A Linguistic Survey of Cannabis Product Packaging Targeting University Students.

Since the early 1900s, life expectancy has generally risen in high-income countries (). While many high-income countries saw a decline in life expectancy in 2014–15, most resumed the trend of increasing life expectancy in 2015–16, with the US and UK being two notable exceptions (). Economists Anne Case and Angus Deaton observed that the decline in US life expectancy was attributable to increasing mortality rates for 45–54-year-old non-Hispanic whites between 1999 and 2013; an increase that was driven primarily by drug overdoses, suicide, and alcohol-specific (DSA) mortality (, , ). Case and Deaton proposed that worsening labour market conditions (among other factors including rising age at marriage, increased childcare responsibilities, and low educational attainment) caused cumulative disadvantage from one birth cohort to the next that has given rise to a sense of despair and ultimately increased the likelihood of DSA mortality (). Since Case and Deaton coined the term deaths of despair, researchers around the world have adopted this phrase and investigated DSA mortality in different settings. While the increase in DSA mortality in the US was initially regarded as atypical for high-income countries, recognition of increasing mortality from these causes has driven research interest in the UK (; ; ; ; ). While the available evidence suggests that the stagnation in life expectancy in the UK before the COVID-19 pandemic was only partially attributable to DSA mortality (), drug overdoses in men have increased substantially in England since 2012 (; ), and suicide mortality has been rising in the UK since 2016 (; ; ). The evidence base surrounding DSA mortality in the UK is largely consistent with that in the US, where these deaths have risen significantly since the early 2000s and have primarily affected people of middle-age (, ). Increases in DSA mortality in both the UK and the US have been primarily driven by significant increases in drug-related mortality, with alcohol-specific mortality and deaths by suicide increasing at a more moderate rate (; ). Within England specifically, northern regions experience a significantly higher burden of DSA mortality relative to other regions (; ). According to the latest available data, the North East has the highest rate of DSA mortality of all English regions (; ). In 2022, Middlesbrough was the local authority with the highest rates of drug-related mortality and alcohol-specific mortality and the second highest rate of suicide in the North East (; ; ). Middlesbrough is a former industrial town of 143,900 people in the Teesside area of North Yorkshire, England (). Once an economic powerhouse that was central to the accumulation of British capital in the 20th century, Middlesbrough experienced rapid deindustrialisation in the latter half of the century that ushered in widespread unemployment and resulting deprivation (, ; ). A detailed overview of Middlesbrough’s economic history is available as supplemental material. Teesside communities like Middlesbrough are home to some of the most pronounced health inequalities in the country (; ). In Middlesbrough, life expectancy is shorter, rates of smoking are higher, and more people are living with a disability that severely impacts their day-to-day life than in other areas of England (; ). Middlesbrough has the highest proportion of severely deprived neighbourhoods of any community in England and the highest proportion of children living in poverty (). These wealth and health inequalities are deeply entrenched and have widened in recent years, leading to the rise of what have been termed ‘left behind’ communities (; ).