Unstable Income, Rising Stress? The Effects of Income Instability on Psychological and Physiological Health

摘要/摘要 穷人的身心健康状况极差。造成这些问题的原因有很多 考虑到了收入差距，包括低收入。但是，贫困家庭的收入不仅是 低，但往往也不稳定和不可预测。这种不稳定性造成了关于 他们是否能够保障自己未来的福祉。根据不平衡负载 框架，长时间激活生理应激反应将导致 增加心血管疾病和与年龄相关的代谢性疾病的风险， 促进认知功能减退和痴呆，加速细胞衰老。 本R01将研究收入不稳定对心理和身体的因果影响 穷人的健康。我们的具体目标是：1)确定收入不稳定对 心理健康(如抑郁、焦虑)、压力的生物标记物(如皮质醇)和身体 健康(如血压)，2)将目标1中确定的影响分解为 可预测和不可预测的不稳定性，以及与增加平均值的影响相比 收入水平；3)调查对健康产生影响的渠道， 包括经济和行为渠道，并估计关键缓和的影响 因素(例如年龄、性别、基线精神健康)。 审判将在孟加拉国西南部进行。我们将操纵收入不稳定 通过改变工作换现金参与者的工作小时数(从而改变收入) 程序。第一个治疗臂的参与者将有一个固定的工作时间表， 每期工作时间和收入。第二个治疗机构的工作时间和收入会有所不同 时间，但波动将提前知道。最后，工作时数和 第三个治疗部门的收益将出现不可预测的波动。这些武器中的每一个都将是 与接受调查但没有提供额外工作的控制组相比。重要的是，我们 将在保持平均收入水平不变的同时改变收入不稳定性，以便 将不稳定的影响从水平效应中分离出来。 这项研究将创造1867个新的工作岗位，这些工作岗位在精益工作期间是无法获得的 工作机会稀缺的季节。干预措施的设计是为了让就业机会 不能让他们比在没有研究的情况下更糟糕。

Summary/Abstract The poor suffer disproportionally from poor mental and physical health. Many causes for these disparities have been considered, including low income. But, poor families' incomes are not only low, but also often unstable and unpredictable. This instability creates uncertainty about whether they will be able to safeguard their future wellbeing. According to the allostatic load framework, prolonged activation of physiological stress responses will cause “wear and tear” on the body, heightening risks of cardiovascular disease and of age-related metabolic diseases, promoting cognitive decline and dementia, and accelerating cellular aging. This R01 will study the causal effects of income instability on the psychological and physical health of the poor. Our specific aims are to: 1) Identify the causal effect of income instability on psychological health (e.g. depression, anxiety), biomarkers of stress (e.g. cortisol), and physical health (e.g. blood pressure), 2) Decompose the effects identified in aim 1 into the effects of predictable and unpredictable instability and compare to the impact of increasing the average level of income, and 3) Investigate the channels through which effects on health occur, including both economic and behavioral channels and estimate the impact of key moderating factors (e.g. age, gender, baseline mental health). The trial will be conducted in southwestern Bangladesh. We will manipulate income instability by varying the number of work hours (and hence earnings) of participants in a cash-for-work program. Participants in the first treatment arm will have a fixed work schedule, with the same hours and earning each period. The hours and earnings of a second treatment arm will vary over time, but the fluctuations will be known in advance. Finally, the number of work hours and earnings of a third treatment arm will fluctuate unpredictably. Each of these arms will be compared to a control group that is surveyed, but not offered additional work. Importantly, we will vary income instability while holding the average level of income constant in order to disentangle the impact of instability from the level-effect. The study will create 1,867 new jobs that would not otherwise be available during the lean season when jobs are scarce. The intervention has been designed so that the job opportunity cannot make them worse off than they would otherwise have been in the absence of research.