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Since the early 2000s, contributors to the deaths-of-despair epidemic such as alcohol and drug related deaths have more than doubled. Evidence of the role of patient networks in the diffusion of prescription behaviors among physicians and of intra-household diffusion of opioids use contribute to important new questions about the population level effects of workplace- and intergenerational networks. This study responds to this need by expanding the focus from households and opioids overdose risk to examine the role of intergenerational and commuting networks in the diffusion of overdose risk from alcohol and drugs more generally among children. Analyses using negative binomial regression combined with computational statistics approaches such as cross-validation and permutation indicated that exposures to extra-local network overdose risks were associated with local adult- and child overdose deaths. These associations remained significant after controlling for multiple socioeconomic and demographic factors. The results showed that the link between network overdose risk and local child overdose deaths was accounted for in large part by intergenerational effects. Above and beyond intergenerational and spatial diffusion, network effects remained significant for Black children. High concentrations of other white residents protected white children against overdose risk but none of the minority groups. In turn, higher concentration of minority residents protected Black and Hispanic children. Higher population density increased the risk of overdose deaths among adults of all racial and ethnic groups, consistent with expectations of social and economic strain. However, it decreased the risk among children, consistent with social control expectations. Implications for future research and policy are discussed.more » « less
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