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Chang H, Jock J, Rosenberg MS, Li C, Cho TC, Gaziano TA, Lisabeth L, Kobayashi LC. The Impact of the Older Person's Grant Expansion on Hypertension Among Older Men in Rural South Africa: Findings From the HAALSI Cohort. Innov Aging 2024; 8:igae010. [PMID: 38628827 PMCID: PMC11020309 DOI: 10.1093/geroni/igae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Indexed: 04/19/2024] Open
Abstract
Background and Objectives Hypertension is a major modifiable contributor to disease burden in sub-Saharan Africa. We exploited an expansion to age eligibility for men in South Africa's noncontributory public pension to assess the impact of pension eligibility on hypertension in a rural, low-income South African setting. Research Design and Methods Data were from 1 247 men aged ≥60 in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa in 2014/2015. We identified cohorts of men from 0 (controls, aged ≥65 at pension expansion) through 5 years of additional pension eligibility based on their birth year. Using the modified Framingham Heart Study hypertension risk prediction model, and the Wand et al. model modified for the South African population, we estimated the difference in the probabilities of hypertension for men who benefitted from the pension expansion relative to the control. We conducted a negative control analysis among older women, who were not eligible for pension expansion, to assess the robustness of our findings. Results Older men with 5 additional years of pension eligibility had a 6.9-8.1 percentage point greater probability of hypertension than expected without the pension expansion eligibility. After accounting for birth cohort effects through a negative control analysis involving older women reduced estimates to a 3.0-5.2 percentage point greater probability of hypertension than expected. We observed a mean 0.2 percentage point increase in the probability of hypertension per additional year of pension eligibility, but this trend was not statistically significant. Discussion and Implications Although the Older Person's Grant is important for improving the financial circumstances of older adults and their families in South Africa, expanded pension eligibility may have a small, negative short-term effect on hypertension among older men in this rural, South African setting.
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Affiliation(s)
- Haeyoon Chang
- Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, Michigan, USA
| | - Janet Jock
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, USA
| | - Molly S Rosenberg
- Department of Epidemiology, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Chihua Li
- Institute of Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Tsai-Chin Cho
- Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas A Gaziano
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Lynda Lisabeth
- Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, Michigan, USA
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Laszlo S, Majid MF, Renée L. Conditional cash transfers and women's reproductive choices. Health Econ 2024; 33:204-228. [PMID: 37845819 DOI: 10.1002/hec.4768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
We study potential non-targeted effects of a large-scale national conditional cash transfer program-Peru's Juntos-on the fertility and reproductive decisions of adult beneficiaries. We use an event study design, exploiting time and geographic variation in the rollout of the program, to identify the causal effects of the program. We find that Juntos decreases the number of children that adult beneficiaries have and that these effects persist over time. We explore various mechanisms and find that Juntos does not affect fertility preferences but rather empowers women to avoid unwanted births. We provide evidence that this decrease is most likely due to better access to and more extensive use of modern birth control methods.
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Jock J, Beidelman ET, Kobayashi LC, Tollman S, Phillips M, Kabudula CW, Rosenberg M. The Impact of Old Age Pension Eligibility on Alcohol Consumption: Evidence From a Population-Based Study in Rural South Africa. Innov Aging 2024; 8:igad136. [PMID: 38628820 PMCID: PMC11020216 DOI: 10.1093/geroni/igad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 04/19/2024] Open
Abstract
Background and Objectives Alcohol causes more than 3 million deaths a year globally and contributes to over 5% of global disease and injury. Heavy drinking and alcohol use disorders among older adults have increased in the last 10-15 years. For individuals living in low-income countries, where wages are low and unemployment is high, old age pensions may provide a significant increase in household income. In turn, the receipt of supplementary income may increase spending on alcohol. Earlier life factors and socioeconomic status may affect alcohol consumption, making it difficult to directly assess the impact of income on alcohol consumption. This study reduces the potential for endogeneity with other life factors by exploiting an exogenous increase in income from old age pensions to isolate the impact of extra income on alcohol consumption for older adults. Research Design and Methods We used a regression discontinuity design to assess changes in drinking patterns among rural, low-income adults who were 3 years below and 3 years above South Africa's Old Age Pension Grant eligibility threshold (age 60). We assessed this relationship separately by gender and for employed and unemployed individuals. Results We observed a significantly increased alcohol use associated with the Old Age Pension Grant eligibility for employed men (β = 4.57, 95% confidence interval: 1.72-12.14). We did not observe this same trend for unemployed men or for women. Discussion and Implications The analysis in this study indicates that increased income from reaching the pension eligibility age may contribute to an increase in alcohol consumption for employed men. Interventions, such as informational campaigns on the risks of alcohol consumption for older adults or age-appropriate health interventions to help individuals reduce alcohol consumption, targeted around the time of pension eligibility age for employed men may help to reduce alcohol-related harms in low-income, rural sub-Saharan African settings.
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Affiliation(s)
- Janet Jock
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana, USA
| | - Erika T Beidelman
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith Phillips
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, USA
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Li Z, Wang H, Chen S, Kong Y, Xie L, Zhang X, Lu C, Subramanian SV, Cohen JL, Atun R. The association of a disability-targeted cash transfer programme with disability status and health-care access: a quasi-experimental study using a nationwide cohort of 4·3 million Chinese adults living with severe disabilities. Lancet Public Health 2023; 8:e933-e942. [PMID: 38000888 DOI: 10.1016/s2468-2667(23)00215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Cash transfer is a crucial policy tool to address inequality. The objective of this study was to investigate the association between China's disability-targeted cash transfer programme and disability status, as well as equitable access to rehabilitation and medical services. METHODS For this quasi-experimental study, we drew data from the nationwide administrative cohort of individuals with disabilities between Jan 1, 2015, and Dec 31, 2019. Individuals were enrolled in the cohort if they were aged 18 years or older, had severe disabilities as defined by the Chinese Government, and had available cash transfer information for at least 4 consecutive years, without having started receiving cash transfer benefits at the time of enrolment. We used a quasi-experimental design with propensity score matching to estimate the effects of cash transfers on disability status, access to rehabilitation services, and access to medical treatment. The primary outcomes were development of new disability and reduction of existing disabilities. Secondary outcomes were use of rehabilitation services, financial barriers as a major obstacle to accessing rehabilitation services, use of medical services by individuals who had an illness in the previous 2 weeks, and financial barriers as a major obstacle to accessing medical services. FINDINGS From an initial pool of 51 356 125 individuals with disabilities registered in the administrative system, 2 686 024 individuals were eligible for analysis, of whom 2 165 335 (80·6%) were cash transfer beneficiaries and 520 689 (19·4%) non-beneficiaries. After propensity score matching, the cohort included 4 330 122 adults with severe disabilities. Cash transfer beneficiaries had significantly lower odds of developing new disabilities over time than non-beneficiaries (odds ratio [OR] 0·90, 95% CI 0·86-0·94; p<0·0001) and higher odds of having a reduced number of disabilities over time (1·17, 1·10-1·25; p<0·0001). Compared with non-beneficiaries, cash transfer beneficiaries were more likely to use rehabilitation services (2·12, 2·11-2·13; p<0·0001) and medical services (1·74, 1·69-1·78; p<0·0001), and less likely to report financial hardship to access rehabilitation services (0·53, 0·52-0·54; p<0·0001) and medical services (0·88, 0·84-0·93; p<0·0001) at the study endpoint. INTERPRETATION The receipt of cash transfers was associated with improved disability status and increased access to disability-related services. The findings suggest that cash transfers could be a potential method for promoting universal health coverage among individuals living with disabilities. FUNDING China National Natural Science Foundation.
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Affiliation(s)
- Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China; Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Hongchuan Wang
- School of Public Policy and Management, Tsinghua University, Beijing, China.
| | - Shaoru Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuhao Kong
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Lifeng Xie
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xiangda Zhang
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Jessica L Cohen
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Bergenfeld I. Empower People… With Money. Int J Public Health 2023; 68:1605932. [PMID: 37465050 PMCID: PMC10351534 DOI: 10.3389/ijph.2023.1605932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Irina Bergenfeld
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
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Heckert J, Martinez EM, Sanou A, Pedehombga A, Ganaba R, Gelli A. Can a gender-sensitive integrated poultry value chain and nutrition intervention increase women's empowerment among the rural poor in Burkina Faso? J Rural Stud 2023; 100:103026. [PMID: 37377776 PMCID: PMC10291270 DOI: 10.1016/j.jrurstud.2023.103026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/10/2023] [Accepted: 04/27/2023] [Indexed: 06/29/2023]
Abstract
Understanding the types of food systems interventions that foster women's empowerment and the types of women that are able to benefit from different interventions is important for development policy. SELEVER was a gender- and nutrition-sensitive poultry production intervention implemented in western Burkina Faso from 2017 to 2020 that aimed to empower women. We evaluated SELEVER using a mixed-methods cluster-randomized controlled trial, which included survey data from 1763 households at baseline and endline and a sub-sample for two interim lean season surveys. We used the multidimensional project-level Women's Empowerment in Agriculture Index (pro-WEAI), which consists of 12 binary indicators, underlying count versions of 10 of these, an aggregate empowerment score (continuous) and a binary aggregate empowerment indicator, all for women and men. Women's and men's scores were compared to assess gender parity. We also assessed impacts on health and nutrition agency using the pro-WEAI health and nutrition module. We estimated program impact using analysis of covariance (ANCOVA) models and examined whether there were differential impacts by flock size or among those who participated in program activities (treatment on the treated). Program impacts on empowerment and gender parity were null, despite the program's multipronged and gender-sensitive approach. Meanwhile, results of the in-depth gender-focused qualitative work conducted near the project mid-point found there was greater awareness in the community of women's time burden and their economic contributions, but it did not seem that awareness led to increased empowerment of women. We reflect on possible explanations for the null findings. One notable explanation may be the lack of a productive asset transfer, which have previously been shown to be essential, but not sufficient, for the empowerment of women in agricultural development programs. We consider these findings in light of current debates on asset transfers. Unfortunately, null impacts on women's empowerment are not uncommon, and it is important to learn from such findings to strengthen future program design and delivery.
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Affiliation(s)
- Jessica Heckert
- Poverty, Gender, and Inclusion Unit, International Food Policy Research Institute, USA
| | - Elena M. Martinez
- CGIAR Research Program on Agriculture for Nutrition and Health, International Food Policy Research Institute, USA
- Friedman School of Nutrition Science and Policy, Tufts University, USA
| | - Armande Sanou
- Agence de Formation de Recherche et d’Expertise en Santé pour l’Afrique (AFRICSanté), USA
| | | | - Rasmané Ganaba
- Agence de Formation de Recherche et d’Expertise en Santé pour l’Afrique (AFRICSanté), USA
| | - Aulo Gelli
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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McCullough E, Zhen C, Shin S, Lu M, Arsenault J. The role of food preferences in determining diet quality for Tanzanian consumers. J Dev Econ 2022; 155:102789. [PMID: 35241868 PMCID: PMC8857606 DOI: 10.1016/j.jdeveco.2021.102789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 05/15/2023]
Abstract
Consumer preferences can be leveraged to magnify the impacts of agricultural investments and interventions on diets for all consumers in an economy, not just farmers. Using nationally representative panel data from Tanzania, we estimate demand for 19 food groups using an Exact Affine Stone Index censored demand system, which is flexible, utility-theoretic, controls for unobserved heterogeneity, and accounts for bias arising from endogenous prices. We find strong links between growth in household expenditures and improved diet quality. Also, staple grain prices are important determinants of nutrient intake. For poor consumers, e.g., protein and iron intake are more sensitive to maize price changes than to changing prices of other foods that contain more protein and iron. We use simulations to show that cash transfers and price vouchers targeting staple grains, pulses & nuts, and starchy staples could be effective in shrinking gaps between recommended and actual dietary intake for poor consumers.
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Affiliation(s)
- Ellen McCullough
- Department of Agricultural and Applied Economics, University of Georgia, USA
- Correspondence to: 315B Conner Hall, Athens, GA 30601, USA.
| | - Chen Zhen
- Department of Agricultural and Applied Economics, University of Georgia, USA
| | | | - Meichen Lu
- Department of Agricultural and Applied Economics, University of Georgia, USA
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Hatcher AM, Neilands TB, Rebombo D, Weiser SD, Christofides NJ. Food insecurity and men's perpetration of partner violence in a longitudinal cohort in South Africa. BMJ Nutr Prev Health 2022; 5:36-43. [PMID: 35814730 PMCID: PMC9237862 DOI: 10.1136/bmjnph-2021-000288] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/17/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Although food insecurity has been associated with intimate partner violence (IPV), few studies examine it longitudinally or among male perpetrators. METHODS We used secondary data from a trial that followed 2479 men in a peri-urban settlement in South Africa (February 2016-August 2018). Men self-completed questionnaires at baseline (T0), 12 months (T1) and 24 months (T2) on food security, household type, relationship status, childhood abuse exposure, alcohol use, and perpetration of physical and/or sexual IPV. Cross-lagged dynamic panel modelling examines the strength and direction of associations over time. RESULTS At baseline, rates of IPV perpetration (52.0%) and food insecurity (65.5%) were high. Food insecure men had significantly higher odds of IPV perpetration at T0, T1 and T2 (ORs of 1.9, 1.4 and 1.4, respectively). In longitudinal models, food insecurity predicted men's IPV perpetration 1 year later. The model had excellent fit after controlling for housing, relationship status, age, childhood abuse and potential effect of IPV on later food insecurity (standardised coefficient=0.09, p=0.031. root mean squared error of approximation=0.016, comparative fit index=0.994). IPV perpetration did not predict later food security (p=0.276). CONCLUSION Food insecurity had an independent, longitudinal association with men's IPV perpetration in a peri-urban South African settlement. These findings suggest food security could be a modifiable risk factor of partner violence. TRIAL REGISTRATION NUMBER NCT02823288.
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Affiliation(s)
- Abigail M Hatcher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina System, Chapel Hill, North Carolina, USA
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Sheri D Weiser
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nicola J Christofides
- School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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McGuire J, Kaiser C, Bach-Mortensen AM. A systematic review and meta-analysis of the impact of cash transfers on subjective well-being and mental health in low- and middle-income countries. Nat Hum Behav 2022; 6:359-370. [DOI: 10.1038/s41562-021-01252-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/04/2021] [Indexed: 12/19/2022]
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Prencipe L, Houweling TAJ, van Lenthe FJ, Palermo T. Do Conditional Cash Transfers Improve Mental Health? Evidence From Tanzania's Governmental Social Protection Program. J Adolesc Health 2021; 69:797-805. [PMID: 34256993 DOI: 10.1016/j.jadohealth.2021.04.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cash transfer interventions broadly improve the lives of the vulnerable, making them exceedingly popular. However, evidence of impacts on mental health is limited, particularly for conditional cash transfer (CCT) programs. We examined the impacts of Tanzania's government-run CCT program on depressive symptoms of youth aged 14-28. METHODS We utilized cluster randomized controlled trial data of 84 communities (48 intervention; 36 control). The intervention administered bimonthly CCTs to eligible households, while control communities were assigned to delayed intervention. The analysis included youth with measurements of depression (10-item Centre for Epidemiological Studies Depression Scale) at baseline and 18 months later. We determined impacts using analysis of covariance models, adjusting for youth characteristics (including baseline depression), district-level fixed effects, and community-level random effects. Differential effects by sex and baseline social support were also estimated. RESULTS Although no evidence was found to suggest that the intervention impacted depressive symptoms among the full sample (n = 880) (effect -.20, 95% confidence interval [CI] -.88 to .48, p = .562), subsample results indicated that depressive symptoms were reduced 1.5 points among males (95% CI -2.56 to -.04, p = .007) and increased 1.1 points among females (95% CI .11-2.09, p = .029). Females 18+ years old (effect 1.55, 95% CI .27-2.83, p = .018) and females with children (effect 1.32, 95% CI -.13 to 2.78, p = .074) drove this negative impact. Social support did not moderate impacts. CONCLUSIONS Despite no overall intervention effects, results suggest that receiving a CCT has differential effects on mental health by sex. Although males benefited from the intervention, conditions which rely on stereotypically female roles may result in negative consequences among women.
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Affiliation(s)
- Leah Prencipe
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, New York
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de Hoop J, Groppo V, Handa S. Cash Transfers, Microentrepreneurial Activity, and Child Work: Evidence from Malawi and Zambia. World Bank Econ Rev 2020; 34:670-697. [PMID: 36909737 PMCID: PMC9997202 DOI: 10.1093/wber/lhz004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Cash transfer programs are rapidly becoming a key component of the social safety net of many countries in Sub-Saharan Africa. The primary aim of these programs is to help households improve their food security and smooth consumption during periods of economic duress. However, beneficiary households have also been shown to use these programs to expand their microentrepreneurial activities. Cluster-randomized trials carried out during the rollout of large-scale programs in Malawi and Zambia reveal that children may increase their work in the household enterprise through such programs. Both programs increased forms of work that may be detrimental to children, such as activities that expose children to hazards in Malawi and excessive working hours in Zambia. However, both programs also induced positive changes in other child well-being domains, such as school attendance and material well-being, leading to a mixed and inconclusive picture of the implications of these programs for children.
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Affiliation(s)
| | | | - Sudhanshu Handa
- public policy, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Abstract
Violence against children and adolescents, a highly prevalent problem, is a clear violation of child rights and has detrimental effects on later life outcomes. Programs that alleviate poverty address a structural determinant of child vulnerability and can thereby reduce child abuse. This paper investigates whether the Government of Zimbabwe's Harmonized Social Cash Transfer (HSCT) Program, which combines cash transfers with complementary services, affects youth exposure to physical violence. The analysis uses data from a non-experimental impact evaluation and a difference-in-differences approach. Results show a 19-percentage point decline in the incidence of physical violence among youth four years into the program. HSCT-induced enhancements in beneficiary households' purchasing capacity and food security, improvements in caregiver subjective well-being, and reductions in youth participation in economic work for pay could be mediating the program's effects on youth abuse. This paper adds to the relatively scarce evidence on the impacts of anti-poverty policies on young people's susceptibility to physical violence in developing countries.
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Affiliation(s)
- Averi Chakrabarti
- Department of Global Health and Population, T.H. Chan School of Public Health, Harvard University, 90 Smith Street, Boston, MA 02120
| | - Sudhanshu Handa
- Department of Public Policy, University of North Carolina at Chapel Hill (UNC-CH)
| | - Gustavo Angeles
- Department of Maternal & Child Health, Gillings School of Global Public Health, UNC-CH
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14
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Kilburn K, Ferrone L, Pettifor A, Wagner R, Gómez-Olivé FX, Kahn K. The Impact of a Conditional Cash Transfer on Multidimensional Deprivation of Young Women: Evidence from South Africa's HTPN 068. Soc Indic Res 2020; 151:865-895. [PMID: 33029038 PMCID: PMC7508742 DOI: 10.1007/s11205-020-02367-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 05/16/2023]
Abstract
Despite the growing popularity of multidimensional poverty measurement and analysis, its use to measure the impact of social protection programs remains scarce. Using primary data collected for the evaluation of HIV Prevention Trials Network (HPTN) 068, a randomized, conditional cash transfer intervention for young girls in South Africa that ran from 2011 to 2015, we construct an individual-level measure of multidimensional poverty, a major departure from standard indices that use the household as the unit of analysis. We construct our measure by aggregating multiple deprivation indicators across six dimensions and using a system of nested weights where each domain is weighted equally. Our findings show that the cash transfer consistently reduces deprivations among girls, in particular through the domains of economic agency, violence, and relationships. These results show how social protection interventions can improve the lives of young women beyond single domains and demonstrate the potential for social protection to simultaneously address multiple targets of the SDGs.
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Affiliation(s)
- Kelly Kilburn
- Carolina Population Center, University of North Carolina, Chapel Hill, NC USA
- Duke Global Health Institute, Duke University, Durham, NC USA
| | - Lucia Ferrone
- Department of Economics and Management, University of Florence, via delle Pandette, 9, 50127 Florence, Italy
| | - Audrey Pettifor
- Carolina Population Center, University of North Carolina, Chapel Hill, NC USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC USA
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathy Kahn
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
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15
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Gibson M, Hearty W, Craig P. The public health effects of interventions similar to basic income: a scoping review. Lancet Public Health 2020; 5:e165-e176. [PMID: 32113520 PMCID: PMC7208547 DOI: 10.1016/s2468-2667(20)30005-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023]
Abstract
Universal, unconditional basic income is attracting increasing policy and academic interest. Income is a key health determinant, and a basic income could affect health through its effect on other determinants, such as employment. However, there is little evidence of its potential effects on public health, because no studies of interventions which meet the definition of basic income have been done. However, there is evidence from studies of interventions with similarities to basic income. Therefore, we aimed to identify these studies and to consider what can be learned from them about the potential effects of such interventions on health and socioeconomic outcomes. We did a systematic scoping review of basic income-like interventions, searching eight bibliographic and eight specialist databases from inception to July, 2019, with extensive hand searching. We included publications in English of quantitative and qualitative studies done in upper-middle-income or high-income countries, of universal, permanent, or subsistence-level interventions providing unconditional payments to individuals or families. We sought to identify the range of outcomes reported by relevant studies, and report health, education, employment, and social outcomes. We extracted and tabulated relevant data and narratively reported effects by intervention and outcome. We identified 27 studies of nine heterogeneous interventions, some universal and permanent, and many evaluated using randomised controlled trials or robust quasi-experimental methods. Evidence on health effects was mixed, with strong positive effects on some outcomes, such as birthweight and mental health, but no effect on others. Employment effects were inconsistent, although mostly small for men and larger for women with young children. There was evidence of spill-over effects in studies measuring effects on large populations. In conclusion, little evidence exists of large reductions in employment, and some evidence suggests positive effects on some other outcomes, including health outcomes. Evidence for macro-level effects is scarce. Quasi-experimental and dynamic modelling approaches are well placed to investigate such effects.
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Affiliation(s)
- Marcia Gibson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK,Correspondence to: Dr Marcia Gibson, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3AX, UK
| | | | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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16
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Abstract
There is increasing interest in the ability of cash transfers to facilitate safe transitions to adulthood in low-income settings; however, evidence from scaled-up government programming demonstrating this potential is scarce. Using two experimental evaluations of unconditional cash transfers targeted to ultra-poor and labor-constrained households over approximately three years in Malawi and Zambia, we examine whether cash transfers delayed early marriage and pregnancy among youth aged 14 to 21 years at baseline. Although we find strong impacts on poverty and schooling, two main pathways hypothesized in the literature, we find limited impacts on safe transition outcomes for both males and females. In addition, despite hypotheses that social norms may constrain potential impacts of cash transfer programs, we show suggestive evidence that pre-program variation in social norms across communities does not significantly affect program impact. We conclude with policy implications and suggestions for future research.
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