Financial difficulties among youth prenatally exposed to substances: a longitudinal register-based cohort study

Figures & data

Table 1. Summary of the main outcome variable, mediators and covariates, and data sources.

Variables	Definition and classification	Data Source (maintained by)	Years covered
Main outcome variable
Youth’s long-term financial social assistance receipt	Receipt of financial social assistance for at least four months during a calendar year at least once between the ages of 18 to 24 years (no, yes)	Register of Social Assistance (THL)	2010–2016
Other characteristics of youth financial social assistance receipt
Age at the first long-term financial social assistance receipt	Age in years at the first long-term financial social assistance receipt	Register of Social Assistance (THL)	2010–2016
The cumulative number of years for which long-term financial social assistance was granted	The cumulative number of years for which long-term financial social assistance was granted	Register of Social Assistance (THL)	2010–2016
Mediator variables
Youth characteristics
Mental or behavioral disorders	Primary or secondary diagnosis from specialized healthcare (i.e. inpatient or outpatient hospital care) following the ICD-9 codes 290–316 (292 excluded) and ICD-10 codes F00–F99 (F17, F70–F79 excluded) during the follow-up (no, yes)	Hospital Discharge Register or Care Register for Health Care (THL)	1992–2016
Secondary education completion	Completed upper secondary education by the end of the follow-up (no, yes)	Education Register (Statistics Finland)	2010–2015
Maternal postnatal characteristics (occurred between child’s birth and 18th birthday)
Maternal mental or behavioral disorders	Primary or secondary diagnosis from specialized healthcare (i.e. inpatient or outpatient hospital care) care following the ICD-9 codes 290 and 293–319 (303–305 excluded), and ICD-10 codes F00–F09 and F20–F99 (no, yes)	Hospital Discharge Register or Care Register for Health Care (THL)	ICD–9 1987–1995 ICD–10 1996–2016
Maternal substance abuse	Primary diagnosis from specialized healthcare (i.e. inpatient or outpatient hospital care) following ICD-9 codes 291–292, 303–305, 3570, 4255, 5353, 5710, 5711–5713, 6483, 6555, 9650, and 9696–9697, and ICD-10 codes E24.4, F10–F16, F18–F19, G31.2, G40.5, G40.51, G40.52, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, K86.08, O35.4–O35.5, P04.4, R78.0–R78.5, T40, T43.6, T50.2–T50.3, T51, Z71.4 and Z72.1–Z72.2 (no, yes)	Hospital Discharge Register or Care Register for Health Care (THL)	ICD–9 1987–1995 ICD–10 1996–2016
Maternal long-term financial social assistance receipt	Receipt of financial social assistance for at least four months during a calendar year at least once (no, yes)	Register of Social Assistance (THL)	2002–2016
Out-of-home care	At least one out-of-home care (OHC) episode prior to the youth’s 18th birthday (no, yes), age in years at the first OHC episode, cumulative lengths of OHC episodes in years	Child Welfare Register (THL)	1992–2016
Covariates
Sex	Female, male	Medical Birth Register (THL)	1992–2016

Table 2. Descriptive characteristics and comparison of 18–24-year-old exposed and unexposed youth and recipients of long-term financial social assistance.

	Total study population			Recipients of long-term financial social assistance
	Exposed n = 355	Unexposed n = 1011	p-value	Exposed n = 179	Unexposed n = 174	p-value
Youth characteristics
Sex			0.411			0.692
Female	175 (49.3)	524 (51.8)		84 (46.9)	78 (44.8)
Male	180 (50.7)	487 (48.2)		95 (53.1)	96 (55.2)
Mental or behavioral disorders			<0.001			0.006
No	152 (42.8)	723 (71.5)		56 (31.3)	79 (45.4)
Yes	203 (57.2)	288 (28.5)		123 (68.7)	95 (54.6)
Secondary education completion			<0.001			0.521
No	248 (69.9)	592 (58.7)		133 (74.3)	124 (71.3)
Yes	107 (30.1)	418 (41.3)		46 (25.7)	50 (28.7)
Maternal postnatal characteristics
Maternal mental or behavioral disorder			<0.001			0.017
No	204 (57.5)	840 (83.1)		107 (59.8)	125 (71.8)
Yes	152 (42.5)	171 (16.9)		72 (40.2)	49 (28.2)
Maternal substance abuse			<0.001			<0.001
No	202 (56.9)	979 (96.8)		96 (53.6)	161 (92.5)
Yes	153 (43.1)	32 (3.2)		84 (46.4)	13 (7.5)
Maternal long-term financial social assistance receipt			<0.001			<0.001
No	97 (27.3)	858 (84.9)		37 (20.7)	106 (60.9)
Yes	258 (72.7)	153 (15.1)		142 (79.3)	68 (39.1)
Out-of-home care (OHC)			<0.001			<0.001
No	126 (35.5)	940 (93.0)		44 (24.6)	127 (73.0)
At least one OHC episode	229 (64.5)	71 (7.0)		135 (75.4)	47 (27.0)
Age in years at the first OHC episode (median, IQR)	3.2 (1.2, 7.5)	12.9 (6.8, 14.7)	<0.001	4.6 (1.9, 9.9)	13.1 (7.9, 14.8)	<0.001
Cumulative length of OHC episodes in years (median, IQR)	10.6 (2.6, 16.0)	1.6 (0.2, 5.0)	<0.001	6.8 (1.8, 15.0)	1.9 (0.3, 5.0)	<0.001

IQR: Interquartile Range; p-values based on χ² test for categorical variables and Mann-Whitney U-test for continuous variables.

Table 3. Comparison of receipt of financial social assistance among 18–24-year-old exposed and unexposed youth.

	Exposed n = 355	Unexposed n = 1011	p-value
Main outcome variable
Receipt of long-term financial social assistance, n (%)	179 (50.4)	174 (17.2)	<0.001
Other characteristics of youth’s receipt of financial social assistance
Age at first long-term financial social assistance receipt (mean, SD)	18.8 (0.97)	19.3 (1.39)	<0.001
Cumulative number of years for which long-term financial social assistance was granted (mean, SD)	2.5 (1.6)	2.1 (1.4)	0.039

Long-term financial social assistance is defined as received financial social assistance for 4–12 months during a calendar year at least once during the follow-up, SD: Standard Deviation, p-values based on χ² test for categorical variables and Independent-Samples t-Test for continuous variables.

Table 4. Unadjusted and adjusted predictors of long-term financial social assistance receipt among 18–24-years old youth.

	Unadjusted				Adjusted*
	b	SE	OR (95% CI)	p-value	b	SE	AOR (95% CI)	p-value
Prenatal substance exposure	1.59	0.14	4.89 (3.76, 6.37)	<0.001	0.28	0.21	1.33 (0.89, 1.98)	0.167
Youth characteristics
Male sex	0.16	0.12	1.17 (0.92, 1.49)	0.200	0.15	0.15	1.17 (0.87. 1.57)	0.312
Mental or behavioral disorders	1.48	0.13	4.38 (3.39, 5.65)	<0.001	0.82	0.16	2.28 (1.68, 3.10)	<0.001
Lack of secondary education	0.68	0.14	1.97 (1.51, 2.57)	<0.001	1.68	0.21	5.39 (3.55, 8.17)	<0.001
Maternal postnatal characteristics
Maternal mental or behavioral disorders	0.75	0.14	2.11 (1.61, 2.76)	<0.001	0.01	0.18	1.01 (0.70, 1.44)	0.979
Maternal substance abuse	1.36	0.16	3.88 (2.82, 5.34)	<0.001	–0.27	0.25	0.76 (0.47, 1.24)	0.274
Maternal long-term financial social assistance receipt	1.78	0.13	5.93 (4.56, 7.72)	<0.001	1.13	0.19	3.09 (2.13, 4.48)	<0.001
Out-of-home care (OHC)
At least one OHC episode	2.09	0.15	8.07 (6.08, 10.72)	<0.001	1.22	0.22	3.39 (2.20, 5.23)	<0.001

Unadjusted and adjusted parameter estimates (b) with standard error (SE), odds ratios (OR), adjusted odds ratios (AOR), 95% Confidence Intervals (CI) and p-values are reported for bivariate and multivariable generalized linear models.

*Adjusted for prenatal substance exposure, youth characteristics, maternal postnatal characteristics, OHC, and follow-up time.

Figure 1. The mediating effect of youth mental or behavioral disorders (M), lack of secondary education (M), maternal long-term financial social assistance receipt (M) and child out-of-home care (M) on the association between prenatal substance exposure (X) and youth’s long-term financial social assistance receipt (Y). Parameter estimates (b) with p-value ***p < 0.001.

Table 5. The mediating effect of youth’s characteristics (i.e. mental or behavioral disorders, lack of secondary education), maternal long-term financial social assistance receipt and child out-of-home care on the association between prenatal substance exposure and youth’s long-term financial social assistance (FSA) receipt.

	Mediators
	Youth characteristics								Maternal characteristics				Out-of-home care
	Mental or behavioral disorder				Lack of secondary education				Long-term financial social assistance receipt				Child out-of-home care
	b	SE	95% CI	p-value	b	SE	95% CI	p-value	b	SE	95% CI	p-value	b	SE	95% CI	p-value
Prenatal substance exposure and mediator (a)	1.21	0.13		<0.001	0.49	0.13		<0.001	2.70	0.15		<0.001	3.18	0.17		<0.001
Mediator and youth’s long-term FSA receipt (b)	1.23	0.14		<0.001	0.58	0.14		<0.001	1.35	0.16		<0.001	1.69	0.18		<0.001
Indirect effect (ab)	0.07		0.05, 0.10	<0.001	0.01		0.004, 0.02	<0.001	0.16		0.12, 0.20	<0.001	0.20		0.16, 0.26	<0.001
Direct effect (c‘)	0.26		0.20, 0.32	<0.001	0.32		0.26, 0.38	<0.001	0.17		0.10, 0.24	<0.001	0.12		0.05, 0.20	<0.001
Proportion mediated (ab/(ab + c’))	0.21		0.14, 0.30	<0.001	0.03		0.01, 0.07	0.004	0.48		0.35, 0.64	<0.001	0.63		0.47, 0.83	0.002
Total effect (c)	0.33		0.28, 0.39	<0.001	0.33		0.28, 0.39	<0.001	0.33		0.28, 0.39	<0.001	0.32		0.27, 0.39	<0.001

Parameter estimates (b) with standard error (SE), 95% Confidence Interval (CI) and p-values.

Data availability statement

The data are not publicly available due to data confidentiality and the authors do not have permission to share the data. Similar data can be applied from Findata, the Finnish Social and Health Data Permit Authority: (https://findata.fi/en/).