Murray, Kulkarni, and Ezzati in their article look at 8 different populations in the United States. The 8 populations they observed were Asians, below-median income whites living in the Northland, Middle America, Poor whites living in Appalachia and the Mississippi Valley, Native Americans living on reservations in the West, black middle-America, Poor blacks living in the rural south, and blacks living in high-risk urban environments. During their observations they found that most mortalities for young and middle aged individuals are due to chronic disease. They also found that each population has their own distinct pattern when it comes to utilization of tobacco, alcohol, and obesity. They recommend that public health efforts need to focus on chronic diseases specifically affecting young and middle-aged Americans in these 8 populations across the United States.