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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要美国有超过1100万儿童生活在贫困之中，还有大量的种族问题。 2019 年，8.3% 的白人儿童和 7.3% 的亚裔儿童贫困。生活在贫困中，而 20.9% 的西班牙裔儿童和 26.4% 的黑人儿童生活在贫困中与贫困相比，经历过童年贫困的成年人的健康状况更有可能更差。没有经历过童年贫困的成年人，包括报告总体健康状况良好的几率降低 50% 童年贫困对成年后健康的影响显着增加 71%。有文献记载，但很少有研究考察经济政策对这种关系的长期影响。改革代表了 20 世纪 90 年代美国向美国人分配现金福利方式的重大转变自从各州开始实施福利改革以来，已经过去了大约 25 年，通过对家庭的援助，从限制较少和更加慷慨的福利分配形式转变受抚养子女 (AFDC) 计划，通过临时计划以更具惩罚性和更少慷慨的形式贫困家庭援助 (TANF) 计划在 1994 年达到顶峰，为 960 万儿童提供了服务。 2020 年，贫困家庭临时援助 (TANF) 仅为 160 万儿童提供服务，这表明福利分配大幅减少。鉴于财政资源与健康之间的密切联系，经济政策可以作为潜在的干预措施促进人口健康并减少社会经济（SES）健康差距福利改革研究。发现这一政策变化对短期健康结果产生重要影响，包括减少获得健康保险和医疗保健利用率下降这些发现表明潜在的负面影响。福利改革带来的长期健康结果，尽管这一领域的研究有限。其他安全网政策（例如食品券计划）的影响发现，更多的好处是我们建议填补有关长期健康影响的研究空白。首先，我们评估了儿童之间关系的州一级差异。 SES 和自我评估的健康状况、慢性病和成年期的心理困扰，以了解其状态根据其他研究结果，环境可能会导致根植于儿童社会经济地位的更大或更小的健康差异。研究检查成人健康差异的州级差异，我们期望发现州级差异，以及其次，我们量化了家庭社会经济地位较低的成年人造成的这种变化。关于儿童社会经济地位与自评健康、慢性病和疾病之间关系的福利改革最后，由于福利管理中存在种族歧视的证据，我们估计了福利改革对健康的长期影响因种族和种族而异的程度。我们承认福利改革将对社会经济地位低的人的健康产生长期负面影响。样本，并且这些影响对西班牙裔和/或黑人特别不利。