Is the Social Safety Net a Long-Term Investment? Large-Scale Evidence From the Food Stamps Program

Early Childhood Food Insecurity and Cardiovascular Health in Young Adulthood

Importance

Food insecurity is a social risk factor that may be associated with cardiovascular health across the life course.

Objective

To evaluate the association of food insecurity in early childhood with cardiovascular health (CVH) in young adulthood and whether associations are modified by participation during childhood in the Supplemental Nutrition Assistance Program (SNAP).

Design, Setting, and Participants

The Future of Families-Cardiovascular Health Among Young Adults cohort study was conducted in 20 US cities among 1071 individuals enrolled at birth (February 1998 to September 2000), evaluated in childhood (age, 3-5 years), and followed up to young adulthood (September 2021 to September 2023; mean [SD] participant age, 22.3 [0.7] years).

Main Outcomes and Measures

Household food insecurity (assessed by the US Department of Agriculture Food Insecurity survey) and SNAP participation at ages 3 to 5 years and CVH (assessed by the American Heart Association Life's Essential 8 [LE8] score, component LE8 scores, and clinical CVH risk factors).

Results

Of the 1071 participants, 570 were female (53%), 422 (39%) lived in households with food insecurity, and 475 (44%) participated in SNAP. Early childhood food insecurity was associated with having a lower LE8 score in young adulthood (β, -2.2 [95% CI, -4.0 to -0.4]). Among component LE8 scores and clinical CVH risk factors, food insecurity was associated with a lower LE8 score for body mass index (BMI; β, -4.9 [95% CI, -9.6 to -0.3]) and higher odds of having a BMI of 30 or more (adjusted odds ratio, 1.40 [95% CI, 1.07-1.84]). Food insecurity was more strongly associated with a lower LE8 score among those whose households did not participate in SNAP (β, -4.9 [95% CI, -7.6 to -2.3]) compared with those whose households participated in SNAP (β, 1.0 [95% CI, -1.6 to 3.7]).

Conclusions and Significance

This study suggests that early childhood food insecurity is associated with a higher BMI in young adulthood, which is associated with a worse overall LE8 score, especially among children whose families did not participate in SNAP. Policies to promote food security among children may promote healthy BMIs and better CVH across the life course.

Early-life nutrition and schooling

We study a large supplemental nutrition program aimed at reducing malnutrition in Chile and its impact on the education of children ages 6-13. Using individual-level data from representative samples from the 1970, 1982, and 1992 national censuses, along with variation in milk distribution across provinces and over time, we estimate the effect of exposure to the milk program on years of schooling. We find that the impact was greatest for cohorts born between 1969 and 1976, a period of significant program expansion. The main effect implies an increase of 0.18 years of schooling due to exposure to the program, accounting for about 20% of the overall growth in educational attainment. These results show the substantial role of an early-life nutritional intervention in improving long-term educational outcomes for a significant portion of the population.

Protecting the health of children with universal child cash benefits

This Health Policy examines the relationship between child cash benefits and child health, with the goal of informing future policy development in the USA. As of 2024, more than 140 countries have adopted large-scale, government-funded child cash transfer programmes. High-income countries more often adopt universal or near universal programmes, while lower-income countries often impose means tests or condition benefits on specific behaviours. Evidence on the adoption of child cash benefits from a broad set of nations finds that they can improve a range of child health outcomes, with the most robust evidence of health benefits occurring when delivered to children younger than 5 years and during the prenatal period. During the 2021 expanded Child Tax Credit (CTC), the USA briefly joined other high-income countries by introducing a near universal, unconditional child cash benefit, which led to a historic decline in child poverty. Although the expanded CTC expired, state and local governments and communities have continued to advocate for and implement policies like it. On the basis of this success and building on global evidence, the USA should adopt a permanent child cash benefit consistent with other high-income countries and the 2021 expanded CTC. Nations further developing their cash benefits should also give special attention to the prenatal and infant period.

Fiscal externalities and underinvestment in early-life human capital: Optimal policy instruments for a developing country

We study policy instruments to correct inefficiently low investment in maternal nutrition in India, where one-fifth of all births occur. We focus on fiscal externalities: healthier babies become more productive adults, who pay more tax. However, parents do not internalize this externality, which, combined with other distortions, results in mothers weighing too little during pregnancy. We calibrate the first sufficient-statistics policy model for the quantitatively important case of fiscal externalities and maternal nutrition in developing countries. The optimal subsidy is large. Yet, welfare gains are even greater from public investment in state capacity to monitor nutrition, enabling targetted incentives.

Immigration concerns and social program avoidance: The roles of legal status and family composition among asian and latino communities

Objectives

Immigration policies significantly affect immigrants and their families' access to social programs. This study examines the role of legal status and familial composition in Asian and Latino adults' avoidance of social programs and assesses differences between the groups. We categorized respondents' familial composition based on whether all household members had the same citizenship status. We created two groups: respondents with cross-status ties and those without.

Methods

We use data from 1000 U.S. adults with proximal or distant ties to noncitizens (collected in September 2021) to employ multivariable generalized linear models with binomial family and logit link to assess avoidance of needed social programs due to immigration concerns.

Results

Our fully adjusted model reveals that compared to U.S. citizens without familial cross-status ties (i.e., all-citizen household members), legally precarious immigrants (LPI) without cross-status ties (odds ratio (OR)= 3.64, 95 % CI: 1.67-7.96), LPI with cross-status ties (OR=1.71, 95 % CI: 1.14-2.57), and U.S. citizens with cross-status ties (OR=1.66, 95 % CI: 1.14-2.40), were more likely to report avoidance of needed social support programs. Further, an interaction analysis shows that Asian lawful permanent residents with cross-status ties exhibit a higher likelihood of avoiding social programs due to immigration concerns compared to their Latino counterparts.

Conclusion

The far-reaching consequences of anti-immigrant policies on noncitizen individuals and their families, including U.S. citizens, may lead to disparities in access to social assistance programs that may exacerbate health disparities. Further, our findings suggest that immigrants' cross-status ties to U.S. citizen family members may be protective against the harmful effects of anti-immigrant policies.

New Advances on an Old Question: Does Money Matter for Children's Outcomes?

Family income is a positive predictor of children's health, human capital, and later-life earnings, but determining the extent to which these associations reflect causal effects is challenging. A recent wave of natural and randomized experiments, together with increased accessibility of large-scale administrative data, are allowing us to gain new perspectives about the importance of families' monetary resources in the U.S. and other high-income countries. This review pulls the emerging literature together to provide deeper insights into what we know, and what we don't know, about the extent to which policies that provide more generous income transfers could make a difference to children's life chances. My reading of the evidence suggests that policies providing financial resources to economically vulnerable families have the potential to improve children's outcomes. The magnitude of predicted impacts varies considerably across studies, however, and may be related to specific features of the income-generating event that researchers' leverage.

Impact of in utero airborne lead exposure on long-run adult socio-economic outcomes: A population analysis using U.S. survey and administrative data

As a neurotoxin, early exposure to lead has long been assumed to affect socioeconomic outcomes well into adulthood. However, the empirical literature documenting such effects has been limited. This study documents the long-term effects of in utero exposure to air lead on adult socio-economic outcomes, including real earnings, disabilities, employment, public assistance, and education, using US survey and administrative data. Specifically, we match individuals in the 2000 US Decennial Census and 2001-2014 American Community Surveys to average lead concentrations in the individual's birth county during his/her 9 months in utero. We then estimate the effects of shocks to airborne lead conditional on observable characteristics, county fixed effects, county-specific time trends, and month-year fixed effects. We find a 0.5 μg/m3 decrease in air lead, representing the average 1975-85 change resulting from the passage of the U.S. Clean Air Act, is associated with an increase in earnings of 3.5%, or a present value, at birth, of $21,400 in lifetime earnings. Decomposing this effect, we find greater exposure to lead in utero is associated with an increase in disabilities in adulthood, an increase in receiving public assistance, and a decrease in employment. Looking at effects by sex, long-term effects for girls seem to fall on participation in the formal labor market, whereas for boys it appears to fall more on hours worked. This is the first study to document such long-term effects from lead using US data. We estimate the present value in 2020, from all earnings impacts from 1975 forward, to be $4.23 Trillion using a discount rate of 3%. In 2020 alone, the benefits are $252 B, or about 1.2% of GDP. Thus, our estimates imply the Clean Air Act's lead phase out is still returning a national dividend of over 1% every year.