Social safety net programs as interventions to reduce opioid-related harms in reproductive-age women

社会安全网计划作为减少育龄妇女阿片类药物相关危害的干预措施

• 批准号: 10772665
• 负责人: Silvia Saboia Martins
• 金额: $ 84.5万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10772665
• 关键词: Address; Adult; Affect; Age; Aid to Families with Dependent Children; Alcohol consumption; Black race; Caregivers; Cessation of life; Child; Child Care; Child Rearing; Chronic; Cities; Communities; Drug usage; Economics; Eligibility Determination; Emergency department visit; Employment Status; Epidemic; Ethnic Origin; Ethnography; Harm Reduction; Health; Health Food; Healthcare; Healthcare Systems; Hospitalization; Income Tax; Indigenous; Individual; Intervention; Interview; Joints; Low income; Mediating; Mediation; Mediator; Medicaid; Medical; Methods; National Institute of Drug Abuse; Not Hispanic or Latino; Opioid; Outcome; Overdose; Pathway interactions; Pattern; Personal Satisfaction; Persons; Policies; Politics; Poverty; Race; Recommendation; Reporting; Research; Resources; Risk; Role; Services; Severities; Shelter facility; Social Work; Stress; Structure; Surveys; Testing; United States; Update; Variant; Woman; behavioral outcome; beneficiary; black women; caregiving; childcare allowance; cohort; coronavirus pandemic; design; dietary supplements; experience; federal poverty level; food insecurity; health care availability; health data; medication for opioid use disorder; men; mortality; opioid misuse; opioid mortality; opioid overdose; opioid use; opioid use disorder; programs; public health emergency; reproductive; safety net; service providers; social; social stigma; substance use treatment; unemployment insurance

Social safety net programs are critical upstream factors that can offset economic stress and affect people’s ability to access basic shelter, health care and food-related needs, which are particularly salient among parenting women who use drugs. Parenting women, especially Black and Indigenous women, are over-represented among people living in poverty, highlighting the need to understand how social safety net programs affect them. They usually they are primary child caregivers, and many with opioid use disorder (OUD) in such roles do not seek treatment or stay in treatment due to lack of resources while fulfilling caregiving roles. Research suggests that individual safety net programs affect behavioral outcomes (e.g., alcohol use outcomes), including among women, but the effects of these programs on opioid outcomes remains underexplored. In addition, the joint impact of these programs on opioid-related outcomes has not been studied. Programs include Unemployment Insurance (UI), Supplemental Nutritional Assistance Programs (SNAP), Temporary Assistance for Needy Families (TANF), the Earned Income Tax Credit (EITC), and Medicaid. Nearly 75% of people living in poverty receive at least one safety net program, and program eligibility varies widely by state. We propose a mixed-methods convergent parallel design to comprehensively evaluate the separate and combined effects of UI, SNAP, TANF, EITC, and Medicaid (including pathways and mediators), on opioid-related outcomes among low-income parenting women. We will leverage the restricted National Survey on Drug Use and Health (NSDUH) from 2013-2022 to address NIDA’s RFA-DA-23-051 to examine how state social safety net programs influence, and can ameliorate, multiple opioid outcomes in low-income parenting women. We will test for differential policy effects by race and ethnicity and potential multi-level mediation mechanisms. Specific Aims are to: Aim 1. Examine the separate and combined effects of state social safety net programs (UI, SNAP, TANF, EITC, Medicaid) on opioid outcomes among low-income parenting women in restricted NSDUH data. In this Aim, we will update, expand and leverage a recently validated multi-program state safety net calculator that fully accounts for interactions between eligibility and generosity in social safety net programs. Aim 2. Investigate potential multi-level mediators of the relationship between social safety net programs (e.g., state-level food insecurity and child care cost burden) and opioid- related outcomes among low-income parenting women in restricted NSDUH data. Aim 3. Explore variations in the administration of state social safety net programs and their effects on the daily lives of low-income parenting women who report past-year nonmedical opioid use via qualitative interviews with key stakeholders and parenting women. This mixed-methods study will extensively examine the separate and combined impact of state social safety net program eligibility and administration on parenting women’s opioid-related outcomes. Findings will have concrete real-world impact providing actionable and politically feasible recommendations for changes in these programs to reduce opioid-related burden and promote women’s wellbeing.

社会安全网计划是可以抵消经济压力并影响人们能力的关键上游因素 获得基本的住房、医疗保健和食品相关需求，这在育儿方面尤为突出 吸毒的妇女，尤其是黑人和土著妇女，在其中所占比例过高。 生活贫困的人们，强调需要了解社会安全网计划如何影响他们。 通常他们是主要的儿童看护者，许多患有阿片类药物使用障碍 (OUD) 的人在担任此类角色时不会寻求帮助 研究表明，由于在履行护理职责时缺乏资源而无法接受治疗或继续治疗。 个人安全网计划影响行为结果（例如饮酒结果），包括妇女、 但这些计划对阿片类药物结果的影响仍未得到充分研究。 这些计划对阿片类药物相关结果尚未进行研究，其中包括失业保险。 (UI)、补充营养援助计划 (SNAP)、贫困家庭临时援助 (TANF)、 劳动所得税抵免 (EITC) 和医疗补助 近 75% 的贫困人口至少获得一项福利。 安全网计划，并且计划资格因州而异，我们提出了混合方法收敛。 并行设计，综合评估 UI、SNAP、TANF、EITC 和 医疗补助（包括途径和中介），关于低收入育儿妇女中与阿片类药物相关的结果。 我们将利用 2013 年至 2022 年受限的全国药物使用与健康调查 (NSDUH) 来解决 NIDA 的 RFA-DA-23-051 旨在研究国家社会安全网计划如何影响并改善多种 我们将测试不同种族和民族的不同政策效果。 和潜在的多层次调解机制 具体目标是： 目标 1. 审查单独的和潜在的多层次调解机制。 州社会安全网计划（UI、SNAP、TANF、EITC、医疗补助）对阿片类药物结果的综合影响 为此，我们将限制 NSDUH 数据的更新、扩展和利用。 最近验证的多计划国家安全网计算器，充分考虑了资格之间的相互作用 目标 2. 调查这种关系的潜在多层次调节因素。 社会安全网计划（例如州级粮食不安全和儿童保育成本负担）和阿片类药物之间 目标 3：探索低收入育儿妇女在有限 NSDUH 数据中的相关结果。 国家社会安全网方案的管理及其对低收入父母日常生活的影响 通过与主要利益相关者进行定性访谈报告过去一年非医疗类阿片类药物使用情况的女性，以及 这项混合方法研究将主要考察养育女性的单独和综合影响。 州社会安全网计划对养育妇女阿片类药物相关结果的资格和管理。 调查结果将对现实世界产生具体的影响，为以下方面提供可行且政​​治上可行的建议： 这些计划的变化是为了减少阿片类药物相关的负担并促进妇女的福祉。