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Dore EC, Wurapa J. The long-term health effects of childhood exposure to social and economic policies: A scoping review. Soc Sci Med 2024; 352:117024. [PMID: 38824839 DOI: 10.1016/j.socscimed.2024.117024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/04/2024]
Abstract
While numerous studies have found a relationship between social and economic policies and short-term health outcomes, fewer studies have explored the long-term health effects of these policies. Given the important association between childhood circumstances and health in adulthood, long-term population health consequences should be considered when designing social and economic policies. This review summarizes the existing literature on the long-term effects of childhood exposure to social and economic policies on adult health, summarizes the findings, the methods employed, and indicates areas for future research. The review process followed the JBI scoping review protocol and PRISMA-ScR reporting guidelines. The search was conducted in three electronic databases (Web of Science, Pub Med, and SCOPUS), and focused on peer-reviewed manuscripts that studied the effects of policy exposures during childhood on health in adulthood. A total of 3471 articles were collected from the databases and 18 were identified as meeting the eligibility criteria. The most commonly studied policies were safety-net policies (N = 6), followed by education policies (N = 5), civil rights policies (N = 3), government investments (N = 3), and child labor laws (N = 1). The health outcomes varied and included chronic conditions, mental health, mortality, and self-rated health. The studies also overwhelmingly employed causal inference techniques (N = 13), including difference-in-differences study designs and instrumental variable analysis. Most studies found long-term positive effects of policies that provided extra resources to historically under-resourced populations, or policies that aimed to increase equality of opportunity. However, there were some studies with null or mixed findings, especially when examining the long-term health effects of education reform. More literature is needed on this important topic, and now is the time to capitalize on longer follow-up periods in currently available data.
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Affiliation(s)
- Emily C Dore
- Emory University, Department of Sociology, 1555 Dickey Dr., Atlanta, GA, 30322, USA.
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Qian H, Wehby GL. Revisiting the effects of state earned income tax credits on infant health: a quasi-experimental study using contiguous border counties approach. BMC Public Health 2023; 23:2422. [PMID: 38053105 PMCID: PMC10698941 DOI: 10.1186/s12889-023-17166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND To examine the effects of refundable state earned income tax credits (EITC) on infant health. METHODS We use the restricted-access U.S. birth certificate data with county codes from 1989 to 2018. Birth outcomes include birth weight, low birth weight, gestational weeks, preterm birth, and the fetal growth rate. The analytical sample includes single mothers with high school education or less. Two specifications of two-way fixed effects models are employed. The first specification accounts for shared time trends across all states/counties. The second specification estimates effects based on EITC changes within contiguous counties across state borders which accounts for contemporaneous events specific to each contiguous county pair. Models are estimated pooling and stratifying by parity subgroups. RESULTS Under the first specification, refundable state EITC is associated with improved birth outcomes. Pooling all parity, a 10%-point increase in refundable EITC is associated with an 8-gram increase in birth weight (95% CI: 2.9,14.6). The effect increases by parity. In contrast, the estimates from the second model are much smaller and statistically non-significant, both pooling and stratifying by parity. CONCLUSIONS Comparing contiguous counties across state borders, there is no evidence that refundable state EITC affects birth outcomes. However, the estimates still do not rule out moderate to large benefits for third or higher born infants.
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Affiliation(s)
- Haobing Qian
- Department of Family and Community Medicine, University of California, San Francisco, USA.
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA.
| | - George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA
- Department of Economics, University of Iowa, Iowa City, IA, USA
- Preventive & Community Dentistry, University of Iowa, Iowa City, IA, USA
- Public Policy Center, University of Iowa, Iowa City, IA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Barnish MS, Tan SY, Robinson S, Taeihagh A, Melendez-Torres GJ. A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes. Soc Sci Med 2023; 339:116402. [PMID: 38000341 DOI: 10.1016/j.socscimed.2023.116402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes. METHODS A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories. FINDINGS From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types. CONCLUSIONS This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.
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Affiliation(s)
- Maxwell S Barnish
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom.
| | - Si Ying Tan
- Alexandra Research Centre for Healthcare in the Virtual Environment (ARCHIVE), Alexandra Hospital, National University Health System, Singapore
| | - Sophie Robinson
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom
| | - Araz Taeihagh
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom
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Karasek D, Batra A, Baer RJ, Butcher BDC, Feuer S, Fuchs JD, Kuppermann M, Gomez AM, Prather AA, Pantell M, Rogers E, Snowden JM, Torres J, Rand L, Jelliffe-Pawlowski L, Hamad R. Estimating the effect of timing of earned income tax credit refunds on perinatal outcomes: a quasi-experimental study of California births. BMC Public Health 2023; 23:2180. [PMID: 37936102 PMCID: PMC10629068 DOI: 10.1186/s12889-023-16920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The largest poverty alleviation program in the US is the earned income tax credit (EITC), providing $60 billion to over 25 million families annually. While research has shown positive impacts of EITC receipt in pregnancy, there is little evidence on whether the timing of receipt may lead to differences in pregnancy outcomes. We used a quasi-experimental difference-in-differences design, taking advantage of EITC tax disbursement each spring to examine whether trimester of receipt was associated with perinatal outcomes. METHODS We conducted a difference-in-differences analysis of California linked birth certificate and hospital discharge records. The sample was drawn from the linked CA birth certificate and discharge records from 2007-2012 (N = 2,740,707). To predict eligibility, we created a probabilistic algorithm in the Panel Study of Income Dynamics and applied it to the CA data. Primary outcome measures included preterm birth, small-for-gestational age (SGA), gestational diabetes, and gestational hypertension/preeclampsia. RESULTS Eligibility for EITC receipt during the third trimester was associated with a lower risk of preterm birth compared with preconception. Eligibility for receipt in the preconception period resulted in improved gestational hypertension and SGA. CONCLUSION This analysis offers a novel method to impute EITC eligibility using a probabilistic algorithm in a data set with richer sociodemographic information relative to the clinical and administrative data sets from which outcomes are drawn. These results could be used to determine the optimal intervention time point for future income supplementation policies. Future work should examine frequent income supplementation such as the minimum wage or basic income programs.
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Affiliation(s)
- Deborah Karasek
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA.
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA.
| | - Akansha Batra
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Rebecca J Baer
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
- Department of Pediatrics, University of California, San Diego, San Diego, USA
| | | | - Sky Feuer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
| | - Jonathan D Fuchs
- Department of Public Health, Population Health Division, San Francisco, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, USA
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, San Francisco, USA
| | - Matt Pantell
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA
| | - Elizabeth Rogers
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, USA
| | - Jacqueline Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
| | - Laura Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Rita Hamad
- Department of Family and Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University, Cambridge, USA
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Muchomba FM, Teitler JO, Reichman NE. Municipal social expenditures and maternal health disparities: a study of linked birth and hospitalisation records. J Epidemiol Community Health 2023; 78:jech-2023-220558. [PMID: 37875339 PMCID: PMC11039565 DOI: 10.1136/jech-2023-220558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Local government expenditures provide services and benefits that can affect health but the extent to which they are associated with narrowing or widening of racial/ethnic and socioeconomic disparities in health is unknown. We examined race/ethnicity-stratified and education-stratified associations between municipal social expenditures-those on housing, transportation, education, and other society-wide needs-and serious life-threatening maternal health conditions in a large US state. METHODS In this cross-sectional study, we used individual birth records for 1 003 974 births in the state of New Jersey from 1 January 2008 to 31 December 2018 linked to individual maternal hospital discharge records and municipality-level characteristics for 564 municipalities. Severe maternal morbidity (SMM) was identified in the discharge records using a measure developed by the US Centers for Disease Control and Prevention. Associations between municipal-level social expenditures per capita and SMM were estimated using multilevel logistic models. RESULTS Residing in a municipality with higher social expenditures was associated with lower odds of SMM across all racial/ethnic groups and education levels. Overall, 1% higher annual social expenditures per capita was associated with 0.21% (95% CI -0.29 to -0.13) lower odds of SMM. The associations were greater for individuals with less than a high school education than for those in the other educational groups in both relative (lnOR -0.53; 95% CI -0.74 to -0.31) and absolute (β -0.013; 95% CI -0.019 to -0.008) terms. CONCLUSION Municipal-level spending on social services is associated with narrowing socioeconomic disparities in SMM. Narrowing racial/ethnic disparities in maternal health will likely require intervening beyond the provision of services to addressing historical and ongoing structural factors.
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Affiliation(s)
- Felix M Muchomba
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Julien O Teitler
- School of Social Work, Columbia University, New York, New York, USA
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Berkowitz SA, Dave G, Venkataramani AS. Potential gaps in income support policies for those in poor health: The case of the earned income tax credit-A cross sectional analysis. SSM Popul Health 2023; 23:101429. [PMID: 37252288 PMCID: PMC10209707 DOI: 10.1016/j.ssmph.2023.101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background The federal Earned Income Tax Credit (EITC) is the primary income support program for low-income workers in the U.S., but its design may hinder its effectiveness when poor health limits, but does not preclude, work. Methods Cross-sectional analysis of nationally-representative U.S. Census Current Population Survey (CPS) data covering 2019. Working-age adults eligible to receive federal EITC were included in this study. Poor health, as indicated by self-report of at least one problem with hearing, vision, cognitive function, mobility, dressing and bathing, or independence, was the exposure. The main outcome was federal EITC benefit category, categorized as no benefit, phase-in (income too low for the maximum benefit), plateau (maximum benefit), phase-out (income above threshold for maximum benefit), or earnings too high to receive any benefit. We estimated EITC benefit category probabilities by health status using multinomial logistic regression. We further examined whether other government benefits provided additional income support to those in poor health. Results 41,659 participants (representing 87.1 million individuals) were included. 2,724 participants (representing 5.6 million individuals) reported poor health. In analyses standardized over age, gender, race, and ethnicity, those in poor health, compared with those not in poor health, were more likely to be in the no benefit (2.40% vs. 0.30%, risk difference 2.10 percentage points [95%CI 1.75 to 2.46 percentage points]), and phase-in (9.28% vs. 2.74%, risk difference 6.54 percentage points [95%CI 5.82 to 7.26 percentage points]) categories. Differences in resources by health status persisted even after accounting for other government benefits. Conclusions EITC program design creates an important gap in income support for those for whom poor health limits work, which is not closed by other programs. Filling this gap is an important public health goal.
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Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gaurav Dave
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Atheendar S. Venkataramani
- Division of Health Policy, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
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Margerison CE, Zamani-Hank Y, Catalano R, Hettinger K, Michling TR, Bruckner TA. Association of the 2021 Child Tax Credit Advance Payments With Low Birth Weight in the US. JAMA Netw Open 2023; 6:e2327493. [PMID: 37556140 PMCID: PMC10413172 DOI: 10.1001/jamanetworkopen.2023.27493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 08/10/2023] Open
Abstract
IMPORTANCE Infants and pregnant people in the US fare worse on almost all health measures compared with those in peer nations. Families in the US are more likely to live in poverty and have a less generous social safety net, which has generated debate over the contribution of economic conditions to this disparity. OBJECTIVE To assess the association between temporary increases in income during pregnancy through the 2021 expanded Child Tax Credit (CTC) and birth outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study applied a comparison-population, interrupted time series design to data from US birth certificates (January 1, 2014, through December 31, 2021) to test whether the log odds of low birth weight (LBW) among monthly cohorts of births exposed to the CTC would coincide with a decreased incidence of LBW. All singleton live births to US residents aged 15 to 49 years with available data were included. EXPOSURE Monthly birth cohorts exposed to the CTC were defined as those born to parous people during the CTC advance payment period from July through December 2021. MAIN OUTCOMES AND MEASURES The main outcome was the natural logarithm of the odds of LBW (<2500 g) among monthly birth cohorts. RESULTS Among included births (n = 28 866 466), 61.2% were to parous people, the majority were to people aged 20 to 39 years (91.7%), and 6.5% were born LBW. The odds of LBW increased above expected values in 5 of the 6 months of the CTC payments (range of increases, 3.3%-5.4% across the 5 months). The outlier-adjusted odds of LBW increased, on average, by 4.2% (95% CI, 2.7%-5.7%) among the monthly birth cohorts exposed to the CTC. CONCLUSIONS AND RELEVANCE This study found that the odds of LBW among birth cohorts exposed to the CTC increased above expected values in 5 of the 6 months of the CTC advance payments. Additional research is needed to evaluate rival explanations for this increase in LBW among births exposed to the CTC payments.
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Affiliation(s)
- Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
| | - Yasamean Zamani-Hank
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
- Now with Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley
| | - Katlyn Hettinger
- Department of Economics, Michigan State University, East Lansing
| | - Timothy R. Michling
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
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Conway KS, Menclova AK. You'll never walk alone - The effects of walkability on pregnancy behaviors and outcomes. ECONOMICS AND HUMAN BIOLOGY 2023; 50:101269. [PMID: 37418829 DOI: 10.1016/j.ehb.2023.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 02/14/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
This study investigates the relationship between local walkability and physical activity and subsequent health outcomes among pregnant women - for whom walking is the recommended, and by far most common, form of exercise. Using an EPA measure of walkability at the county level (as well as other county-level characteristics) combined with rich individual-level data on pregnant women yields evidence that higher walkability translates into improvements in maternal and infant health outcomes as well as physical activity. Using the 2011 Natality Detail Files with geographic identifiers and controlling for the overall health of women in the community as well as the individual mother's pre-pregnancy BMI, we show that women residing in more walkable counties are less likely to experience preterm birth, low birth weight, gestational diabetes and hypertension. While one potential mechanism is through improved gestational weight gain, the evidence points to more general improvements in health as walkability does not seem to prevent excessive weight gain or macrosomic babies. Evidence that these general improvements derive at least in part from greater physical activity comes from analyses using the 2011 Behavioral Risk Factor Surveillance System, in which higher walkability translates into more physical activity among pregnant women (and also relative to their non-pregnant counterparts). Our study suggests more broadly that pregnant women's physical activity responds to factors that facilitate it and that such activity makes a difference to birth outcomes.
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Affiliation(s)
- Karen S Conway
- Department of Economics, University of New Hampshire, 10 Garrison Avenue, Durham, NH 03824, USA
| | - Andrea K Menclova
- Department of Economics and Finance, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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Rook JM, Yama CL, Schickedanz AB, Feuerbach AM, Lee SL, Wisk LE. Changes in Self-Reported Adult Health and Household Food Security With the 2021 Expanded Child Tax Credit Monthly Payments. JAMA HEALTH FORUM 2023; 4:e231672. [PMID: 37354539 PMCID: PMC10290752 DOI: 10.1001/jamahealthforum.2023.1672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/21/2023] [Indexed: 06/26/2023] Open
Abstract
Importance The 2021 Expanded Child Tax Credit (ECTC) provided families with children monthly payments from July 2021 to December 2021. The association of this policy with adult health is understudied. Objective To examine changes in adult self-reported health and household food security before and during ECTC monthly payments. Design, Setting, and Participants This repeated cross-sectional study used multivariable regression with a difference-in-differences estimator to assess adult health and food security for 39 479 respondents to the National Health Interview Survey (January 2019 to December 2021) before vs during monthly payments. Analyses were stratified by income to focus on low-income vs middle-income and upper-income households. Exposure Eligibility for ECTC monthly payments from July 2021 to December 2021. Main Outcomes and Measures Overall self-reported adult health and household food security as binary outcomes (excellent or very good health vs good, fair, or poor health; food secure vs food insecure). Results In this nationally representative cross-sectional study of 39 479 US adults (mean [SD] age, 41.0 [13.0] years; 7234 [21.7%] Hispanic, 321 [0.9%] non-Hispanic American Indian/Alaska Native, 2205 [5.7%] non-Hispanic Asian, 5113 [13.7%] non-Hispanic Black, and 23 704 [55.8%] White individuals), respondents were predominantly female (21 511 [52.4%]), employed (33 035 [86.7%]), and married (19 838 [55.7%]). Before disbursement of ECTC monthly payments, 7633 ECTC-eligible adults (60.1%) reported excellent or very good health, and 10 950 (87.8%) reported having food security. Among ECTC-ineligible adults, 10 778 (54.9%) reported excellent or very good health and 17 839 (89.1%) reported food security. Following disbursement of monthly payments, ECTC-eligible adults experienced a 3.0 percentage point (pp) greater adjusted increase (95% CI, 0.2-5.7) in the probability of reporting excellent or very good health compared with ECTC-ineligible adults. Additionally, ECTC-eligible adults experienced a 1.9 pp greater adjusted increase (95% CI, 0.1-3.7) in the probability of food security than ECTC-ineligible adults. In income-stratified analyses, the association between ECTC eligibility and overall health was concentrated among middle-income and upper-income households (3.7-pp increase in excellent or very good health; 95% CI, 0.5-6.9). Conversely, the association between ECTC eligibility and food security was concentrated among low-income adults (3.9-pp increase in food security; 95% CI, 0-7.9). Conclusions and Relevance The results of this cross-sectional study suggest that monthly ECTC payments were associated with improved adult overall health and food security. Cash transfer programs may be effective tools in improving adult health and household nutrition.
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Affiliation(s)
- Jordan M. Rook
- Greater Los Angeles Veterans Administration Healthcare System, Los Angeles, California
- University of California, Los Angeles National Clinician Scholars Program, Los Angeles, California
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Cecile L. Yama
- University of California, Los Angeles National Clinician Scholars Program, Los Angeles, California
| | - Adam B. Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Alec M. Feuerbach
- Department of Emergency Medicine, State University of New York Downstate Kings County, New York
| | - Steven L. Lee
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lauren E. Wisk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Health Policy and Management, Fielding School of Public Health at UCLA, Los Angeles, California
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PILKAUSKAS NATASHAV. Child Poverty and Health: The Role of Income Support Policies. Milbank Q 2023; 101:379-395. [PMID: 37096615 PMCID: PMC10126958 DOI: 10.1111/1468-0009.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/29/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Child poverty is associated with both short- and long-term health and well-being, and income support policies can be used to improve child health. This article reviews the types of income support policies used in the United States and the evidence of the effectiveness of these policies in improving child health, highlighting areas for future research and policy considerations specific to income support policies.
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Narain KDC, Harawa N. Evidence for the Role of State-Level Economic Policy in HIV Risk Reduction: State Earned Income Tax Credit Generosity and HIV Risk Behavior Among Single Mothers. AIDS Behav 2023; 27:182-188. [PMID: 35776251 PMCID: PMC9852166 DOI: 10.1007/s10461-022-03754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 01/24/2023]
Abstract
We investigated the impact of State-level Earned Income Tax Credit (SEITC) generosity on HIV risk behavior among single mothers with low education. We merged individual-level data from the Behavioral Risk Factor Surveillance System (2002-2018) with state-level data from the University of Kentucky Center for Poverty Research and conducted a multi-state, multi-year difference-in-differences (DID) analysis. We found that a refundable SEITC ≥ 10% of the Federal Earned Income Tax Credit was associated with 21% relative risk reduction in reporting any high-risk behavior for HIV in the last year, relative to no SEITC. We also found that a 10-percentage point increase in SEITC generosity was associated with 38% relative risk reduction in reporting any high-risk HIV behavior in the last year. SEITC policy may be an important strategy to reduce the burden of HIV infections among women with low socioeconomic status, particularly single mothers.
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Affiliation(s)
- Kimberly Danae Cauley Narain
- grid.19006.3e0000 0000 9632 6718Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA (DGSOM), University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Center for Health Advancement, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA USA ,Center for the Study of Racism, Social Justice, and Health Los Angeles, Los Angeles, CA USA
| | - Nina Harawa
- grid.19006.3e0000 0000 9632 6718Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA (DGSOM), University of California, Los Angeles, Los Angeles, CA USA ,Center for the Study of Racism, Social Justice, and Health Los Angeles, Los Angeles, CA USA ,grid.254041.60000 0001 2323 2312Department of Psychiatry, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
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12
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Das V. The effect of state Earned Income Tax Credit (EITC) eligibility on food insufficiency during the COVID-19 pandemic. REVIEW OF ECONOMICS OF THE HOUSEHOLD 2022; 21:485-518. [PMID: 36588915 PMCID: PMC9789515 DOI: 10.1007/s11150-022-09637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
This paper uses data from the Household Pulse Survey to examine whether and for how long the eligibility to receive state Earned Income Tax Credit (EITC) benefits reduced self-reported household food insufficiency among lower-income households with dependent children during the COVID-19 pandemic. The results of models estimated using difference-in-differences (DD) and difference-in-difference-in-differences (DDD) methods suggest that state EITC eligibility, on average, reduced food insufficiency by about 3 percentage points between March 2021 and early October 2021. However, the results of models estimated using an event study method show that the effect was not visible in all the post-March bimonthly periods. Overall, this paper finds some evidence to suggest that state EITC eligibility reduced food insufficiency over a short period.
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Affiliation(s)
- Vivekananda Das
- Department of Consumer Science, School of Human Ecology, University of Wisconsin-Madison, 1300 Linden Dr, Madison, WI 53706 USA
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13
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Hamad R, Gosliner W, Brown EM, Hoskote M, Jackson K, Esparza EM, Fernald LCH. Understanding Take-Up Of The Earned Income Tax Credit Among Californians With Low Income. Health Aff (Millwood) 2022; 41:1715-1724. [PMID: 36469822 DOI: 10.1377/hlthaff.2022.00713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Earned Income Tax Credit (EITC) is the largest poverty alleviation program for families with children in the US, and it has well-documented health effects. However, not all eligible families receive benefits. The Assessing California Communities' Experiences with Safety Net Supports (ACCESS) Study interviewed 411 EITC-eligible Californians with young children to understand low take-up of the federal EITC and California's supplemental CalEITC. Interviews were conducted in English and Spanish in 2020 and 2021 to gather information on sociodemographic characteristics, tax filing, and EITC receipt (verified via tax forms). Among those eligible for the EITC or CalEITC, 9 percent of participants did not file taxes; among those who did file taxes, about 84 percent received the EITC, and 83 percent received the CalEITC. Lower likelihood of federal EITC receipt among those eligible and filing taxes was associated with being younger, not speaking English, and not having prior knowledge of the EITC. Lower likelihood of CalEITC receipt among those eligible and filing taxes was associated with not speaking English. These findings can inform policies and community interventions to increase EITC take-up and thereby help address health equity.
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Affiliation(s)
- Rita Hamad
- Rita Hamad, University of California San Francisco, San Francisco, California
| | - Wendi Gosliner
- Wendi Gosliner, University of California Agriculture and Natural Resources, Oakland, California
| | - Erika M Brown
- Erika M. Brown, University of California San Francisco
| | - Mekhala Hoskote
- Mekhala Hoskote, University of California Berkeley, Berkeley, California, and University of California San Francisco
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Noghanibehambari H, Engelman M. Social insurance programs and later-life mortality: Evidence from new deal relief spending. JOURNAL OF HEALTH ECONOMICS 2022; 86:102690. [PMID: 36228384 PMCID: PMC10023131 DOI: 10.1016/j.jhealeco.2022.102690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/22/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
A growing body of research explores the long-run effects of social programs and welfare spending. However, evidence linking welfare support in early life with longevity is limited. We add to this literature by evaluating the effect of in-utero and early-life exposure to the largest increases in welfare spending in the US history under the New Deal programs. Using Social Security Administration death records linked with the 1940-census and spending data for 115 major cities, we show that the spending is correlated with improvements in old-age longevity. A treatment-on-treated calculation focused on a period when spending rose by approximately 1900 percent finds that a 100 percent rise in municipal spending in the year of birth is associated with roughly 3.5 months higher longevity. We show that these effects are not driven by endogenous selection of births, selective fertility, endogenous migration, and sample selection caused by endogenous data linking. Additional analysis suggests that rises in education and socioeconomic status are likely channels of impact.
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Affiliation(s)
- Hamid Noghanibehambari
- Center for Demography of Health and Aging, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA.
| | - Michal Engelman
- Department of Sociology, Center for Demography of Health and Aging, and Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI 53706, USA
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15
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Thomson D, Chen Y, Gennetian LA, Basurto LE. Earned Income Tax Credit Receipt By Hispanic Families With Children: State Outreach And Demographic Factors. Health Aff (Millwood) 2022; 41:1725-1734. [PMID: 36469820 DOI: 10.1377/hlthaff.2022.00725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Earned Income Tax Credit (EITC), the largest refundable tax credit for low-to-middle-income US families with children, has been shown to improve maternal and child health and reduce public spending on health. However, many eligible families do not receive it. This study used 2014 Survey of Income and Program Participation data to explore predictors of EITC receipt among Hispanic families, an understudied segment of the eligible population. We found lower likelihoods of receipt among Hispanic income-eligible families, even those who were eligible US citizens by naturalization, compared with their peers. Parent self-employment and lower English language proficiency were also associated with lower EITC receipt. With new data collected on state policies, we found that states' granting of drivers' licenses to undocumented people, availability of government information in Spanish, and employer mandates to inform employees were associated with greater EITC receipt among all income-eligible families, including Hispanic families. These findings showcase ways in which information and outreach at the state level can support the equitable receipt of tax refunds and similar types of benefits distributed through the tax system.
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16
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Moe CA, Kovski NL, Dalve K, Leibbrand C, Mooney SJ, Hill HD, Rowhani-Rahbar A. Cumulative Payments Through the Earned Income Tax Credit Program in Childhood and Criminal Conviction During Adolescence in the US. JAMA Netw Open 2022; 5:e2242864. [PMID: 36399341 PMCID: PMC9675000 DOI: 10.1001/jamanetworkopen.2022.42864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE Childhood poverty is associated with poor health and behavioral outcomes. The Earned Income Tax Credit (EITC), first implemented in 1975, is the largest cash transfer program for working families with low income in the US. OBJECTIVE To assess whether cumulative EITC payments received during childhood are associated with the risk of criminal conviction during adolescence. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, the analytic sample consisted of US children enrolled in the 1979 National Longitudinal Study of Youth. The children were born between 1979 and 1998 and were interviewed as adolescents (age 15-19 years) between 1994 and 2016. Data analyses were performed from May 2021 to September 2022. EXPOSURE Cumulative simulated EITC received by the individual's family from birth through age 14 years. MAIN OUTCOMES AND MEASURES The main outcome was dichotomous, self-reported conviction for a crime during adolescence (age 14-18 years). A cumulative, simulated measure of mean EITC benefits received by a child's family from birth through age 14 years was derived from federal, state, and family-size differences in EITC eligibility and payments during the study period to capture EITC benefit variation due to differences in policy parameters but not endogenous factors such as changes in household income. Logistic regression models with fixed effects for state and year and robust SEs clustered by mother estimated relative risk of adolescent conviction. Models were adjusted for state-, mother-, and child-level covariates. RESULTS The analytical sample consisted of 5492 adolescents born between 1979 and 1998; 2762 (50.3%) were male, 1648 (30.0%) were Black, 1125 (20.5%) were Hispanic, and 2719 (49.5%) were not Black or Hispanic. Each additional $1000 of EITC received during childhood was associated with an 11% lower risk of self-reported criminal conviction during adolescence (adjusted odds ratio, 0.89; 95% CI, 0.84-0.95). Adjusted risk differences were larger among boys (-14.2 self-reported convictions per 1000 population [95% CI, -22.0 to -6.3 per 1000 population]) than among girls (-6.2 per 1000 population [95% CI, -10.7 to -1.6 per 1000 population]). CONCLUSIONS AND RELEVANCE The findings suggest that income support from the EITC may be associated with reduced youth involvement with the criminal justice system in the US. Cost-benefit analyses of the EITC should consider these longer-term and indirect outcomes.
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Affiliation(s)
- Caitlin A. Moe
- Department of Epidemiology, University of Washington, Seattle
| | - Nicole L. Kovski
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle
| | - Kimberly Dalve
- Department of Epidemiology, University of Washington, Seattle
| | | | | | - Heather D. Hill
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
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17
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Dalve K, Moe CA, Kovski N, Rivara FP, Mooney SJ, Hill HD, Rowhani-Rahbar A. Earned Income Tax Credit and Youth Violence: Findings from the Youth Risk Behavior Surveillance System. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1370-1378. [PMID: 35917082 DOI: 10.1007/s11121-022-01417-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 01/28/2023]
Abstract
Family- and neighborhood-level poverty are associated with youth violence. Economic policies may address this risk factor by reducing parental stress and increasing opportunities. The federal Earned Income Tax Credit (EITC) is the largest cash transfer program in the US providing support to low-income working families. Many states have additional EITCs that vary in structure and generosity. To estimate the association between state EITC and youth violence, we conducted a repeated cross-sectional analysis using the variation in state EITC generosity over time by state and self-reported data in the Youth Risk Behavior Surveillance System (YRBSS) from 2005 to 2019. We estimated the association for all youth and then stratified by sex and race and ethnicity. A 10-percentage point greater state EITC was significantly associated with 3.8% lower prevalence of physical fighting among youth, overall (PR: 0.96; 95% CI 0.94-0.99), and for male students, 149 fewer (95% CI: -243, -55) students per 10,000 experiencing physical fighting. A 10-percentage point greater state EITC was significantly associated with 118 fewer (95% CI: -184, -52) White students per 10,000 experiencing physical fighting in the past 12 months while reductions among Black students (75 fewer; 95% CI: -176, 26) and Hispanic/Latino students (14 fewer; 95% CI: -93, 65) were not statistically significant. State EITC generosity was not significantly associated with measures of violence at school. Economic policies that increase financial security and provide financial resources may reduce the burden of youth violence; further attention to their differential benefits among specific population subgroups is warranted.
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Affiliation(s)
- Kimberly Dalve
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA. .,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.
| | - Caitlin A Moe
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Nicole Kovski
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Stephen J Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Center for Studies in Demography & Ecology, University of Washington, Seattle, WA, USA
| | - Heather D Hill
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA.,Center for Studies in Demography & Ecology, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Center for Studies in Demography & Ecology, University of Washington, Seattle, WA, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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18
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Jackson MI, Rauscher E, Burns A. Social Spending and Educational Gaps in Infant Health in the United States, 1998-2017. Demography 2022; 59:1873-1909. [PMID: 36135222 PMCID: PMC9791646 DOI: 10.1215/00703370-10230542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recent expansions of child tax, food assistance, and health insurance programs have made American families' need for a robust social safety net highly evident, while researchers and policymakers continue to debate the best way to support families via the welfare state. How much do children-and which children-benefit from social spending? Using the State-by-State Spending on Kids Dataset, linked to National Vital Statistics System birth data from 1998 to 2017, we examine how state-level child spending affects infant health across maternal education groups. We find that social spending has benefits for both low birth weight and preterm birth rates, especially among babies born to mothers with less than a high school education. The stronger benefits of social spending among lower educated families lead to meaningful declines in educational gaps in infant health as social spending increases. Our findings are consistent with the idea that a strong local welfare state benefits infant health and increases equality of opportunity, and that spending on nonhealth programs is equally beneficial for infant health as investments in health programs.
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Affiliation(s)
| | - Emily Rauscher
- Department of Sociology, Brown University, Providence, RI, USA
| | - Ailish Burns
- Department of Sociology, Brown University, Providence, RI, USA
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19
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Edmonds AT, Moe CA, Adhia A, Mooney SJ, Rivara FP, Hill HD, Rowhani-Rahbar A. The Earned Income Tax Credit and Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12519-NP12541. [PMID: 33703934 DOI: 10.1177/0886260521997440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intimate partner violence (IPV) is a serious public health problem in the United States with adverse consequences for affected individuals and families. Recent reviews of the literature suggest that economic policies should be further investigated as part of comprehensive strategies to address IPV. The Earned Income Tax Credit (EITC) is the nation's largest anti-poverty program for working parents, and especially benefits low-income women with children, who experience an elevated risk of IPV. The EITC may prevent IPV by offering financial resources; such resources may help individuals experiencing IPV leave abusive relationships or address IPV risk factors, thereby preventing entry into abusive relationships. However, the association between EITC generosity and IPV has not been previously examined. We used state-level and individual-level datasets to examine the association between EITC generosity and IPV. Our state-level data source was the nationally representative National Crime Victimization Survey (NCVS; N = ~ 95,000 households per year). For NCVS, we used a difference-in-difference approach to investigate the relationship between state EITC generosity and IPV rates. We also used individual-level longitudinal data from the Fragile Families and Child Well-being Study (n = 13,422 person-waves). Using this cohort of US families at higher risk for IPV, we evaluated associations between estimated EITC benefits based on the mother's state of residence and number of children and self-reported IPV. In both state- and individual-level analyses, no significant association between state EITC benefits and IPV was found. Factors that may account for these null findings include program ineligibility for individuals who separate from abusive spouses. Future research efforts should more closely examine EITC policy implementation processes and the lived experience of participating in anti-poverty programs for people experiencing IPV.
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20
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Jones LE, Wang G, Yilmazer T. The long-term effect of the Earned Income Tax Credit on women's physical and mental health. HEALTH ECONOMICS 2022; 31:1067-1102. [PMID: 35318768 DOI: 10.1002/hec.4501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
Using a novel method, and data from the National Longitudinal Survey of Youth 1979 (NLSY79), we estimate the cumulative, long-term, causal effect of Earned Income Tax Credit (EITC) eligibility on women's physical and mental health at age 50. We find that an increase in lifetime eligible EITC benefits is associated with long-term improvements in physical health, such as reduced occurrence of activity-limiting health problems and reduced reported diagnoses of mild and severe diseases. We explore intermediate health behaviors and outcomes, and find that an increase in lifetime eligible EITC benefits increases the number of hours worked and access to employer-sponsored health insurance, and decreases body mass index in the short-term. We find no significant effects of the EITC on mental health at age 50. Finally, we find that White women benefit disproportionately from the EITC in terms of mobility-related health issues, while Black and Hispanic women benefit in terms of lung-related illnesses like asthma, as well as cancer and stroke.
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Affiliation(s)
- Lauren E Jones
- Department of Human Sciences and John Glenn College of Public Affairs, The Ohio State University, Columbus, Ohio, USA
| | - Guangyi Wang
- Social Policies for Health Equity Research Program (SPHERE), Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Tansel Yilmazer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
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21
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Yoo PY, Duncan GJ, Magnuson K, Fox NA, Yoshikawa H, Halpern-Meekin S, Noble KG. Unconditional cash transfers and maternal substance use: findings from a randomized control trial of low-income mothers with infants in the U.S. BMC Public Health 2022; 22:897. [PMID: 35513842 PMCID: PMC9070980 DOI: 10.1186/s12889-022-12989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Policy debates over anti-poverty programs are often marked by pernicious stereotypes suggesting that direct cash transfers to people residing in poverty encourage health-risking behaviors such as smoking, drinking, and other substance use. Causal evidence on this issue is limited in the U.S. Given the prominent role of child allowances and other forms of cash assistance in the 2021 American Rescue Plan and proposed Build Back Better legislation, evidence on the extent to which a monthly unconditional cash gift changes substance use patterns among low-income mothers with infants warrants attention, particularly in the context of economic supports that can help improve early environments of children. METHOD We employ a multi-site, parallel-group, randomized control trial in which 1,000 low-income mothers in the U.S. with newborns were recruited from hospitals shortly after the infant's birth and randomly assigned to receive either a substantial ($333) or a nominal ($20) monthly cash gift during the early years of the infant's life. We estimate the effect of the unconditional cash transfer on self-report measures of maternal substance use (i.e., alcohol, cigarette, or opioid use) and household expenditures on alcohol and cigarettes after one year of cash gifts. RESULTS The cash gift difference of $313 per month had small and statistically nonsignificant impacts on group differences in maternal reports of substance use and household expenditures on alcohol or cigarettes. Effect sizes ranged between - 0.067 standard deviations and + 0.072 standard deviations. The estimated share of the $313 group difference spent on alcohol and tobacco was less than 1%. CONCLUSIONS Our randomized control trial of monthly cash gifts to mothers with newborn infants finds that a cash gift difference of $313 per month did not significantly change maternal use of alcohol, cigarettes, or opioids or household expenditures on alcohol or cigarettes. Although the structure of our cash gifts differs somewhat from that of a government-provided child allowance, our null effect findings suggest that unconditional cash transfers aimed at families living in poverty are unlikely to induce large changes in substance use and expenditures by recipients. TRIAL REGISTRATION Registered on Clinical Trials.gov NCT03593356 in July of 2018.
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Affiliation(s)
- Paul Y. Yoo
- School of Education, University of California, Irvine, 401 E. Peltason Drive, Suite 3200, Irvine, CA 92697 USA
| | - Greg J. Duncan
- School of Education, University of California, Irvine, 401 E. Peltason Drive, Suite 3200, Irvine, CA 92697 USA
| | - Katherine Magnuson
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, 1350 University Ave, Madison, WI 53706 USA
| | - Nathan A. Fox
- College of Education, University of Maryland, College Park, 3119 Benjamin Building, College Park, MD 20742 USA
| | - Hirokazu Yoshikawa
- Steinhardt School of Culture, Education, and Human Development, New York University, 82 Washington Square E, New York, NY 10003 USA
| | - Sarah Halpern-Meekin
- School of Human Ecology & La Follette School of Public Affairs, University of Wisconsin-Madison, 1300 Linden Dr., Madison, WI 53706 USA
| | - Kimberly G. Noble
- Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027 USA
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22
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Pearlman J, Robinson DE. State Policies, Racial Disparities, and Income Support: A Way to Address Infant Outcomes and the Persistent Black-White Gap? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:225-258. [PMID: 34522974 DOI: 10.1215/03616878-9517205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low birth weight and preterm births vary by state, and Black mothers typically face twice the risk that their white counterparts do. This gap reflects an accumulation of psychosocial and material exposures that include interpersonal racism, differential experience with area-level deprivation such as residential segregation, and other harmful exposures that the authors refer to as "institutional" or "structural" racism. The authors use logistic regression models and a dataset that includes all births from 1994 to 2017 as well as five state policies from this period-Aid to Families with Dependent Children/Temporary Aid for Needy Families, housing assistance, Medicaid, minimum wage, and the earned income tax credit (EITC)-to examine whether these state social policies, designed to provide a financial safety net, are associated with risk reduction of low birth weight and preterm birth to Black and white mothers, and whether variations in state generosity attenuate the racial inequalities in birth outcomes. The authors also examine whether the relationship between state policies and racial inequalities in birth outcomes is moderated by the education level of the mother. We find that the EITC reduces the risk of low birth weight and preterm birth for Black mothers. The impact is much less consistent for white mothers. For both Black and white mothers, the benefits to birth outcomes are larger for mothers with less education.
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23
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Fraser T, Aldrich DP, Panagopoulos C, Hummel D, Kim D. The harmful effects of partisan polarization on health. PNAS NEXUS 2022; 1:pgac011. [PMID: 36712795 PMCID: PMC9802430 DOI: 10.1093/pnasnexus/pgac011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 09/26/2021] [Accepted: 02/11/2022] [Indexed: 02/01/2023]
Abstract
Partisan polarization significantly drives stress and anxiety among Americans, and recent aggregate-level studies suggest polarization may be shaping their health. This individual-level study uses a new representative dataset of 2,752 US residents surveyed between December 2019 and January 2020, some US residents report more days of poor physical and mental health per month than others. Using negative binomial models, zero inflated models, and visualizations, we find evidence that polarization is linked to declines in physical health: the more distant an individual feels politically from the average voter in their state, the worse health outcomes he or she reports. By uncovering the individual-level political correlates of health, this study aims to encourage further study and attention to the broader consequences of political polarization on American communities.
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Affiliation(s)
- Timothy Fraser
- To whom correspondence should be addressed: 960A Renaissance Park, 360 Huntington Ave, Boston, MA 02115.
| | - Daniel P Aldrich
- Political Science Department, Northeastern University, Boston, MA 02115, USA
| | - Costas Panagopoulos
- Political Science Department, Northeastern University, Boston, MA 02115, USA
| | - David Hummel
- Economics Department, Northeastern University, Boston, MA 02115, USA
| | - Daniel Kim
- Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA
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24
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WEBSTER JESSICAL, PAUL DAVID, PURTLE JONATHAN, LOCKE ROBERT, GOLDSTEIN NEALD. State-Level Social and Economic Policies and Their Association With Perinatal and Infant Outcomes. Milbank Q 2022; 100:218-260. [PMID: 35128726 PMCID: PMC8932633 DOI: 10.1111/1468-0009.12548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Policy Points State-level social and economic policies that expand tax credits, increase paid parental leave, raise the minimum wage, and increase tobacco taxes have been demonstrated to reduce adverse perinatal and infant health outcomes. These findings can help prioritize evidence-based legislated policies to improve perinatal and infant outcomes in the United States. CONTEXT Rates of preterm birth and infant mortality are alarmingly high in the United States. Legislated efforts may directly or indirectly reduce adverse perinatal and infant outcomes through the enactment of certain economic and social policies. METHODS We conducted a narrative review to summarize the associations between perinatal and infant outcomes and four state-level US policies. We then used a latent profile analysis to create a social and economic policy profile for each state based on the observed policy indicators. FINDINGS Of 27 articles identified, nine focused on tax credits, eight on paid parental leave, four on minimum wages, and six on tobacco taxes. In all but three studies, these policies were associated with improved perinatal or infant outcomes. Thirty-three states had tax credit laws, most commonly the earned income tax credit (n = 28, 56%). Eighteen states had parental leave laws. Two states had minimum wage laws lower than the federal minimum; 14 were equal to the federal minimum; 29 were above the federal minimum; and 5 did not have a state law. The average state tobacco tax was $1.76 (standard deviation = $1.08). The latent profile analysis revealed three policy profiles, with the most expansive policies in Western and Northeastern US states, and the least expansive policies in the US South. CONCLUSIONS State-level social and economic policies have the potential to reduce adverse perinatal and infant health outcomes in the United States. Those states with the least expansive policies should therefore consider enacting these evidence-based policies, as they have shown a demonstratable benefit in other states.
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Affiliation(s)
| | - DAVID PAUL
- ChristianaCare, Department of PediatricsNewarkDE,Thomas Jefferson University Sidney Kimmel College of MedicinePhiladelphia
| | - JONATHAN PURTLE
- Drexel University Dornsife School of Public HealthPhiladelphia
| | - ROBERT LOCKE
- ChristianaCare, Department of PediatricsNewarkDE,Thomas Jefferson University Sidney Kimmel College of MedicinePhiladelphia
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25
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Morgan ER, Hill HD, Mooney SJ, Rivara FP, Rowhani-Rahbar A. State earned income tax credits and depression and alcohol misuse among women with children. Prev Med Rep 2022; 26:101695. [PMID: 35096518 PMCID: PMC8783139 DOI: 10.1016/j.pmedr.2022.101695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/27/2021] [Accepted: 01/15/2022] [Indexed: 01/28/2023] Open
Abstract
About 30% of single mothers in the US live at or below the poverty line. Poverty is associated with higher risk of depression and substance use. We investigated associations between state earned income tax credit (EITC) policies and reported depressive symptoms and alcohol misuse among birthing parents who responded to Pregnancy Risk Assessment Monitoring Survey spanning 1990-2017. Nearly half of birthing parents reported no more than a high school education (45.4%; 95% CI: 45.3%-45.6%). An estimated 28.5% of birthing parents reported binge drinking in the three months prior to conception (95% CI: 28.3-28.8%). Among birthing parents, each 10 percentage-point increase in the generosity of state EITC relative to the federal EITC was associated with a lower prevalence of binge drinking (prevalence ratio = 0.96; 95% CI: 0.93-0.99) prior to conception. This association was more pronounced among birthing parents with no more than high school education (prevalence ratio = 0.92; 95% CI: 0.88-0.97). There was no association between state EITC and number of reported depressive symptoms prior to conception or after birth, except among those with lower educational attainment (prevalence ratio = 0.94; 95% CI: 0.89-0.99). Anti-poverty policies such as EITC may reduce the burden of alcohol misuse, especially among people with children.
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Affiliation(s)
- Erin R. Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA,Corresponding author at: University of Washington, School of Public Health, Department of Epidemiology, University of Washington, Box 351619, Seattle, WA 98195, USA.
| | - Heather D. Hill
- Daniel J. Evans School of Public Policy and Governance, University of Washington, Seattle, WA, USA
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Frederick P. Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA,Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
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Abstract
Governance is an important factor in urban health, and law is an important element of healthy governance. Law can be an intervention local government wields to influence behavior and shape environments. Law can also be an important target of health promotion efforts: Law and the enforcement and implementation behaviors it fosters can promote unhealthy behaviors and environmental conditions, and can act as a barrier to healthy interventions or practices. Finally, law is a design and construction tool for the organization of governance. Law is the means through which cities are formally established. Their powers and duties, organizational structure, boundaries and decision-making procedures are all set by law. Regardless of the form of government, cities have legal levers they can manipulate for health promotion. Cities can use tax authority to influence the price of unhealthy products, or to encourage consumption of healthy foods. Cities can use their legal powers to address incidental legal effects of policies that they themselves cannot control. Cities may also have the authority to use law to address deeper determinants of health. The overall level of income or wealth inequality in a country reflects factors well-beyond a local government’s control, but city government nonetheless has levers to directly and indirectly reduce economic and social inequality and their effects. A renewed focus on law and urban governance is the key to assuring health and well-being and closing the health equity gap.
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Affiliation(s)
- Scott Burris
- Beasley School of Law, Temple University, Philadelphia, PA, USA
| | - Vivian Lin
- Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region, China
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Riley AR, Collin D, Grumbach JM, Torres JM, Hamad R. Association of US state policy orientation with adverse birth outcomes: a longitudinal analysis. J Epidemiol Community Health 2021; 75:689-694. [PMID: 33408163 PMCID: PMC8257762 DOI: 10.1136/jech-2020-214858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/01/2020] [Accepted: 12/15/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The current US context is marked by extreme right-left partisanship, which means that state policies tend to bundle together and are not experienced in isolation. While prior work has leveraged abrupt shifts in single policies to examine the effects of state policy on birth outcomes, we examined a holistic measure that captures political polarisation. METHODS Data were drawn from national birth certificates for 2003-2017 (N=56 770 470). Outcomes included preterm birth, low birth weight, small-for-gestational age and other perinatal health measures. The primary exposure was a composite index of right-left state policy orientation, generated from historical data on 135 state policies. Multivariable regressions were used to estimate the association between state policy orientation and each outcome, adjusting for relevant covariates. RESULTS Compared with infants born in states with right-leaning policy orientations, those born in left-leaning states had lower odds of adverse birth outcomes (eg, low birth weight: OR 0.95 (0.93, 0.97), preterm birth: OR 0.94 (0.92, 0.95)). Subgroup analyses revealed stronger associations for US-born and White mothers. With the inclusion of state fixed effects, left-leaning policy orientation was no longer associated with lower odds of adverse birth outcomes. Models were otherwise robust to alternative specifications. CONCLUSION While left-leaning state policy orientation has protective associations with a range of birth outcomes, the associations may be explained by stable characteristics of states, at least during the study period. Future studies should examine state policy orientation in association with other health outcomes and study periods.
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Affiliation(s)
- Alicia R Riley
- Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Daniel Collin
- Family Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jacob M Grumbach
- Political Science, University of Washington, Seattle, Washington, USA
| | - Jacqueline M Torres
- Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Rita Hamad
- Family Community Medicine, University of California San Francisco, San Francisco, California, USA
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A Strategic Plan for Strengthening America's Families: A Brief from the Coalition of Behavioral Science Organizations. Clin Child Fam Psychol Rev 2021; 23:153-175. [PMID: 32347415 PMCID: PMC7186188 DOI: 10.1007/s10567-020-00318-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America’s children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas.
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Qian H, Wehby GL. The Effects of Refundable and Nonrefundable State Earned Income Tax Credit Programs on Health of Mothers of Two or More Children. Womens Health Issues 2021; 31:448-454. [PMID: 34052090 DOI: 10.1016/j.whi.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND More than one-half of U.S. states have enacted Earned Income Tax Credit (EITC) programs. Yet little is known about the effects of state EITC programs on the health of recipients. This study examines the effects of refundable and nonrefundable state EITC programs on health of single low-educated women of childbearing age with two or more children, the group receiving the highest credits on average. METHODS The data come from the Behavioral Risk Factors Surveillance Survey from 1993 through 2018. Outcomes include self-rated general health, days not in good physical health, and days not in good mental health, both in the past 30 days. The research design accounts for time-invariant differences between states, national trends shared across states, and other state policies. RESULTS Depending on the outcome measure, the analytical sample ranges between 103,362 and 107,782 mothers. Refundable state EITC programs are associated with improvements in all three health outcomes. A 10 percentage-point increase in refundable state EITC is associated with better self-rated health by 0.02 points (95% confidence interval [CI], 0.006-0.04) on a 1- to 5-point scale, or 0.7% improvement above the sample mean; 0.2 fewer days not in good physical health (95% CI, -0.21 to -0.12) in the past 30 days, or 4.4% lower than the sample mean; and 0.2 fewer days not in good mental health (95% CI, -0.29 to -0.1), or 3.4% lower than the sample mean. Estimates for nonrefundable EITC programs are smaller and not statistically significant. As expected, there are small and statistically insignificant refundable EITC effects for single low-educated childless women who receive low state EITC benefits on average. CONCLUSIONS These findings suggest that an increase in refundable state EITC improves the health of single women of childbearing age with low incomes and two or more children; this factor may also lead to better preconception health. There is no evidence for effects from nonrefundable state EITC credits.
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Affiliation(s)
- Haobing Qian
- Department of Health Management and Policy, College of Public Health University of Iowa, Iowa City, Iowa
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health University of Iowa, Iowa City, Iowa; Department of Economics, University of Iowa, Iowa City, Iowa; Department of Preventive & Community Dentistry, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa; Public Policy Center, University of Iowa, Iowa City, Iowa; National Bureau of Economic Research, Cambridge, Massachusetts.
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Swanson ML, Whetstone S, Illangasekare T, Autry A(M. Obstetrics and Gynecology and Reparations: The Debt We Owe (and Continue to Accumulate). Health Equity 2021; 5:353-355. [PMID: 34084987 PMCID: PMC8170721 DOI: 10.1089/heq.2021.0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Obstetrics and gynecology (OBGYN) is rife with exploitation and oppression of Black individuals and disparate health outcomes. We posit that racial disparities in OBGYN are fueled by racism and the racial wealth gap stemming from slavery, legal segregation, and institutionalized discrimination against Black Americans. We believe reparations are not only morally requisite, but would also improve health outcomes for our patients. Supporting legislation to explore and remedy the harms of slavery and its legacy is critical to address systemic racism that results in disparate health outcomes.
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Affiliation(s)
- Megan L. Swanson
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sara Whetstone
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Tushani Illangasekare
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Amy (Meg) Autry
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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Morgan ER, DeCou CR, Hill HD, Mooney SJ, Rivara FP, Rowhani-Rahbar A. State earned income tax credits and suicidal behavior: A repeated cross-sectional study. Prev Med 2021; 145:106403. [PMID: 33388334 DOI: 10.1016/j.ypmed.2020.106403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 01/28/2023]
Abstract
Suicide is an increasingly common cause of death in the United States and recent increases in suicide rates disproportionately impact low income individuals. We sought to assess the impact of income support in the form of state earned income tax credit policies on suicide-related behaviors. This state-level study used repeated cross-sectional data from vital records and the National Survey of Drug Use and Health data representative at the state-level. The population included adults who either died by suicide or were selected for in-person NSDUH interviews between 2008 and 2018. Exposure was measured as the generosity of a refundable state earned income tax credit policy measured as a percentage of the federal policy. Outcomes assessed were suicidal ideation, suicidal planning, non-fatal suicide attempt, suicide deaths, and combined fatal and non-fatal suicide attempts. Analyses were performed between April and June 2020. A 10 percentage-point increase in the generosity of state earned income tax credit was associated with lower frequency of non-fatal suicide attempts (prevalence ratio [PR] = 0.96; 95% CI: 0.93-0.99), combined fatal and non-fatal suicide attempts (PR = 0.96; 95% CI: 0.93-0.99), and suicide deaths (PR = 0.99; 95% CI: 0.99-1.00). This translates to 4 fewer suicide attempts per 10,000 population each year. Generous state earned income tax credit policies are associated with reductions in the frequency of most severe suicidal behavior. Income support policies may be one way to reduce suicide attempts and death, especially among low-income adults.
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Affiliation(s)
- Erin R Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America.
| | - Christopher R DeCou
- Department of Psychiatry & Behavioral Science, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Heather D Hill
- Daniel J. Evans School of Public Policy and Governance, University of Washington, Seattle, WA, United States of America
| | - Stephen J Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America
| | - Frederick P Rivara
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America
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Collin DF, Shields-Zeeman LS, Batra A, White JS, Tong M, Hamad R. The effects of state earned income tax credits on mental health and health behaviors: A quasi-experimental study. Soc Sci Med 2021; 276:113274. [PMID: 33740636 DOI: 10.1016/j.socscimed.2020.113274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 10/22/2022]
Abstract
The earned income tax credit (EITC) is the largest U.S. poverty alleviation program for families with children, and state EITC policies provide a modest supplement to the federal program. Yet there are few studies of the effects of state EITC policies on population health. We examined whether state EITC policies affect mental health and health behaviors. Participants were drawn from the 1995-2015 waves of the Panel Study of Income Dynamics, a diverse national cohort study (N = 10,567). We used a quasi-experimental difference-in-differences analysis to examine the effects of state EITC programs among eligible individuals, accounting for secular trends among similar individuals in non-EITC states. Outcomes included self-reported general health, psychological distress, alcohol use, and smoking. The mean size of state EITC refunds in our sample was $265 for eligible individuals. In the overall sample, state EITC programs were not associated with any health outcomes of interest. This finding was robust to alternative specifications, and similar in subgroup analyses by gender and marital status. This study suggests that state EITC programs, which tend to provide smaller refunds than the federal program, may not be large enough to have a positive impact on mental health and health behaviors. These findings may inform policymaking related to the generosity of state EITC programs, especially as states seek to address the socioeconomic consequences of the COVID-19 pandemic.
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Affiliation(s)
- Daniel F Collin
- University of California San Francisco, Department of Family & Community Medicine, San Francisco, CA, USA
| | - Laura S Shields-Zeeman
- University of California San Francisco, Department of Family & Community Medicine, San Francisco, CA, USA
| | - Akansha Batra
- University of California San Francisco, Department of Epidemiology & Biostatistics, San Francisco, CA, USA
| | - Justin S White
- University of California San Francisco, Department of Epidemiology & Biostatistics, San Francisco, CA, USA; University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA
| | - Michelle Tong
- University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - Rita Hamad
- University of California San Francisco, Department of Family & Community Medicine, San Francisco, CA, USA; University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
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Batra A, Hamad R. Short-term effects of the earned income tax credit on children's physical and mental health. Ann Epidemiol 2021; 58:15-21. [PMID: 33621630 DOI: 10.1016/j.annepidem.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Child poverty is associated with worsened health, although there is limited research on whether U.S. poverty alleviation policies improve children's health. We examined the short-term effects of the earned income tax credit (EITC), among the largest U.S. poverty alleviation programs, on children's food insecurity, weight status, and mental health. METHODS Using data from the National Health Interview Survey (NHIS, 1998-2016), we examined the effects of the EITC using a quasi-experimental difference-in-differences methodology. About 90% of EITC-eligible individuals receive tax refunds in February-April, while NHIS interviews occur throughout the year. We took advantage of this timing of refund receipt to compare EITC-eligible families interviewed in February-April with those interviewed in the other months, "differencing out" seasonal trends in outcomes among noneligible families. Analyses involved multivariable linear regressions. RESULTS We found that food insecurity decreased in the months following EITC refund receipt, with no effects for weight status or mental health. Results were robust to alternative specifications. CONCLUSION While these findings suggest that food insecurity among vulnerable children was reduced immediately after EITC refund receipt, this also means that the EITC may contribute to cyclical food insecurity. Policies to enhance income stability may be one solution to address these findings.
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Affiliation(s)
- Akansha Batra
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA.
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA; Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA
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Dunlop AL, Essalmi AG, Alvalos L, Breton C, Camargo CA, Cowell WJ, Dabelea D, Dager SR, Duarte C, Elliott A, Fichorova R, Gern J, Hedderson MM, Thepaksorn EH, Huddleston K, Karagas MR, Kleinman K, Leve L, Li X, Li Y, Litonjua A, Ludena-Rodriguez Y, Madan JC, Nino JM, McEvoy C, O’Connor TG, Padula AM, Paneth N, Perera F, Sathyanarayana S, Schmidt RJ, Schultz RT, Snowden J, Stanford JB, Trasande L, Volk HE, Wheaton W, Wright RJ, McGrath M. Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts. PLoS One 2021; 16:e0245064. [PMID: 33418560 PMCID: PMC7794036 DOI: 10.1371/journal.pone.0245064] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate's degree, vocational or technical training [reference category]; bachelor's degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor's degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61-0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00-1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor's degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography.
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Affiliation(s)
- Anne L. Dunlop
- Woodruff Health Sciences Center, School of Medicine and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Alicynne Glazier Essalmi
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Lyndsay Alvalos
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Carrie Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Carlos A. Camargo
- Department of Epidemiology Harvard University, Cambridge, Massachusetts, United States of America
| | - Whitney J. Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Stephen R. Dager
- Department of Radiology and Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Cristiane Duarte
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Amy Elliott
- Avera Research Institute Center for Pediatric & Community Research, Sioux Falls, South Dakota, United States of America
| | - Raina Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - James Gern
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Elizabeth Hom Thepaksorn
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Kathi Huddleston
- College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Leslie Leve
- Prevention Science Institute, University of Oregon, Eugene, Oregon, United States of America
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - Yijun Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - Augusto Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Yunin Ludena-Rodriguez
- Division of Environmental and Occupational Health, Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America
| | - Juliette C. Madan
- Department of Epidemiology Geisel School of Medicine at Dartmouth Hitchcock Medical Center, Hanover, New Hampshire, United States of America
| | - Julio Mateus Nino
- Obstetrics and Gynecology, Maternal and Fetal Medicine, Atrium Health, Charlotte, North Carolina, United States of America
| | - Cynthia McEvoy
- Division of Neonatal, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Thomas G. O’Connor
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Frederica Perera
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington & Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Rebecca J. Schmidt
- Division of Environmental and Occupational Health, Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America
| | - Robert T. Schultz
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jessica Snowden
- Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, Arkansas, United States of America
| | - Joseph B. Stanford
- Department of Family Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Heather E. Volk
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - William Wheaton
- Science and Technology Program, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Monica McGrath
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
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Abstract
Financial resources are known to affect health outcomes. Many types of social policies and programs, including social assistance and social insurance, have been implemented around the world to increase financial resources. We refer to these as cash transfers. In this article, we discuss theory and evidence on whether, how, for whom, and to what extent purposeful cash transfers improve health. Evidence suggests that cash transfers produce positive health effects, but there are many complexities and variations in the outcomes. Continuing research and policy innovation-for example, universal basic income and universal Child Development Accounts-are likely to be productive.
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Affiliation(s)
- Sicong Sun
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
| | - Jin Huang
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri 63103, USA;
| | - Darrell L Hudson
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
| | - Michael Sherraden
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
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36
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Moe CA, Adhia A, Mooney SJ, Hill HD, Rivara FP, Rowhani-Rahbar A. State Earned Income Tax Credit policies and intimate partner homicide in the USA, 1990-2016. Inj Prev 2020; 26:562-565. [PMID: 32703905 PMCID: PMC8055473 DOI: 10.1136/injuryprev-2020-043675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 01/28/2023]
Abstract
Economic insecurity is a risk factor for intimate partner homicide (IPH). The Earned Income Tax Credit (EITC) is the largest cash transfer programme to low-income working families in the USA. We hypothesised that EITCs could provide financial means for potential IPH victims to exit abusive relationships and establish self-sufficiency. We conducted a national, quasiexperimental study of state EITCs and IPH rates in 1990-2016 using a difference-in-differences approach. The national rate of IPH decreased from 1.9 per 100 000 adult women in 1990 to 1.3 per 100 000 in 2016. We found no statistically significant association between state EITC generosity and IPH rates (coefficient indicating change in IPH rates per 100 000 adult female years for additional 10% in amount of state EITC, measured as the percentage of federal EITC: 0.02, 95% CI -0.03 to 0.08). Financial control associated with abuse and current EITC eligibility rules may prevent potential IPH victims from accessing the EITC.
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Affiliation(s)
- Caitlin A Moe
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA,Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
| | - Avanti Adhia
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA,Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
| | - Heather D Hill
- Public Policy & Governance, University of Washington Daniel J. Evans School of Public Affairs, Seattle, Washington, USA
| | - Frederick P Rivara
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA,Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
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Komro KA, Dunlap P, Sroczynski N, Livingston MD, Kelly MA, Pepin D, Markowitz S, Rentmeester S, Wagenaar AC. Anti-poverty policy and health: Attributes and diffusion of state earned income tax credits across U.S. states from 1980 to 2020. PLoS One 2020; 15:e0242514. [PMID: 33216767 PMCID: PMC7678980 DOI: 10.1371/journal.pone.0242514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The U.S. federal Earned Income Tax Credit (EITC) is often considered the most effective antipoverty program for families in the U.S., leading to a variety of improved outcomes such as educational attainment, work incentives, economic activity, income, and health benefits for mothers, infants and children. State EITC supplements to the federal credit can significantly enhance the magnitude of this intervention. In this paper we advance EITC and health research by: 1) describing the diffusion of state EITC policies over 40 years, 2) presenting patterns in important EITC policy dimensions across space and time, and 3) disseminating a robust data set to advance future research by policy analysts and scientists. METHODS We used current public health law research methods to systematically collect, conduct textual legal analysis, and numerically code all EITC legislative changes from 1980 through 2020 in the 50 states and Washington, D.C. RESULTS First, the pattern of diffusion across states and time shows initial introductions during the 1990s in the Midwest, then spreading to the Northeast, with more recent expansions in the West and South. Second, differences by state and time of important policy dimensions are evident, including size of credit and refundability. Third, state EITC benefits vary considerably by household structure. CONCLUSION Continued research on health outcomes is warranted to capture the full range of potential beneficial effects of EITCs on family and child wellbeing. Lawyers and policy analysts can collaborate with epidemiologists and economists on other high-quality empirical studies to assess the many dimensions of policy and law that potentially affect the social determinants of health.
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Affiliation(s)
- Kelli A. Komro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Phenesse Dunlap
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Nolan Sroczynski
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Melvin D. Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Megan A. Kelly
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dawn Pepin
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sara Markowitz
- Department of Economics, Emory University, Atlanta, Georgia, United States of America
| | - Shelby Rentmeester
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Alexander C. Wagenaar
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Morgan ER, Hill HD, Mooney SJ, Rivara FP, Rowhani‐Rahbar A. State earned income tax credits and general health indicators: A quasi-experimental national study 1993-2016. Health Serv Res 2020; 55 Suppl 2:863-872. [PMID: 32643176 PMCID: PMC7518814 DOI: 10.1111/1475-6773.13307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To assess the relationship between the presence and generosity of state-level Earned Income Tax Credits (EITC) and multiple self-reported measures of general health. DATA SOURCES Data on state-level tax credits and covariates were obtained from the National Bureau of Economic Research and University of Kentucky Center for Poverty Research, respectively. These data were merged with Behavioral Risk Factor Surveillance System survey records from 1993-2016. STUDY DESIGN Using difference-in-differences approaches and survey-weighted Poisson regression that accounted for clustering of observations and included state and year fixed-effects, we assessed relationships between EITC and self-reported overall health, frequent mental distress, and frequent poor physical health in the prior 30 days. Covariates included state minimum wage, state GDP, and adoption of Medicaid expansion. Sensitivity analyses revealed that parallel trends were plausible; there were no significant lead and lag effects. DATA EXTRACTION METHODS Analyses were restricted to respondents with no more than a high school diploma or equivalent because less-educated adults are more likely to be low-wage earners and therefore qualify for EITC. PRINCIPAL FINDINGS Among adults with no education beyond high school (n = 2 884 790), each additional 10-percentage-point increase in the generosity of state EITC-relative to the federal credit-was associated with fewer reports of frequent mental distress (-97.3 per 100 000; 95% CI: -237.2, 42.6) and frequent poor physical health (-149.6 per 100 000; 95% CI: -284.4, -14.9). When restricted to individuals interviewed during the three months when tax rebates are commonly disbursed, the magnitude of the association between EITC and prevalence of reported frequent mental distress was greater (-329.7 per 100 000; 95% CI: -636.0, -23.5). CONCLUSIONS The generosity of state EITC policies is positively associated with significant reductions in frequent mental distress and poor physical health, especially during months when the credit is received. Interventions to reduce poverty may positively impact health by reducing material hardship and stress.
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Affiliation(s)
- Erin R. Morgan
- Harborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashington,Department of EpidemiologySchool of Public HealthUniversity of WashingtonSeattleWashington
| | - Heather D. Hill
- Daniel J. Evans School of Public Policy and GovernanceUniversity of WashingtonSeattleWashington
| | - Stephen J. Mooney
- Harborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashington,Department of EpidemiologySchool of Public HealthUniversity of WashingtonSeattleWashington
| | - Frederick P. Rivara
- Harborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashington,Department of PediatricsSchool of MedicineUniversity of WashingtonSeattleWashington
| | - Ali Rowhani‐Rahbar
- Harborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashington,Department of EpidemiologySchool of Public HealthUniversity of WashingtonSeattleWashington,Department of PediatricsSchool of MedicineUniversity of WashingtonSeattleWashington
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Siegler AJ, Komro KA, Wagenaar AC. Law Everywhere: A Causal Framework for Law and Infectious Disease. Public Health Rep 2020; 135:25S-31S. [PMID: 32735203 PMCID: PMC7407060 DOI: 10.1177/0033354920912991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Aaron J Siegler
- 25798 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kelli A Komro
- 25798 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alexander C Wagenaar
- 25798 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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40
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Courtin E, Aloisi K, Miller C, Allen HL, Katz LF, Muennig P. The Health Effects Of Expanding The Earned Income Tax Credit: Results From New York City. Health Aff (Millwood) 2020; 39:1149-1156. [PMID: 32634360 PMCID: PMC7909715 DOI: 10.1377/hlthaff.2019.01556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Antipoverty policies may hold promise as tools to improve health and reduce mortality rates among low-income Americans. We examined the health effects of the New York City Paycheck Plus randomized controlled trial. Paycheck Plus tests the impact of a potential fourfold increase in the Earned Income Tax Credit for low-income Americans without dependent children. Starting in 2015, Paycheck Plus offered 5,968 study participants a credit of up to $2,000 at tax time (treatment) or the standard credit of about $500 (control). Health-related quality of life and other outcomes for a representative subset of these participants (n = 3,289) were compared to those of a control group thirty-two months after randomization. The intervention had a modest positive effect on employment and earnings, particularly among women. It had no effect on health-related quality of life for the overall sample, but women realized significant improvements.
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Affiliation(s)
- Emilie Courtin
- Emilie Courtin is an assistant professor in the Department of Public Health, Environments, and Society in the Faculty of Public Health and Policy at the London School of Hygiene and Tropical Medicine, in London, United Kingdom. At the time the study was conducted, she was a David E. Bell Fellow at the Harvard Center for Population and Development Studies, in Boston, Massachusetts
| | - Kali Aloisi
- Kali Aloisi is a master's degree student in the Department of Statistics, University of Michigan, in Ann Arbor. At the time the study was conducted, she was a research assistant at MDRC, in New York City
| | - Cynthia Miller
- Cynthia Miller is a senior fellow in the Low-Wage Workers and Communities Policy Area, MDRC
| | - Heidi L Allen
- Heidi L. Allen is an associate professor in the School of Social Work, Columbia University, in New York City
| | - Lawrence F Katz
- Lawrence F. Katz is the Elisabeth Allison Professor of Economics in the Department of Economics, Harvard University, in Cambridge, Massachusetts
| | - Peter Muennig
- Peter Muennig is a professor of health policy and management at the Mailman School of Public Health, Columbia University
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41
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Andrea SB, Messer LC, Marino M, Goodman JM, Boone-Heinonen J. A nationwide investigation of the impact of the tipped worker subminimum wage on infant size for gestational age. Prev Med 2020; 133:106016. [PMID: 32045614 DOI: 10.1016/j.ypmed.2020.106016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
Tipped workers, primarily women of reproductive-age, can be paid a "subminimum wage" 71% lower than the federal minimum wage. We estimated the effects of increasing the state-level tipped worker subminimum wage (federally, $2.13 per hour) on infant size for gestational age in the US as infants born small or large are at risk for poor health across the lifecourse. Utilizing unconditional quantile regression and difference-in-differences analysis of data from 2004 to 2016 Vital Statistics Natality Files (N = 41,219,953 mother-infant dyads), linked to state-level wage laws, census, and antipoverty policy data, we estimated the effect of increasing the subminimum wage on birthweight standardized for gestational age (BWz). Smallest and largest infants are defined as those in the 5th and 95th BWz percentiles, respectively. Increases in the subminimum wage affected the BWz distribution. When compared to a static wage of $2.13 for the duration of the study period, wage set to 100% of the federal minimum ($5.15-$7.25) was associated with an increase in BWz of 0.024 (95% CI: 0.004, 0.045) for the smallest infants and a decrease by 0.041 (95% CI: -0.054, -0.029) for the largest infants. Increasing the subminimum wage may be one strategy to promote healthier birthweight in infants.
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Affiliation(s)
- Sarah B Andrea
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
| | - Lynne C Messer
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Miguel Marino
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Julia M Goodman
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Janne Boone-Heinonen
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
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42
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Dench D, Joyce T. The earned income tax credit and infant health revisited. HEALTH ECONOMICS 2020; 29:72-84. [PMID: 31758742 DOI: 10.1002/hec.3972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
Hoynes, Miller, and Simon (2015), henceforth HMS, report that the national expansion of the Earned Income Tax Credit (EITC) is associated with decreases in low birth weight. We question their findings. HMS's difference-in-differences estimates are unidentified in some comparisons, while failed placebo tests undermine others. Their effects lack a plausible mechanism as the association between the EITC and prenatal smoking also fails placebo tests. We contend that the waning of the crack epidemic is a possible confound, but we show that any number of policies directed at poor women also eliminate the effect of the EITC when aggregated to the national level. Identifying small, causal effects of a national policy at a single point in time is exceedingly challenging.
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Affiliation(s)
- Daniel Dench
- Program in Economics, Graduate Center, City University of New York, New York, NY
| | - Theodore Joyce
- Department of Economics & Finance, Baruch College & Graduate Center, City University of New York & National Bureau of Economic Research, New York, NY
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43
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Lenhart O. The effects of state-level earned income tax credits on suicides. HEALTH ECONOMICS 2019; 28:1476-1482. [PMID: 31469485 DOI: 10.1002/hec.3948] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
This study examines the relationship between state-level earned income tax credit (EITC) laws in the United States on suicides. Following findings in previous work showing that the EITC is associated with lower depression rates and reduced number of risky biomarkers, I estimated the effects of state EITC generosity on suicide rates. Using data for the years 1996 to 2016, a period with 74 state-level EITC policy changes, I find that introducing a high state EITC rate reduces suicide rates for adults aged 25 or above by 3.91%. The results are consistent across four different measures of EITC generosity.
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Affiliation(s)
- Otto Lenhart
- Department of Economics, University of Strathclyde, Duncan Wing, Strathclyde Business School, Scotland, UK
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44
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Impact of the Chicago Earned Income Tax Periodic Payment intervention on food security. Prev Med Rep 2019; 16:100993. [PMID: 31737468 PMCID: PMC6849410 DOI: 10.1016/j.pmedr.2019.100993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 09/05/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022] Open
Abstract
This article examines the Earned Income Tax Credit Periodic Payment Pilot and its effectiveness in reducing food insecurity for low-income households. Low-income families in Chicago who were eligible for the Earned Income Tax Credit provided data over four waves of data collection between 2014 and 2015. We utilize longitudinal random effects logit models to test the likelihood of experiencing food insecurity. The sample was composed mostly by women with low educational levels. The intervention significantly decreased the likelihood of experiencing food insecurity over time (T2: β = -0.23, p = .581; T3: β = -0.89, p < .10; T4: β = -2.21, p < .01). The Periodic Payment Pilot seems effective at reducing food insecurity in low-income families. Further research should examine how changes to the Earned Income Tax Credit payment distribution could improve the lives of low-income families, specifically concerning food insecurity.
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45
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Tang D, Gao X, Coyte PC. The effects of compulsory health insurance on birth outcomes: evidence from China's UEBMI scheme. BMC Health Serv Res 2019; 19:779. [PMID: 31675975 PMCID: PMC6824087 DOI: 10.1186/s12913-019-4657-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite extensive research concerning the impact of health insurance on the advancement of infant health in developed countries, few studies have adjusted their results for potential confounding due to adverse selection in insurance coverage, wherein those who anticipate a need for health services tend to be the ones that acquire insurance. The presence of compulsory health insurance in China, such as the Urban Employee Basic Medical Insurance (UEBMI) scheme may provide an opportunity to estimate the effect of health insurance on infant health, by reducing the endogeneity problem into insurance due to the adverse selection. The objective is to assess the relationship between UEBMI and infant health outcomes in one sizeable municipal-level obstetrics hospital in Shanghai, East China. METHODS Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013 to April 30, 2019 were used to form an analysis dataset of 160,429 live births which was comprised of Shanghai residents with UEBMI coverage (n = 101,153) and women without any insurance coverage (n = 59,276). A propensity score matching approach using conjoint quantile regression and probit regression models was used to eliminate latent endogeneity of UEBMI coverage in order to garner robust results. Further analysis stratified by maternal migrant status was conducted to further assess the sensitivity of the findings to distinct patient subgroups. RESULTS The UEBMI scheme was shown to be associated with improvements in infant birth outcomes. The scheme was associated with: an increase in birth weight of about 30 g (p < 0.001, 95% CI 23.908-35.295). This finding was evident in other five different birth outcomes (premature birth, low birth weight, very low birth weight, low Apgar score, and an abnormal health condition at birth). After stratifying by migrant status, the UEBMI was shown to have a greater effect on migrants compared to local residents of Shanghai. CONCLUSIONS Our findings suggest that health insurance coverage for pregnant women, especially for migrants, has the potential to significantly and directly improve infant health outcomes. Further research is required to determine whether these findings can be replicated for other Chinese jurisdictions.
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Affiliation(s)
- Di Tang
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2669 Gaoke West Road, Pudong New Area, Shanghai, 201204 China
- School of Public Administration, East China Normal University, Zhongshan Rd, Shanghai, 200062 China
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada
| | - Xiangdong Gao
- School of Public Administration, East China Normal University, Zhongshan Rd, Shanghai, 200062 China
| | - Peter C. Coyte
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada
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46
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Rosenquist NA, Cook DM, Ehntholt A, Omaye A, Muennig P, Pabayo R. Differential relationship between state-level minimum wage and infant mortality risk among US infants born to white and black mothers. J Epidemiol Community Health 2019; 74:14-19. [PMID: 31630121 DOI: 10.1136/jech-2019-212987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Compared to other Organisation for Economic Co-operation and Development (OECD) nations, US infant mortality rates (IMRs) are particularly high. These differences are partially driven by racial disparities, with non-Hispanic black having IMRs that are twice those of non-Hispanic white. Income inequality (the gap between rich and poor) is associated with infant mortality. One proposed way to decrease income inequality (and possibly to improve birth outcomes) is to increase the minimum wage. We aimed to elucidate the relationship between state-level minimum wage and infant mortality risk using individual-level and state-level data. We also determined whether observed associations were heterogeneous across racial groups. METHODS Data were from US Vital Statistics 2010 Cohort Linked Birth and Infant Death records and the 2010 US Bureau of Labor Statistics. We fit multilevel logistic models to test whether state minimum wage was associated with infant mortality. Minimum wage was standardised using the z-transformation and was dichotomised (high vs low) at the 75th percentile. Analyses were stratified by mother's race (non-Hispanic black vs non-Hispanic white). RESULTS High minimum wage (adjusted OR (AOR)=0.93, 95% CI 0.83 to 1.03) was associated with decreased odds of infant mortality but was not statistically significant. High minimum wage was significantly associated with reduced infant mortality among non-Hispanic black infants (AOR=0.80, 95% CI 0.68 to 0.94) but not among non-Hispanic white infants (AOR=1.04, 95% CI 0.92 to 1.17). CONCLUSIONS Increasing the minimum wage might be beneficial to infant health, especially among non-Hispanic black infants, and thus might decrease the racial disparity in infant mortality.
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Affiliation(s)
- Natalie A Rosenquist
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA
| | - Daniel M Cook
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA
| | - Amy Ehntholt
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anthony Omaye
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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47
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Hamad R, Niedzwiecki MJ. The short-term effects of the earned income tax credit on health care expenditures among US adults. Health Serv Res 2019; 54:1295-1304. [PMID: 31566732 DOI: 10.1111/1475-6773.13204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To test the hypothesis that the earned income tax credit (EITC)-the largest US poverty alleviation program-affects short-term health care expenditures among US adults. DATA SOURCES Adult participants in the 1997-2012 waves of the US Medical Expenditure Panel Survey (MEPS) (N = 1 282 080). STUDY DESIGN We conducted difference-in-differences analyses, comparing health care expenditures among EITC-eligible adults in February (immediately following EITC refund receipt) with expenditures during other months, using non-EITC-eligible individuals to difference out seasonal variation in health care expenditures. Outcomes included total out-of-pocket expenditures as well as spending on specific categories such as outpatient visits and inpatient hospitalizations. We conducted subgroup analyses to examine heterogeneity by insurance status. PRINCIPAL FINDINGS EITC refund receipt was not associated with short-term changes in total expenditures, nor any expenditure subcategories. Results were similar by insurance status and robust to numerous alternative specifications. CONCLUSIONS EITC refunds are not associated with short-term changes in health care expenditures among US adults. This may be because the refund is spent on other expenses, because of income smoothing, or because of similar refund-related variation in health care expenditures among noneligible adults. Future studies should examine whether other types of income supplementation affect health care expenditures, particularly among individuals in poverty.
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Affiliation(s)
- Rita Hamad
- Department of Family & Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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48
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Hayashi I, Takakura K, Yamaguchi K, Sumitomo M, Suzuki M, Sumitomo A, Minato S, Nose Y, Nagai N, Sakane N. Association between socioeconomic status and small-for-gestational-age in Japan: A single center retrospective cohort study. J Obstet Gynaecol Res 2019; 46:110-118. [PMID: 31392834 DOI: 10.1111/jog.14069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/03/2019] [Indexed: 11/29/2022]
Abstract
AIM Small-for-gestational-age (SGA) status has negative health consequences in neonates and later life. Low socioeconomic status (SES) is a reported risk factor for adverse birth outcomes, such as SGA and preterm birth (PTB). The present study investigated whether maternal SES is associated with adverse outcomes in Japanese pregnant women. METHODS Retrospective data were collected for 1970 Japanese women with singleton pregnancies who delivered between January 2007 and December 2011 at a single center: low SES group (n = 197); and controls (n = 1773). Low SES was defined according to the criteria of the Japanese pregnant-childbirth hospitalization support policy system. RESULTS The low SES group included a significantly higher proportion of young women, women with single marital status, greater parity, pre-pregnancy smoking and a lack of regular employment (P < 0.001, respectively). The crude odds ratio (OR) for the association between low maternal SES and SGA was 1.80 (95% confidence interval [CI] 1.15-2.82, P = 0.010). After adjustment for baseline maternal age, parity, body mass index, smoking and gestational weight gain, the adjusted OR for the association between low maternal SES and SGA was 1.92 (95% CI 1.17-3.17, P = 0.010). No significant association was found between maternal SES and PTB. CONCLUSION The present results suggest that low maternal SES is associated with SGA births in the Japanese population. Mitigation of low maternal SES could be urgent public health to prevent disadvantage birth outcome.
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Affiliation(s)
- Ikuyo Hayashi
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan.,Laboratory of Nutritional Physiology, Graduate School of Human and Environmental Science, University of Hyogo, Himegi, Hyogo, Japan
| | - Kenji Takakura
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
| | - Masahiro Sumitomo
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
| | - Maki Suzuki
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan.,Laboratory of Nutritional Physiology, Graduate School of Human and Environmental Science, University of Hyogo, Himegi, Hyogo, Japan
| | - Aya Sumitomo
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
| | - Satomi Minato
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan.,Laboratory of Nutritional Physiology, Graduate School of Human and Environmental Science, University of Hyogo, Himegi, Hyogo, Japan
| | - Yoko Nose
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan.,Laboratory of Nutritional Physiology, Graduate School of Human and Environmental Science, University of Hyogo, Himegi, Hyogo, Japan
| | - Narumi Nagai
- Laboratory of Nutritional Physiology, Graduate School of Human and Environmental Science, University of Hyogo, Himegi, Hyogo, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
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49
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Komro KA, Markowitz S, Livingston MD, Wagenaar AC. Effects of State-Level Earned Income Tax Credit Laws on Birth Outcomes by Race and Ethnicity. Health Equity 2019; 3:61-67. [PMID: 30886942 PMCID: PMC6419088 DOI: 10.1089/heq.2018.0061] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Health disparities persist in birth outcomes by mother's income, education, and race in the United States. Disadvantaged mothers may experience benefit from supplements to family income, such as the earned income tax credit (EITC). We examined the effects of state-level EITCs on birth outcomes among women with a high school education or less, stratified by race and ethnicity. Methods: A quasi-experimental multistate and multiyear difference-in-differences design is used to assess effects of the presence and generosity of 23 state-level EITC laws on birth outcomes from 1994 to 2013. The methods utilized the U.S. National Vital Statistics System birth data for the outcomes: birth weight, probability of low birth weight (LBW; <2500 g), and gestation weeks. Results: Across all subgroups, any level of state EITC is associated with better birth outcomes with the largest effects seen among states with more generous EITCs. Black mothers experience larger percentage point reductions in the probability of LBW and increases in gestation duration. Among mothers with a high school education or less, results translate into 3760 fewer LBW babies with black mothers and 8364 fewer LBW babies with white mothers per year at the most generous state EITC level (i.e., 10% or more of federal and refundable). Hispanic and non-Hispanic mothers display relatively similar effects. Conclusions: The EITC at the federal and state level is an effective policy tool to reduce poverty and improve birth outcomes across racial and ethnic subgroups. Given the historically higher risk among black mothers, state-level EITC expansions offer one policy option to address this persistent health disparity.
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Affiliation(s)
- Kelli A Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sara Markowitz
- Department of Economics, Emory University, Atlanta, Georgia
| | - Melvin D Livingston
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Alexander C Wagenaar
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
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50
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Wagenaar AC, Livingston MD, Markowitz S, Komro KA. Effects of changes in earned income tax credit: Time-series analyses of Washington DC. SSM Popul Health 2019; 7:100356. [PMID: 30723771 PMCID: PMC6351581 DOI: 10.1016/j.ssmph.2019.100356] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/09/2018] [Accepted: 01/14/2019] [Indexed: 01/12/2023] Open
Abstract
Poverty has numerous deleterious effects on health, and the Earned Income Tax Credit (EITC) is the major policy tool used to alleviate poverty in the U.S. We evaluate effects of four distinct changes in earned income tax credit law in Washington, DC on maternal behaviors and infant outcomes. An interrupted time-series design was used with 312 monthly measures from 1990 through 2015 analyzed in 2018 (total n = 225,933 births). States with no EITC were included as the comparison group; analyses involved ARIMA modeling. Outcomes were derived from birth certificates, and included percent of live births below 2500 g, mean birth weight, mean gestation weeks, first trimester prenatal care, and maternal smoking during pregnancy. We found a pattern of significant improvements across all three infant outcome measures, with the size of the effect estimate monotonically matching the magnitude of the tax credit—ranging from a 1.9 (-2.9, -0.9) reduction in rate per 100 births of low birth weight for the smaller 10% credit, to a 4.7 (-5.4, -4.0) reduction with the 40% credit. Results for maternal smoking and prenatal care were mixed. Results suggest that earned income tax credit policies improve birth outcomes; mechanisms for this effect deserve further study.
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Affiliation(s)
- Alexander C Wagenaar
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, GCR 556, Atlanta, GA 30322, USA
| | - Melvin D Livingston
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, GCR 556, Atlanta, GA 30322, USA
| | - Sara Markowitz
- Department of Economics, Emory University, Atlanta, GA, USA
| | - Kelli A Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, GCR 556, Atlanta, GA 30322, USA
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