Abstract
Aims
Methods
Results
Conclusions
Opioid Misuse and Chronic Pain Among Women Military Veterans
Limited Research on Complementary and Integrative Health and Gender in Veterans
- Hempel S.
- Taylor S.L.
- Marshall N.J.
- Miake-Lye I.M.
- Beroes J.M.
- Shanman R.
- Shekelle P.G.
- U.S. Government Publishing Office
Clarke, T. C., Black, L. I., Stussman, B. J., Barnes, P. M., & Nahin, R. L. (2015). Trends in the use of complementary health approaches among adults: United States, 2002-2012. National Health Statistics Report, (79), 1-16. Available from: https://nccih.nih.gov/research/statistics/NHIS. Accessed: April 1, 2018.
Methods
Study Design and Participants
Measures
Women (n = 79,537) | Men (n = 389,269) | |||
---|---|---|---|---|
Used CIH? n (%) | Used CIH? n (%) | |||
Yes 28,463 (35.8) | No 51,074 (64.2) | Yes 99,369 (25.5) | No 289,900 (74.5) | |
Age (y), | ||||
18-34 | 8,798 (30.9) | 17,039 (33.4) | 31,583 (31.8) | 88,258 (30.4) |
35-44 | 9,583 (33.7) | 16,563 (32.4) | 30,971 (31.2) | 90,105 (31.1) |
45-54 | 10,082 (35.4) | 17,472 (34.2) | 36,815 (37.1) | 111,537 (38.5) |
Race/ethnicity, | ||||
White, non-Hispanic | 15,590 (54.8) | 25,178 (49.3) | 61,101 (61.5) | 176,262 (60.8) |
Black, non-Hispanic | 8,128 (28.6) | 17,694 (34.6) | 20,192 (20.3) | 63,922 (22.1) |
Hispanic or Latino/a | 2,364 (8.3) | 3,682 (7.2) | 10,296 (10.4) | 24,015 (8.3) |
Other, non-Hispanic | 1,236 (4.3) | 1,931 (3.8) | 4,041 (4.1) | 9,951 (3.4) |
Missing | 1,145 (4.0) | 2,589 (5.1) | 3,739 (3.8) | 15,750 (5.4) |
Marital status, | ||||
Married | 9,120 (32.0) | 18,804 (36.8) | 43,701 (44.0) | 147,490 (50.9) |
Divorced/separated/widowed | 11,259 (39.6) | 18,099 (35.4) | 30,473 (30.7) | 75,296 (26.0) |
Single/never married | 8,043 (28.3) | 14,001 (27.4) | 25,023 (25.2) | 66,025 (22.8) |
Missing/unknown | 41 (0.14) | 170 (0.33) | 172 (0.17) | 1,089 (0.38) |
Copayment, | ||||
Exempt | 43,543 (85.3) | 25,732 (90.4) | 84,793 (85.3) | 236,812 (81.7) |
Required | 5,189 (10.2) | 1,471 (5.2) | 6,683 (6.7) | 37,851 (13.1) |
Other + missing | 2,342 (4.6) | 1,260 (4.4) | 7,893 (7.9) | 15,237 (5.3) |
Insurance status, | ||||
VA | 16,823 (59.1) | 30,796 (60.3) | 63,048 (63.5) | 182,435 (62.9) |
Private | 5,426 (19.1) | 12,764 (25.0) | 16,243 (16.4) | 67,145 (23.2) |
Non-VA government | 6,214 (21.8) | 7,514 (14.7) | 20,078 (20.2) | 40,320 (13.9) |
Comorbid conditions | ||||
Depression, | 2,003 (70.3) | 21,549 (42.2) | 64,517 (64.9) | 96,506 (33.3) |
Substance abuse, | 11,813 (41.5) | 14,747 (28.9) | 59,971 (60.4) | 119,342 (41.2) |
Post-traumatic stress disorder, | 14,920 (52.4) | 13,321 (26.1) | 55,489 (55.8) | 84,260 (29.1) |
Anxiety, | 11,453 (40.2) | 11,069 (21.7) | 35,008 (35.2) | 50,023 (17.3) |
Sleep, | 7,424 (26.1) | 8,630 (16.9) | 33,198 (33.4) | 67,061 (23.1) |
Traumatic brain injury, | 2,288 (8.0) | 1,613 (3.2) | 19,618 (19.4) | 22,626 (7.8) |
Musculoskeletal pain diagnoses | ||||
Back pain, | 13,670 (48.0) | 22,469 (44.0) | 56,589 (57.0) | 148,482 (51.2) |
Joint pain, | 8,941 (31.4) | 21,090 (41.3) | 32,931 (33.1) | 121,854 (42.0) |
Neck pain, | 6,386 (22.4) | 8,606 (16.9) | 19,235 (19.4) | 41,864 (14.4) |
Fibromyalgia, | 4,173 (14.7) | 5,506 (10.8) | 6,437 (6.5) | 16,866 (5.8) |
Osteoarthritis, | 1,662 (5.8) | 3,301 (6.5) | 7,275 (7.3) | 23,109 (8.0) |
Tempomandibular disorder, | 334 (1.2) | 421 (0.8) | 478 (0.5) | 947 (0.3) |
Data Analysis
Results
Gender Differences in the Use of CIH Therapies
Gender Differences in Type of CIH Therapy Used
Women (n = 28,463), n (%) | Men (n = 99,369), n (%) | |
---|---|---|
Type of CIH therapy | ||
Meditation | 10,594 (37.2) | 41,759 (42.0) |
Yoga | 4,792 (16.8) | 9,819 (9.9) |
Acupuncture | 4,287 (15.1) | 14,576 (14.7) |
Chiropractic | 3,987 (14.0) | 14,952 (15.1) |
Biofeedback | 1,641 (5.8) | 5,685 (5.7) |
Massage | 1,603 (5.6) | 6,203 (6.2) |
Guided imagery | 988 (3.5) | 4,237 (4.3) |
Tai Chi | 539 (1.9) | 2,268 (2.3) |
Hypnosis | 112 (0.4) | 370 (0.4) |
Multivariate Predictors of CIH Therapy Use Among Women and Men
Women (n = 79,537) | Men (n = 389,269) | |||
---|---|---|---|---|
Main Effects Model | Main Effects Model Plus Interactions | Main Effects Model | Main Effects Model Plus Interactions | |
OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
Age, y (reference group: 18–34) | ||||
35-44 | 1.18*** (1.13–1.22) | 1.12*** (1.06–1.18) | 1.20*** (1.18–1.23) | 1.19*** (1.16–1.22) |
45-54 | 1.16*** (1.12–1.21) | 1.06* (1.00–1.12) | 1.21*** (1.18–1.23) | 1.14*** (1.11–1.17) |
Race/ethnicity (reference group: White) | ||||
Hispanic/Latina/o | 1.15*** (1.09–1.22) | 1.01 (0.92–1.10) | 1.39*** (1.35–1.42) | 1.27*** (1.22–1.33) |
Black | 0.81*** (0.79–0.84) | 0.70*** (0.65–0.75) | 1.04*** (1.02–1.06) | 0.92*** (0.88–0.96) |
Other | 1.13** (1.05–1.23) | 1.13 (0.99–1.28) | 1.29*** (1.24–1.34) | 1.29*** (1.21–1.39) |
Missing | 0.86*** (0.79–0.93) | 0.94 (0.81–1.08) | 0.88*** (0.84–0.91) | 0.89** (0.82–0.96) |
Marital status (reference group: married) | ||||
Single/never married | 1.26*** (1.21–1.31) | 1.26*** (1.21–1.31) | 1.32*** (1.29–1.35) | 1.32*** (1.29–1.35) |
Divorced/separated/widowed | 1.15*** (1.11–1.19) | 1.15*** (1.11–1.19) | 1.18*** (1.15–1.20) | 1.18*** (1.15–1.20) |
Missing | 0.61** (0.43–0.88) | 0.61** (0.42–0.87) | 0.74*** (0.63–0.88) | 0.74*** (0.63–0.88) |
Copayment (reference group: exempt) | ||||
Required | 0.60*** (0.57–0.64) | 0.60*** (0.57–0.64) | 0.64*** (0.61–0.65) | 0.64*** (0.62–0.65) |
Other + missing | 0.94 (0.88–1.02) | 0.95 (0.88–1.02) | 1.40*** (1.36–1.45) | 1.40*** (1.36–1.45) |
Insurance status (reference group: VA) | ||||
Private | 0.89*** (0.86–0.93) | 0.89*** (0.86–0.93) | 0.86*** (0.84–0.88) | 0.86*** (0.84–0.87) |
Non-VA government | 1.31*** (1.25–1.36) | 1.31*** (1.25–1.36) | 1.26*** (1.24–1.29) | 1.26*** (1.24–1.29) |
Comorbid conditions | ||||
Depression (reference group: no) | 2.01*** (1.95–2.09) | 2.02*** (1.95–2.09) | 2.23*** (2.19–2.27) | 2.23*** (2.19–2.27) |
Anxiety (reference group: no) | 1.49*** (1.44–1.55) | 1.49*** (1.44–1.54) | 1.52*** (1.49–1.55) | 1.52*** (1.49–1.55) |
Post-traumatic stress disorder (reference group: no) | 2.03*** (1.96–2.10) | 2.03*** (1.96–2.10) | 1.84*** (1.81–1.88) | 1.84*** (1.81–1.87) |
Traumatic brain injury (reference group: no) | 1.67*** (1.56–1.80) | 1.67*** (1.56–1.80) | 1.80*** (1.76–1.84) | 1.80*** (1.75–1.84) |
Substance abuse (reference group: no) | 1.24*** (1.20–1.28) | 1.24*** (1.20–1.28) | 1.54*** (1.51–1.56) | 1.54*** (1.51–1.56) |
Sleep disorder (reference group: no) | 1.23*** (1.18–1.27) | 1.23*** (1.18–1.27) | 1.19*** (1.16–1.21) | 1.19*** (1.16–1.21) |
Musculoskeletal pain diagnoses | ||||
Back pain (reference group: no) | 1.16*** (1.12–1.21) | 1.17*** (1.12–1.21) | 1.15*** (1.13–1.17) | 1.15*** (1.13–1.17) |
Neck pain (reference group: no) | 1.34*** (1.28–1.40) | 1.34*** (1.28–1.40) | 1.18*** (1.16–1.21) | 1.18*** (1.16–1.21) |
Joint pain (reference group: no) | 0.83*** (0.80–0.87) | 0.83*** (0.80–0.87) | 0.80*** (0.78–0.81) | 0.80*** (0.78–0.81) |
Osteoarthritis (reference group: no) | 0.90** (0.84–0.97) | 0.90** (0.84–0.97) | 0.92*** (0.89–0.95) | 0.92*** (0.89–0.95) |
Tempomandibular disorder (reference group: no) | 1.32*** (1.12–1.54) | 1.31*** (1.12–1.53) | 1.29*** (1.14–1.45) | 1.29*** (1.14–1.45) |
Fibromyalgia (reference group: no) | 1.35*** (1.28–1.42) | 1.35*** (1.28–1.42) | 1.10*** (1.07–1.14) | 1.10*** (1.07–1.14) |
Interaction term: age (reference group: 18–34) × race/ethnicity (reference group: White) | – | Omnibus test p < .001 | – | Omnibus test p < .001 |
35–44 × Black | – | 1.18*** (1.08–1.29) | – | 1.05 (0.99–1.11) |
35–44 × Hispanic/Latina/o | – | 1.18* (1.03–1.36) | – | 1.12*** (1.05–1.20) |
35–44 × Other | – | 0.95 (0.78–1.14) | – | 1.02 (0.92–1.12) |
35–44 × Missing | – | 0.89 (0.73–1.08) | – | 1.01 (0.91–1.11) |
45–54 × Black | – | 1.29*** (1.18–1.41) | – | 1.26*** (1.20–1.33) |
45–54 × Hispanic/Latina/o | – | 1.37*** (1.18–1.60) | – | 1.17*** (1.09–1.25) |
45–54 × Other | – | 1.07 (0.88–1.31) | – | 0.97 (0.87–1.07) |
45–54 × Missing | – | 0.89 (0.74–1.08) | – | 0.97 (0.88–1.07) |
Differences in CIH Therapy Use by Gender, Race/Ethnicity, and Age

Discussion
Implications for Practice and/or Policy
- U.S. Department of Veterans Affairs
Clarke, T. C., Black, L. I., Stussman, B. J., Barnes, P. M., & Nahin, R. L. (2015). Trends in the use of complementary health approaches among adults: United States, 2002-2012. National Health Statistics Report, (79), 1-16. Available from: https://nccih.nih.gov/research/statistics/NHIS. Accessed: April 1, 2018.
Limitations and Strengths
- Mor M.
- Veterans Healthcare Administration (VHA)
- Healthcare Analysis & Information Group (HAIG)
Conclusions
Supplementary Data
- Data profile
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Biography
Article info
Publication history
Footnotes
Funding for this research was provided by the Department of Veterans Affairs, Health Services Research and Development Service, 1 R01 HX001704-1. Dr. Elizabeth Evans was also supported by the Iris Cantor-UCLA Women's Health Center Advisory Board (NCATS UCLA CTSI UL1TR001881) and The Greenwall Foundation.
All authors report no conflicts of interest.