The Long-Term Effects of Welfare Reform on Life Course Health

福利改革对生命全程健康的长期影响

• 批准号: 10683726
• 负责人: Emily Catherine Dore
• 金额: $ 5.02万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10683726
• 关键词: Adult; Affect; Aid to Families with Dependent Children; American; Area; Asian; Black race; Buffers; Child; Child Health; Childhood; Chronic; Chronic Disease; Data; Data Set; Depressed mood; Diabetes Mellitus; Discrimination; Disease; Distress; Economic Policy; Economics; Education; Eligibility Determination; Employment; Ethnic Origin; Exposure to; Family; Federal Government; Financial Support; Food; Goals; Health; Health Insurance; Health behavior; Health behavior and outcomes; Heart Diseases; Height; Hispanic; Hypertension; Incentives; Income; Individual; Inequality; Intervention; Life Cycle Stages; Life Expectancy; Link; Literature; Long-Term Effects; Low income; Marketing; Measures; Mental Health; Metabolic syndrome; Outcome; Patient Self-Report; Persons; Policies; Politics; Population; Population Decreases; Poverty; Race; Reporting; Research; Research Personnel; Resources; Sampling; Shapes; Social Conditions; Social Welfare; Socioeconomic Status; State Government; Stress; System; Time; United States; Variant; Work; beneficiary; critical developmental period; design; experience; family structure; health care service utilization; health disparity; low socioeconomic status; mortality; panel study of income dynamics; physical conditioning; policy implication; poor health outcome; population health; programs; psychological distress; racial discrimination; racial disparity; response; safety net; socioeconomics; theories; waiver; welfare

Project Summary/Abstract There are over 11 million children living in poverty in the United States. There are also substantial racial disparities in childhood poverty. In 2019, 8.3 percent of White children and 7.3 percent of Asian children were living in poverty, while 20.9 percent of Hispanic children and 26.4 percent of Black children were living in poverty. Adults who experienced childhood poverty are more likely to have worse health outcomes compared to adults who did not experience childhood poverty, including 50% lower odds of reporting good general health and 71% higher odds of having heart disease. Childhood poverty’s impact on subsequent adult health is well- documented, but few studies examine the long-term effect of economic policies on this relationship. Welfare reform represented a major shift in the 1990s in how the United States distributed cash benefits to Americans needing financial support. About 25 years have passed since states began to implement changes to welfare, shifting from a less restrictive and more generous form of welfare distribution through the Aid to Families with Dependent Children (AFDC) program, to a more punitive and less generous form, through the Temporary Assistance to Needy Families (TANF) program. At its height in 1994, AFDC served 9.6 million children, while TANF served only 1.6 million children in 2020, suggesting a large decrease in welfare benefits distribution. Due to the close link between financial resources and health, economic policies serve as potential interventions to promote population health and decrease socioeconomic (SES) health disparities. Studies on welfare reform have found important implications of this policy change on short-term health outcomes, including reduced access to health insurance and decreased health care utilization. These findings suggest potentially negative long-term health outcomes due to welfare reform, though research in this area is limited. Studies on long-term effects of other safety-net policies, such as the Food Stamp Program, have found that more benefits are associated with better long-term health. We propose to fill this gap in studies on the long-term health effects of welfare reform with this project. First, we assess the state-level variation in the relationship between childhood SES and self-rated health, chronic conditions, and psychological distress in adulthood to understand how state context may lead to larger or smaller health disparities rooted in childhood SES. Based on findings from other studies that examine state-level variation in adult health disparities, we expect to find state-level variation, and for this variation to be driven by adults whose families were lower-SES. Second, we quantify the effect of welfare reform on the relationship between childhood SES and self-rated health, chronic conditions, and psychological distress in adulthood. Lastly, due to evidence of racial discrimination in welfare administration, we estimate the extent to which the long-term health effects of welfare reform differ based on race and ethnicity. We hypothesize that welfare reform will have negative long-term health effects for the low-SES sample, and for those effects to be particularly detrimental for individuals who are Hispanic and/or Black.

项目摘要/摘要 在美国，有超过1100万儿童生活在贫困中。也有大量的种族 童年贫困的差异。 2019年，有8.3％的白人儿童和7.3％的亚洲儿童为 生活在贫困中，而20.9％的西班牙裔儿童和26.4％的黑人儿童居住在 贫困。与童年贫困经历的成年人相比，更有可能的健康状况更可能 对于没有童年贫困的成年人，包括报告良好总体健康状况的50％的几率 患有心脏病的几率增加了71％。童年贫困对随后的成人健康的影响很好 有记录，但是很少有研究研究经济政策对这种关系的长期影响。福利 改革代表了1990年代美国如何向美国人分配现金福利的重大转变 需要财政支持。自从各州开始实施福利变更以来，大约25年已经过去了 通过援助向有援助 通过临时的儿童（AFDC）计划，更惩罚性，更慷慨的形式 为有需要的家庭提供帮助（TANF）计划。在1994年的高峰期，AFDC为960万儿童服务，而 TANF在2020年仅服务于160万儿童，这表明福利分配大幅下降。到期的 对于财务资源与卫生之间的紧密联系，经济政策是潜在的干预措施 促进人口健康并减少社会经济（SES）健康差异。福利改革的研究 已经发现了这种政策变化对短期健康成果的重要含义，包括减少 获得健康保险并改善医疗保健利用。这些发现表明潜在的负面 尽管这一领域的研究是有限的，但由于福利改革而引起的长期健康结果。长期研究 其他安全网政策的影响，例如食品券计划，发现更多的好处是 与更好的长期健康有关。我们建议在研究长期健康影响的研究中填补这一空白 该项目的福利改革。首先，我们评估童年之间关系的状态级别差异 SES和自我评价的健康，慢性病和成年后的心理困扰，以了解状态如何 上下文可能导致植物SES植根于较大或较小的健康差异。根据其他发现 研究成人健康分布中州级变异的研究，我们希望找到州级变异，并 为了使这种变化由家庭较低的成年人驱动。其次，我们量化了 福利改革儿童时期与自我评估的健康，慢性病和 成年的心理困扰。最后，由于福利管理中种族歧视的证据， 我们估计福利改革的长期健康影响根据种族和 种族。我们假设福利改革将对低SES产生负面的长期健康影响 样本，这些影响对于西班牙裔和/或黑人的个体特别有害。