Advanced Child Tax Credit Monthly Payments and Substance Use Among US Parents.

Importance: 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.

Objective: 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.

Main Outcomes And Measures: 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.

Results: 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.

Conclusions: The study results suggest that 2021 ACTC monthly payments were not associated with increased parental substance use.