Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s
Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s
复制标题
DOI：
10.1093/aje/kwv249
复制
发表时间：
2016-03-15
影响因子：
5
通讯作者：
Kawachi, Ichiro
中科院分区：
文献类型：
--
作者：
Basu, Sanjay;Rehkopf, David H.;Kawachi, Ichiro
我们研究了受美国近代史上最大的社会政策变化影响的低收入美国妇女的健康：1996年福利改革。使用行为风险因素监测系统（1993-2012），我们进行了2种类型的分析。首先，我们使用差异中的差异分析来估计福利改革与健康结果之间的关联，其中受影响最大的妇女（1997年18-64岁的单身母亲; n = 219，469）与受影响较小的妇女（1997年相同年龄范围的已婚母亲，单身非母亲和已婚非母亲; n = 2，422，265）相比。我们还使用了一种综合控制方法，通过对受影响较小的群体的结果进行加权，以匹配单身母亲改革前的结果，为单身母亲构建了一个更理想的控制组。在这两个规格，受福利改革影响最大的群体（单身母亲）经历了更糟糕的健康结果比受改革影响较小的对照组。例如，在控制了年龄、教育水平和医疗保险状况后，改革与酗酒至少增加4.0个百分点（95%置信区间：0.9，7.0）和能够负担医疗费用的概率减少2.4个百分点（95%置信区间：0.1，4.8）相关。虽然改革因减少对福利的依赖而受到赞扬，但它们可能对健康产生了不利影响。
We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health.