A Longitudinal Examination of the Social and Environmental Influences on Substance Use among Non-Prescriber/Non-Executive Healthcare Workers in the United States

Healthcare workers represent a large and growing segment of the US workforce, and the strain of the COVID- 19 pandemic on the healthcare system has brought to light the significant stress, trauma, and burnout that healthcare workers experience. These experiences may have lasting effects on healthcare workers’ substance use, mental health symptomatology, and suicidality, particularly among those in lower-wage occupations. These workers often have fewer supports and resources, less autonomy in the workplace (e.g., scheduling/hours worked, workload), and experience greater occupational hazards than their higher-earning counterparts yet remain highly understudied. Most of the published studies related to substance use, mental health symptomatology, and suicidality among healthcare workers have disproportionately focused on physicians and other high-wage healthcare occupations. The objective of the proposed research is to examine the social and environmental influences on the substance use, mental health symptomatology, and suicidality of non- prescriber/non-executive healthcare workers over time, with particular attention to the effects of moral injury (i.e., psychosocial and behavioral impacts of “failing to prevent or bearing witness to acts that transgress deeply held moral beliefs and expectations”) and workplace policies, programs, and practices. The rationale for the proposed research is that identification of factors beyond the individual level that confer risk or protection to healthcare workers’ substance use, mental health symptomatology, and suicidality can inform the development of more effective prevention and intervention efforts, particularly as it relates to the implementation of psychosocially safe and healthy workplace practices. Individual-level explanations for people’s risk and resilience to substance use, mental health symptomatology, and suicidality remain dominant in the scientific literature. However, we will also focus on interpersonal, organizational, community, and societal factors – and their intersections with socioeconomic positioning – that affect the health, well-being, and risk for substance use, substance-related harms, and substance use disorders among healthcare workers. This research proposes to 1) examine the effects of moral injury on changes in substance use, substance use disorders, problematic mental health symptomatology, and suicidality; 2) examine the impact of other individual, social, and environmental factors on these outcomes over time; and 3) examine the unique impacts of workplace policies, programs, and practices on the risk and resilience of healthcare workers. We will pursue these aims using an innovative approach and unique focus. The proposed research will examine a diverse sample of healthcare workers recruited via social media, including low-wage healthcare support occupations (e.g., nursing assistants, dietary aides, custodians). The proposed research is significant because the examination of factors external to the individual will identify modifiable social and environmental risk factors that are more efficient and effective intervention targets, given the broad impacts of population-level interventions.