Opioid use disorder and high-risk opioid prescription increase the risks for overdose and death. In Veterans, military sexual trauma is associated with increased risk for assorted health conditions. ...This study evaluates the association of military sexual trauma with opioid use disorder and high-risk opioid prescription and potential moderation by gender.
In a national sample of Veterans Health Administration outpatients receiving care from October 1, 2009 to August 1, 2017, logistic regression models were fit to evaluate the associations between military sexual trauma and opioid use disorder and high-risk opioid prescription, adjusting for demographic and clinical covariates. A second set of models included a gender X military sexual trauma interaction. Analyses were conducted in 2020–2021.
Patients with history of military sexual trauma (n=327,193) had 50% higher odds of opioid use disorder diagnosis (AOR=1.50, 95% CI=1.45, 1.54, p<0.001) and 5% higher odds of high-risk opioid prescription (AOR=1.05, 95% CI=1.04, 1.07, p<0.001) than those without history of military sexual trauma (n=7,738,665). The effect of military sexual trauma on opioid use disorder was stronger in men than in women . The predicted probability of opioid use disorder among men with history of military sexual trauma (1.5%) was nearly double that of women with history of military sexual trauma (0.8%).
Military sexual trauma was a significant risk factor for opioid use disorder and high-risk opioid prescription, with the former association particularly strong in men. Clinical care for Veterans with military sexual trauma should consider elevated risk of opioid use disorder and high-risk opioid prescription.
Background
App‐based drivers face work disruptions and infection risk during a pandemic due to the nature of their work, interactions with the public, and lack of workplace protections. Limited ...occupational health research has focused on their experiences.
Methods
We surveyed 100 app‐based drivers in Seattle, WA to assess risk perceptions, supports, and controls received from the company that employs them, sources of trust, stress, job satisfaction, COVID‐19 infection status, and how the pandemic had changed their work hours. Data were summarized descriptively and with simple regression models. We complemented this with qualitative interviews to better understand controls and policies enacted during COVID‐19, and barriers and facilitators to their implementation.
Results
Drivers expressed very high levels of concern for exposure and infection (86%–97% were “very concerned” for all scenarios). Only 31% of drivers reported receiving an appropriate mask from the company for which they drive. Stress (assessed via PSS‐4) was significantly higher in drivers who reported having had COVID‐19, and also significantly higher in respondents with lower reported job satisfaction. Informants frequently identified supports such as unemployment benefits and peer outreach among the driver community as ways to ensure that drivers could access available benefits during COVID‐19.
Conclusions
App‐based drivers received few protections from the company that employed them, and had high fear of exposure and infection at work. There is increased need for health‐supportive policies and protections for app‐based drivers. The most effective occupational and public health regulations would cover employees who may not have a traditional employer–employee relationship.
Using an online survey, we explored workplace determinants of perceived stress during COVID-19 in n = 2910 county government workers, and differences in perceived stress by gender and work ...arrangement (work from home v. do not work from home). We explored relationships with descriptive statistics and linear regression. Access to health and safety resources, increased workplace safety climate, support for work-life balance, and increased access to sick leave were related to lower stress; dependent care stress and female gender were related to higher stress. Among those working from home, higher stress related to an increase in workload and erosion of work/life boundaries. Findings show how the workplace impacts stress, differential determinants by gender/work arrangement, and areas to intervene to improve employee health and well-being.
Objective: The objective of this study was to identify patterns of risk and resilience by the intersections of race/ethnicity and sexual orientation in mental health symptom severity, sexism, and ...social support among U.S. women veterans. Method: A national sample of women veterans (N = 648; 38% sexual minority, 15% racial/ethnic minority) was recruited online in 2013. Using cross-sectional survey data, we evaluated main and interactive associations between race/ethnicity and sexual orientation on depression, anxiety, posttraumatic stress, unhealthy alcohol use, sexism, and social support. Models were adjusted for other demographic characteristics. Results: Across depression, anxiety, and sexism, White heterosexual women reported the least distress and racial/ethnic minority heterosexual women reported the most distress (Race/Ethnicity × Sexual Orientation interactions, p < .05). Among White women, sexual minority women reported greater levels of depression, anxiety, and sexism than heterosexual women. The effects were the opposite among racial/ethnic minority women, in which heterosexual women reported similar or worse depression, anxiety, and sexism than sexual minority women. There were no race/ethnicity or sexual orientation interaction effects on posttraumatic stress symptoms or unhealthy alcohol use and marginally significant effects on social support. Conclusions: Among women veterans, race/ethnicity and sexual orientation were associated with mental health and sexism, alone and in combination. Findings suggest that those who were both racial/ethnic and sexual minorities may develop resilience from their lived experience. On the other hand, women veterans with a minority race/ethnicity or a minority sexual orientation appeared more vulnerable to adverse outcomes and may need targeted care.
Public Significance Statement
This study suggests that women veterans with minority race/ethnicity or minority sexual orientation report higher levels of depression, anxiety, alcohol use, and experiences of sexism when compared with White heterosexual women veterans. Surprisingly, women veterans with both minority race/ethnicity and minority sexual orientation did not always fare worse than White heterosexual women veterans, suggesting that women at the intersection of these minority identities may develop resilience from their lived experience.
Opioid use disorder (OUD), a chronic illness associated with substantial morbidity and mortality, is common in veterans. Despite several national Department of Veteran Affairs (VA) initiatives over ...the last 15 years to increase access to medications to treat OUD (MOUD), MOUD remain underutilized. Women and veterans with mental health comorbidities are less likely to receive MOUD. The current study evaluated associations between military sexual trauma (MST), one common comorbidity among veterans, and receipt of MOUD among VA outpatients. We also evaluated whether gender moderated the MST-MOUD association and whether mental health conditions were associated with lower rates of MOUD across MST status.
In a cross-sectional study using a national sample of 80,845 veterans with OUD who sought care at VA facilities from 2009 to 2017, we fit mixed-effects logistic regression models to assess the association between MST and MOUD, adjusting for demographic and clinical characteristics, and with facility modeled as a random effect. Secondary analyses added interaction terms of MST x gender and MST x mental health diagnoses and compared average predicted probabilities to evaluate whether the MST and MOUD association varied by gender or mental health diagnoses. The study used a p-value threshold of .001 to determine significance due to multiple comparisons and large sample size.
Overall, 35% of veterans with OUD received MOUD. MST (8.1% overall; 5.2% of men, 48.8% of women) was not significantly associated with receipt of MOUD in a fully adjusted model (OR = 1.08; 99% CI 1.00, 1.17). No significant MST x gender interaction (p = .377) and no significant MST x mental health interaction (p = .722) occurred.
Both men and women veterans with and without a history of MST received MOUD treatment at similar rates. Room for improvement exists in MOUD receipt and future research should continue to assess barriers to MOUD receipt.
•Overall receipt of medications for opioid use disorder (MOUD) for Veterans with OUD in years 2009-2017 was low at 35%.•Military Sexual Trauma (MST) was not associated with lower receipt of MOUD.•There was a trend towards Veterans with a history of MST having greater odds of MOUD receipt than those without.•The location where a Veteran seeks treatment for OUD became a less important indicator of MOUD receipt over the last decade.
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