Adolescent Predictors of Firearm Suicide Over Four Decades of Life in U.S. Men.

INTRODUCTION: There are meager individual-level data on long-term predictors of firearm suicide. METHODS: This was an analysis of males (N=189,558) in the Project Talent cohort, a national probability sample of high school schools in 1960 when students completed a baseline Project Talent self-report inventory. Mortality follow-up was contingent on survival until 1979, the onset of the National Death Index when the cohort had a mean age of 35.7 years. Mortality follow-up continued until death or age 75 years, reached by all surviving members by 2018. Analyses were conducted in 2022, with the main outcome being firearm suicide deaths (n=479). Factor analyses of Project Talent items yielded three key factors: (1) interests in firearm-related professions (i.e., military service, police force), (2) interests in hunting or fishing and knowledge of long guns, and (3) stereotypic masculinity. RESULTS: Survival analyses showed that long-term risk for firearm suicide was associated with 1-SD increases in firearm-related vocational interests in adolescence (adjusted hazard ratio [95% CI]=1.23 [1.09, 1.40]) and masculinity (adjusted hazard ratio [95% CI]=1.15 [1.04, 1.28]). Decreased long-term firearm suicide risk was associated with increased hunting interests and knowledge of long guns in adolescence (adjusted hazard ratio [95% CI]=0.86 [0.77, 0.96]) and competitive sports participation, an exploratory variable (adjusted hazard ratio [95% CI]=0.89 [0.80, 0.99]). CONCLUSIONS: Prevention efforts are needed to lower long-term firearm suicide risk among adolescent males with high stereotypic masculinity and those interested in military or police service. Potential protective effects of competitive sports participation and socialization to long guns through hunting require further study.

The relationship between adolescent reading habits and older adult social engagement - A longitudinal cohort analysis.

OBJECTIVES: To investigate an access point during youth with the potential to have a positive impact on social engagement in later-life. Our social selves begin long before older adulthood, a life-stage during which people face extensive changes to their social milieu. Adolescence is a sensitive period for sociocultural processing and adolescent activities have the potential to impact social engagement in older adulthood. We examine reading since, in adolescence, it promotes social-cognitive skills which facilitate social engagement. METHODS: Our main goal was to study the relationship between adolescent reading and older adult social engagement. We used longitudinal cohort data from Project Talent and ordered logistic regression as well as two-wave, cross-lagged panel model to analyze this relationship. Ancillary analyses examined recognized relationships between reading and social-cognition and between social-cognition and social engagement in both adolescence and older adulthood. RESULTS: Adolescent reading was related to more frequent older adult social engagement with both family and friends. This relationship was independent of reading during older adulthood, social engagement during adolescence, and social-cognition at both life-stages. Adolescent social engagement was not associated with older adult reading in the two-wave, cross-lagged model. Reading was positively related to social-cognition in adolescence, but was insignificant in older adulthood. And, social-cognition was positively related to social engagement in both adolescence and older adulthood. DISCUSSION: Reading is declining for both young and older Americans. Young Americans are also socializing less than in previous decades. These trends could have a detrimental influence on social engagement and social isolation in future cohorts of older adults. We recommend continuing to look for activities and experiences during youth, especially the sensitive period of adolescence, that could stimulate social engagement over the life-course and into older adulthood.

Effects of a Geriatric Assessment Intervention on Patient-Reported Symptomatic Toxicity in Older Adults With Advanced Cancer.

PURPOSE: Providing a geriatric assessment (GA) summary with management recommendations to oncologists reduces clinician-rated toxicity in older patients with advanced cancer receiving treatment. This secondary analysis of a national cluster randomized clinical trial (ClinicalTrials.gov identifier: NCT02054741) aims to assess the effects of a GA intervention on symptomatic toxicity measured by Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE). METHODS: From 2014 to 2019, the study enrolled patients age ≥ 70 years, with advanced solid tumors or lymphoma and ≥ 1 GA domain impairment, who were initiating a regimen with high prevalence of toxicity. Patients completed PRO-CTCAEs, including the severity of 24 symptoms (11 classified as core symptoms) at enrollment, 4-6 weeks, 3 months, and 6 months. Symptoms were scored as grade ≥ 2 (at least moderate) and grade ≥ 3 (severe/very severe). Symptomatic toxicity was determined by an increase in severity during treatment. A generalized estimating equation model was used to assess the effects of the GA intervention on symptomatic toxicity. RESULTS: Mean age was 77 years (range, 70-96 years), 43% were female, and 88% were White, 59% had GI or lung cancers, and 27% received prior chemotherapy. In 706 patients who provided PRO-CTCAEs at baseline, 86.1% reported at least one moderate symptom and 49.7% reported severe/very severe symptoms at regimen initiation. In 623 patients with follow-up PRO-CTCAE data, compared with usual care, fewer patients in the GA intervention arm reported grade ≥ 2 symptomatic toxicity (overall: 88.9% v 94.8%, P = .035; core symptoms: 83.4% v 91.7%, P = .001). The results for grade ≥ 3 toxicity were comparable but not significant (P > .05). CONCLUSION: In the presence of a high baseline symptom burden, a GA intervention for older patients with advanced cancer reduces patient-reported symptomatic toxicity.

The helping older people engage (HOPE) study: Protocol & COVID modifications for a randomized trial.

Objectives: Evidence-based strategies to reduce loneliness in later life are needed because loneliness impacts all domains of health, functioning, and quality of life. Volunteering is a promising strategy, as a large literature of observational studies documents associations between volunteering and better health and well-being. However, relatively few studies have used randomized controlled trials (RCTs) to examine benefits of volunteering, and none have examined loneliness. The primary objective of the Helping Older People Engage (HOPE) study is to examine the social-emotional benefits of a social volunteering program for lonely older adults. This manuscript describes the rationale and design of the trial. Methods: We are randomly assigning adults aged 60 or older (up to 300) who report loneliness to 12 months of either AmeriCorps Seniors volunteering program or an active control (self-guided life review). Co-primary outcomes are assessed via self-report-loneliness (UCLA Loneliness Scale) and quality of life (WHOQOL-Bref). Enrollment was completed in May 2022 and follow-up assessments will continue through May 2023, with completion of primary outcomes soon thereafter. Conclusions: Since older adults who report loneliness are less likely to actively seek out volunteering opportunities, if results support efficacy of volunteering for reducing loneliness, dissemination and scaling up efforts may involve connecting primary care patients who are lonely with AmeriCorps Seniors through aging services agencies.This RCT is registered at clinicaltrials.gov (NCT03343483).

Intergenerational social mobility and suicide risk by firearm and other means in US males.

Firearms are the leading method of suicide in US men, and socioeconomic status (SES) is associated with suicide risk. In this 40-year mortality follow-up of a national cohort of US men, we examined if improved SES relative to one's family of origin, upward intergenerational social mobility (ISM), is associated with lowered risk for firearm suicide and suicide by other means in US men. Family of origin SES was assessed as part of Project Talent, a broad survey of US high school students in 1960. 42,766 men in the cohort completed follow-up surveys at age 29, assessing attained SES via education, occupation, and income. ISM was measured by change between harmonized SES composites. Mortality follow-up was conducted through age 70. Adjusting for baseline SES and race/ethnicity, a 1 standard deviation increase in SES was associated with a 31% reduction in firearm suicide risk later in the life course (HR [95% CI] = 0·69 [0·54, 0·88], P = 0·003), and a smaller, non-significant reduction in suicide by other means (HR [95% CI] = 0·80 [0·60, 1·07], P = 0·136). Traits associated with both suicide and SES attainment (cognitive ability, calm, impulsivity) only modestly attenuated this association. Upward ISM was more strongly associated with reduced firearm suicide risk in males with parents of low SES. The association between upward ISM and reduced firearm suicide mortality risk prevailed over ensuing decades. Policies improving social mobility in US males, particularly those of lower SES, may function as de-facto firearm suicide prevention strategies.

The relationship between health and political ideology begins in childhood.

We investigate whether childhood health status influences adult political ideology and whether health at subsequent life-stages, adolescent personality traits, or adolescent academic aptitude mediate this relationship. Using a national longitudinal cohort sample, we found that better health among children under age 10 was positively related to conservative political ideology among adults over age 64. Children with excellent health compared to very poor health were 16 percentage points more likely to report having a conservative political ideology in adulthood. Children with excellent health compared to very poor health were 13 percentage points less likely to report having a liberal political ideology in adulthood. Adults who had excellent health as children were 30 percentage points more likely to report conservative ideology than liberal ideology. However, the difference in ideological position for adults who had very poor childhood health was negligible. That is, the health and ideology relationship is being driven by those who were healthier early in life, after controlling for family income and material wealth. No evidence was found for mediation by adolescent heath, adult heath, adolescent personality traits, or adolescent academic aptitude. The magnitude of the coefficient for childhood health was substantively and statistically equivalent across race and sex. We discuss the possibility that, instead of being mediated, childhood health may actually be a mediator bridging social, environmental, and policy contexts with political ideology. We also discuss the potential of social policy to influence health, which influences ideology (and voting participation), which eventually circles back to influence social policy. It is important to understand the nexus of political life and population health since disparities in voice and power can exacerbate health disparities.

Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration.

Background: U.S. women recently released from incarceration experience significantly higher rates of trauma and exacerbation of mental health conditions, and the period following release has been identified as a window of heightened risk for mental health distress and human immunodeficiency virus (HIV), sexually transmitted infections (STI) and hepatitis C (HCV) transmissions. Despite these vulnerabilities, and an urgent need for supports, optimal engagement strategies remain unclear. WORTH Transitions is a program made up of two evidence-based interventions focused on improving the health of women returning to the community from incarceration with substance use disorders. Combining the two was designed to reduce HIV/STIs/HCV risks and increase overall health treatment engagement using a community health worker led intervention. Methods: We examined associations between trauma, mental health symptomology, and HIV/STI/HCV outcomes among women who engaged in the WORTH Transitions intervention (N = 206) Specifically, bivariate and longitudinal multivariate models were created to examine associations between trauma and mental health distress (defined as depressive and PTSD symptoms), on (1) types of engagement in HIV/STIs/HCV prevention and behavioral health services; and (2) HIV/STIs/HCV risk outcomes. The women who engaged in the intervention were 18 years and older and some were White, Black and other racial or ethnic minority. Results: PTSD symptomology and being a Black or indigenous woman of color was significantly (p = 0.014) associated with individual or group session engagement. Neither trauma nor PTSD symptoms were associated with higher HIV/STIs/HCV risks. Instead, relative to those who did not engage in HIV/STI/HCV risky behaviors, PTSD symptomology (p = 0.040) was associated with more than 3-fold increase in the probability of being lost to follow up (relative risk ratio = 3.722). Conclusion: Given the impact of PTSD-related symptoms on driving both engagement in HIV/STIs/HCV prevention services and intervention attrition among women leaving incarceration, physical and behavioral health interventions must be both overtly trauma- and mental health-informed. As was the case with WORTH Transitions, physical and behavioral health services for this population must include intentional and active support of the forms of treatment participants endorse to ensure maximal engagement.

Moderate to Severe Chronic Pain in Later Life: Risk and Resilience Factors for Recovery.

Despite extensive research on the development and risk factors of chronic pain, the process of recovery from chronic pain in later life has been rarely studied. We estimated the recovery rate of moderate to severe chronic pain (chronic pain of moderate or severe severity or interfering with usual activities) among older adults and investigated predictors of recovery. Leveraging the longitudinal Health and Retirement Study 2006-2016 data (6 waves), we estimated the biennial national attrition-adjusted recovery rate of moderate to severe chronic pain among 6,132 US adults aged 65-75 at baseline. Generalized estimating equation Poisson models examined pain-related, sociodemographic, psychosocial and health-related factors in relation to recovery within any 2-year interval using longitudinal lagged design. Between 2006-2016, the prevalence of moderate to severe chronic pain increased from 28% to 33% with the incidence increasing from 14% to 18% and the recovery rate approximately 30%. Previous chronic pain duration, age, chronic diseases and a personality trait (agreeableness) were associated with a lower probability of recovery. Greater financial wealth and physical activity, better sleep quality and self-reported health were associated with a greater probability of recovery. Interventions that improve physical activity and sleep quality may be important avenues for reducing chronic pain burden among older adults. PERSPECTIVE: Our longitudinal findings suggested that recovery from moderate to severe chronic pain is common in later life and we further identified several key factors associated with this recovery process. Future research should consider the potential of interventions that improve physical activity and sleep quality to enhance recovery among older adults.

Prospective Association between Dysmenorrhea and Chronic Pain Development in Community-Dwelling Women.

Despite emerging evidence of associations between dysmenorrhea, enhanced pain sensitivity, and functional neuroimaging patterns consistent with chronic pain, it is unknown whether dysmenorrhea is prospectively associated with chronic pain development. Gaining a better understanding of this relationship could inform efforts in prevention of chronic pain. Using data from the national Midlife in the United States cohort, we examined the prospective association between dysmenorrhea and chronic pain development during a 10-year follow-up (starting 10 years after dysmenorrhea was measured) among 874 community-dwelling women aged 25-74 at baseline (when dysmenorrhea was measured). We fit modified Poisson regression models adjusting for sociodemographic, lifestyle and psychosocial factors. Among women who were menstruating at baseline, self-reported dysmenorrhea was associated with a 41% greater (95% confidence interval [CI] = 6%-88%) risk of developing chronic pain. Women with dysmenorrhea also developed chronic pain in more body regions (≥3 regions vs 1-2 regions vs none, odds ratio [OR] = 1.77, 95% CI = 1.18-2.64) and experienced greater pain interference (high-interference vs low-interference vs none, OR = 1.73, 95% CI = 1.15-2.59). Among women who had stopped menstruation at baseline, we did not find evidence of an association between their history of dysmenorrhea and subsequent risk of chronic pain development. Results suggest dysmenorrhea may be a general risk factor for chronic pain development among menstruating women. PERSPECTIVE: This study supports the temporality of dysmenorrhea and chronic pain development in a national female sample. Dysmenorrhea was also associated with developing more widespread and disabling pain among women who were still menstruating. Early management of dysmenorrhea may reduce the development and severity of chronic pain in women, although further research is required to determine whether dysmenorrhea is a causal risk factor or a risk marker of chronic pain.

Introducing the Psychological Autopsy Methodology Checklist.

OBJECTIVE: Case-control psychological autopsy studies are the research standard for the postmortem, quantitative study of ongoing or recent risk factors for suicide. We aimed to develop a reliable checklist of methodological quality of these studies. METHOD: We adapted items from a validated checklist to address general methodological elements and created novel items to address the unique aspects of psychological autopsy research to generate a 16-item checklist assessing reporting, external validity, internal validity, and power. We used percent agreement and kappa to evaluate inter-rater reliability of the items and overall checklist based on independent ratings of 26 case-control psychological autopsy studies conducted internationally. We also summed the items to generate overall quality ratings, assessing internal consistency with coefficient alpha (α). RESULTS: Inter-rater reliability for the overall checklist was high (percent agreement, 86.5%) and that based conservatively on kappa was substantial (κ .71) whereas internal consistency was low (α = 0.56). The inter-rater reliability of the individual items showed acceptable to high agreement. CONCLUSION: A novel checklist provides a reliable means to assess the methodological quality of specific elements of quantitative case-control psychological autopsy studies, providing detailed guidance in planning such studies. Lower internal consistency may limit its utility as a summary measure of study quality.

The Increased Risk for HIV and Other Sexually Transmitted Infections Among Substance-Using and Depressed Women in the Legal System.

This study was conducted in Alabama's Black Belt Counties to examine the association between household food insecurity and self-reported health status. Data were collected from 400 households to measure household food insecurity and self-reported general health status using the U.S. Food Security Module. In bivariate analyses, household food insecurity was Policy changes to increase economic resources and access to federal food programs are needed to reduce household food insecurity in this region. Gendered experiences in the context of consequences of poverty should not be ignored.

Attitudes Toward Computers Moderate the Effect of Computerized Cognitive Trainings in Oldest-Old Senior Living Center Residents.

BACKGROUND AND OBJECTIVES: Computerized cognitive interventions (CCIs) have been increasingly implemented among older adults with mild cognitive impairment (MCI). However, older individuals' attitudes toward technology may limit CCI engagement. This exploratory-developmental study examined whether a "multi-functional interactive computer system" (MICS), which provides pleasurable activities via computer, would improve attitudes toward computers and in turn increase the efficacy of a subsequent CCI. RESEARCH DESIGN AND METHODS: A phase one double-blind trial randomized 49 seniors with MCI to a MICS + CCI condition or a CCI-only condition. Attitudes toward technology use was assessed using The Attitudes Toward Computers Questionnaire (ATCQ), and cognition was assessed using episodic memory and executive function composite scores at baseline, the ends of MICS and CCI phases, and 3-month follow-up. RESULTS: The MICS + CCI group did not show significantly greater improvement in cognition than the CCI only group. Secondary analyses indicated that improvement in executive function from baseline occurred in both groups. Participants who did show improved attitudes toward computers, whether through MICS or simply computer exposure itself, showed improvement in executive function. DISCUSSION AND IMPLICATION: Participants in the MICS + CCI group used MICS less than expected. A more structured and supervised approach may be needed to facilitate MICS exposure. Improved attitudes toward computers regardless of MICS exposure may benefit candidates for CCI.

Blood Dehydroepiandrosterone and Dehydroepiandrosterone Sulfate as Pathophysiological Correlates of Chronic Pain: Analyses Using a National Sample of Midlife Adults in the United States.

OBJECTIVE: Identifying biomarkers is a priority in translational chronic pain research. Dehydroepiandrosterone (DHEA) and its sulfated form, DHEA-S, are adrenocortical steroids in the blood with neuroprotective properties that also produce sex hormones. They may capture key sex-specific neuroendocrine mechanisms of chronic pain. DESIGN: Cross-sectional study. METHODS: Using data from 1,216 community-dwelling adults aged 34-84 from the Midlife in the United States (MIDUS) cohort, we examined blood DHEA and DHEA-S levels in association with chronic pain in men and women, adjusting for demographics, chronic diseases, medications including opioids, and psychosocial factors. If an association was found, we further explored dose-response relationships by the number of pain locations and the degree of pain interference. RESULTS: In women, chronic pain was associated with 0.072 lower (95% confidence interval [CI], -0.127 to -0.017) log10 DHEA-S µg/dL, with pain in one to two locations associated with 0.068 lower (95% CI, -0.131 to -0.006) and in three or more locations 0.071 lower (95% CI, -0.148 to 0.007) log10 DHEA-S (P for trend = 0.074). Furthermore for women, low-interference pain was associated with 0.062 lower (95% CI, -0.125 to -0.000), whereas high-interference pain was associated with 0.138 lower (95% CI, -0.233 to -0.043) log10 DHEA-S (P for trend = 0.004). Chronic pain was not associated with DHEA or DHEA-S levels in men or DHEA levels in women. CONCLUSIONS: Chronic pain and its functional interference correspond to lower blood DHEA-S levels in women.

Editorial Comment on Firth et al. (2019).

This Editorial Comment addresses an article by Firth et al. published in the February issue of 2019.

Motivational Interviewing to Address Suicidal Ideation: A Randomized Controlled Trial in Veterans.

OBJECTIVE: Although the months following discharge from psychiatric hospitalization are a period of acute risk for veterans, there is a dearth of empirically supported treatments tailored to veterans in acute psychiatric hospitalization. METHOD: We conducted a randomized controlled trial to test the efficacy of Motivational Interviewing to Address Suicidal Ideation (MI-SI) that explored and resolved ambivalence, and a revised MI-SI (MI-SI-R) that resolved ambivalence, on suicidal ideation (SI) in hospitalized veterans who scored > 2 on the Scale for Suicidal Ideation. Participants were randomized to receive MI-SI plus treatment as usual (TAU), MI-SI-R+TAU, or TAU alone. MI-SI+TAU and MI-SI-R+TAU included two in-hospital therapy sessions and one telephone booster session. Participants completed follow-up assessments over 6 months. RESULTS: Participants in all groups experienced reductions in the presence and severity of SI, but there were no significant differences among the groups. For the presence of SI, results were in the hypothesized direction for both MI-SI+TAU conditions. CONCLUSIONS: Results are nondefinitive, but the effect size of both versions of MI-SI+TAU on the presence of SI was consistent with prior MI findings. Exploratory analyses suggest MI-SI-R may be preferable to MI-SI. More intensive MI-SI-R with a greater number of follow-ups may increase its effectiveness.

Mortality Risk Associated With Personality Facets of the Big Five and Interpersonal Circumplex Across Three Aging Cohorts.

OBJECTIVE: To address the common reliance on the global Big Five domains in the personality and longevity literature, the present study examined mortality risk associated with subdimensions of Big Five domains as well as specific traits within the interpersonal circumplex (IPC) model of personality. METHODS: Data were drawn from three major longitudinal studies of aging that administered the NEO Personality Inventory-Revised, a comprehensive measure of the Big Five, and comprised a total of 4223 participants. Item Response Theory models were used to generate latent trait scores for each of the 30 Big Five facets and eight scales from the IPC. Pooled mortality risk estimates were obtained from demographic-adjusted Cox regression models within each study. RESULTS: With a high degree of consistency, the vulnerability facet of neuroticism was associated with higher mortality risk and the activity facet of extraversion, with lower risk. None of the openness or agreeableness facets were associated with mortality, although the IPC scales submissiveness and hostile submissiveness were linked with elevated risk. All but one of the facets in the conscientiousness domain were robustly and consistently associated with lower mortality risk. CONCLUSIONS: Findings indicate that specific facets of neuroticism and extraversion carry greater or lesser mortality risk. Broad composite scales averaging across all facets mask important personality risk factors. In contrast, nearly all facets within the conscientiousness domain confer protection against mortality. Finally, the IPC model may capture more nuanced interpersonal risk factors than the facets of Big Five agreeableness or extraversion. Understanding of the role of personality in longevity requires a more precise approach to conceptualization and measurement than broad, composite constructs usually provide.

Association Between High School Personality Phenotype and Dementia 54 Years Later in Results From a National US Sample.

Importance: Personality phenotype has been associated with subsequent dementia in studies of older adults. However, neuropathologic changes often precede cognitive symptoms by many years and may affect personality itself. Therefore, it is unclear whether supposed dementia-prone personality profiles (high neuroticism and low conscientiousness) are true risk factors or merely reflections of preexisting disease. Objectives: To examine whether personality during adolescence-a time when preclinical dementia pathology is unlikely to be present-confers risk of dementia in later life and to test whether associations could be accounted for by health factors in adolescence or differed across socioeconomic status (SES). Design, Setting, and Participants: Cohort study in the United States. Participants were members of Project Talent, a national sample of high school students in 1960. Individuals were identified who received a dementia-associated International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code during any year between 2011 and 2013. The dates of our analysis were March 2018 to May 2019. Exposures: Ten personality traits were measured by the 150-item Project Talent Personality Inventory. Socioeconomic status was measured by a composite based on parental educational level, income, occupation, and property ownership. Participants were also surveyed on demographic factors and height and weight. Main Outcomes and Measures: Medicare records were collected, with dementia diagnoses in the period of 2011 to 2013 classified according to the US Centers for Medicare & Medicaid Services ICD-9-based algorithm. Cox proportional hazards regression models estimated the relative risk of dementia based on the 10 personality traits, testing interactions with SES and adjusting for demographic confounders. Results: The sample of 82 232 participants was 50.1% female, with a mean (SD) age of 15.8 (1.7) years at baseline and 69.5 (1.2) years at follow-up. Lower risk of dementia was associated with higher levels of vigor (hazard ratio for 1 SD, 0.93; 95% CI, 0.90-0.97; P < .001). Calm and maturity showed protective associations with later dementia that increased with SES. At 1 SD of SES, calm showed a hazard ratio of 0.89 (95% CI, 0.84-0.95; P < .001 for the interaction) and maturity showed a hazard ratio of 0.90 (95% CI, 0.85-0.96; P = .001 for the interaction). Conclusions and Relevance: This study's findings suggest that the adolescent personality traits associated with later-life dementia are similar to those observed in studies of older persons. Moreover, the reduction in dementia risk associated with a calm and mature adolescent phenotype may be greater at higher levels of SES. Personality phenotype may be a true independent risk factor for dementia by age 70 years, preceding it by almost 5 decades and interacting with adolescent socioeconomic conditions.

Political parties and mortality: The role of social status and personal responsibility.

Previous research findings across a variety of nations show that affiliation with the conservative party is associated with greater longevity; however, it is thus far unclear what characteristics contribute to this relationship. We examine the political party/mortality relationship in the United States context. The goal of this paper is two-fold: first, we seek to replicate the mortality difference between Republicans and Democrats in two samples, controlling for demographic confounders. Second, we attempt to isolate and test two potential contributors to the relationship between political party affiliation and mortality: (1) socioeconomic status and (2) dispositional traits reflecting a personal responsibility ethos, as described by the Republican party. Graduate and sibling cohorts from the Wisconsin Longitudinal Study were used to estimate mortality risk from 2004 to 2014. In separate Cox proportional hazards models controlling for age and sex, we adjusted first for markers of socioeconomic status (such as wealth and education), then for dispositional traits (such as conscientiousness and active coping), and finally for both socioeconomic status and dispositional traits together. Clogg's method was used to test the statistical significance of attenuation in hazard ratios for each model. In both cohorts, Republicans exhibited lower mortality risk compared to Democrats (Hazard Ratios = 0.79 and 0.73 in graduate and sibling cohorts, respectively [p < 0.05]). This relationship was explained, in part, by socioeconomic status and traits reflecting personal responsibility. Together, socioeconomic factors and dispositional traits account for about 52% (graduates) and 44% (siblings) of Republicans' survival advantage. This study suggests that mortality differences between political parties in the US may be linked to structural and individual determinants of health. These findings highlight the need for better understanding of political party divides in mortality rates.