Identifying Populations with High Opioid Use Disorder Stigma: Results from a Multi-State Survey

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Despite tragic outcomes and effective treatments, only a small proportion of people with opioid use disorder (OUD) receive care. A primary barrier to treatment is stigma. This study surveyed the general population in 13 Southern states, exploring characteristics associated with high OUD stigma. The authors sought to identify subpopulations with high levels of stigma to inform community anti-stigma education strategies in the South. A sample of 1,676 respondents were surveyed using the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS), and results were analyzed using multiple linear regression. Findings showed that being married, being in a mental health-related workforce profession, and having higher perceived stress were associated with higher stigma scores, while being female or having a history of a behavioral health problem oneself or in one's family was associated with lower stigma. Though additional research is needed, the findings suggest that community-based anti-stigma programming could benefit from targeting groups with high proportions of men and from combining this education with content aimed at stress management. Particularly concerning was the finding that mental health-related workforce professionals held significantly higher stigmatizing beliefs, indicating that outreach to health clinics, mental health centers, pharmacies, and related agencies is needed in community-based anti-stigma campaigns. Organizational partnerships in which members are likely to have low stigma, such as mental health or substance misuse advocacy groups, could benefit from anti-OUD-stigma efforts. opioid misuse OUD stigma anti-stigma education predictors of stigma Introduction Over the past two decades, the United States has experienced an ongoing opioid epidemic. Despite tragic outcomes, only a small proportion of people with opioid use disorder (OUD) receive appropriate treatment. A primary barrier to receiving care is stigma, defined as a set of negative beliefs, attitudes, and behaviors that result in prejudice and discrimination toward a specific group of people (National Academies, 2016). Fear of stigma can encourage individuals with OUD to avoid treatment, and if they do seek treatment, stigma from providers often results in harmful experiences (Burgess et al., 2021 ). The researchers are faculty from the University of [STATE] Cooperative Extension, which, as part of its community well-being mission, provides programming that promotes health and health-services access. Extension is beginning an initiative to provide OUD information and address OUD stigma in rural [STATE]. As an initial step, the researchers surveyed respondents in [STATE/REGION] in Fall 2025 to identify and prioritize populations in which OUD stigma was high, with the intention of using these findings to inform our and others’ anti-stigma interventions. Literature Review OUD in the United States As of 2023, 8.9 million people in the United States misused opioids, and 5.7 million people had an opioid use disorder (OUD; Substance Abuse and Mental Health Services Administration [SAMHSA], 2024a). Since 1999, the annual number of opioid overdose deaths has increased nearly 10 times, with about 82,000 people dying from an opioid overdose in 2022 (U.S. Centers for Disease Control [CDC], 2024). The rise in overdose deaths involving synthetic opioids is particularly concerning, with an increase from 1 to 11.4 per 100,000 from 2013 to 2019 (National Center for Health Statistics, 2021). In 2020, the American Society of Addiction Medicine (ASAM) recommended that all FDA-approved medications for the treatment of OUD (i.e., methadone, buprenorphine, and naltrexone) be available to all patients (ASAM, 2020). However, only about 25% of those who need OUD treatment receive any recommended medications (Dowell et al., 2024 ). In rural America, OUD is particularly complex. Individuals in rural areas report higher rates of non-medical use (i.e., misuse) of prescription opioids than those in urban areas, and rural overdose deaths continue to climb (Rural Health Information Hub, 2025; SAMHSA, 2024a). There is less access to treatment for OUD in rural areas than in urban areas (Pew, 2019); indeed, nearly 89% of large rural counties lack sufficient numbers of treatment programs. Consequently, rural areas must frequently rely on primary care physicians to provide office-based OUD treatment, which requires specialized training. Only 2.2% of urban counties lack an office-based OUD provider, compared with 30% of rural counties (Pew, 2019). In response to the OUD crisis, the Stanford–Lancet Commission was formed to conduct a comprehensive analysis of OUD causes and solutions. The commission noted a lack of accessible, high-quality, non-stigmatizing, integrated care services for people with OUD in the United States and identified stigma as a primary reason for the ongoing epidemic (Humphreys et al., 2022 ). Stigma and OUD Stigma is a discriminatory process whereby one category of person uses negative and anxiety-provoking labels and stereotypes to separate another group from the majority (“them” vs. “us”). Stigma only occurs when there is power asymmetry between the stigmatized and the stigmatizer (Andersen et al., 2022 ). Previous research has identified stigma as a major barrier preventing people with OUD from receiving quality treatment (Knaak et al., 2022 ; McCurry et al., 2023 ; SAMHSA, 2024b). Results from the 2023 National Survey on Drug Use and Health indicated that a common reason people with OUD did not receive treatment was due to concerns about what people would think if they sought help (SAMHSA, 2024b). Stigma toward individuals with OUD can include stereotyped attributional beliefs (Witte, et al., 2019 ); that is, people with OUD are often perceived as dangerous, deceitful, incapable of decision making, and culpable for their condition (Yang et al., 2017 ). Stigma can involve social distancing from a person or persons with OUD (Adams et al., 2021 ). It is present not only within the general population (Stone et al., 2024 ; Taylor et al., 2021 ), but also among law enforcement officers (Reichert et al., 2023 ) and healthcare providers (Garpenhag & Dahlman, 2021 ; Madden et al., 2021 ; McCurry et al., 2023 ). Stigma also influences policy, shaping taxpayers’ and lawmakers’ willingness to fund OUD treatment services (Goodyear & Chavanne, 2021 ; Kruis et al., 2024 ). Moreover, individuals with OUD can themselves incorporate society’s stigmatizing beliefs—an internalization that can pose a tremendous barrier to treatment and recovery (Akdag et al., 2018 ). However, there are multiple promising interventions for addressing stigma toward individuals with OUD. Research has found that acceptance and commitment group therapy can significantly reduce self-stigma (Luoma et al., 2008 ), while several studies have shown that contact with individuals in recovery can reduce stigma in healthcare providers (Bielenberg et al., 2021 ). In addition, researchers and practitioners have identified community-based education an effective anti-stigma strategy (Condie et al., 2023 ; Luty et al., 2008 ). Specifically, stigma-reduction education programs can help correct misinformation, increase knowledge, and change negative attitudes (National Academies, 2016). Research Objectives Although targeting audiences for anti-stigma community-based intervention is important, research has revealed contradictory findings around the association between demographic and professional characteristics and stigma (National Academies, 2016). As such, this study sought to examine the association between OUD stigma and a number of variables. We focused on categories informed by Andersen et al.’s ( 2022 ) theory of stigma—categories in which power asymmetry (e.g., regarding demographics and profession) may exist, in which anxiety (stress) may be high, or in which lived experience (history) may preclude simple stereotyping. Specifically, we investigated the association between the following variables and stigma toward individuals with OUD: Gender, race, ethnicity, age, marital status, employment status, income, military service history, and/or rurality Profession (mental health-related workforce vs. others) A history of behavioral health problems for oneself or in one’s family Level of perceived stress Methods Measures and Data Collection The study used a survey design to assess public stigma toward people with OUD in the southern United States. We contracted with the survey software and service provider Qualtrics to survey adults in 13 Southern states (all part of the Southern Ag Exchange Network), including Georgia, Florida, Alabama, North Carolina, South Carolina, Tennessee, Mississippi, Louisiana, Texas, Oklahoma, Arkansas, Virginia, and Kentucky. We employed quota sampling to obtain a demographically representative sample. The demographic characteristics used to divide the population into subgroups included rural/urban (using rural–urban continuum codes; U.S. Department of Agriculture, 2025), gender, race, ethnicity, and income. We used the Opening Minds Provider Attitudes Toward Opioid-Use Scale (OM-PATOS) as our stigma measure. The OM-PATOS was designed to measure stigma toward people with OUD in health/direct-service providers, including first responders (Knaak et al., 2022 ). Responses are rated on a 5-point Likert scale, from 5 (“strongly agree”) to 1 (“strongly disagree”), with lower summative scores indicating lower levels of stigma. Results from a recent validation study (Authors, under review) provided support for our use of 16 of the 19 items on the OM-PATOS with the general population (see Appendix A for the list of items comprising the newly validated measure). We measured perceived stress using the Perceived Stress-Short Form survey, which consists of four items (Warttig et al., 2013 ) rated on a 5-point Likert scale from 0 (“never”) to 4 (“very often”), with high summative scores reflecting greater perceived stress. Sample The study sample consisted of 1,676 individuals. As shown in Table 1 , the sample was predominantly White (65.6%), not Hispanic/Latino (85.7%), not affiliated with current or previous military service (90.9%), and urban (71.2%). About 60% of the participants reported being female or not married, or having a self- or family history of behavioral health problems. Over half (51.5%) reported having low-income status (< $ 50,000) and being employed full- (41.7%) or part-time (12.4%) and were aged 35 to 64 (56.9%). Over 17% reported working in a mental health-related workforce position, including those who provide mental health prevention and treatment services and who provide ancillary primary care services, mental health and behavioral health support services, and emergency care and crisis response (SAMHSA, 2023). Table 1 Characteristics of Study Sample (N = 1,676) Independent Variables N % OM-PATOS Score M SD Total sample 1,676 100 44.68 13.10 Gender Female 998 59.50 42.70 12.20 Male 670 40.00 47.70 13.70 Race White 1,099 65.60 44.40 13.20 Black 412 24.60 45.00 13.20 Other 165 9.80 45.90 12.50 Ethnicity Not Hispanic or Latino 1,436 85.70 44.30 12.90 Hispanic or Latino 240 14.30 47.10 14.00 Age 18–34 400 23.90 44.70 14.10 35–64 954 56.90 44.90 13.40 65 and older 322 19.20 44.10 10.80 Income $ 0– $ 49,999 864 51.50 43.30 12.50 $ 50,000– $ 99,999 504 30.10 44.40 12.20 $ 100,000 or greater 308 18.40 49.10 15.30 Employment status Employed, full-time 699 41.70 46.50 14.40 Employed, part-time 208 12.40 43.90 12.30 Other 769 45.90 43.20 11.80 Marital status Married 689 41.10 47.10 13.40 Not married 987 58.90 43.00 12.60 Having a self- or family history of behavioral health problems Yes 668 39.90 43.50 13.80 No 1,008 60.10 45.50 12.50 Profession Mental Health-Related workforce 287 17.12 48.80 14.30 Other 1,389 82.88 43.80 12.70 Rurality Urban 1,194 71.20 44.90 13.30 Rural 482 28.80 44.30 12.70 Current or previous military service member Yes 152 9.07 48.70 15.20 No 1,524 90.93 44.30 12.80 [Table 1 about here] Data Analysis We used a multiple linear regression model to analyze the data. The dependent variable was the total scale score on the OM-PATOS ( M = 44.68, SD = 13.10, Min = 16, Max = 80), with higher scores indicating higher levels of stigma. The independent variables were categorical, as shown in Table 1 , and perceived stress score ( M = 12.69, SD = 2.43, Min = 4, Max = 20). IRB Statement This study was reviewed, determined to be exempt, and approved by the University of [STATE] Institutional Review Board (Project ID #FP00024015). Results As shown in Table 2 , generally, when controlling for all else, being married, being in a mental health-related workforce profession, or having higher perceived stress was associated with higher stigma toward people with OUD. Being female or having a self- or family history of behavioral health problems was associated with lower stigma. On average, married people or mental health-related workforce professionals had a stigma scale score that was 2.6 and 4 points higher than people who were not married or were non-mental health professionals, respectively. In addition, for every 1-point increase in an individual’s stress score, their stigma score increased by approximately 1.3 points. Females or people with a self- or family history of behavioral health problems had, on average, a stigma score 3.7 or 2.5 points lower than males or people without a self- or family history of behavioral health problems, respectively. Overall, the model was statistically significant ( F (16, 1651) = 17.94, p < 0.001), explaining about 14% of the variance in stigma toward people with OUD (R 2 = 0.15, R 2 _Adjusted = 0.14). Table 2 Results of the Multiple Logistic Regression Model Independent Variables Est. S.E. t p Gender Female -3.68 0.65 -5.67 < 0.001 Race White -0.40 0.76 -0.53 0.60 Other 0.28 1.19 0.23 0.82 Ethnicity Hispanic or Latino 1.58 0.91 1.75 0.08 Age 35–64 0.12 0.76 0.15 0.88 65 and older 0.50 1.05 0.47 0.64 Income $ 50,000– $ 99,999 -0.60 0.73 -0.82 0.41 $ 100,000 or greater 1.78 0.94 1.89 0.06 Employment status Employed, part-time -0.30 1.00 -0.30 0.77 Other -0.30 0.75 -0.39 0.69 Marital status Married 2.59 0.68 3.82 < 0.001 Having a self- or family history of behavioral health problems Yes -2.50 0.63 -3.96 < 0.001 Profession Mental health-related workforce 4.04 0.84 4.80 < 0.001 Rurality Rural 0.37 0.67 0.55 0.58 Current or previous military service member Yes 1.57 1.07 1.47 0.14 Perceived stress 1.32 0.13 10.53 < 0.001 Intercept 29.00 1.89 15.32 < 0.001 Note . Est. = Estimate; S.E. = Standard error. [Table 2 about here] Discussion Given the multiple negative impacts of OUD stigma, including reluctance to seek treatment, poor treatment, and provider reluctance to provide evidence-based OUD medications (Burgess et al., 2021 ; Cody et al., 2023 ; Eschilman et al., 2024 ; Madden et al., 2021 ), addressing OUD stigma is crucial in stemming the opioid epidemic. Our findings identified specific subpopulations that are at higher risk of stigmatizing people with OUD—information that will be invaluable in planning and targeting anti-OUD-stigma education. Marital Status The study results revealed that being married was associated with a higher likelihood of having high OUD stigma, with scores 2.6 points higher than for those who were not married. This is a notable finding not often discussed in the literature; the few studies that have examined stigma and marital status have typically focused on stigma toward individuals with mental health challenges, and even these have produced contradictory findings. For instance, Hartini et al. ( 2018 ) found that married individuals were more tolerant of people with a mental health disorder, while Al-Adawi et al. ( 2002 ) and Meng et al. ( 2022 ) found that married individuals held more stigmatizing attitudes. Previous OUD literature either has not included marital status as a variable in analyses (Kaynak et al., 2022 ; Lin et al., 2022 ) or has found it be a non-significant variable (Jacobi et al., 2022 ). It may be that other, currently unidentified variables have interaction effects with marital status; therefore, additional research is needed in this area. Mental Health-Related Workforce Similarly to prior research, our results indicated that mental health-related workforce professionals had more stigma toward people with OUD than the general population. Studies have found that health-science students (Bareni et al., 2023), counselors (Ricciutti, 2023 ) social-work students (Wimberley et al., 2024 ), and law enforcement officers (Kruis et al., 2021 ; Reichert et al., 2023 ; Stone et al., 2024 ) showed high levels of stigma toward people with substance use disorder. In addition, people with OUD have reported experiencing stigma in hospitals and pharmacies (Burgess et al., 2021 ) as well as primary care (Garpenhag & Dahlman, 2021 ; McCurrey et al., 2023). A particular form of OUD stigma occurs when healthcare providers hold negative attitudes toward evidence-based medications for opioid use disorder (MOUD). This has been demonstrated in a number of studies, including Dickson-Gomez and colleagues’ ( 2022 ) work revealing drug treatment providers’ negative perceptions of MOUD; Madden and colleagues’ ( 2021 ) systematic review showing that providers’ lack of training influences their high MOUD stigma; and Piscalko et al.’s ( 2024 ) research showing high stigma and negative attitudes toward MOUD in physicians and nurses with lower knowledge of MOUD. MOUD stigma has also been shown in corrections officers (Friedmann et al., 2015 ), law enforcement officers, and first responders (Kruis et al., 2021 ; Reichert et al., 2023 ). These findings highlighting the highly stigmatizing views held by mental health-related workforce professionals toward individuals with OUD and toward MOUD are deeply concerning. One would hope that, as frontline responders, treatment referrers, treatment providers, and general providers of healthcare, mental health-related workforce professionals would be less stigmatizing toward people with OUD and more accepting of MOUD treatment. Anti-stigma education should be an ongoing priority for mental health/related workforce professionals. Stress In our findings, perceived stress level was closely associated with the level of stigma toward people with OUD. On average, for each 1-point increase in perceived stress score, the OM-PATOS score increased about 1.3 points. This was an intuitively logical finding, since individuals under stress might not have the emotional “bandwidth” to see beyond societal judgments and therefore might more easily accept stigmatizing beliefs. However, our literature review uncovered little previous research discussing the relationship between stress and engaging in stigma. One possible explanation for this phenomenon is that empathy mediates the relationship between stress and stigma. Studies have shown that higher levels of empathy are associated with lower stigma toward individuals with behavioral health disorder (Clinton & Pollini, 2021 ; Saguem et al., 2022 ), and that empathy-eliciting media messages decrease stigma toward individuals with mental illnesses (Hecht et al., 2022 ). Studies have also demonstrated the negative impact of perceived stress on overall empathy levels (Rudnik et al., 2025 ; Zhao et al., 2024 ). Research exploring the relationships among stress, empathy, and stigma could be an important advance in the understanding of stigma dynamics. Gender As reflected in our study findings, females were significantly less stigmatizing toward people with OUD than males. The research on gender and stigma has produced conflicting findings; thus, our results were supported by some previous studies but not by all. For instance, Woods and Elliott ( 2020 ) found that female undergraduates were significantly less likely to condone discrimination against people with OUD. A statewide survey found that being male was a significant positive predictor of OUD-related stigma (Kruis et al., 2024 ), and Kaynak et al. ( 2022 ) found that men reported significantly higher stigmatizing attitudes toward people with OUD. Conversely, other research did not support our findings. In their survey and community members and law enforcement officers, Stone and colleagues ( 2024 ) found that gender had no significant impact on stigma against people with OUD. Similarly, Reichert and colleagues ( 2023 ) found that male police officers were less likely to blame those with OUD for their condition than female officers. A nationally representative survey of stigma toward people with OUD showed that, for some aspects (e.g., willingness to have someone with OUD marry into one’s family), men exhibited lower stigma levels than women (Lin et al., 2022 ). A few studies have examined the impact of gender on attitudes toward MOUD. In Kaynak et al.’s ( 2022 ) general population study, men reported significantly higher negative attitudes about MOUD. However, a survey of first responders found that men expressed more positive attitudes toward MOUD than women (Kruis et al., 2021 ). It is important to note that different studies have examined different aspects of stigma—for instance, desire for social distance, belief in dangerousness, blame for one’s condition, and confidence in OUD treatment. Therefore, it will be important for future research to engage in more nuanced examinations of gender and the subcomponents of stigma to fully understand the interplay of gender and OUD stigma. History of Mental and Behavioral Health Problems Our findings demonstrated that people with a self- or family history of behavioral health problems—and thus high familiarity with such problems—had less stigma toward people with OUD than those without this history. Though prior research on stigma toward individuals with mental health issues has indicated that being close with someone with a mental health disorder is associated with lower stigma (Couture & Penn, 2003 ), research on the association between stigma and close familiarity with someone with SUD is less clear-cut. This is made more complex by the fact that the association between familiarity and stigma can vary by substance. For example, Jacobi et al. ( 2022 ) found that in congregations, familiarity was associated with lower stigma for depression and alcohol use disorder, but not drug use disorders. Some prior research has supported our findings. A survey conducted in a rural Indiana county found that both knowing someone and personal misuse of opioids reduced the stigma-driven desire for social distance (Railey & Greene, 2024 ). Janulis et al. ( 2013 ) found that having a family member who used heroin was associated with two aspects of stigma: decreased perceived dangerousness and decreased desire for social distance. Conversely, some literature has suggested that individuals who have—or whose family members have—a behavioral health problem may be more stigmatizing. In a national survey, Kennedy-Hendrick et al. (2017) found that people with a family member or close friend with prescription OUD had higher stigma. Much of the research on family, OUD, and stigma has highlighted complicated associations among these variables. Lin et al. ( 2022 ) found that individuals with a family member with OUD were less stigmatizing toward people with a history of OUD but were more stigmatizing toward those with current OUD. Satler et al. ( 2021 ) found that women with a family member with an OUD had higher empathy for someone using drugs than people without this level of familiarity. However, they also found that women with high familiarity were more likely to say they would support withholding help from someone with an OUD. Ledford ( 2025 ) found that when presented with media messages conveying the perils of opioid use, family members of people with OUD had lower scores in some aspects of stigma (e.g., desire for social distance) but higher scores in other aspects (i.e., desire for behavioral regulation and less support for opioid-related helping policies). The dynamics of OUD stigma among individuals who have experienced behavioral health problems in themselves or in family members are complex and multifaceted. It is easy to understand how the experience of a behavioral health disorder in oneself or a loved one could enhance support for individuals with OUD. At the same time, higher stigma may result from internalized stigma toward people with their own history of behavioral health disorder. For family, the negative experiences of having a family member with a behavioral health problem and the stigma associated with these experiences (Sheehan et al., 2017 ) may result in increased anger and frustration that fuel higher stigma. Future research should focus on disentangling the phenomena at play in OUD stigma among individuals with a self- or family history of behavioral health problems. Implications Implications for Research This study focused on characteristics associated with stigma toward individuals with OUD as a way to inform anti-stigma programming. Our findings highlight several areas for additional research. For instance, more research is needed to understand our somewhat puzzling finding that stigma is higher among married individuals. In addition, it is important to better understand the relationship between stress and stigma, and gender and stigma. Since both internalized stigma and familial stigma are barriers to recovery (Akdag et al., 2018 ; Sheehan et al., 2017 ), future studies should examine the differences in stigma among people with a personal history, those with a family history (excluding oneself), and/or those with a combination of both self- and family history of behavioral health problems. Similarly, it is essential to conduct research to improve intervention in addressing high levels of OUD stigma and MOUD stigma in mental health-related workforce professionals. People with OUD have indicated that stigmatizing experiences with helping professionals is a significant barrier to entering and staying in treatment (Cody et al., 2023 ; Reichert et al., 2023 ); decreasing these stigma barriers is necessary to maximize treatment success for individuals with OUD. Given the significant impact of media on stigma, future research should examine variables such as patterns of media portrayal of people with OUD, the stereotypes of dangerousness and unpredictability within these portrayals, and the consumption of such media to provide a fuller picture of factors affecting stigma. Research has shown that stigmatizing terms are frequently and increasingly used in news media coverage of the opioid crisis (McGinty et al., 2019 ; Webster et al., 2020 ). Research has also indicated that partisan media consumption affects stigma toward OUD (Kresovich et al., 2025 ). The extent of media portrayal of OUD and its relationship with public stigma toward OUD remains under-researched. Implications for Community Programming The findings of this study have important implications for priority targets in anti-OUD-stigma community education. One such target for education is men. Community outreach to groups that typically have high proportions of men, such as civic organizations, sports groups, or fraternal organizations, to develop partnerships for educational programming could be highly impactful. The higher levels of stigma found among mental health-related workforce professionals and among individuals with a self- or family history of behavioral health problems suggest that outreach to these populations is important. This could include partnerships for educational programming in local health and mental health centers, police or sheriff’s departments, hospitals, and organizations that support people in recovery and their families. Emphasizing the value of MOUD in such trainings is also critical. Additionally, our finding that high levels of stress are associated with higher OUD stigma suggests that programming and interventions to alleviate community stress through Extension and other community organizations could have the added benefit of decreasing stigma toward individuals with OUD. Extension already provides programming on stress management and well-being in some areas (e.g., farmer stress work occurring in [STATE] [Authors, 2024]). With enhanced understanding of the dynamics of stress and stigma, Extension could tailor education to address these two community needs through integrated programming. Limitations Though informative, our study did have limitations. Despite our efforts to ensure that subgroups of interest within the population were represented in the sample, there was an overrepresentation of rural subgroups in the final sample. Since quota sampling is a nonrandom sampling method, and because our sampling was limited to the U.S. South, our findings may have limited generalizability. However, we believe the results comprise the most comprehensive information currently available regarding the sources of public stigma toward people with OUD in the South. Another limitation to the applicability of our findings is that the study examined the relationship between select demographic characteristics and stigma toward people with OUD in the general population across the southern United States, not in specific subregions or communities. Hence, our findings provide a broad picture of stigma, and they may or may not hold when considering a specific context. In addition, our study investigated OUD stigma as a whole and did not analyze stigma responses by any of the range of subfactors described in the literature (e.g., attribution, dangerousness, etc.). A more nuanced understanding of the characteristics of stigma associated with subgroups was therefore not possible. In addition, we focused on common demographic characteristics and did not collect data on other potential factors such as media consumption and OUD stereotypes. This could be addressed by future research to provide a more comprehensive picture of the sources of stigma toward people with OUD. Conclusions Stigma toward individuals with OUD is a significant problem, creating barriers to effective care at a time when the opioid epidemic continues to rage. Cooperative Extension and other community groups are well poised to address the challenge of OUD stigma. Our study surveyed individuals across the southern United States to identify groups that may particularly benefit from anti-OUD-stigma education. In collaboration with community partners, targeted anti-stigma programming can help reduce barriers to care and promote prevention of and recovery from opioid use disorder. Declarations Author Contribution VB designed the research study, identified the scales, worked with the third-party vendor, oversaw TP's data analysis and helped write and review the article.TP took the lead on the data analysis and writing of the methods and results sections.DB is the grant's PI and provided input into the study design and assisted in writing the article.MB assisted in the design of the study, provided feedback on sampling strategy, reviewed the data and assisted with the article.AS contributed substantially to the interpretation of the data from the social work/behavioral health side and writing of the manuscript. The study was funded by a Rural Health and Safety Education Grant (#FP00029869) through the National Institute for Food and Agricultural, US Department of Agriculture. References Adams, Z., Taylor, B., Flanagan, E., Kwon, E., Johnson-Kwochka, A., Elkington, K., Becan, J., & Aalsma, M. (2021). 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U.S. Department of Health and Human Services. https://sprc.org/wp-content/uploads/2022/11/SPARS-Indicators-Cheatsheet-Campus-Cohort-12.pdf Substance Abuse and Mental Health Services Administration. (2024a, July). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health. U.S. Department of Health and Human Services. https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-national.htm Substance Abuse and Mental Health Services Administration. (2024b, July). 2023 NSDUH detailed tables. U.S. Department of Health and Human Services. https://www.samhsa.gov/data/report/2023-nsduh-detailed-tables Taylor, B., Lamuda, P., Flanagan, E., Watts, E., Pollack, H., & Schneider, J. (2021). Social stigma toward persons with opioid use disorder: Results from a nationally representative survey of U.S. adults. 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Factors influencing stigma toward individuals who have substance use disorders. Substance Use & Misuse, 54 (7), 1115–1124. Wimberley, A., Petros, R., Sacco, P., Tennor, M., Murray-Browne, S., & Arikat, L. (2024). Factors that contribute to stigma toward opioid users among social work students. Journal of Social Work Practice in the Addictions, 24 (1), 37–48. https://doi.org/10.1080/1533256X.2022.2103982 Woods, E., & Elliott, M. (2020). Opioid addiction stigma: The intersection of race, social class, and gender. Substance Use & Misuse, 55 (5), 818–827. https://doi.org/10.1080/10826084.2019.1703750 Yang, L., Wong, L., Grivel, M., & Hasin, D. (2017). Stigma and substance use disorders: An international phenomenon. Current Opinions in Psychiatry, 30 (5), 378–388. https://doi.org/10.1097/YCO.0000000000000351 Zhao, Q., Shen, Mingqi, Lin, C., Cong, Y., & Li, C. (2024). The negative impacts of life stress on empathy for emotions, for music, but not for pain. Mindfulness, 15 , 2825–2839. https://doi.org/10.1007/s12671-024-02464-w [Authors]. (2024). The farmer stress production meeting model: Acceptability and feasibility of an intervention. Journal of Extension, 62 (4), Article 10. https://doi.org/10.34068/joe.62.04.10 [Authors]. (under review). Construct validity of the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS) in the general population. Additional Declarations No competing interests reported. Supplementary Files AppendixA.docx Cite Share Download PDF Status: Published Journal Publication published 24 Apr, 2026 Read the published version in Community Mental Health Journal → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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experienced an ongoing opioid epidemic. Despite tragic outcomes, only a small proportion of people with opioid use disorder (OUD) receive appropriate treatment. A primary barrier to receiving care is stigma, defined as a set of negative beliefs, attitudes, and behaviors that result in prejudice and discrimination toward a specific group of people (National Academies, 2016). Fear of stigma can encourage individuals with OUD to avoid treatment, and if they do seek treatment, stigma from providers often results in harmful experiences (Burgess et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe researchers are faculty from the University of [STATE] Cooperative Extension, which, as part of its community well-being mission, provides programming that promotes health and health-services access. Extension is beginning an initiative to provide OUD information and address OUD stigma in rural [STATE]. As an initial step, the researchers surveyed respondents in [STATE/REGION] in Fall 2025 to identify and prioritize populations in which OUD stigma was high, with the intention of using these findings to inform our and others\u0026rsquo; anti-stigma interventions.\u003c/p\u003e"},{"header":"Literature Review","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eOUD in the United States\u003c/h2\u003e\u003cp\u003eAs of 2023, 8.9\u0026nbsp;million people in the United States misused opioids, and 5.7\u0026nbsp;million people had an opioid use disorder (OUD; Substance Abuse and Mental Health Services Administration [SAMHSA], 2024a). Since 1999, the annual number of opioid overdose deaths has increased nearly 10 times, with about 82,000 people dying from an opioid overdose in 2022 (U.S. Centers for Disease Control [CDC], 2024). The rise in overdose deaths involving synthetic opioids is particularly concerning, with an increase from 1 to 11.4 per 100,000 from 2013 to 2019 (National Center for Health Statistics, 2021). In 2020, the American Society of Addiction Medicine (ASAM) recommended that all FDA-approved medications for the treatment of OUD (i.e., methadone, buprenorphine, and naltrexone) be available to all patients (ASAM, 2020). However, only about 25% of those who need OUD treatment receive any recommended medications (Dowell et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn rural America, OUD is particularly complex. Individuals in rural areas report higher rates of non-medical use (i.e., misuse) of prescription opioids than those in urban areas, and rural overdose deaths continue to climb (Rural Health Information Hub, 2025; SAMHSA, 2024a). There is less access to treatment for OUD in rural areas than in urban areas (Pew, 2019); indeed, nearly 89% of large rural counties lack sufficient numbers of treatment programs. Consequently, rural areas must frequently rely on primary care physicians to provide office-based OUD treatment, which requires specialized training. Only 2.2% of urban counties lack an office-based OUD provider, compared with 30% of rural counties (Pew, 2019).\u003c/p\u003e\u003cp\u003eIn response to the OUD crisis, the Stanford\u0026ndash;Lancet Commission was formed to conduct a comprehensive analysis of OUD causes and solutions. The commission noted a lack of accessible, high-quality, non-stigmatizing, integrated care services for people with OUD in the United States and identified stigma as a primary reason for the ongoing epidemic (Humphreys et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStigma and OUD\u003c/h3\u003e\n\u003cp\u003eStigma is a discriminatory process whereby one category of person uses negative and anxiety-provoking labels and stereotypes to separate another group from the majority (\u0026ldquo;them\u0026rdquo; vs. \u0026ldquo;us\u0026rdquo;). Stigma only occurs when there is power asymmetry between the stigmatized and the stigmatizer (Andersen et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Previous research has identified stigma as a major barrier preventing people with OUD from receiving quality treatment (Knaak et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; McCurry et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; SAMHSA, 2024b). Results from the 2023 National Survey on Drug Use and Health indicated that a common reason people with OUD did not receive treatment was due to concerns about what people would think if they sought help (SAMHSA, 2024b).\u003c/p\u003e\u003cp\u003eStigma toward individuals with OUD can include stereotyped attributional beliefs (Witte, et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2019\u003c/span\u003e); that is, people with OUD are often perceived as dangerous, deceitful, incapable of decision making, and culpable for their condition (Yang et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Stigma can involve social distancing from a person or persons with OUD (Adams et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It is present not only within the general population (Stone et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Taylor et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), but also among law enforcement officers (Reichert et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and healthcare providers (Garpenhag \u0026amp; Dahlman, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Madden et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; McCurry et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Stigma also influences policy, shaping taxpayers\u0026rsquo; and lawmakers\u0026rsquo; willingness to fund OUD treatment services (Goodyear \u0026amp; Chavanne, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Kruis et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Moreover, individuals with OUD can themselves incorporate society\u0026rsquo;s stigmatizing beliefs\u0026mdash;an internalization that can pose a tremendous barrier to treatment and recovery (Akdag et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, there are multiple promising interventions for addressing stigma toward individuals with OUD. Research has found that acceptance and commitment group therapy can significantly reduce self-stigma (Luoma et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), while several studies have shown that contact with individuals in recovery can reduce stigma in healthcare providers (Bielenberg et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In addition, researchers and practitioners have identified community-based education an effective anti-stigma strategy (Condie et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Luty et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Specifically, stigma-reduction education programs can help correct misinformation, increase knowledge, and change negative attitudes (National Academies, 2016).\u003c/p\u003e\n\u003ch3\u003eResearch Objectives\u003c/h3\u003e\n\u003cp\u003eAlthough targeting audiences for anti-stigma community-based intervention is important, research has revealed contradictory findings around the association between demographic and professional characteristics and stigma (National Academies, 2016). As such, this study sought to examine the association between OUD stigma and a number of variables. We focused on categories informed by Andersen et al.\u0026rsquo;s (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) theory of stigma\u0026mdash;categories in which power asymmetry (e.g., regarding demographics and profession) may exist, in which anxiety (stress) may be high, or in which lived experience (history) may preclude simple stereotyping. Specifically, we investigated the association between the following variables and stigma toward individuals with OUD:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eGender, race, ethnicity, age, marital status, employment status, income, military service history, and/or rurality\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eProfession (mental health-related workforce vs. others)\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eA history of behavioral health problems for oneself or in one\u0026rsquo;s family\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eLevel of perceived stress\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eMeasures and Data Collection\u003c/h2\u003e\u003cp\u003eThe study used a survey design to assess public stigma toward people with OUD in the southern United States. We contracted with the survey software and service provider Qualtrics to survey adults in 13 Southern states (all part of the Southern Ag Exchange Network), including Georgia, Florida, Alabama, North Carolina, South Carolina, Tennessee, Mississippi, Louisiana, Texas, Oklahoma, Arkansas, Virginia, and Kentucky. We employed quota sampling to obtain a demographically representative sample. The demographic characteristics used to divide the population into subgroups included rural/urban (using rural\u0026ndash;urban continuum codes; U.S. Department of Agriculture, 2025), gender, race, ethnicity, and income.\u003c/p\u003e\u003cp\u003eWe used the Opening Minds Provider Attitudes Toward Opioid-Use Scale (OM-PATOS) as our stigma measure. The OM-PATOS was designed to measure stigma toward people with OUD in health/direct-service providers, including first responders (Knaak et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Responses are rated on a 5-point Likert scale, from 5 (\u0026ldquo;strongly agree\u0026rdquo;) to 1 (\u0026ldquo;strongly disagree\u0026rdquo;), with lower summative scores indicating lower levels of stigma. Results from a recent validation study (Authors, under review) provided support for our use of 16 of the 19 items on the OM-PATOS with the general population (see Appendix A for the list of items comprising the newly validated measure). We measured perceived stress using the Perceived Stress-Short Form survey, which consists of four items (Warttig et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) rated on a 5-point Likert scale from 0 (\u0026ldquo;never\u0026rdquo;) to 4 (\u0026ldquo;very often\u0026rdquo;), with high summative scores reflecting greater perceived stress.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSample\u003c/h2\u003e\u003cp\u003eThe study sample consisted of 1,676 individuals. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the sample was predominantly White (65.6%), not Hispanic/Latino (85.7%), not affiliated with current or previous military service (90.9%), and urban (71.2%). About 60% of the participants reported being female or not married, or having a self- or family history of behavioral health problems. Over half (51.5%) reported having low-income status (\u0026lt; \u003cspan\u003e$\u003c/span\u003e50,000) and being employed full- (41.7%) or part-time (12.4%) and were aged 35 to 64 (56.9%). Over 17% reported working in a mental health-related workforce position, including those who provide mental health prevention and treatment services and who provide ancillary primary care services, mental health and behavioral health support services, and emergency care and crisis response (SAMHSA, 2023).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eCharacteristics of Study Sample (N\u0026thinsp;=\u0026thinsp;1,676)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIndependent Variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eOM-PATOS Score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal sample\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,676\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e998\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e670\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e412\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot Hispanic or Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,436\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic or Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e954\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e65 and older\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e322\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0\u0026ndash;\u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e864\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50,000\u0026ndash;\u003cspan\u003e$\u003c/span\u003e99,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e100,000 or greater\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployment status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed, full-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e699\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed, part-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e689\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eHaving a self- or family history of behavioral health problems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e668\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health-Related workforce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,389\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRurality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e482\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent or previous military service member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,524\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e about here]\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eWe used a multiple linear regression model to analyze the data. The dependent variable was the total scale score on the OM-PATOS (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;44.68, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13.10, \u003cem\u003eMin\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16, \u003cem\u003eMax\u003c/em\u003e\u0026thinsp;=\u0026thinsp;80), with higher scores indicating higher levels of stigma. The independent variables were categorical, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, and perceived stress score (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.69, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.43, \u003cem\u003eMin\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4, \u003cem\u003eMax\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIRB Statement\u003c/h3\u003e\n\u003cp\u003eThis study was reviewed, determined to be exempt, and approved by the University of [STATE] Institutional Review Board (Project ID #FP00024015).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, generally, when controlling for all else, being married, being in a mental health-related workforce profession, or having higher perceived stress was associated with higher stigma toward people with OUD. Being female or having a self- or family history of behavioral health problems was associated with lower stigma. On average, married people or mental health-related workforce professionals had a stigma scale score that was 2.6 and 4 points higher than people who were not married or were non-mental health professionals, respectively. In addition, for every 1-point increase in an individual\u0026rsquo;s stress score, their stigma score increased by approximately 1.3 points. Females or people with a self- or family history of behavioral health problems had, on average, a stigma score 3.7 or 2.5 points lower than males or people without a self- or family history of behavioral health problems, respectively. Overall, the model was statistically significant (\u003cem\u003eF\u003c/em\u003e(16, 1651)\u0026thinsp;=\u0026thinsp;17.94, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), explaining about 14% of the variance in stigma toward people with OUD (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.15, R\u003csup\u003e2\u003c/sup\u003e_Adjusted\u0026thinsp;=\u0026thinsp;0.14).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eResults of the Multiple Logistic Regression Model\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndependent Variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eEst.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eS.E.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-3.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-5.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic or Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e65 and older\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50,000\u0026ndash;\u003cspan\u003e$\u003c/span\u003e99,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e100,000 or greater\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployment status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed, part-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eHaving a self- or family history of behavioral health problems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental health-related workforce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRurality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent or previous military service member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote\u003c/em\u003e. Est. = Estimate; S.E. = Standard error.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e about here]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eGiven the multiple negative impacts of OUD stigma, including reluctance to seek treatment, poor treatment, and provider reluctance to provide evidence-based OUD medications (Burgess et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Cody et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Eschilman et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Madden et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), addressing OUD stigma is crucial in stemming the opioid epidemic. Our findings identified specific subpopulations that are at higher risk of stigmatizing people with OUD\u0026mdash;information that will be invaluable in planning and targeting anti-OUD-stigma education.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eMarital Status\u003c/h2\u003e\u003cp\u003eThe study results revealed that being married was associated with a higher likelihood of having high OUD stigma, with scores 2.6 points higher than for those who were not married. This is a notable finding not often discussed in the literature; the few studies that have examined stigma and marital status have typically focused on stigma toward individuals with mental health challenges, and even these have produced contradictory findings. For instance, Hartini et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that married individuals were more tolerant of people with a mental health disorder, while Al-Adawi et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) and Meng et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) found that married individuals held more stigmatizing attitudes. Previous OUD literature either has not included marital status as a variable in analyses (Kaynak et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Lin et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) or has found it be a non-significant variable (Jacobi et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). It may be that other, currently unidentified variables have interaction effects with marital status; therefore, additional research is needed in this area.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eMental Health-Related Workforce\u003c/h2\u003e\u003cp\u003eSimilarly to prior research, our results indicated that mental health-related workforce professionals had more stigma toward people with OUD than the general population. Studies have found that health-science students (Bareni et al., 2023), counselors (Ricciutti, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) social-work students (Wimberley et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and law enforcement officers (Kruis et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Reichert et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Stone et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) showed high levels of stigma toward people with substance use disorder. In addition, people with OUD have reported experiencing stigma in hospitals and pharmacies (Burgess et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) as well as primary care (Garpenhag \u0026amp; Dahlman, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; McCurrey et al., 2023).\u003c/p\u003e\u003cp\u003eA particular form of OUD stigma occurs when healthcare providers hold negative attitudes toward evidence-based medications for opioid use disorder (MOUD). This has been demonstrated in a number of studies, including Dickson-Gomez and colleagues\u0026rsquo; (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) work revealing drug treatment providers\u0026rsquo; negative perceptions of MOUD; Madden and colleagues\u0026rsquo; (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) systematic review showing that providers\u0026rsquo; lack of training influences their high MOUD stigma; and Piscalko et al.\u0026rsquo;s (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) research showing high stigma and negative attitudes toward MOUD in physicians and nurses with lower knowledge of MOUD. MOUD stigma has also been shown in corrections officers (Friedmann et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), law enforcement officers, and first responders (Kruis et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Reichert et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese findings highlighting the highly stigmatizing views held by mental health-related workforce professionals toward individuals with OUD and toward MOUD are deeply concerning. One would hope that, as frontline responders, treatment referrers, treatment providers, and general providers of healthcare, mental health-related workforce professionals would be \u003cem\u003eless\u003c/em\u003e stigmatizing toward people with OUD and more accepting of MOUD treatment. Anti-stigma education should be an ongoing priority for mental health/related workforce professionals.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eStress\u003c/h2\u003e\u003cp\u003eIn our findings, perceived stress level was closely associated with the level of stigma toward people with OUD. On average, for each 1-point increase in perceived stress score, the OM-PATOS score increased about 1.3 points. This was an intuitively logical finding, since individuals under stress might not have the emotional \u0026ldquo;bandwidth\u0026rdquo; to see beyond societal judgments and therefore might more easily accept stigmatizing beliefs. However, our literature review uncovered little previous research discussing the relationship between stress and engaging in stigma.\u003c/p\u003e\u003cp\u003eOne possible explanation for this phenomenon is that empathy mediates the relationship between stress and stigma. Studies have shown that higher levels of empathy are associated with lower stigma toward individuals with behavioral health disorder (Clinton \u0026amp; Pollini, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Saguem et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and that empathy-eliciting media messages decrease stigma toward individuals with mental illnesses (Hecht et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Studies have also demonstrated the negative impact of perceived stress on overall empathy levels (Rudnik et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Zhao et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Research exploring the relationships among stress, empathy, and stigma could be an important advance in the understanding of stigma dynamics.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eGender\u003c/h2\u003e\u003cp\u003eAs reflected in our study findings, females were significantly less stigmatizing toward people with OUD than males. The research on gender and stigma has produced conflicting findings; thus, our results were supported by some previous studies but not by all. For instance, Woods and Elliott (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) found that female undergraduates were significantly less likely to condone discrimination against people with OUD. A statewide survey found that being male was a significant positive predictor of OUD-related stigma (Kruis et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and Kaynak et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) found that men reported significantly higher stigmatizing attitudes toward people with OUD.\u003c/p\u003e\u003cp\u003eConversely, other research did not support our findings. In their survey and community members and law enforcement officers, Stone and colleagues (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) found that gender had no significant impact on stigma against people with OUD. Similarly, Reichert and colleagues (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) found that male police officers were less likely to blame those with OUD for their condition than female officers. A nationally representative survey of stigma toward people with OUD showed that, for some aspects (e.g., willingness to have someone with OUD marry into one\u0026rsquo;s family), men exhibited lower stigma levels than women (Lin et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA few studies have examined the impact of gender on attitudes toward MOUD. In Kaynak et al.\u0026rsquo;s (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) general population study, men reported significantly higher negative attitudes about MOUD. However, a survey of first responders found that men expressed more positive attitudes toward MOUD than women (Kruis et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It is important to note that different studies have examined different aspects of stigma\u0026mdash;for instance, desire for social distance, belief in dangerousness, blame for one\u0026rsquo;s condition, and confidence in OUD treatment. Therefore, it will be important for future research to engage in more nuanced examinations of gender and the subcomponents of stigma to fully understand the interplay of gender and OUD stigma.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eHistory of Mental and Behavioral Health Problems\u003c/h2\u003e\u003cp\u003eOur findings demonstrated that people with a self- or family history of behavioral health problems\u0026mdash;and thus high familiarity with such problems\u0026mdash;had less stigma toward people with OUD than those without this history. Though prior research on stigma toward individuals with mental health issues has indicated that being close with someone with a mental health disorder is associated with lower stigma (Couture \u0026amp; Penn, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2003\u003c/span\u003e), research on the association between stigma and close familiarity with someone with SUD is less clear-cut. This is made more complex by the fact that the association between familiarity and stigma can vary by substance. For example, Jacobi et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) found that in congregations, familiarity was associated with lower stigma for depression and alcohol use disorder, but not drug use disorders.\u003c/p\u003e\u003cp\u003eSome prior research has supported our findings. A survey conducted in a rural Indiana county found that both knowing someone and personal misuse of opioids reduced the stigma-driven desire for social distance (Railey \u0026amp; Greene, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Janulis et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) found that having a family member who used heroin was associated with two aspects of stigma: decreased perceived dangerousness and decreased desire for social distance. Conversely, some literature has suggested that individuals who have\u0026mdash;or whose family members have\u0026mdash;a behavioral health problem may be more stigmatizing. In a national survey, Kennedy-Hendrick et al. (2017) found that people with a family member or close friend with prescription OUD had higher stigma.\u003c/p\u003e\u003cp\u003eMuch of the research on family, OUD, and stigma has highlighted complicated associations among these variables. Lin et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) found that individuals with a family member with OUD were less stigmatizing toward people with a history of OUD but were more stigmatizing toward those with current OUD. Satler et al. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) found that women with a family member with an OUD had higher empathy for someone using drugs than people without this level of familiarity. However, they also found that women with high familiarity were more likely to say they would support withholding help from someone with an OUD. Ledford (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) found that when presented with media messages conveying the perils of opioid use, family members of people with OUD had lower scores in some aspects of stigma (e.g., desire for social distance) but higher scores in other aspects (i.e., desire for behavioral regulation and less support for opioid-related helping policies).\u003c/p\u003e\u003cp\u003eThe dynamics of OUD stigma among individuals who have experienced behavioral health problems in themselves or in family members are complex and multifaceted. It is easy to understand how the experience of a behavioral health disorder in oneself or a loved one could enhance support for individuals with OUD. At the same time, higher stigma may result from internalized stigma toward people with their own history of behavioral health disorder. For family, the negative experiences of having a family member with a behavioral health problem and the stigma associated with these experiences (Sheehan et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) may result in increased anger and frustration that fuel higher stigma. Future research should focus on disentangling the phenomena at play in OUD stigma among individuals with a self- or family history of behavioral health problems.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eImplications\u003c/h2\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003eImplications for Research\u003c/h2\u003e\u003cp\u003eThis study focused on characteristics associated with stigma toward individuals with OUD as a way to inform anti-stigma programming. Our findings highlight several areas for additional research. For instance, more research is needed to understand our somewhat puzzling finding that stigma is higher among married individuals. In addition, it is important to better understand the relationship between stress and stigma, and gender and stigma. Since both internalized stigma and familial stigma are barriers to recovery (Akdag et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Sheehan et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), future studies should examine the differences in stigma among people with a personal history, those with a family history (excluding oneself), and/or those with a combination of both self- and family history of behavioral health problems.\u003c/p\u003e\u003cp\u003eSimilarly, it is essential to conduct research to improve intervention in addressing high levels of OUD stigma and MOUD stigma in mental health-related workforce professionals. People with OUD have indicated that stigmatizing experiences with helping professionals is a significant barrier to entering and staying in treatment (Cody et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Reichert et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); decreasing these stigma barriers is necessary to maximize treatment success for individuals with OUD.\u003c/p\u003e\u003cp\u003eGiven the significant impact of media on stigma, future research should examine variables such as patterns of media portrayal of people with OUD, the stereotypes of dangerousness and unpredictability within these portrayals, and the consumption of such media to provide a fuller picture of factors affecting stigma. Research has shown that stigmatizing terms are frequently and increasingly used in news media coverage of the opioid crisis (McGinty et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Webster et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Research has also indicated that partisan media consumption affects stigma toward OUD (Kresovich et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The extent of media portrayal of OUD and its relationship with public stigma toward OUD remains under-researched.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Community Programming\u003c/h2\u003e\u003cp\u003eThe findings of this study have important implications for priority targets in anti-OUD-stigma community education. One such target for education is men. Community outreach to groups that typically have high proportions of men, such as civic organizations, sports groups, or fraternal organizations, to develop partnerships for educational programming could be highly impactful. The higher levels of stigma found among mental health-related workforce professionals and among individuals with a self- or family history of behavioral health problems suggest that outreach to these populations is important. This could include partnerships for educational programming in local health and mental health centers, police or sheriff\u0026rsquo;s departments, hospitals, and organizations that support people in recovery and their families. Emphasizing the value of MOUD in such trainings is also critical.\u003c/p\u003e\u003cp\u003eAdditionally, our finding that high levels of stress are associated with higher OUD stigma suggests that programming and interventions to alleviate community stress through Extension and other community organizations could have the added benefit of decreasing stigma toward individuals with OUD. Extension already provides programming on stress management and well-being in some areas (e.g., farmer stress work occurring in [STATE] [Authors, 2024]). With enhanced understanding of the dynamics of stress and stigma, Extension could tailor education to address these two community needs through integrated programming.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThough informative, our study did have limitations. Despite our efforts to ensure that subgroups of interest within the population were represented in the sample, there was an overrepresentation of rural subgroups in the final sample. Since quota sampling is a nonrandom sampling method, and because our sampling was limited to the U.S. South, our findings may have limited generalizability. However, we believe the results comprise the most comprehensive information currently available regarding the sources of public stigma toward people with OUD in the South. Another limitation to the applicability of our findings is that the study examined the relationship between select demographic characteristics and stigma toward people with OUD in the general population across the southern United States, not in specific subregions or communities. Hence, our findings provide a broad picture of stigma, and they may or may not hold when considering a specific context.\u003c/p\u003e\u003cp\u003eIn addition, our study investigated OUD stigma as a whole and did not analyze stigma responses by any of the range of subfactors described in the literature (e.g., attribution, dangerousness, etc.). A more nuanced understanding of the characteristics of stigma associated with subgroups was therefore not possible. In addition, we focused on common demographic characteristics and did not collect data on other potential factors such as media consumption and OUD stereotypes. This could be addressed by future research to provide a more comprehensive picture of the sources of stigma toward people with OUD.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eStigma toward individuals with OUD is a significant problem, creating barriers to effective care at a time when the opioid epidemic continues to rage. Cooperative Extension and other community groups are well poised to address the challenge of OUD stigma. Our study surveyed individuals across the southern United States to identify groups that may particularly benefit from anti-OUD-stigma education. In collaboration with community partners, targeted anti-stigma programming can help reduce barriers to care and promote prevention of and recovery from opioid use disorder.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eVB designed the research study, identified the scales, worked with the third-party vendor, oversaw TP's data analysis and helped write and review the article.TP took the lead on the data analysis and writing of the methods and results sections.DB is the grant's PI and provided input into the study design and assisted in writing the article.MB assisted in the design of the study, provided feedback on sampling strategy, reviewed the data and assisted with the article.AS contributed substantially to the interpretation of the data from the social work/behavioral health side and writing of the manuscript.\u003c/p\u003e\u003cp\u003eThe study was funded by a Rural Health and Safety Education Grant (#FP00029869) through the National Institute for Food and Agricultural, US Department of Agriculture.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdams, Z., Taylor, B., Flanagan, E., Kwon, E., Johnson-Kwochka, A., Elkington, K., Becan, J., \u0026amp; Aalsma, M. (2021). Opioid use disorder stigma, discrimination, and policy attitudes in a national sample of U.S. young adults. \u003cem\u003eJournal of Adolescent Health, 69\u0026cedil; \u003c/em\u003e321\u0026ndash;328.\u003cem\u003e \u003c/em\u003ehttps://doi.org/10.1016/j.jadohealth.2020.12.142\u003cem\u003e \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eAkdag, E., Kotan, V., Kose, S., Tıkır, B., Aydemir, M., Okay, I., Goka, E., \u0026amp; Ozkaya. G. (2018). The relationship between internalized stigma and treatment motivation, perceived social support, depression and anxiety levels in opioid use disorder. \u003cem\u003ePsychiatry and Clinical Psychopharmacology, 28\u003c/em\u003e(4), 394\u0026ndash;401. https://doi.org10.1080/24750573.2018.1478190 . \u003c/li\u003e\n\u003cli\u003eAl-Adawi, S., Dorvolo, A., Al-Ismaily, S., Al-Ghafry, D., Burke, D., Shah, K., Ghassany, H., Chand, S. (2002). Perceptions and attitudes towards mental illness in Oman. \u003cem\u003eInternational Journal of Social Psychiatry, 48\u003c/em\u003e(4), 4305\u0026ndash;4317. \u003c/li\u003e\n\u003cli\u003eAmerican Society of Addiction Medicine. (2020). \u003cem\u003eNational practice guidelines for the treatment of opioid use disorders\u003c/em\u003e. https://www.asam.org/quality-care/clinical-guidelines/national-practice-guideline \u003c/li\u003e\n\u003cli\u003eAndersen, M., Varga, S., \u0026amp; Folker, A. (2022). On the definition of stigma. \u003cem\u003eJournal of Evaluation of Clinical Practice, 28\u003c/em\u003e, 847\u0026ndash;853. https://doi.org/10.1111/jep.13684 \u003c/li\u003e\n\u003cli\u003eBarenie, R., Cernasev, A., Heidel, E., Stewart, S. Hohmeier, K. (2023). 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(2022). \u0026ldquo;You\u0026rsquo;re not supposed to be on it forever\u0026rdquo;: Medications to treat opioid use disorder (MOUD) related stigma among drug treatment providers and people who use opioids. \u003cem\u003eSusbtance Abuse: Research and Treatment, 16\u003c/em\u003e, 1\u0026ndash;10. https://doi.org/10.1177/11782218221103859 \u003c/li\u003e\n\u003cli\u003eDowell, D., Brown, S., Gyawali, S., Hoenig, J., Ko, J., Mikosz, C., Ussery, E., Baldwin, G., Jones, C., Olsen, Y., Tomoyasu, N. M., Han, B., Compton, W., \u0026amp; Volkow, N. (2024). Treatment for opioid use disorders: Population estimates\u0026mdash;United States, 2022. \u003cem\u003eMorbidity and Mortality Weekly Report, 73\u003c/em\u003e(25), 567\u0026ndash;574. https://doi.org/10.15585/mmwr.mm7325a1 \u003c/li\u003e\n\u003cli\u003eEschilman, E., Choe, K., DeLucia, A., Addison, E., Jackson, V., Murray, S., German, D., Genberg, B., \u0026amp; Kaufman, M. (2024). 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Stigma and substance use disorders: An international phenomenon. \u003cem\u003eCurrent Opinions in Psychiatry, 30\u003c/em\u003e(5), 378\u0026ndash;388. https://doi.org/10.1097/YCO.0000000000000351 \u003c/li\u003e\n\u003cli\u003eZhao, Q., Shen, Mingqi, Lin, C., Cong, Y., \u0026amp; Li, C. (2024). The negative impacts of life stress on empathy for emotions, for music, but not for pain. \u003cem\u003eMindfulness, 15\u003c/em\u003e, 2825\u0026ndash;2839. https://doi.org/10.1007/s12671-024-02464-w \u003c/li\u003e\n\u003cli\u003e[Authors]. (2024). The farmer stress production meeting model: Acceptability and feasibility of an intervention. \u003cem\u003eJournal of Extension, 62\u003c/em\u003e(4), Article 10. https://doi.org/10.34068/joe.62.04.10 \u003c/li\u003e\n\u003cli\u003e[Authors]. (under review). Construct validity of the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS) in the general population.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"opioid misuse, OUD stigma, anti-stigma education, predictors of stigma","lastPublishedDoi":"10.21203/rs.3.rs-7650734/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7650734/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"The United States is experiencing an ongoing opioid epidemic. Despite tragic outcomes and effective treatments, only a small proportion of people with opioid use disorder (OUD) receive care. A primary barrier to treatment is stigma. This study surveyed the general population in 13 Southern states, exploring characteristics associated with high OUD stigma. The authors sought to identify subpopulations with high levels of stigma to inform community anti-stigma education strategies in the South. A sample of 1,676 respondents were surveyed using the Opening Minds Provider Attitudes Towards Opioid-Use Scale (OM-PATOS), and results were analyzed using multiple linear regression. Findings showed that being married, being in a mental health-related workforce profession, and having higher perceived stress were associated with higher stigma scores, while being female or having a history of a behavioral health problem oneself or in one's family was associated with lower stigma. Though additional research is needed, the findings suggest that community-based anti-stigma programming could benefit from targeting groups with high proportions of men and from combining this education with content aimed at stress management. Particularly concerning was the finding that mental health-related workforce professionals held significantly higher stigmatizing beliefs, indicating that outreach to health clinics, mental health centers, pharmacies, and related agencies is needed in community-based anti-stigma campaigns. Organizational partnerships in which members are likely to have low stigma, such as mental health or substance misuse advocacy groups, could benefit from anti-OUD-stigma efforts.","manuscriptTitle":"Identifying Populations with High Opioid Use Disorder Stigma: Results from a Multi-State Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 13:29:08","doi":"10.21203/rs.3.rs-7650734/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af9f5591-75b9-4b33-a272-499a7697f852","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:02:53+00:00","versionOfRecord":{"articleIdentity":"rs-7650734","link":"https://doi.org/10.1007/s10597-026-01636-3","journal":{"identity":"community-mental-health-journal","isVorOnly":false,"title":"Community Mental Health Journal"},"publishedOn":"2026-04-24 15:58:44","publishedOnDateReadable":"April 24th, 2026"},"versionCreatedAt":"2025-10-16 13:29:08","video":"","vorDoi":"10.1007/s10597-026-01636-3","vorDoiUrl":"https://doi.org/10.1007/s10597-026-01636-3","workflowStages":[]},"version":"v1","identity":"rs-7650734","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7650734","identity":"rs-7650734","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}