American journal of preventive medicine
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Veterans face elevated risk of suicide and homelessness, with housing instability being a significant, independent risk factor among this population. Addressing housing instability through primary, secondary, and tertiary prevention services is crucial for improving health and mortality outcomes, though research remains limited. The objective of this study is to assess the association between receipt of primary, secondary, and tertiary homelessness prevention services and risk of suicide and all-cause mortality among Veterans within 24 months of experiencing housing instability. ⋯ Continued receipt of services to address housing instability is associated with reduced mortality risk. Exiting programs to address housing instability may be a vulnerable period for Veterans, and investment in homelessness prevention is crucial to reduce mortality and improve outcomes among Veterans. Ongoing support is essential to mitigate risks associated with program exit.
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Despite the heavy toll of alcohol use disorder (AUD) in the U.S., efficacious medications for AUD (MAUD) are rarely used. Minimal research has explored clinician prescribing practices involving MAUD. ⋯ Most clinicians prescribing MAUD in a year did so rarely. Policy and health system change is needed to improve clinicians' pharmacologic treatment of AUD, with a focus on primary care physicians, with whom individuals with AUD may have the most frequent contact.
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Suicides and deaths of undetermined intent frequently involve cannabis or opioids, yet the relationships between cannabis and opioids, and cannabis policies and cannabis or opioid involvement in these deaths, are not well-characterized. Additionally, although there have been substantial changes to cannabis policies, there have been conflicting findings on relationships between changing cannabis policies and cannabis-involved or opioid-involved deaths. ⋯ These findings do not support the idea that cannabis policy liberalization and/or cannabis use are likely to be useful strategies to reduce cannabis or opioid involvement in deaths of suicide and undetermined intent.
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Many U.S. states expanded the generosity of Medicaid insurance coverage of tobacco dependence treatment over the last fifteen years, but little is known about how coverage impacts cigarette smoking, especially for individuals with substance use disorder. ⋯ Comprehensive tobacco dependence treatment coverage had no differential effect on smoking cessation among ever smokers with or without substance use disorder, and its expansion was not associated with changes in smoking behaviors for Medicaid beneficiaries with substance use disorder. Other multilevel interventions may be needed to impact smoking cessation rates, such as awareness and education campaigns of expanded tobacco dependence treatment coverage benefits, and interventions that reduce social and structural barriers to treatment.
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Physicians and nurses have lower annual mortality rates than the general population. One explanation for the low mortality rates of these healthcare workers emphasizes their specialized medical knowledge and greater access to healthcare while a second emphasizes their generally higher level of education. We evaluated the extent to which general educational level accounts for the lower all-cause mortality rates of US healthcare than non-healthcare workers. We also compared cause-specific mortality risks of healthcare and non-healthcare workers. ⋯ Higher educational attainment accounted for the longer life expectancy of US healthcare workers than other workers. Nevertheless, healthcare work relative to non-healthcare work was associated with lower hazards of deaths due to cardiovascular diseases and lung cancer, but higher hazards of deaths due to external causes.