Suicide in the US has increased in the last decade, across virtually every age and demographic group. Research on suicide has consistently demonstrated that suicide shares many properties with a communicable disease, including person-to-person transmission, point-source outbreaks, and environmental hot spots. Therefore, applying an epidemiological perspective for suicide surveillance uncovers these environmental determinants and their impacts. This talk will highlight the growing prevalence and severity of suicide hotspots over the past two decades, with a focus on escalating racial disparities, particularly among young Black women. We reveal that about 10% of U.S. suicides are geographically clustered, with this figure notably higher among Native Americans. Four percent of counties in the US represent those at the highest suicide rates, mainly in sparsely populated areas in the West and Alaska. Counties with the highest suicide rates were more likely to have agricultural and service economies and less likely to have urban professional economies. Higher agricultural (RR = 4.42) and service (RR = 4.26) economic indexes were associated with an increased risk of being in a county with the highest suicide rate among residents aged 18–64 years old. Point-source outbreaks are also emerging and contributing to suicide risk, including inappropriate reporting of high-profile suicide deaths, and fictional depictions of suicide in popular culture. For example, an excess of 1,841 cases (9.9% increase) of suicide deaths in the US in 2014 are attributable to media reporting of the death of a prominent entertainer, Robin Williams. In sum, environmental determinants of suicide death are critical to identify in order to mobilize resources and reduce rates through prevention efforts. Using large-scale surveillance approaches, including cluster analysis, distributed lag models, and time series analysis, this series of studies presents the most up-to-date picture of environmental determinants of suicide death in the US to date.