Impacts of Childhood Welfare Participation on Adulthood Substance Use: Evidence from the National Longitudinal Study of Adolescent to Adult Health

Background: The vulnerabilities associated with adolescence are accentuated by poverty (Dashiff et al., 2009) and can have a cumulative effect on adolescents’ risk and resilience (Fraser, 2004). The associations between early life-socioeconomic status and health, specifically substance use, throughout the life course is well substantiated and includes studies on the relationship between substance use and welfare participation. Adolescence is also a critical period when substance use is often initiated and can set the course for associated behavioral health trajectories into adulthood. As 1996 welfare reform was debated, estimates ranged from 6-37% of welfare recipients who had a substance use problem (Metsch et al., 1999). However, this data is for adult welfare recipients only and to date, there is no comparable data of substance use rates for children and adolescents who received AFDC or TANF benefits. Furthermore, this wide discrepancy is due to different data sources, definitions, methodology, and thresholds for substance abuse over different increments of time. Purpose: To address the research gap, this paper explores whether childhood welfare participation impacts substance use rates, prevalence and initiation patterns during emerging adulthood (24-31).

Methods: The longitudinal, nationally representative Add Health data was used for this study. Substance use of adults in Wave 4 were measured by 6 dimensions of alcohol use (e.g., number of days; average amounts of drinking for each time), and 5 variables of measuring drug use, including steroids, marijuana, cocaine, crystal meth, and other illegal drug. Welfare participation was whether any of participants’ family member had received welfare benefits before 18 years. Demographic and socioeconomic variables were controlled for at the parental, adult, household and community level. Using propensity score matching methods to balance the selection bias, a series of regression models were run (logistic regression for dummy outcome variables, whereas OLS regression for continues variables) on the matched dataset.

Results: Findings show no statistically significant differences among the two groups (with and without childhood welfare participation experience) on any of the 5 alcohol-related variables. However, regarding drug use, those who participated in welfare before 18 had statistically significant higher rates of using marijuana (by 45%; p < 0.001), cocaine (by 22%, p < 0.05) and other illegal drug (by 20%, p < 0.05) during adulthood, as compared with their counterparts.

Conclusion and Implications: Unmet behavioral health needs in this age group have long-term effects on life course outcomes and collective public expenditures for housing, education, employment, disability, income support, criminal justice, among other social welfare services (Kieling et al., 2011). Findings of this study highlight long-term behavioral health risks of adolescents who participate in welfare programs before 18. Prevention and treatment interventions for adults need to consider the heightened vulnerabilities of youth who experience socio-economic risks associated with poverty. The prevention of long-term negative outcomes, including the development of behavioral health disorders, hinges on early diagnosis and intervention. A renewed emphasis on the screening, prevention, and early intervention for behavioral health problems can have great benefit, particularly for those experiencing poverty early on in the life-course.