Modeling upstream socioeconomic inequities and syndemic conditions among mothers over time.
Courtney Caiola, Thomas P McCoy, Shawn M Kneipp
PMID 33155326WHAT IT FOUND
Mothers who reported more economic hardship in one interview tended to report more substance use, physical violence, and economic abuse together in a later interview.
Race and TANF sanctions were linked to this pattern. The study cannot show cause.
Key findings
01Any substance use reported by mothers rose from 4.7% at Y1 to 13.7% at Y3, 14.8% at Y5, and 20.2% at Y9.
02Economic hardship at an earlier wave predicted higher syndemic condition sum scores at a later wave: Y1 to Y3 exp(b)=1.25, p=.004; Y5 to Y9 exp(b)=1.37, p<.001.
03For Y5 syndemic condition sum scores, TANF sanctions partially mediated the effect of economic hardship (indirect effect=0.011, Sobel p=.005, 95% CI [.004, .020]).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis used secondary data from a cohort created for other purposes, and baseline Year 0 did not include TANF or syndemic variables, so the first usable TANF and syndemic data were from Year 1. The intended SAVA measure could not be used fully because the HIV-risk behaviour indicator had extremely low prevalence and was excluded; the outcome was only substance use, physical intimate partner violence, and economic intimate partner violence. Measurement over time was not fully stable because substance use was asked about the past month at Y1 but the past year at later waves, so Y1 was modelled separately. All data were self-reported and could have been affected by stigma or fear of child welfare or criminal justice reporting. Attrition was material: of 4,898 mothers, complete-case modelling data were available for 3,604 at Y3, 3,309 at Y5, and 2,752 at Y9, although full-information maximum likelihood used available data. The study is observational, so it cannot show that economic hardship, TANF receipt, or sanctions caused the syndemic conditions. Data collection for the waves used ended in 2010, so current conditions may differ.
Declared interests
The supplied text does not include a conflict-of-interest declaration. The article is tagged as supported by NIH extramural and non-U.S. government research.
The easy way to misread this
Do not conclude that economic hardship, TANF receipt, or sanctions caused substance use, violence, or HIV risk. The study was observational, the HIV-risk indicator was excluded, and substance use was measured with different time frames at Y1 and later waves.