{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T20:46:33Z","timestamp":1760647593871,"version":"3.40.5"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["K08AA029150"],"award-info":[{"award-number":["K08AA029150"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA044526","R25DA035692"],"award-info":[{"award-number":["R01DA044526","R25DA035692"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate how the COVID\u201019 pandemic impacted low\u2010income individuals with substance use disorder (SUD) in New York City (NYC) during the beginning of the pandemic, using a structural competency and structural vulnerability theoretical framework and a qualitative research approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>Primary qualitative data were collected from racial\/ethnic minority adults enrolled in Medicaid receiving outpatient substance use treatment (e.g., medication, counseling) in NYC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Semi\u2010structured in\u2010depth qualitative interviews (<jats:italic>N<\/jats:italic>\u00a0=\u00a020) were conducted during \u201cstay\u2010at\u2010home\u201d orders in NYC, the first epicenter of the COVID\u201019 pandemic in the United States. Interviews were conducted over the phone during the earlier stages of the pandemic, between April 2020 and June 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection\/Extraction Methods<\/jats:title><jats:p>Semi\u2010structured in\u2010depth interviews were conducted and audio recorded, transcribed, and analyzed using a thematic analysis approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Three themes were yielded from our thematic analysis: (1) COVID\u201019 heightened food insecurity and housing conditions increased risks of infection; (2) stay\u2010at\u2010home orders limited access to resources but had positive impacts in strengthening social relationships and reducing substance use triggers; and (3) although COVID\u201019 created challenges for treatment, most described that SUD care improved during the pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>While COVID\u201019 exacerbated numerous structural vulnerabilities among low\u2010income individuals with SUD, programmatic adaptations to COVID\u201019 SUD care, including telehealth and loosening restrictions around medications for opioid use disorders mitigated past difficulties that patients had faced. Reducing structural vulnerabilities for Medicaid patients will require continuation of telehealth treatment delivery, retaining flexible medication regulations, and mobilizing community resources to mitigate economic disparities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13975","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T09:28:31Z","timestamp":1648373311000},"page":"1104-1111","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Using a structural vulnerability framework to understand the impact of COVID\u201019 on the lives of Medicaid beneficiaries receiving substance use treatment in New York City"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5870-2617","authenticated-orcid":false,"given":"Jenny","family":"Zhen\u2010Duan","sequence":"first","affiliation":[{"name":"Disparities Research Unit, Department of Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neerav","family":"Gade","sequence":"additional","affiliation":[{"name":"Disparities Research Unit, Department of Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Community Health Tufts University  Medford Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Falgas\u2010Bagu\u00e9","sequence":"additional","affiliation":[{"name":"Disparities Research Unit, Department of Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly L.","family":"Sue","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"DeJonckheere","sequence":"additional","affiliation":[{"name":"Department of Family Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2241-707X","authenticated-orcid":false,"given":"Margarita","family":"Alegr\u00eda","sequence":"additional","affiliation":[{"name":"Disparities Research Unit, Department of Medicine Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Psychiatry Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"CDC. 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