Donahoe J Travis, Brown-Podgorski Brittany L, Gaire Sabin, Krans Elizabeth E, Jarlenski Marian
Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania.
Department of Obstetrics, Gynecology, and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Research Institute, Pittsburgh, Pennsylvania.
JAMA Health Forum. 2025 Jan 3;6(1):e244699. doi: 10.1001/jamahealthforum.2024.4699.
2021 Advance child tax credit (ACTC) monthly payments were associated with reduced US child poverty rates; however, policymakers have expressed concerns that permanent adoption would increase parental substance use.
To assess whether 2021 ACTC monthly payments were temporally associated with changes in substance use among parents compared with adults without children.
DESIGN, SETTING, AND PARTICIPANTS: The primary sample included adults aged 18 to 64 years who responded to the National Survey on Drug Use and Health in 2021. Difference-in-differences models were used to test whether substance use changed for parents compared with adults without children after ACTC monthly payments went into effect. Additional National Survey on Drug Use and Health data from 2018 to 2020 were used to assess pretrends in substance use for parents and adults without children. Analyses were survey weighted and conducted from September 2023 to November 2024. The treatment group was defined as adults with dependent children in the home who would have been eligible for the tax credit from July to December 2021. Adults without children, who would not have been eligible for the tax credit, comprised the comparison group.
Outcomes included binary measures of any self-reported use of tobacco, alcohol, cannabis, and illicit substances (eg, cocaine, opioids, or other stimulants or sedatives) during the previous 30 days; counts of the number of days of use of tobacco, alcohol, cannabis, and illicit substances during the previous 30 days among people who used these substances; and counts of the number of cigarettes and alcoholic beverages consumed during the previous 30 days among people who used these substances.
Of 41 853 adults, 17 308 were parents and 24 545 were adults without children. ACTC monthly payment implementation was associated with a -4.3-percentage point (95% CI, -6.6 to -2.0) decline in the probability of using tobacco during the previous 30 days for parents compared with adults without children. Among parents who smoked, payments were associated with a -46.8-percentage point (95% CI, -93.1 to -0.5) decline in the number of cigarettes smoked during the previous 30 days. Estimated changes in the probability, frequency, and quantity of other substance use (alcohol, cannabis, and illicit substances) for parents were null and not significant.
The study results suggest that 2021 ACTC monthly payments were not associated with increased parental substance use.
2021年儿童税收抵免预付款（ACTC）的月度支付与美国儿童贫困率降低相关；然而，政策制定者担心长期采用该政策会增加父母的药物使用情况。
评估2021年ACTC月度支付与有子女的父母相比无子女的成年人药物使用变化之间是否存在时间上的关联。
设计、背景和参与者：主要样本包括2021年对全国药物使用和健康调查做出回应的18至64岁成年人。采用差异中的差异模型来测试在ACTC月度支付生效后，有子女的父母与无子女的成年人相比，药物使用情况是否发生变化。利用2018年至2020年的其他全国药物使用和健康调查数据来评估有子女的父母和无子女的成年人在药物使用方面的前期趋势。分析采用调查加权法，于2023年9月至2024年11月进行。治疗组定义为家中有受抚养子女且在2021年7月至12月有资格获得税收抵免的成年人。无子女且无资格获得税收抵免的成年人组成对照组。
结局包括过去30天内自我报告的烟草、酒精、大麻和非法药物（如可卡因、阿片类药物或其他兴奋剂或镇静剂）使用情况的二元测量指标；过去30天内使用这些物质的人使用烟草、酒精、大麻和非法药物的天数计数；以及过去30天内使用这些物质的人消耗的香烟和酒精饮料数量计数。
在41853名成年人中，17308名是父母，24545名是无子女的成年人。与无子女的成年人相比，ACTC月度支付的实施使父母在过去30天内使用烟草的概率下降了4.3个百分点（95%CI，-6.6至-2.0）。在吸烟的父母中，支付与过去30天内吸烟量下降46.8个百分点（95%CI，-93.1至-0.5）相关。父母在其他药物（酒精、大麻和非法药物）使用的概率、频率和数量方面的估计变化为零且不显著。
研究结果表明，2021年ACTC月度支付与父母药物使用增加无关。
