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

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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.