Impact of casino-based cash transfers on youth suicides among the Eastern Band of Cherokee Indians in North Carolina, USA

Abstract

Suicide accounts for the second leading cause of death among American Indian/Alaska Native (AI/AN) youth in the US. In 2019, suicides (per 100,000 population) among AI/AN youth aged 10-24 years exceeded those among other race/ethnicities by nearly three-fold. Despite these concerning trends, scant research focuses on policy and programmatic measures to reduce the high burden of suicides in this population. Research shows that provision of supplementary income through cash transfers may improve mental health among AI/AN youth that, in turn, may also reduce suicides. The relation between cash transfers and suicides in AI/AN populations , however, remains untested. We propose to examine whether unconditional cash transfers from casino-based percapita payments (percap) correspond with fewer suicides among the Eastern Band of Cherokee Indians (EBCI) in Graham, Swain and Jackson counties in North Carolina, USA. Starting 1995 (and currently ongoing), EBCI members in these counties started receiving percap payments following the opening of new casinos on their reservation in western North Carolina. This percap distributes a part of casino revenue to registered EBCI members (high school graduates or ≥ 21 years of age). Owing to the lack of conditionalities attached to income receipt, we regard percap disbursements in this context as unconditional cash transfers (UCT). Prior research on the impact of this UCT finds substantial improvements in child mental health among recipient families. We seek to examine, in a quasi-experimental longitudinal framework, whether and to what extent, percap payments correspond with a reduction in youth suicides (ages 10-24 years) among the EBCI, relative to other comparison groups in the region. Our findings may hold implications for suicide-prevention in vulnerable populations, and add to the current evidence base on psychiatric impacts of universal basic income.