The association between environmental factors and substance use outcomes among a vulnerable Veteran population

Abstract: Background: Illicit substance use among veterans is a complex and multifaceted issue. As individuals who have served in the armed forces return to civilian life, they may face a range of challenges, including mental health issues, physical injuries, and difficulties readjusting to societal norms. Unfortunately, for some veterans, these challenges can contribute to the allure of illicit substances as a coping mechanism. The intersection of the unique stressors associated with military service creates a population with an increased vulnerability to select health and psychosocial issues and susceptible to substance misuse (Tsai & Rosenheck, 2015). In addition to military experiences, environmental conditions exert an important influence on the behaviors and health outcomes of veterans. Environmental factors that promote social connection are important to lessening the impact of potentially harmful veteran experiences. Objective: To test whether environmental characteristics that facilitate social connection, specifically parks and greenspaces, places of worship, participation in civic and social organizations, public transit access and internet connectivity, are associated with illicit substance use among veterans who have experienced multiple adverse social determinants of health (maSDOH), specifically homelessness, unemployment and justice-involvement. Methods . Administrative data collected during health-related visits to the Veterans Health Administration (VHA) medical facilities across the nation during 2018 or 2019 calendar years. Veterans with an incident diagnosis of homelessness, unemployment and justice-involvement in their electronic health record were included (n=2,633) in this cross-sectional, retrospective study. These data were matched by zip code to publicly available social environment data, the National Neighborhood Data Archive (NaNDA) created by the University of Michigan. Prevalence ratios (PR) and odds ratios (OR) were reported. Results: More than one-third of veterans with maSDOH (37.3%) used illicit substances. Exposure to area-adjusted resources (per square mile) were protective against illicit substance use - number of parks (PR=0.83*, 95% CI (0.72, 0.96)), size of parks (PR=0.79*, 95% CI (0.69, 0.91)), number of religious organizations (PR=0.86, 95% CI (0.74, 1.00)) and civic/social organizations (PR=0.80*, 95% CI (0.70, 0.93)). Logistic regression models that controlled for age, race and sex also confirmed an inverse, protective relationship between social connection resources and illicit substance use. Religious organizations (OR=0.983; 95% CI (0.970, 0.966); p =0.0101) and civic / social organizations (OR=0.982; 95% CI (0.965, 0.999); p=0.0349) per square mile, were statistically significant. Most population-adjusted measures (per 1,000 residents) were also inversely related to illicit substance use. Overall, 9 of 11 social connection factors examined (82%), were found to be protective against illicit substance use. Conclusion: The prevalence of illicit substance use was lower among veterans residing in neighborhoods with characteristics that promote social connection compared to veterans who do not. Exploring the underlying factors and consequences of illicit substance use among veterans is crucial not only for the well-being of those who have served but also for the development of effective support mechanisms and interventions to address this pressing public health concern.