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.

社会保障计划是关键的上游因素，可以抵消经济压力并影响人们的能力 获得基本住房、保健和与食品有关的需求，这些需求在育儿工作中尤为突出 吸毒的女人。养育子女的妇女，特别是黑人和土著妇女，在 他强调，有必要了解社会安全网方案如何影响他们。他们 通常他们是孩子的主要照顾者，许多有阿片类药物使用障碍(OUD)的人不会在这种角色中寻求 在履行照顾者角色的同时，由于缺乏资源而接受治疗或留在治疗中。研究表明， 个人安全网方案影响行为结果(例如，饮酒结果)，包括在妇女中， 但这些方案对阿片类药物结果的影响仍未得到充分研究。此外，联合影响还包括 这些关于阿片类药物相关结果的方案还没有研究过。计划包括失业保险 (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了一份 安全网计划，计划资格因州而异。我们提出了一种混合方法收敛的方法 并行设计，全面评估UI、SNAP、TANF、EITC和 医疗补助(包括途径和中介)，对低收入育儿妇女中阿片类药物相关结果的影响。 我们将利用2013-2022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，以检查国家社会保障网络计划如何影响并可以改善多个 低收入育儿妇女的阿片类药物结局。我们将测试不同种族和民族的不同政策效果 以及潜在的多层次调解机制。具体目标是：目标1.检查分开的和 国家社会安全网计划(UI、SNAP、TANF、EITC、Medicaid)对阿片类药物结果的综合影响 在NSDUH数据有限的低收入育儿女性中。在这一目标中，我们将更新、扩展和利用 最近经过验证的多计划州安全网计算器，完全考虑了资格之间的相互作用 以及在社会保障网络计划中的慷慨。目标2.调查潜在的多层次关系调解人 在社会安全网计划(例如，州一级的粮食不安全和儿童保育成本负担)和阿片类药物之间- NSDUH受限数据中低收入育儿妇女的相关结果。目标3.探索 国家社会保障计划的管理及其对低收入父母日常生活的影响 报告过去一年非医用阿片类药物使用情况的女性，通过与关键利益相关者和 养育女性。这项混合方法的研究将广泛地检验单独和联合影响 关于育儿妇女阿片类药物相关结果的国家社会安全网计划资格和管理。 调查结果将产生具体的现实影响，为 这些方案的变化是为了减少与阿片类药物相关的负担，促进妇女的福祉。