Labor force participation in a sample of substance users

Cohort Profile: The Assessing Economic Transitions (ASSET) Study-A Community-Based Mixed-Methods Study of Economic Engagement among Inner-City Residents

The Assessing Economic Transitions (ASSET) study was established to identify relationships between economic engagement, health and well-being in inner-city populations given that research in this area is currently underdeveloped. This paper describes the objectives, design, and characteristics of the ASSET study cohort, an open prospective cohort which aims to provide data on opportunities for addressing economic engagement in an inner-city drug-using population in Vancouver, Canada. Participants complete interviewer-administered surveys quarterly. A subset of participants complete nested semi-structured qualitative interviews semi-annually. Between April 2019 and May 2022, the study enrolled 257 participants ages 19 years or older (median age: 51; 40% Indigenous, 11.6% non-Indigenous people of colour; 39% cis-gender women, 3.9% transgender, genderqueer, or two-spirit) and 41 qualitative participants. At baseline, all participants reported past daily drug use, with 27% currently using opioids daily, and 20% currently using stimulants daily. In the three months prior to baseline, more participants undertook informal income generation (75%) than formal employment (50%). Employed participants largely had casual jobs (42%) or jobs with part-time/varied hours (35%). Nested qualitative studies will focus on how inner-city populations experience economic engagement. The resulting evidence will inform policy and programmatic initiatives to address socioeconomic drivers of health and well-being.

Labor force status as a buffer against mortality risks associated with alcohol consumption: A study of adult U.S. women, 2001-2015

The association between women's labor force participation, their alcohol consumption patterns, and mortality risk is unclear. This study assessed all-cause mortality risk among women in the United States, considering their labor force status and alcohol drinking. This study used discrete-time hazard models to examine this association using 2001-2015 National Health Interview Survey-Linked Mortality Files (NHIS-LMF) data (n = 147,714) for women aged 25 to 65 with 5725 deaths in this sample. Complex survey-weighted adjustments and E-values calculations were used to limit quantitative and observational biases. Alcohol consumption and labor force status together lead to substantial mortality risks. There is a statistically significant mortality risk among unemployed women (HR 2.15, 95% CI 1.18-3.91) and women not in labor force (HR 2.38, 95% CI 1.87-3.01). In the stratified models, non-Hispanic blacks (HR 1.48, 95% CI 1.30-1.67) and Asians (HR 1.93, 95% CI 1.54-2.44) have heightened mortality risks borne out of employment. Women with higher psychological distress have a 26% higher risk of all-cause mortality when not in labor force. With the help of cross-sectional data, this study demonstrates that women not in labor force and unemployed women are more likely to be affected by their drinking habits, and their employment status is associated with lower mortality risk. Further research should be focused on cause-specific mortality, gender roles and norms, reasons for unemployment, and comorbidities using more recent data, causal modeling techniques, and an extended mortality follow-up period.

Transitions from Treatment to Work: Employment Patterns following Publicly Funded Substance Abuse Treatment

This investigation involved a first-attempt at modeling long-term treatment and work trajectories in a large, urban sample of individuals in publicly funded substance abuse treatment: (a) determining the demographic factors that predicted work patterns and (b) examining the longitudinal relationship between work status and continued treatment, persistent drug use, and psychological problems investigated work status across three years. Mixed-effects regression models revealed that significantly more participants were working and looking for work at each follow-up. Gains in labor force participation were greatest at six months while gains in employment were greatest at 24 months. Several demographic variables predicted later work status including age, gender, living arrangement, occupational skills, and having children in foster care. Participants who continued treatment, continued to use drugs, or reported psychological problems were most likely to be out of the labor force. By far, the greatest barrier to long-term employment was continued drug use.

Economic Stressors, Social Integration, and Drug Use among Women in an Inner City Community

This article uses data from a study of 122 adult women drug users residing in the Atlanta, Georgia metropolitan area to identify associations between economic stressors related to occupying disadvantaged statuses, institutional integration, and drug use. The data stem from targeted sampling and ethnographic mapping procedures. The findings suggest that experiencing stressors related to economic circumstance and daily subsistence increased the likelihood of drug use. Results also indicate religious involvement and kinship networks are independently and negatively associated with drug use, but fail to reduce the negative effects of economic stressors on drug use. The author suggests that institutional integration, however limited, may be a formidable deterrent to drug use. Continued identification of multi-level integration sources may inform drug treatment approaches in community programs.

The impact of social, structural and physical environmental factors on transitions into employment among people who inject drugs

Despite growing awareness of the importance of context for the health of people who use drugs, studies examining labour market outcomes have rarely considered the role that physical, social and structural factors play in shaping labour market participation among drug users. Using discrete time event history analyses, we assessed associations between high-intensity substance use, individual drug use-related risk and features of inner-city drug use scenes with transitions into regular employment. Data were derived from a community-recruited cohort of people who inject drugs in Vancouver, Canada (n = 1579) spanning the period of May 1996-May 2005. Results demonstrate that systematic socio-demographic differences in labour market outcomes in this context generally correspond to dimensions of demographic disadvantage. Additionally, in initial analyses, high-intensity substance use is negatively associated with transitions into employment. However, this negative association loses significance when indicators measuring exposure to physical, social and structural features of the broader risk environment are considered. These findings indicate that interventions designed to improve employment outcomes among drug users should address these social, structural and physical components of the risk environment as well as promote the cessation of drug use.

The mental health benefits of work: do they apply to welfare mothers with a drinking problem?

A longstanding tradition of employment-related research has shown the mental health advantages of employment. However, given welfare reform mandates for employment and a welfare population with disproportionately high rates of depression and co-occurring substance abuse problems, it is unclear if women on welfare reap this advantage. This analysis draws on 4 years of data from the Welfare Client Longitudinal Study to examine the mental health benefits of employment among women on welfare (N = 419) and to assess whether drinking problems alter the relationship. Repeated measures analyses suggest that women who enter welfare with a drinking problem may not experience the same decline in depression symptoms following employment. Improving the connections between welfare and treatment services for women with alcohol problems may, however, have important implications for their mental health.

The urban poor's economic profile of tobacco use

OBJECTIVES

Low-income minority tobacco users are price sensitive and are more likely to quit when tobacco prices go up. No prior research documents economic characteristics of low-income tobacco users. The study investigates economic profile of tobacco use among urban low-income African Americans.

METHODS

In this baseline study (n = 338), tobacco users and nonusers were compared, and their economic conditions of tobacco use including (current and past) employment barriers were examined.

RESULTS

The study results demonstrate that tobacco use status appeared to be associated with employment barriers among low income populations. Controlling for other independent variables in the multivariate logistic regression model, previous criminal activity, planning to move out, and female gender were found to be linked to labor force status.

CONCLUSIONS

More research efforts on how indigent tobacco-using individuals develop their employment skills and become economically independent are needed.

Factors for employment: a case-control study of fully employed and unemployed heroin users

The purpose of this article is to characterize fully employed users of heroin, compare them with their unemployed counterparts, and identify demographic, human, and social capital and drug misuse factors that are differentially associated with full employment. A nested case-control research design was used to identify 122 fully employed users (cases) and 466 unemployed users (controls) from a larger study of African American, Hispanic, and non-Hispanic White men and women who were active heroin injectors and sniffers and recruited from the streets of Miami-Dade County, Florida, between July 1997 and February 2000. Multivariate logistic regression techniques were used to analyze data from the Modified AIDS Risk Behavior Questionnaire. Findings indicated that employed users were more likely to possess human capital and social capital and less likely to use crack cocaine than unemployed users. Intervention to increase and sustain the employability of persons who misuse heroin is essential. Protocols that enhance human capital and social capital and reduce the misuse of drugs will benefit programs that seek to improve the employment status of persons who misuse heroin. The study's limitations are noted.

The association between EIC receipt and employment in a sample of drug using and non-drug using TANF recipients

This article examines the extent to which Temporary Assistance to Needy Families (TANF) recipients file income tax returns and take advantage of the Earned Income Credit (EIC), a program specifically designed to increase the economic self-sufficiency of lower income earners by supplementing earned and other income to make working more profitable. This study consisted primarily of Black and Hispanic women (n = 317), recruited for a longitudinal study designed to examine the effects of welfare reform on drug using and non-drug using welfare recipients. At the 2-year mark, 70% of the sample reported having ever filed an income tax return, of these 76% had received an EIC. Both hours worked and earnings were positively associated with EIC receipt. In this population, EIC appears to be a successful mechanism for improving economic self-sufficiency.

Effect of peers on employment and implications for drug treatment

We examined the effect peers have on Temporary Assistance to Needy Families (TANF) recipients' employment behavior. Nondrug using and chronic drug using TANF recipients (n=433) participating in a study funded by the National Institute on Drug Abuse were asked how many of the people they regularly spent time with over the past 4 months had jobs and how many of them encouraged the individual to look for work. Results of a path analysis showed that age, education, and chronic drug use were significantly related to the nature of peer relationships. A significant and positive association between the number of peers that worked and the number of hours worked in the following 4 months was observed. Examining the effect of peers on labor force participation by TANF recipients is necessary to assist recipients in securing and maintaining employment.