Public Assistance Programs Research Articles

Structural Determinants of Health Literacy Among Formerly Incarcerated Individuals: Insights From the Survey of Racism and Public Health.

Formerly incarcerated individuals (FIIs) encounter difficulties with covering the cost of dental and medical care, adhering to medication regimens, and receiving fair treatment from health care providers. Yet, no published research has examined modifiable pathways to increase FIIs' health literacy (HL), which is essential for addressing the health needs of this vulnerable population. The aim of this article is to examine neighborhood characteristics (neighborhood deprivation, racial and economic polarization, and residential segregation) and public assistance program enrollment as structural determinants of limited health literacy (LHL) among FIIs. Using a socioecological framework, we analyzed a subsample of 578 FIIs from the 2023 Survey of Racism and Public Health, an online cross-sectional survey spanning U.S. Department of Health & Human Services Regions 1, 2, and 3. HL was assessed using the Brief Health Literacy Screen. Logistic regression models estimated unadjusted and adjusted associations of LHL with neighborhood characteristics and public assistance program enrollment. Adjusted models controlled for age, race and ethnicity, gender identity, educational attainment, marital and employment status, number of children, chronic health conditions, and incarceration length. The 578 FIIs had an average age of 46, with 42% having LHL. We observed a statistically significant association between public assistance program enrollment and LHL (unadjusted odds ratio [OR] = 2.72, 95% confidence interval [CI]: 1.87, 4.01; adjusted OR = 2.50, 95% CI: 1.62, 3.88). We found no statistically significant associations of LHL with neighborhood deprivation, racial and economic polarization, and residential segregation. Our findings suggest that there may be an opportunity to develop tailored interventions for increasing HL among FIIs through public assistance programs. Dissemination of HL resources among this marginalized group can improve their self-management of chronic diseases. This is of paramount importance because FIIs must simultaneously navigate other challenges after incarceration (e.g., unstable housing). [HLRP: Health Literacy Research and Practice. 2025;9(1):e8-e18.].

Conceptual Framework for AI-powered fraud detection in E-commerce: Addressing systemic challenges in public assistance programs

Fraud in public assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and Electronic Benefit Transfer (EBT), poses significant economic and social challenges, diverting vital resources from vulnerable populations. Traditional fraud detection methods, including manual audits and static rule-based systems, have proven insufficient to address the complexity and adaptability of modern fraudulent schemes. This paper proposes a conceptual framework for AI-powered fraud detection, emphasizing the use of machine learning, anomaly detection, and predictive analytics to combat fraud effectively. The framework addresses systemic challenges, including evolving fraud tactics, sector-specific issues, and technological barriers such as data privacy and scalability. It highlights the core components of AI-driven systems, ensuring interoperability across public assistance programs and e-commerce platforms. Ethical considerations, such as transparency, fairness, and accountability, are integrated into the framework to prevent algorithmic bias and protect beneficiaries' rights. The paper also explores AI adoption's economic and social implications, outlining the potential for cost savings, operational efficiency, and improved equity in benefit distribution. Finally, strategic recommendations are provided to support the ethical design, sector-agnostic deployment, and continuous improvement of AI-based fraud detection systems. By addressing these challenges, this paper aims to contribute to a more efficient, fair, and transparent approach to public resource protection.

The Financial Inclusion Question in Zimbabwe’s Post-COVID -19, New Normal: Implications for Adoption of Financial Technology (FinTech) on Service Providers

Financial inclusion will be accelerated by the technological opportunities for online financial transactions brought forth by the COVID-19 outbreak. As a result, because there were fewer digital financial transactions, the threats to COVID-19 that were present previously are now more substantial. The aim of this article is to assess the dangers, challenges, and opportunities for financial inclusion brought forth by the use of technology by COVID-19. According to the article, the inherent characteristics of financial technology (FinTech) in connection to financial inclusion allow it to reduce the negative economic and social effects of the ongoing COVID-19 situation. Under COVID-19, the introduction of digital financial transactions has sped up corporate operations and cut expense on doing business. As a result, women now have greater access to transactions involving financial technology (FinTech). The growth of digital financial transactions has made contactless and cashless purchases possible throughout the COVID-19 crisis. The expansion of digital financial inclusion makes it easier to swiftly and effectively implement public assistance programs, such as those for epidemic-affected women. Financial inclusion is being boosted by digital finance, which may eventually replace or improve traditional banking institutions. Working from home has undergone a "revolution" in a number of industries during COVID-19, including banking. Businesses should identify the optimal operating model mix for the future and make sure they have the infrastructure to support widespread, mass flexible working. This calls for reevaluating the function and application of corporate real estate. Since the labor force is likely to become more automated at the same time, resilience is essential. Conceptual Framework of this study is based on the financial inclusion and FinTech concepts which are the main variables guiding the study and it is underpinned by the theories of diffusion of innovation and the Financial Intermediation.

Trauma-informed Financial Empowerment Programming Associated with Improved Financial Well-being

Financial well-being and overall health are significantly linked, especially among those in poverty who have been exposed to violence and suffer from unaddressed trauma. Yet existing public assistance programs fail to address the presence or impact of trauma and adversity. Built specifically for families living in poverty who experience adversity, the Building Wealth and Health Network (the Network) provides a space for families to heal from the effects of trauma while also building social networks and economic security. The sample for this study was primarily Black (91%) women (92%) in Philadelphia with at least one child. A repeated measures linear regression model was performed via a Difference-in-Differences approach to test differences in financial well-being scores between two groups (full participation vs. low/no participation) at two time points (baseline vs 3 months, and baseline vs 6 months). We use this program as a field study to better understand the financial well-being of program participants who took part in fewer or more program sessions. Those who participated in more sessions reported greater increases in two measures of financial well-being at three months and six months post baseline, when compared to those with low or no participation.

Food for thought: The intersection between SNAP stigma, food insecurity, and gender

The Supplemental Nutrition Assistance Program (SNAP) helps millions of families with low incomes to afford and purchase food each year. Prior research has noted that welfare stigma—negative stereotypes about people who participate in public assistance programs—can limit SNAP participation. Stigma may also contribute to worse mental health among subgroups like male participants; qualitative evidence suggests males may struggle to accept public assistance benefits due to norms surrounding gender roles. Yet there is little research about who is most likely to experience stigma, how stigma relates to food insecurity, whether this relationship varies by gender identity, and whether stigma is associated with online shopping (which may protect against stigma). To address these gaps, we analyzed a national survey of 1383 SNAP participants about their experiences of SNAP stigma, food insecurity, and online shopping. In adjusted models, we found that male participants had 40% higher odds (95% CI: 1.09–1.80) of reporting any stigma experience compared to female participants. SNAP participants reporting stigma had over three times the odds (OR: 3.54, 95% CI: 2.60–4.81) of reporting food insecurity relative to those not reporting stigma, and male participants reporting stigma had nearly three times higher odds of food insecurity than female participants reporting stigma (OR: 2.94, 95% CI: 1.53, 5.66). In addition, stigma was not significantly associated with shopping online or using SNAP benefits online. In this national sample of SNAP participants, male respondents had greater odds of welfare stigma, experiences of stigma were associated with greater odds of food insecurity, male respondents experiencing stigma had greater odds of food insecurity compared to female respondents, and stigma was not associated with online shopping behaviors. Efforts to reframe public assistance may be needed to destigmatize programs like SNAP to both improve program uptake among non-participants and improve health outcomes among participants.

Long COVID and the Higher Risk of Food Insecurity Among Participants and Nonparticipants of Food Assistance Programs in the United States

BackgroundIn the aftermath of the COVID-19 public health emergency, it is important to understand the extent of socioeconomic burdens of long COVID, defined as continuation of symptoms after initial infection, including food insecurity. ObjectiveThis study aimed to assess the association between long COVID and family food insecurity among low-income individuals (or any of their family members living with them) who were participants and nonparticipants in public food assistance programs (Supplemental Nutrition Assistance Program [SNAP], Special Supplemental Nutrition Program for Women, Infants, and Children [WIC], and National School Lunch Program [NSLP]) in the United States. DesignThe study used an observational cross-sectional design. Participants/settingData on 7151 adults (aged 18+ years), with family income of < 200% of the Federal Poverty line, from the 2022 National Health Interview Survey, were analyzed. Main outcome measuresLevel of family food security, based on responses to a set of 10 questions measuring family’s food security during the past 30 days. Statistical analyses performedMultinomial logistic regression models were estimated to obtain relative risk ratios of marginal and low/very low food security, relative to the base outcome of high food security, for long COVID status. Multivariable models were estimated separately for the full sample and for subgroups of food assistance participants and nonparticipants. A seemingly unrelated regression (SUR) specification was estimated to assess whether the estimates were different across the participant and nonparticipant subgroups. ResultsCompared with individuals who never had COVID-19, the adjusted relative risks of experiencing marginal and low/very low food security were 1.42 (95% CI, 1.00–2.02) and 1.43 (95% CI, 1.08–1.91) times higher, respectively, for individuals who had long COVID. Although the adjusted risks were not observed to be statistically significant in the participant subgroup, among nonparticipants, adjusted relative risk ratios were 2.34 (95% CI, 1.43–3.82) and 1.56 (95% CI, 1.02–2.39), respectively. SUR results showed that relationships between long COVID and food insecurity were only different for marginal and not low/very low levels of food security between food assistance participant and nonparticipant groups. ConclusionsStudy findings highlight a significantly higher risk of marginal and low/very low- food security among low-income adults who had long COVID, especially those who were nonparticipants in public food assistance programs. Further research is warranted to explore the causal pathways of this relationship for informing policies to mitigate the burden of long COVID.

Examining the effects of social assistance on suicide-related behaviour among impoverished older adults in Korea using a nationwide cohort study from 2010–2019

Suicide rates among older adults in Korea are one of the highest in the world. Although prior research found that poverty is associated with suicide mortality among older adults in Korea, it is unknown whether being a recipient of social assistance may reduce suicide risk among older adults living in poverty. We examined the impact of the public assistance program on suicide-related behaviour (SRB). Data from a nationwide cohort in the Korean National Health Insurance Database, including demographic and medical treatment information, linked to the vital statistics for 2010–19 was used. The entire Korean population born before 1951 was included (n = 7,889,086). Flexible parametric survival model was performed to assess whether the risk of SRB hospitalisation and death differed across a) different levels of socioeconomic status, and b) social assistance status among the poor, using gender-stratified models. Older age, chronic disease, poverty, and being out of the labour market were associated with higher SRB hospitalisation and death for both genders. Among those living in poverty, social assistance recipients had lower rates for SRB death and hospitalisation, compared to the low-income non-recipients. Men who were non-recipients had 0.21 higher hazards ratio (95%CI 0.20 to 0.22) for SRB deaths compared to recipients, and the difference was 0.11 (95%CI 0.10 to 0.11) in women, with similar patterns for SRB hospitalizations. Poverty was associated with higher SRB death and hospitalisation among older adults in Korea. Social assistance targeting the older population may help reduce SRB.

A welfare analysis of Medicaid and recidivism.

We present conservative estimates for the marginal value of public funds (MVPF) associated with providing Medicaid to inmates exiting prison. The MVPF measures the ratio between a policy's social benefits and its governmental costs. Our MVPF estimates suggest that every additional $1 the government spends on providing inmates exiting prison with Medicaid coverage can result in social benefits ranging between $3.45 and $10.62. A large proportion of the benefits we consider stems from the reduced future criminal involvement among former inmates who receive Medicaid. Employing a difference-in-differences approach, we find that Medicaid expansions reduce the average number of times a released inmate is reimprisoned within 1year by approximately 11.5%. By combining this estimate with key values reported elsewhere (e.g., victimization costs, data on victimization and incarceration), we quantify specific benefits arising from the policy. These encompass diminished criminal harm due to lower reoffense rates, direct benefits to former inmates through Medicaid coverage, increased employment opportunities, and reduced loss of liberty resulting from fewer future reimprisonments. Net-costs consist of the cost of providing Medicaid net of changes in the governmental cost of imprisonment, changes in the tax revenue due to increased employment, and changes in spending on other public assistance programs. We interpret our estimates as conservative since we deliberately err on the side of under-estimating benefits and over-estimating costs when data on specific items are imprecise or incomplete. Our findings align closely with others in the sparse literature investigating the crime-related welfare impacts of Medicaid access, underscoring the substantial indirect benefits public health insurance programs can offer through crime reduction, in addition to their direct health-related advantages.

The reach of decentralized poverty governance: Race, politics, and framing poverty in community action agency mission statements

AbstractThe literature on decentralized public assistance programs in the United States documents racialized, partisan poverty governance founded on paternalism and individualistic frameworks. This article extends that literature to consider such frameworks in a unique site of poverty governance, Community Action Agencies (CAAs). Established during the War on Poverty in the 1960's, CAAs emphasized “maximum feasible participation” from low‐income citizens, aspiring to participatory models and funding structures that some believed could block systemically racist and politicized resource allocation. Drawing on a novel dataset of mission statements for CAAs across the US, I test how three distinct dimensions of the framing of poverty vary by the racial and partisan context of each agency's geographic location. Individualist, passive framings are common, and significantly more so in geographic areas with more residents of color and greater support for Republican political candidates. But some of the inclusive and participatory aspirations of CAA structures remain evident too, with race and politics predicting these even more strongly. Thus, my analyses provide new evidence for the way decentralization allows the deep reach of racialized and partisan approaches to addressing poverty, even with new measures and even in an arena in which inclusive participation was a central founding aspiration.

The study of constructing evaluation indicators for the implementation of employee assistance programs in public sectors.

Employee assistance programs require resources and manpower of various natures across different types of public sector organization. This study began by outlining elements for comparing employee assistance programs' evaluation criteria in four types of public sector organization on the basis of 22 service measures for such programs implemented by the Ministry of Labor in relation to three major aspects: work, life, and health. Elements of the evaluation criteria for public sector employee assistance programs were determined by surveying a panel of experts using the modified Delphi method. Last, the weight associated with the elements of evaluation criteria were calculated using the fuzzy analytic hierarchy process, and the criteria of four types of public sector organization were explored. Data analysis indicated that the weight and priorities associated with elements of evaluation criteria for EAPs implemented by four types of public sector organization were not fully identical. The results of this study suggest that, in terms of EAPs, the Directorate-General of Personnel Administration of the Executive Yuan should be pursuant to appropriate employee assistance programs provided by various public sector organizations according to the needs of their employees as well as the diverse objective conditions in which these organizations operate.

Statistical learning to identify salient factors influencing FEMA public assistance outlays

Both the number of disasters in the U.S. and federal outlays following disasters are rising. FEMA’s Public Assistance (PA) is a key program for rebuilding damaged public infrastructure and aiding local and state governments in recovery. It is the primary post-disaster source of recovery funds. Between 2000 and 2019, more than $125B (adjusted, 2020 dollars) was awarded through PA. While all who qualify for PA should have equal opportunity to receive aid, not all do, and the factors influencing how the program has been administered are complex and multifaceted. Lacking an understanding of the factors positively associated with historical receipt of aid, there is little way to objectively evaluate the efficacy of the PA program. In this work, we evaluate the salient features that contribute to the number of county-level PA applicants and projects following disasters. We use statistical learning theory applied to repetitive flooding events in the upper Midwest between 2003 and 2018 as a case study. The results suggest that many non-disaster related indicators are key predictors of PA outlays, including the state in which the disaster occurred, the county’s prior experience with disasters, the county’s median income, and the length of time between the end of the disaster and the date when a disaster is declared. Our work suggests that indicators of PA aid are tied to exposure, bureaucratic attributes, and human behavior. For equitable distribution of aid, policymakers should explore more disaster-relevant indicators for PA distribution.

Poverty Stigma: Assessing the Surveillance of and Psychological Reframing by WIC Recipients

ABSTRACT The current study examines the poverty stigma experienced by Women, Infants, and Children program recipients during grocery store transactions. Through in-person interviews with 32 WIC recipients in metro Detroit, the study examines perceptions of the social context, strategies to manage stigma, and the social psychological consequences. The findings highlight the resilience of interviewees and the need for public assistance programs to address not just practical needs but also the social psychological well-being of recipients. This research contributes significantly to understanding poverty stigma, especially within the context of WIC food assistance. Policy implications are discussed.

Street-level bureaucrats in the professional context of primary care social services in Spain

PurposeThis study aims to identify the street-level approaches of professional workers in complex public social service organisations when attending to social assistance claimants.Design/methodology/approachThe study employed a multifaceted approach comprising documentary analysis, semi-structured individual interviews (17) and focus group discussions (8) with qualified frontline social workers from primary care social services in Tarragona.FindingsSocial workers embodied three specific sets of cognitive, normative and emotional dispositions when attending to people with low incomes. First, the compassionate approach conceives clients as defensive regarding social services and emotionally vulnerable because of deprivation. Second, the instructional approach frames clients as being baffled by a new, precarious, institutional and economic context. They also lack information, abilities and the proper mindset to conceive of and attain available welfare and occupational resources. Third, the enforcement approach tends to define clients as suspicious, trying to obtain an excessive and unfair advantage of the welfare system that would eventually hamper their social opportunities.Originality/valueResearch thus far has tended to define public social assistance programmes in Southern welfare state contexts as mostly inefficient and hardly relevant residual social policies. The street-level approach shows that social workers try to resist the mere administrative processing of benefits, which is a professionally troubling and organisationally unsustainable way to proceed. They attempt to help clients by providing inclusive content in order to implement their benefits.

Diverging equity implications of FEMA disaster aid received by counties in Gulf coast states

Climate change disproportionately impacts marginalized communities, but we also need to understand how addressing these impacts might exacerbate existing inequalities. Exploring how generic structural socioeconomic and political inequalities relate to responses to specific climate-driven hazards can help inform efforts to address climate-driven risks without reinforcing inequalities. This study sheds light on the relationship between generic capitals that local governance systems might draw on to reduce risks and a specific outcome that reduces the impact of climate-driven risks. We explore patterns in the amount of aid counties in the five Gulf States (Alabama, Florida, Louisiana, Mississippi, and Texas) received from the US Federal Emergency Management Agency’s Public Assistance Program from 2000 to 2020. Using linear regressions, we explore how the amount of aid these counties received relates to the presence of five dimensions of potential generic capitals (social, economic, political, human, and environmental) at the county-level. We found evidence that patterns in the distribution of aid were consistent with simultaneously both reducing and amplifying existing inequalities – e.g., counties with higher levels of individual poverty and more rural residents received more aid while counties with higher percentages of Black and Hispanic residents received less. At the same time, we found evidence that aid received might be particularly low for populations vulnerable due to both racial/ethnic inequities and lack of access to services located in more urbanized areas. These results highlight the need for assessments exploring the multidimensional nature of equity to prevent efforts to address climate-related risks further marginalizing those left behind.

The Economics of the Disability Poverty Trap

This paper examines how the structure of existing public assistance, such as Supplemental Security Income (SSI) in the United States, created the current disability poverty trap. SSI creates barriers to saving with the implementation of low asset tests while at the same time establishing disincentives for work. As a result, the program fails to improve the quality of life for disabled people who need the benefits and prevents them from ever transitioning off the program. The inability to achieve a critical mass of income with limited benefits and low asset tests results in a poverty trap. Analyzing this dilemma utilizing behavioral economics, leisure demand and labor supply curves, income and substitution effects, and savings vs. consumption models reveals how public assistance programs systemically reinforce the disability poverty trap. Such reinforcement is done through limits on financial agency and failures to account for the socioeconomic role of disability in someone’s life. This analysis concludes that low monthly benefits and limitations on savings in public assistance programs fail to account for the extra costs of living with a disability and barriers to employment. Future policy solutions should increase the monthly benefits recipients receive on SSI, increase asset test limits, create more robust transitional periods off the program, and expand work opportunities.

Repeat audit findings: How FEMA responds to feedback

Given climate change, expansive hardscapes and high housing density across the United States, and with the increasing frequency and ferociousness of natural disasters of all sorts, the damages and costs associated with human lives, land, and property will continue to grow. In this environment, state and local governments have heavy reliance on federal assistance to repair and rebuild communities following such crises, specifically via the Public Assistance (PA) grant program. The U.S. Federal Emergency Management Agency (FEMA) administers this grant through a process of application and approval managed by ten regional offices. Increased claims to FEMA have strained these regional offices leading to their failure to incorporate audit feedback and review policies for the purpose of continuous improvement. In these disastrous times, FEMA's operational improvement is vital to the continued support of communities across the nation. The Agency has objectives to promote effective recovery, streamline funding to reduce costs, and conduct the PA program efficiently to realize better return on investment.This research measures this problem by examining the U.S. Office of Inspector General's (OIG) audit findings of FEMA regional offices to see if and how these audits are being utilized and incorporated. Results show that over time, these offices are conducting the due diligence related to feedback; however, they are not incorporating details of audits in a meaningful way. Though total errors do not result in significant change in how FEMA apportions funding among regional offices over time, the type of error (either overspending or underspending) does influence such change. Therefore, consistent errors continue in financial response to disasters to which the Agency responds, indicating future FEMA decisions and OIG recommendations should require shifting the focus from repeat audit findings to financial prudence.

HIV pre-exposure prophylaxis provision by U.S. health centers in 2021.

The aim of this study was to assess HIV preexposure prophylaxis (PrEP) provision in U.S. health centers. The U.S. Ending the HIV Epidemic (EHE) initiative designated health centers as the main healthcare system through which PrEP scale-up occurs. Health centers offer primary care to over 30 million disproportionately uninsured, racially or ethnically minoritized, and low-income patients. This study is the first to assess PrEP provision across health centers, including characteristics of clinics, patient populations, and policies associated with PrEP prescribing. The Health Resources and Services Administration's Uniform Data System contained aggregate data on PrEP prescriptions and patient sociodemographics at health centers from January 1 through December 31, 2021, in 50 U.S. states, the District of Columbia, and eight U.S. territories. We compared patient demographics and availability of Medicaid expansion and PrEP assistance programs at health centers that prescribed vs. those that did not prescribe PrEP. Across 1375 health centers serving 30 193 278 patients, 79 163 patients were prescribed PrEP. Health centers that prescribed any PrEP had higher proportions of sexual, gender, racial, and ethnic minority patient populations compared with health centers that prescribed no PrEP. Compared with health centers that prescribed no PrEP, a higher proportion of health centers that prescribed PrEP were located in designated high-priority jurisdictions of the EHE initiative or states with Medicaid expansion or public PrEP assistance programs. Health centers are critical for scaling up PrEP in minoritized populations disproportionately affected by HIV, facilitated through federal and state-level policies. These findings highlight service gaps and inform future interventions to optimize PrEP implementation and support EHE initiative goals.

Support seeking, system avoidance, and citizenship: Social safety net usage after incarceration

AbstractScholars have long described the American penal state and welfare state as joined by a common logic of social marginalization. But researchers have only recently begun to explore how the individuals who pass through the carceral system also interact with welfare state programs. Using data from the National Longitudinal Survey of Youth 1979, in this article, I explore how formerly incarcerated individuals make claims on the welfare state and how participation varies across social programs and states, as well as by race, drawing on theories of social welfare rights‐claiming and system avoidance. In so doing, I provide the first nationwide estimates of the extent to which previously incarcerated adults use social safety net resources. I find that participation in welfare programs varies with incarceration history, program structure, and race. Rather than finding patterns consistent with system avoidance, I find that previously incarcerated White Americans seem to engage in active rights claiming, participating in public assistance programs more than similarly eligible never‐incarcerated counterparts. All formerly incarcerated individuals, however, have limited access to more generous social insurance programs, and the shift to an increasingly employment‐based social safety net seems likely to further limit access to the welfare state for the growing population of Americans leaving prison.

State Public Assistance Spending and Survival Among Adults With Cancer

Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations. To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity. This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023. Differential state-level public assistance spending. The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage. A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects). This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.

Organizational access points and substance use disorder treatment utilization among Black women: a longitudinal cohort study

IntroductionHealth and social service organizations, including the emergency department (ED) and public assistance programs, constitute a social safety net that may serve as an “access point” for substance use treatment utilization. Racialization of substance use disorder (SUD) and gender disparities in access to treatment contribute to differences in health and social service utilization, including substance use treatment for Black women. We therefore explored the role of various access points in facilitating the use of substance use treatment among Black women with substance use and involvement in the criminal justice system.MethodsWe used data from the Black Women in the Study of Epidemics (B-WISE) project (2008–2011), which recruited Black women who use drugs from community, probation, and prison recruitment settings in Kentucky. B-WISE is a three-wave panel survey collected on a six-month interval. We estimated dynamic panel models to understand whether time-varying use of services influenced women’s substance use treatment utilization over 18-months, adjusting for time-invariant characteristics. We stratified the analysis based on where women were recruited (i.e., community, prison, and probation).ResultsThe sample included 310 persons and 930 person-waves. For the community and prison samples, the use of an ED in the 6 months prior decreased women’s likelihood of subsequent substance use treatment use (Coef: -0.21 (95% CI: -0.40, -0.01); -0.33 (95% CI: -0.60, -0.06), respectively). For the probation sample, receiving support from public assistance (i.e., food stamps, housing, cash assistance) increased the likelihood of subsequent substance use treatment use (0.27 (95% CI: 0.08, 0.46)).ConclusionInteractions with health and social service organizations predicted Black women’s use of substance use treatment services and varied based on their involvement in the criminal justice system. Public assistance venues for Black women on probation may be a point of intervention to increase their access to and use of substance use treatment.