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The Relationship Between Substance Use Patterns and Economic and Health Outcomes Among Low-Income Caregivers and Children

Dr. Meara is affiliated with the Department of Health Care Policy and Dr. Greenfield is with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Meara at the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115 (e-mail: meara{at}hcp.med.harvard.edu).

OBJECTIVE: This study estimated how patterns of substance use are related to work status, public program use, and well-being among a sample of female caregivers and children. METHODS: This study assessed work, public program use, and well-being measures as a function of substance use among 1,623 female caregivers of children aged zero to four or ten to 14 who participated in the Welfare of Children and Families study and lived in low- and moderate-income neighborhoods in Boston, Chicago, and San Antonio. Data were analyzed from baseline interviews that were conducted from March through December 1999 and from follow-up interviews that were conducted 11 to 26 months after baseline (average of 16 months). Substance use patterns were placed into three categories: light or no substance use reported in both interviews, moderate or heavy substance use (that is, moderate or heavy use in both interviews or increased substance use during the study period), and reduced substance use during the study period. RESULTS: Among caregivers who reduced their substance use, measures of work status, receipt of income assistance, mental health symptoms, and reports of child behavior problems were not significantly different at follow-up from those of caregivers with light or no substance use. At follow-up, compared with caregivers with light or no substance use, those with moderate or heavy substance use were significantly less likely to experience improvements in mental health symptoms and to see improvements in their children's behavioral problems. Caregivers with moderate or heavy substance use were more likely to be "detached" (p=.051)—that is, neither working nor collecting income assistance—although this difference was only marginally significant. CONCLUSIONS: Caregivers with increased substance use fared poorly on measures of well-being and work. Policies that promote, rather than impede, reductions in substance use are more likely to promote self-sufficiency and well-being.

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