The Role of Financial Strain in Adult Alcohol, Cannabis, CNS Depressant and Polysubstance Use, and Mitigating Effects of Earned Income Tax Credit Policies: a Longitudinal Study using PATH data

项目摘要/摘要 经济压力和药物使用在美国很普遍，因为许多成年人难以满足 基本的经济需求。财务压力不同于其来源(例如，工作或收入损失)，作为对压力的感知 可能是必要的，以产生一种压力反应，促使物质作为一种应对机制。研究 研究经济压力和药物使用之间的关系的重点是两者之间的联系 经济压力和饮酒，或由于工作或收入的突然变化而造成的严重经济压力。然而，在那里 有必要研究财政紧张和物质使用之间的关系是否因实质而异， 以及财政压力的持续时间(例如，因突然失业或收入损失而造成的严重经济压力，长期财政压力 由于持续的剥夺造成的压力，或由于反复的经济周期而造成的间歇性经济压力 不安全感)。诸如联邦劳动所得税抵免(EITC)等反贫困计划可能会提供 通过向低收入者提供财政支持来减少资金压力和随后的物质使用的机会 人口。目前的R36提案寻求提供关于急性、非传染性疾病之间的联系的新见解， 长期或间歇性的经济压力和大麻、中枢神经系统镇静剂、酒精和多种物质的使用，以及 联邦EITC的资格是否会改变这些关系。为了实现这些目标，我们提出了三个目标 将利用5波(2013-2019年)烟草人口评估中的个人和州一级数据 以及健康研究，这是一个由30,000名美国成年人组成的纵向队列。目标1将研究两者之间的关联 在随后的时间点上使用经济压力和大麻、中枢神经系统镇静剂、酒精或多种物质 参数g计算，考虑时变混杂，并按性别检验效应修正。 目标2将创建财务压力的暴露轨迹(即，无、急性、慢性和间歇性) 数据收集浪潮，并检查大麻、中枢神经系统镇静剂、酒精或多物质使用的风险 第五波使用混合模型对物质使用轨迹和最近的财务压力进行调整。目标3将 检查联邦EITC资格是否与经济压力、大麻、中枢神经系统的短期变化有关 使用镇静剂、酒精或多种物质，以及经济压力是否调节了联邦政府 EITC资格和物质使用，按性别和州EITC检查效果修改。这项工程将会取得进展 NIDA的研究重点是支持研究影响药物使用的社会因素的论文研究 结果，并确定政策如何影响药物使用趋势。这项R36研究的结果将有助于确定 面临药物使用风险的个人，为寻求缓解经济压力的政策提供信息，并将为未来提供信息 K奖申请。拟议的项目和指导小组将为首席调查员提供 在卫生经济学、物质使用流行病学和政策的交叉领域发展专业知识的机会 为了追求成为一家学术机构的独立研究员的长期目标，她从事研究工作。

PROJECT SUMMARY/ ABSTRACT Financial strain and substance use are widespread in the United States (US), as many adults struggle to meet basic financial needs. Financial strain is distinct from its sources (e.g., job or income loss), as perception of strain may be necessary to produce a stress-response that prompts substance use as a coping mechanism. Studies examining the relationship between financial strain and substance use have focused on the association between financial strain and alcohol use, or acute financial strain due to sudden changes in job or income. However, there is a need to examine whether the relationship between financial strain and substance use varies by substance, and the duration of financial strain (i.e., acute financial strain due to sudden job or income loss, chronic financial strain due to persistent deprivation, or intermittent financial strain due to repeated periods of economic insecurity). Anti-poverty programs such as the federal Earned Income Tax Credit (EITC) may provide an opportunity to reduce financial strain and subsequent substance use by providing financial support to low-income populations. The current R36 proposal seeks to provide novel insights about the associations between acute, chronic, or intermittent financial strain and cannabis, CNS depressant, alcohol, and polysubstance use, and whether federal EITC eligibility alters these relationships. To achieve these goals, we propose three aims that will leverage individual- and state-level data from 5 waves (2013-2019) of the Population Assessment of Tobacco and Health study, a longitudinal cohort of >30,000 US adults. Aim 1 will examine the association between financial strain and cannabis, CNS depressant, alcohol, or polysubstance use at subsequent time points using parametric g-computation, accounting for time-varying confounding, and examining effect modification by sex. Aim 2 will create exposure trajectories of financial strain (i.e., none, acute, chronic, and intermittent) across four waves of data collection, and examine the risk of cannabis, CNS depressant, alcohol, or polysubstance use at Wave 5 using a mixed model to adjust for substance use trajectories and recency of financial strain. Aim 3 will examine whether federal EITC eligibility is associated with short-term changes in financial strain, cannabis, CNS depressant, alcohol or polysubstance use, and whether financial strain mediates the relationship between federal EITC eligibility and substance use, examining effect modification by sex and state EITC. This project will advance NIDA’s research priority to support dissertation research examining social factors that influence drug use outcomes, and determine how policies affect drug use trends. Findings from this R36 study will help identify individuals at risk for substance use, inform policies seeking to alleviate financial strain, and will inform a future K award application. The proposed project and mentorship team will provide the principal investigator with the opportunity to develop expertise at the intersection of health economics, substance use epidemiology, and policy research, in pursuit of her long-term goal of becoming an independent researcher at an academic institution.