME WITH THE OPIOID CRISIS. PEOPLE ARE NOT DYING AS MUCH AS FROM OPIOIDS BUT ALCOHOL AND LIVER DISEASE. IN THE MOUNTAIN STATES SUICIDE IS A BIG RISK WE THINK OF IT AS PICK YOUR POISON. IT MANIFESTS DIFFERENTLY IN DIFFERENT PLACES IN ALL STATES WE SEE INCREASES IN ALL THREE CAUSES OF DEATH. IT'S HAPPENING TO MEN AND WOMEN SO A LOT OF NEWSPAPER WRITERS PICKING UP THE STORY WE TELL AND IN THE HEADLINE IT WILL SAY WHITE MEN DYING BUT THE TRUTH IS FOR WOMEN AND MEN WITHOUT A B.A., THE INCREASE OF MORTALITY FROM DEATHS OF DESPAIR HAS BEEN ALMOST IDENTICAL. SO WOMEN MORE LIKELY HAVE BEEN MORE LIKELY TO KILL THEMSELVES IN ALL THREE OF THESE WAYS BUT WOMEN ARE KEEPING PACE WITH MEN IN TERMS OF THE INCREASE. AND WOMEN DO KILL THEMSELVES IN THESE WAYS AND THINK WRITERS DON'T BELIEVE WOMEN WOULD KILL THEMSELVES IN THESE DAYS BUT IT'S HAPPENING. I WANTED TO ASK YOU IF YOU CAN SEE THE GREAT RECESSION IN THE PICTURE. WHAT YOU SEE IN THE PICTURE IS A SLOW, STEADY TREND LINE UP IN TERMS OF INCREASES IN DEATH FROM DRUGS AND ALCOHOL AND SUICIDE. AND YOU CAN SEE WHAT THE DEATHS LOOKED LIKE BEFORE THE GREAT RECESSION AND AFTER THE HIGHER AFTER BUT THEY WERE RISING AS FAR AS BACK WE HAVE THE ABILITY TO DIVIDE DEATH CERTIFICATES WITH OR WITHOUT A B.A. AND THOUGHT IT WAS ECONOMIC CONDITIONS AND UNEMPLOYMENT RATES AND CUTS IN PEOPLE'S INCOMES AND WE DIDN'T FIND THAT. WE DUG DEEPER WE SEE INCREASING REPORTS OF SOCIAL ISOLATION AND OF POOR MENTAL HEALTH YEAR ON YEAR BUT ONLY IN THOSE WITHOUT A COLLEGE DEGREE. FOR PEOPLE WITH A B.A. IT'S PRETTY MUCH AS IT WAS. AND YOU CAN ASK PEOPLE ABOUT THEIR PAIN AND THEY MAY MISS THIS BUT WITH WHEN YOU COMBINE THEM WITH THE INCREASES IN MORTALITY WE THINK THEY FIT IN A LARGER PICTURE. THIS QUOTE FROM A BOOK THAT THE COLLEGE DEGREE IS A CONDITION OF DIGNIFIED WORK AND SOCIAL ESTEEM AND THINK IT DESCRIBES WHAT WE SEE HERE BUT IF YOU LOOK AT WAGES OF PEOPLE WITH LESS THAN A B.A., THEY'VE BEEN -- WE LOOKED AT THE BLUE COLLAR WAGES IN 1975 AND TOOK THE POPULATION SURVEY AND ASKING IT TO TELL YOU ABOUT MEDIAN WAGES FOR MEN WITHOUT A B.A. OVER THE SWEEP OF TIME AND YOU CAN SEE IT'S ON AN UPWARD TREND. WAGES GO UP AND DOWN WITH THE BUSINESS CYCLE, THAT'S NATURAL. POST-RECESSION FINALLY WORKING CLES MEN WERE START -- CLASS MEN WERE STARTING TO RISE. YOU CAN SEE THEY'VE BEEN RISING BUT NOT WHERE THEY WERE IN THE 2000 LET ALONE THE 1980s. THERE'S BEEN A REAL DECLINE IN WAGES FOR MEN WITHOUT A B.A. FOR WOMEN THE WAGES ROSE A BIT BUT THEY'VE BEEN DECLINING SINCE ABOUT 2000. IN ADDITION TO THAT, ATTACHMENT TO THE LABOR FORCE HAS FALLEN FOR PEOPLE WITHOUT A COLLEGE DEGREE. FOR WOMEN WITHOUT A B.A. PEAKED IN 2000 AND FALLING SINCE THEN AND MEN WITHOUT A B.A. HAVE BEEN A LONG-TERM DECLINE IN EMPLOYMENT. SO THE RIGHT HAND PICTURE IS THE EMPLOYMENT TO POPULATION RATIO. THIS TELLS YOU WHAT THE NUMBER OF PEOPLE EMPLOYED RELATIVE TO THE POPULATION AND SINCE 1979 EMPLOYMENT DROPS DURING RECESSIONS YOU CAN SEE BY THE RED LINES. PEOPLE MAKE THEIR WAY BACK INTO THE LABOR FORCE EVENTUALLY AND THERE'S BEEN A RATCHETING DOWNWARD. AFTER PEOPLE REATTACH TO THE LABOR MARKET FEWER ARE WORKING THAN THE PREVIOUS PEAK WHICH IS LOWER THAN THE PEAK BEFORE THAT. THERE'S BEEN A LONG TERM DECLINE IN ATTACHMENT TO THE LABOR MARKET AND LONG-TERM DECLINE. SO LOSS OF WAGES AND IT COMES FROM REPLACING JOBS AND MANY REPLACED ARE WORSE THAN THE JOBS THEY LEFT. OFTEN TIMES OUTSOURCED JOBS TO TRANSPORT TO SECURITY COMPANIES AND FOOD SERVICES. THESE ARE COMPANIES WITH CLEANING SERVICES. THERE'S NO POSSIBILITY OF ADVANCEMENT AND NO ON THE JOB TRAINING. YOU DON'T HAVE PROSPECTS. WE THINK THAT IS A HUGE PART OF WHAT HAPPENED NEXT TO THE COMMUNITY WHICH IS LESS ABOUT MATERIAL WELL BEING BUT WHERE A LOSS OF REAL STATUS THROUGH WORK. IT'S ALSO THE CASE OUR FRIENDS IN SOCIOLOGY HAVE BEEN TELLING US FOR A COUPLE DECADES THAT WORKING CLASS PEOPLE DON'T FEEL THEY GET MARRIED NOW UNLESS ONE HAS A JOB WITH PROSPECTS. I THOUGHT THAT'S INTERESTING BUT I DIDN'T REALIZE HOW IMPORTANT IT WOULD BE FOR MY OWN WORK. WHAT'S HAPPENED IS MARRIAGE RATES DECLINED SIMULTANEOUSLY BUT ONLY WITH PEOPLE WITHOUT A B.A. PEOPLE COHABIT AND COHABITATIONS IN THE U.S. ARE QUITE FRAGILE SO PEOPLE COHABIT AND MAY HAVE A CHILD AND BREAK UP AND COHABIT AGAIN AND HAVE ANOTHER CHILD AND THEN BREAK UP. THE INSTABILITY AND WORK LIFE AND INSTABILITY IN HOME LIFE. THERE'S LOSS OF COMMUNITY. THERE'S A RECIPE FOR SUICIDE. WE SEE A LOT OF PARALLELS TO WHAT HAPPENED TO THE WHITE WORKING CLASS OVER THIS PERIOD AND THE BLACK WORKING CLASS IN THE 1960s AND 1970s WHEN MANUFACTURING LEFT THE CITIES THEN LEFT COMMUNITIES WITHOUT A SOURCE OF JOBS AND MEANING THROUGH WORK AND MARRIAGE RATES DECLINED AND OUT OF WED LOCK CHILDBEARING INCREASED. IN THE AFRICAN AMERICAN COMMUNITIES THERE WAS A CRACK EPIDEMIC AND THE WHITE WORKING CLASS COMMUNITIES THERE WAS AN OPIOID EPIDEMIC. THE PARALLELS ARE NOT GOING TO BE PERFECT BUT STILL FACE THE SAME COVERT AND OVERT DISCRIMINATION AND THERE'S MANY THINGS THEY HAVE IN COMMON. THE FIRST TIME IT CAME TO THE BLACK WORKING CLASS AND NOW HAS COME AROUND AND THIS TIME TO THE WHITE WORKING CLASS. THIS IS FOR NEW WORK WE JUST PUBLISHED LOOKS AT EXPECTED YEARS OF LIFE LIVED BETWEEN ALL PERSONS 25th AND 75th BIRTHDAY. SOMETIMES CALLED LIFE EXPECTANCY THOUGH TEMPORARY HERE SEEMS LIKE AN ODD PHRASE GIVEN WE'RE LOOKING AT A 50-YEAR PERIOD OF TIME. THE MAXIMUM NUMBER OF YEARS DURING THAT STRETCH OF TIME WILL BE 50 AND IF YOU LOOK ON THE LEFT AND WOMEN ON THE RIGHT, IF YOU LOOK AT THE EXPECTED YEARS OF LIFE TO LIVE, BACK IN 1990, THOSE EXPECTED YEARS TO LIVE WAS MUCH MORE SIMILAR BY RACE THAT CLOSE TO 2000, THE YEARS LEFT TO LIVE IS SIMILAR TO EDUCATION. WE THINK IT'S POSSIBLE DISCRIMINATION BASED RACE IS GIVING WAY TO DISCRIMINATION BASED ON EDUCATION AND IT'S STILL THE CASE THAT BLACK LIFE EXPECTANCY IS BELOW WHITE LIFE EXPECTANCY BUT LOOKS LIKE THEY'RE CONVERGING BASED ON EDUCATION RATHER THAN BY. -- RATHER THAN BY RACE. WHAT HAPPENED TO THE WORKING CLASS? THERE WAS GLOBALIZATION WHICH HAS GOTTEN QUITE A LOT OF ATTENTION. JOBS LEAVING THE COUNTRY. THERE'S AUTOMATION. WE'RE STILL PRODUCING AS MUCH AS IN THE U.S. AS WE EVER DID BUT WE NEED FEWER WORKERS BECAUSE WE HAVE SO MANY MORE ROBOTS. THAT WAS TRUE OF ALL THE RICH COUNTRIES BUT DIDN'T SEE THE DEATHS OF DESPAIR RISE. WE HAVE TO THINK WHAT IS DIFFERENT ABOUT THE U.S.? THERE ARE TWO THINGS WE HIGHLIGHT IN THE BOOK. THE FIRST IS THE OTHER RICH COUNTRIES DID NOT UNLEASH HEAVY DUTY OPIOIDS INTO THE POPULATION. NOW, IN THE BOOK WE ARGUE THE DESPA DESPAIR IN INCREASE AND DRUG OVERDOSE AND LIVER DISEASE BEGAN TO RISE IN 1996 PRIOR TO OXYCONTIN AND THAT'S A DRUG ONE AND A HALF TIMES THE STRONG AS MORPHINE ANY DOCTOR WITH A SCRIPT CAN WRITE A PRESCRIPTION FOR AND BIG PHARMA IN PARTICULAR LOOKED FOR AREAS WHERE THEY PUSHED THE DRUGS IN THOSE AREAS MADE THE CRISIS MORE HORRIFIC THAN IT NEEDED TO BE. A LOT'S BEEN WRITTEN ON THIS. I DON'T WANT TO SPEND THAT MUCH TIME ON IT HERE AND MORE TO THE OTHER THING THAT'S REALLY DIFFERENT ABOUT THE U.S. RELATIVE TO THE REST OF THE RICH WORLD. THAT IS OUR HEALTH CARE INDUSTRY. OUR HEALTH CARE IS THE MOST EXPENSIVE IN THE WORLD. ON MANY METRIC WE HAVE THE MOST EXPENSIVE IN A RICH WORLD AND LIFE EXPECTANCY FALLING AND WE COME OUT NEAR THE BOTTOM. IN THE BOOK WE ARGUE LIFE EXPECTANCY IN THE U.S. FELL NOT IN SPICE OF HEALTH CARE BUT BECAUSE OF WHAT WE SPEND ON HEALTH CARE. IT CAN BE USEFUL TO LOOK AT A COMPARISON WITH OTHER RICH COUNTRIES OVER THE PERIOD BETWEEN 1970 AND 2015. IF YOU LOOK AT THE U.K. AND LIFE EXPECTANCY AT BIRTH AND SEE HOW MUCH THE COUNTRY WAS SPENDING ON HEALTH EXPENDITURE PER CAPITA BETWEEN 1970, WHICH IS GOING TO BE THE LOWER LEFT HERE AND 2015, WHICH IS GOING ON THE UPPER RIGHT HERE, YOU CAN SEE IN THE U.K. LIFE EXPECTANCY INCREASED. SAME IN CANADA AND THEY SPEND MORE PER PERSON THAN THE U.K. BUT STILL IN THE SAME NEIGHBORHOOD AS IS FRANCE. THE NEXT MOST EXPENSIVE COUNTRY AFTER THE U.S. IS SWITZERLAND AND THEY SPEND MORE BUT ALSO LIVE FIVE YEARS LONGER THAN DO AMERICANS. IF YOU WANT TO SEE HOW AMERICANS STACK UP AGAINST THE OTHER RICH COUNTRIES, THIS WAS THE U.S. BETWEEN 1970 AND 1982. MORE EXPENSIVE AND POORER OUTCOMES EVEN BACK IN 170. -- 1970 AND THIS IS WHAT IT LOOKS LIKE IN 1990 AND NOW 2015. WE LEFT THE HERD IN TERMS OF HOW MUCH WE SPEND AND OUR LIFE EXPECTANCY STARTED TO TURN. IT'S HARD TO EXAGGERATE THE EFFECT ON THE ECONOMY AT A WHOLE. SWITZERLAND IS THE NEXT MOST EXPENSIVE AT 12.5%. IF WE SPENT WHAT THE SWISS SPEND WE'D SPEND MORE THAN A TRILLION DOLLARS A YEAR AND THERE'S A JAMA ARTICLE THAT DOES IT FROM THE BOTTOM UP AND COME UP WITH A SIMILAR NUMBER OF A TRILLION DOLLARS A YEAR. THAT'S MORE THAN $8300 A HOUSEHOLD. THAT'S JUST EXCESS IT'S MORE THAN WE SPEND ON THE ENTIRE MILITARY. THAT HAS TO COME FROM SOMEWHERE. IN WAGES OR PROFIT OR TAXES, MOST PEOPLE THINK HEALTH CARE INSURANCE IS A GIFT. THAT GIFT IS BEING DEDUCTED IN PART FROM YOUR PAYCHECK. IF I'M AN EMPLOYER I DON'T CARE IF I PAY WAGES OR DIVIDE IT UP WITH THEIR HEALTH CARE PREMIUM AND AS IT GOES UP AND UP, OUR WAGES DECLINE AND DECLINE. AND MANY BASE THEIR SHARE, WHICH IS ON AVERAGE 71% OF A $21,000 A YEAR PREMIUM WHICH IS WHAT IT WAS IN 2019 FOR A FAMILY POLICY, THEY LOOK AT THAT AND THINK, I'M GOING OUT SOURCE THE LOW-WAGE JOBS WHICH IS HOW YOU WORK FOR A CLEANING COMPANY INSTEAD OF A BRAND NAME HOTEL. THE CEO AND JANITOR ARE GOING TO BE SIMILAR AND THERE'S A BIG COST AN THERE'S A LOT OF TALK ABOUT WHAT AFFECT RAISING THE MINIMUM WAGE MIGHT HAVE AND MAY HAVE EFFECTS ON EMPLOYMENT AND THIS SAY PERENNIAL ISSUE AND DISCUSSION WE HAVE AND WHAT THAT DOES FOR EMPLOYER DECISIONS ABOUT HIRING LOW-SKILLED WORKERS. WE ARGUE FINANCING HEALTH CARE IN THIS WAY TAKES A WRECKING BALL TO THE LOW SKILLED LABOR MARKET IN THE SUCH. -- U.S. AND IT'S ALSO THE CASE STATES HAVE TO PAY THEIR FAIR SHARE OF MEDICAID. AS THE COSTS GO UP AND UP THE STATES HAVE LESS MONEY FOR OTHER THINGS WE NEED AND WE WANT. LESS MONEY FOR SCHOOLS. LESS MONEY FOR THE STATE UNIVERSITY SYSTEMS AND LESS FOR INFRASTRUCTURE. THIS IS A COST THAT HAS FINGERS EVERYWHERE AND HAS EFFECT ON THE LOW WAGE LABOR MARKET WHICH HAS EFFECTS ON MARRIAGE MARKETS AND AFFECTS ON CHILD MARKET AND WE THINK ALL OF THESE ARE KNOCK-ON AFFECTS IN LARGE PART BECAUSE OF THE WAY WE DECIDED TO FUND OUR HEALTH CARE SYSTEM AND LET OUR HEALTH CARE SYSTEM BECOME SO EXPENSIVE. WE THINK CAPITALISM NEEDS TO BE FIXED AND BACK ON THE RAILS AND USE HEALTH CARE AS AN EXAMPLE BECAUSE WE THINK WE THOUGHT COVID MAY GIVE US AN OPPORTUNITY IN THE SENSE WHERE PEOPLE IN THE MIDDLE OF THE DISTRIBUTION START TO GET MEDICAL BILLS THEY CANNOT PAY, THEY MAY BEGIN TO TAKE THE FUNDING OF HEALTH CARE MORE SERIOUSLY THAN THEY HAD IN THE PAST. IT STILL REMAINS TO BE SEEN. THERE ARE FIVE HEALTH CARE LOBBYISTS FOR EVERY MEMBER OF CONGRESS. THEY'RE AT THE TABLE WHEN LEGISLATION IS WRITTEN. IT'S A VERY POWERFUL FORCE RIGHT NOW. GENERALLY WE THINK THE RISE OF CORPORATE LOBBYING AND THE DECLINE OF [INDISCERNIBLE] LEFT LESS REPRESENTATION FOR LOWER WAGE EARNERS AND IF YOU'RE NOT AT THE TABLE, YOU'RE ON THE MENU AND WORRY THAT'S WHAT HAPPENED TO THE LOW-WAGE WORKERS WHICH IS HAVING AFFECTS THAT HAS DRIVEN THESE DEATHS OF DESPAIR. NOW, WE DID HAVE TO TAKE ON BOARD THE FACT WE PUBLISHED THIS BOOK THE SAME WAY WE STARTED TO HAP HAVE A NATIONAL EMERGENCY BECAUSE OF COVID. TRY NOT TO PUBLISH YOUR BOOK [INDISCERNIBLE] PROPORTIONS. AND WE SEE SIMILARITIES BETWEEN THE EPIDEMIC WE WROTE ABOUT IN THE BOOK AND COVID EPIDEMIC. LOW SKILLED WORKERS ARE OFTEN TIMES THE FRONT LINE WORKERS, THE BUS DRIVERS, PEOPLE WORKING IN HOSPITALS OR IN GROCERY STORES. THE EPIDEMIC WE WRITE ABOUT IN THE BOOK HAVE BEEN THE WORSE DISTRUST IN GOVERNMENT. SO IT'S THE CASE THAT LOW-SKILLED, LESS-EDUCATED PEOPLE THINK THE SYSTEM IS RIGGED AGAINST THEM AND THEY DON'T TRUST GOVERNMENT BECAUSE THEY HAVE NOT SEEN GOVERNMENT DO THINGS THAT MIGHT BE HELPFUL TO LEVEL THE PLAYING FIELD FOR THEM. IN THE COVID EPIDEMIC AS WE KNOW THERE ARE A LOT PEOPLE WITH SOCIAL DISTANCING AND THOSE WERE COMING DOWN FROM ON HIGH AND WE DON'T TRUST THE VOICES TELLING US TO DO THOSE THINGS. MANY COUNTRIES THAT HAVE GOOD PUBLIC HEALTH SYSTEMS ALSO HAVE HAD LARGE DIFFICULTIES DURING THE COVID EPIDEMIC. ECONOMICS HIGHLIGHT DIFFERENT REASONS WHY TYING HEALTH INSURANCE TO EMPLOYERS IS A MISERABLE WAY TO FUND HEALTH CARE SYSTEMS WHEN EMPLOYERS HAVE TO PAY THE PREMIUM AND THEY GET OUT OF CONTROL THERE'S IMPLICATIONS FOR THE LABOR MARKET WITH THE COVID EPIDEMIC WHEN 20 MILLION PEOPLE LOST THEIR JOBS IN THE FIRST MONTH AFTER LOCKDOWN AND A LARGE FRACTION LOST THEIR HEALTH INSURANCE SIMULTANEOUSLY IT TELLS YOU THIS MAY NOT BE THE BEST WAY TO PROVIDER HEALTH INSURANCE. THERE'S DIFFERENCES BETWEEN THE EPIDEMICS THOUGH. PEOPLE OF COLOR HAVE BEEN HIT HARDER THAN NON-WHITE HISPANICS AND COVID HAS BEEN HEAVILY CONCENTRATED AMONG THE ELDERLY. THERE'S VACCINES FOR COVID BUT THERE ARE NO VACCINES AVAILABLE FOR DEATHS OF DESPAIR. I WANT TO END BY SHOWING YOU NEW WORK THE DEATH RATES IN 2020 LOOK LIKE BY ETHNICITY FOR PRIME AGE PEOPLE 25 TO 64 AND FOR PEOPLE 65 AND ABOVE AND CONTRAST PEOPLE WITH AND WITHOUT A COLLEGE DEGREE. YOU CAN SEE NATIVE AMERICANS AND HISPANIC AMERICANS HAVE BEEN HARDER HIT BY COVID THAN DEATHS OF DESPAIR AND SAME FOR ALL THE GROUPS THAT PEOPLE WITH A B.A. HAVE BEEN MUCH MORE PROTECTED THAN THE PEOPLE WITHOUT A B.A. THAT CONTINUES TO BE TRUE EVEN AMONG THE ELDERLY. THESE PEOPLE HAVE NOT MOSTLY WORKING AT JOBS WHERE THEY'RE ON THE FRONT LINES WITHOUT A COLLEGE DEGREE. IT'S STILL THE CASE THAT OTHER PEOPLE WITH A B.A. AND I'M HAPPY IT TAKE QUESTIONS. >> THANK YOU FOR AN INCREDIBLE LECTURE. I'VE BEEN THINKING ABOUT THAT FOR DAYS TO COME IF NOT LONGER. I WANTED TO OFFER THE FIRST QUESTION TO OUR DEPUTY DIRECTOR AND CHRISTINE IF THEY HAD SOMETHING TO ASK YOU OTHERWISE I'LL GO TO THE QUESTIONS IN THE CHAT AND I'M SURE WILL CONTINUE TO COME IN THE CHAT. >> IS THERE AN ASSOCIATION WITH WHEN THAT HAPPENED AND IN THE 70s YOU BEGIN TO SEE A DIFFERENCE. >> I BELIEVE TWO WEEKS AFTER TODAY YOU'LL BE ABLE TO REVIEW THE TALKS WE HEARD TODAY. SO LET ME START AT THE TOP. THIS IS INTERESTING. ARE THERE ANY PROTECTIVE EFFECTS FOR CO-OCCUPY HOUSEHOLD MEMBERS AND EDUCATION WITH HIGHER THAN A B.A. >> THAT'S A GREAT QUESTION AND I WISH WE COULD ANSWER IT BUT LIKE SO MANY OF THE THINGS THAT IS IT'S NOT ON THE DEATH CERTIFICATE. INCOME ISN'T THERE AND OCCUPATION ISN'T THERE AND COHABITATION ISN'T THERE BUT IT DOES NOT MEAN EVENTUALLY WE MAY NOT KNOW MORE ABOUT IT. TO THE EXTENT THAT SOME GROUPS ARE VERY FORMAL -- TO SEE WHETHER OR NOT THEY CAN ATTACH MORE DEATH RECORDS BACK TO THE POPULATION SURVEY. SOME OF THOSE QUESTIONS MAY AT SOME POINT BE ANSWERABLE. CURRENTLY, WE DON'T KNOW. IT'S A GREAT QUESTION. >> SOME OF THESE I THINK CAME IN BEFORE YOU ACTUALLY ENDED UP ANSWERING THEM DURING YOUR DISCUSSION. YOU TALKED ABOUT THE DIFFERENCES IN DEATHS AND DESPAIR AND A QUESTION OVER TIME AND REPORTING. >> WE THINK BY THE TIME WE'RE TALKING ABOUT POST-1990, THAT SUICIDES AND DRUG OVERDOSES HAVE TO BE AND THINK IT'S THE CASE FROM THAT POINT THERE'S GOING TO BE SOME MISCLASSIFICATION PERHAPS A HEART ATTACK BUT IT'S A SUICIDE AND WE WERE WORRIED ABOUT THAT WE THINK IT'S PICKING UP A REAL PHENOMENON. >> THERE'S A QUESTION ON IT BE IN RURAL. >> I'M SORRY I DON'T HAVE A SLIDE ON THAT BECAUSE I DO AND IF YOU GO TO CDC WONDER YOU CAN PULL THIS BY LEVEL OF URBANICITY YOU SEE THE SAME INCREASE. SO THE SUBURB LIKE WHERE I'M IN, START AT A LOWER LEVEL OF DEATH FROM THESE CAUSES BUT THE INCREASE HAS BEEN IDENTICAL. THE RURAL IS IN THE MIX AND I DON'T THINK THE PRESS HAS IT IN THE MINDS THE AREA WAS PRISTINE AND THEN THIS HIT THEM AND MAYBE THAT'S WHY THEY HIGHLIGHT IT AS A PROBLEM BUT IT'S AN EVERYWHERE PROBLEM. IF ECONOMIC IMPACTS HAVE INCREASED WHAT CATALYZED THE DECLINE AND WHAT HAPPENED IN THE '80s THAT WERE SO SIGNIFICANT? >> PART IS THERE'S A REAL SHIFT IN THE POWER BETWEEN CAPITAL LABOR SO UNIONS DECLINED QUITE DRAMATICALLY OVER THAT PERIOD OF TIME. IT WAS THE CASE ALSO THAT PEOPLE WHO HAD A HIGH SCHOOL DEGREE WHO WOULD HAVE BEEN EMPLOYABLE IN THE RIGHT KIND OF JOB, THOSE JOBS STARTED TO DISAPPEAR AND WERE REPLACED BY PEOPLE WITH A B.A. PEOPLE WITH A HIGH SCHOOL DEGREE BEGAN TO FIND THEY COULD NOT FIND GOOD JOB PROSPECTS THE WAY THEY MIGHT HAVE A GENERATION BEFORE THAT. SO IT'S SORT OF A CONFLUENCE OF THINGS. FOR EXAMPLE, I HAD FRIENDS IN THE CLINTON ADMINISTRATION WHEN NAFTA PASSED THE NORTH AMERICAN FREE TRADE AGREEMENT AND THOUGHT JOBS WOULD BE LOST BUT THERE WOULD BE AN IMPETUS TO UPSCALE AND THE UPSCALING DID NOT TAKE PLACE. THERE'S BEEN REPEATED SITUATIONS IN WHICH THE PIE IS GETTING BIGGER BUT THERE'S BEEN A REDISTRIBUTION OF THE PIE AND A DIFFERENCE BETWEEN THE PEOPLE ON THE CAPITAL AND IF I SOUND LIKE AN MARXIST I'M NOT. WE NEED TO THINK WHETHER WORKING FROM HOME IN THE U.S. TODAY. THE 2030 CENSUS MIGHT BE 2020 CENSUS BUT I'LL LET DETERMINE THAT WE'RE RELYING MORE ON ADMINISTRATIVE RECORDS. WHAT WOULD YOU ADVICE DECISION MAKERS ABOUT THE USE OF ADMINISTRATIVE RECORDS FOR GIVING CONTEXT TO MAJOR HEALTH TRENDS? >> I'M IN THE SURE I UNDERSTAND THE QUESTION BUT MAYBE THE PERSON -- >> IS RICHARD MORE IS ON? COULD HE BE UNMUTED TO CLARIFY THE QUESTION. >> I WAS REFERRING TO THE 2030 CENSUS LOOKING FORWARD AT THE TREND OF GOING INCREASINGLY TO THE USE OF ADMINISTRATIVE RECORDS AND I WAS OBSERVING FROM YOUR TALK THAT YOU GLEANED A LOT FROM DEATH RECORDS BUT NOT ENTIRELY SATISFYING. IF THE FUTURE CENSUS WAS TO PROVIDE A MORE GRANULAR CONTEXT TO THE WORK YOU'RE DOING, ARE THERE TWO OR THREE THEMES THAT YOU WOULD EMPHASIZE FOR THOSE PEOPLE WHO ARE PLANNING THE FUTURE CENSUS GIVEN THE CENSUS IS A RESOURCE TO ALL SORTS OF DEMOGRAPHIC AND PUBLIC HEALTH RESEARCH IN THE COUNTRY. >> IN ORDER FOR PEOPLE'S ANONYMITY IT'S DIFFICULT AND THE RESEARCH GROUP AT OPPORTUNITY INSIGHT HAS DONE TERRIFIC WORK MATCHING DEATH RECORDS WITH TAX RECORDS. THE ONLY PROBLEM IS YOU DON'T HAVE EDUCATION, ETHNICITY ISN'T ON THE TAX RECORD. YOU WOULD NEED SOMETHING LIKE THE CURRENT POPULATION SURVEY OR AMERICAN COMMUNITY SURVEY WHICH IS A ROLLING SURVEY BETWEEN THE DECENNIAL CENSUS THAT IS EXTRAORDINARILY LARGE BUT IF PEOPLE COULD SOMEHOW FIND A WAY TO COMBINE THE DEATH RECORDS WITH RECORDS FROM THE AMERICAN COMMUNITY SURVEY, THAT WOULD BE HUGE THAT WOULD OPEN UP THE OPPORTUNITY FOR EXAMPLE THE FIRST QUESTION ON MARRIAGE SO WE'RE IN A WORLD TO WITH SAFE SPACE [NO AUDIO] >> THANK YOU. VERY HELPFUL AND THOUGHTFUL COMMENT. >> MY 18-YEAR-OLD TOLD ME IT'S NOT IMPORTANT TO GO TO COLLEGE NOW BECAUSE THEY SEE SO MANY PEOPLE NOT GOING TO COLLEGE AND STILL OKAY LOOK AT ZUCKERBERG. WHAT SHOULD THE MESSAGE BE TO OUR KIDS? >> OH, MY GOSH. I KNOW WHAT IT WOULD BE TO MY KIDS, I'LL SHOW YOU THE GRAPHS, YOU'RE GOING TO COLLEGE. YOU NEED TO LOOK AT THE PRE-K TO 12 EDUCATION SYSTEM SO IT STOPS BEING LASER FOCUSSED ON THE MINORITY OF KIDS COLLEGE BOUND AND PROVIDE SKILLS OR TRAINING FOR KIDS WHO FOR WHATEVER REASON CHOOSE NOT TO GO TO COLLEGE. I THINK EVERYBODY WHO WANTS TO GO TO COLLEGE SHOULD BE ABLE HAVE A SHOT AT IT. I DON'T THINK IT MEANS ALL OF US NEED TO GO TO COLLEGE AGAINST THESE THINGS HAPPENING. HISTORICALLY THE WAGE PREMIUM, THE EARNS DEGREE OF COLLEGE DEGREE OVER A HIGH SCHOOL DEGREE WAS 40% ON AN AVERAGE A PERSON WITH A COLLEGE DEGREE WOULD EARN 40% MORE THAN A PERSON WITH A HIGH SCHOOL DEGREE. BY 2000 NO DOUBLED. INSTEAD OF A 40% PREMIUM IT'S AN 80% PREMIUM. THAT'S HUGE. THERE ARE ZUCKERBERGS BUT THERE'LL BE ROCK STARS. IT'S THE CASE WITHOUT ADDITIONAL TRAINING OF SOME SORT YOU COULD BECOME A VERY SUCCESSFUL ELECTRICIAN OR PLUMBER OR HAVE A SKILL SET WHERE YOU WORK IN A HOSPITAL AND ARE HIGHLY EXILED JOB YOU COULD GET AND THOSE JOBS WILL BE OUT THERE BUT THAT'S A ROUGHER ROAD THAN COLLEGE RIGHT NOW. >> TO WHAT EXTENT DO THEY HAVE A HIGHER LIFE EXPECTANCY BECAUSE OF BETTER ENVIRONMENTAL CONDITIONS. A PLACE EFFECT OR GREATER CULTURAL HETEROGENEITY RATHER THAN HIGHER PER PERSON SPENDING ON HEALTH CARE. THIS PERSON NOTES THE U.S. IS A DIFFERS PLACE. -- DIVERSE PLACE. >> IT IS BUT IF YOU LOOK AT NON-WHITE HISPANICS AND AMONG HISPANICS AS WELL. IT'S -- WE SPENT TWICE AS MUCH AS THE U.K. AND MOST EUROPEAN COUNTRIES AND THEY'RE LIVING LONGER THAN WE ARE. NOT AS DIVERSE BUT THEY HAVE THEIR ONLY CHALLENGES AND LIVING LONGER THAN WE ARE SPENDING HALF AS MUCH. THE TENSION HERE WOULD COME IF WE HAD LONGER LIFE EXPECTANCY AND SPENT TWICE AS MUCH BUT THE TRUTH IS OUR HEALTH IS POORER EVEN IF YOU LOOK NARROWLY BETWEEN EDGE ETHNICITIES WE DO A POORER JOB THAN OTHER COUNTRIES. I THINK WE CAN DO A LOT MORE WITH A LOT LESS. WOULD YOU DISCUSS HOW FORECASTED CHANGES IN INDUSTRY SUCH AS AUTOMATION WILL AFFECT U.S. EMPLOYERS AND THE U.S. GOVERNMENT TO MEET THE HEALTH AND WELL BEING OF THE U.S. WORKFORCE? >> THIS SAY CHALLENGE. IT'S A -- THIS IS A CHALLENGE. A POLITICAL DECISION ABOUT HOW WE WANT TO CON FIGURE AND THE NATION. IN MANY COUNTRIES THERE'S MORE COHESION AND IN THE U.S. IT'S MORE THE CASE, I TAKE CARE OF ME AND MY FAMILY AND YOU TAKE CARE OF YOU AND YOUR FAMILY AND WE LIKE IT THAT WAY. WHETHER OR NOT WE COME TO A DECISION THAT WHAT HAPPENS IN EARLY CHILDHOOD IS OUR STRONG DETERMINATES OF THE WAY THE REST OF YOUR LIFE IS GOING TO GO REGARDLESS OF PRE-K PROGRAM AND GETTING KIDS ON A TRAJECTORY AND THEY'RE ABLE TO DEVELOP A SKILL SET B.A. OR NO B.A. WILL ALLOW THEM I A LIFE WITH MEANING. THAT'S A POLITICAL DECISION. I'M PRETTY GOOD AT DOCUMENTING KIDS IN A LOWER INCOME HOUSEHOLDS ARE ON A LOWER LIFE TRAJECTORY BUT AFTER THAT IT GOES TO SOMEONE ELSE. UNFORTUNATELY, THAT IS WHERE WE AS A RESEARCHER I HAND IT OFF TO SOMEONE ELSE. >> THANK YOU CASE, THANK YOU FOR JOINING US TODAY. IT WAS AN INCREDIBLE LECTURE. I'D LIKE TO THANK ALL THE ESIs FOR THEIR LECTURES AS WELL. A SILVER ROUND OF APPLAUSE -- A VIRTUAL ROUND OF APPLAUSE FOR EVERYBODY. IT WAS A VERY FRUITFUL DAY. DR. RILEY, WOULD YOU LIKE TO WRAP THINGS UP FOR US TODAY? >> I WOULD, THANK YOU. AND THANK YOU AGAIN FOR YOUR PRESENTATION TODAY I NEVER THOUGHT OF EMPLOYER SPONSORED HEALTH INSURANCE AS A REGRESSIVE TAX IT'S A REFRAME OF THAT AND THE FIXED COSTS ASSOCIATED WITH IT. THAT AMONG MANY THINGS I LEARNED FROM YOUR LECTURE SO MUCH APPRECIATED AND GREAT TO ADD YOU TO THE MUTUAL LIST OF HEROES AS A LECTURER. PROUD TO HAVE YOU PART OF THE GROUP. WE'VE BEEN DOING THE EARLY STAGE INVESTIGATOR AWARDS FOR SOME TIME AND WHEN WE STARTED IT WE THOUGHT OF DOING IT HAVING THE DISTINGUISHED LECTURER GO AND THEY'RE BUSY AND WE DID IT IN THE OPPOSITE DIRECTION AND I'VE BEEN HAPPY WE'VE DONE IT THAT WAY BECAUSE YOU AND EVERY OTHER DISTINGUISHED LECTURER WE'VE HAD HAS SAID HOW INSPIRING IT IS TO HEAR FROM AN EARLY STAGE INVESTIGATOR AND THE WORK THEY'RE DOING. >> IT'S EXTRAORDINARY AND THESE ARE VARIED RESEARCH PATHS. I'M GLAD THE NIH SEIZE THE VALUE IN THE SEES THE VALUE IN THE RESEARCH AND SOMETHING TO INVEST IN. I'M GRATEFUL FOR THAT. >> WELL, THANK YOU. THANK YOU AGAIN. I WANT TO THANK OUR EARLY STAGE INVESTIGATORS WHO WERE ALSO INSPIRED IN THE OPPOSITE DIRECTION BY YOUR PRESENTATION AS WELL. I WANT TO THANK ALL OF YOU WHO HAVE ATTENDED. WE HAD A NICE ATTENDANCE THOUGH IT WAS VIRTUAL. THANKS AGAIN TO ERICA SPOTTS FOR THE DISTINGUISHED LECTURER SELECTION AND ALL THE PEOPLE WHO REVIEWED HUNDREDS OF PAPER SUBMISSION TO SELECT OUR EARLY STAGE INVESTIGATOR PAPER AWARDEES. THAT WILL CLOSE OUT FOR THIS YEAR'S HONORS SELECTION ON HONORS DAY. THANK YOU ALL VERY MUCH AND THANK YOU FOR YOUR TIME.