Importance: Deaths from self-injury are increasing. Understanding the sources of risk is important for prevention and treatment. Objective: To estimate the risks of suicide and drug poisoning deaths among adult men whose adolescent occupational expectations were not met in adulthood. Design, Setting, and Participants: This cohort study included a sample of men interviewed as part of the High School and Beyond study, a nationally representative study of US high school sophomores and seniors in 1980, who were interviewed every 2 years through 1986; those who were sophomores in 1980 were reinterviewed in 1992. Men who survived to 1992 and reported occupational expectations were included in the present study. Death records prior to 2018 were linked to mortality databases and released in 2019. Data analysis was conducted from May to October 2020. Exposure: Occupational expectations. Main Outcomes and Measures: Survival or death by suicide, drug poisoning, chronic liver disease, heart disease, cancer, or some other cause, categorized from International Classification of Diseases, Ninth Revision and Tenth Revision codes. Competing risk Fine-Gray survival models regressed cause of death on adolescent occupational expectations and covariates. Results: The 11680 men in the High School and Beyond cohort study had a median (interquartile range) age of 29 (28-30) years in 1992, when the analysis of their future mortality began. Most men survived until 2015 (11060 [weighted percentage, 95.0%]). Reported causes of death were suicide (60 [weighted percentage, 0.5%]), drug poisoning (40 [weighted percentage, 0.4%]), chronic liver disease (20 [weighted percentage, 0.2%]), heart disease (130 [weighted percentage, 1.0%]), cancer (100 [weighted percentage, 1.0%]), and other (280 [weighted percentage, 2.0%]). Subhazard ratios for death by suicide and drug poisoning were 2.91 (95% CI, 1.07-7.88; P =.04) and 2.62 (95% CI, 1.15-5.94; P =.02) times higher, respectively, among those who in 1980 expected to hold a subbaccalaureate occupation that later declined in labor market share compared with those with professional occupational expectations. The actual job held by men did not attenuate the hazards of deaths from suicide and drug poisoning. Conclusions and Relevance: In this cohort study, men whose occupational expectations were not met because of labor market declines were at a higher risk of death from suicide or drug poisoning than men with different occupational expectations. Interventions to mitigate labor market changes should account for individuals' expectational ideals.

Educational gradients in health status, morbidity, and mortality are well established, but which aspects of schooling produce those gradients is only partially understood. We draw on newly available data from the midlife follow-up of the High School and Beyond sophomore cohort to analyze the relationship between students' level of coursework in high school and their long-term health outcomes. We additionally evaluate the mediating roles of skill development, postsecondary attendance and degree attainment, and occupational characteristics. We find that students who took a medium- to high-level course of study in high school have better self-reported health and physical functioning in midlife, even net of family background, adolescent health, baseline skills, and school characteristics. The association partially operates through pathways into postsecondary education. Our findings have implications for both educational policy and research on the educational gradient in health.