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

项目摘要/摘要 美国有1100多万儿童生活在贫困中。还有大量的种族问题 儿童贫困方面的差距。2019年，8.3%的白人儿童和7.3%的亚洲儿童 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 贫穷。与之相比，经历过童年贫困的成年人更有可能有更差的健康结果 对于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% 患心脏病的几率要高出71%。儿童贫困对随后的成人健康的影响是好的- 但很少有研究考察经济政策对这种关系的长期影响。福利 改革代表着20世纪90年代美国向美国人分配现金福利的方式发生了重大转变 需要资金支持。自从各州开始实施福利改革以来，已经过去了大约25年， 通过援助从限制较少和更慷慨的福利分配形式转向有经济困难的家庭 受抚养儿童(AFDC)方案，通过临时的 援助贫困家庭(TANF)计划。在1994年的鼎盛时期，AFDC为960万儿童提供服务，而 2020年，TANF只为160万儿童提供了服务，这表明福利分配大幅减少。到期 由于财政资源和卫生之间的密切联系，经济政策可以作为潜在的干预措施 促进人口健康，缩小社会经济(SES)健康差距。关于福利改革的研究 发现了这一政策变化对短期健康结果的重要影响，包括减少 获得医疗保险和降低医疗保健利用率。这些发现暗示了潜在的负面影响。 福利改革带来的长期健康结果，尽管这一领域的研究有限。关于长期发展的研究 其他安全网政策的影响，如食品券计划，发现更多的好处是 与更好的长期健康有关。我们建议填补这一空白的长期健康影响的研究 随着这个项目的福利改革。首先，我们评估了儿童与儿童之间关系的州水平差异 了解自测的健康状况、慢性病及成年后的心理困扰情况 背景可能导致根植于儿童自闭症的更大或更小的健康差距。基于来自其他机构的调查结果 检查成人健康差异的州水平差异的研究，我们预计会发现州水平差异，以及 这种变异是由家庭SES较低的成年人推动的。其次，我们量化了 关于儿童自尊心与自测健康、慢性病和 成年后的心理困扰。最后，由于福利管理中存在种族歧视的证据， 我们估计福利改革的长期健康影响在多大程度上基于种族和 种族问题。我们假设，福利改革将对低社会经济地位的人产生负面的长期健康影响 样本，这些影响对西班牙裔和/或黑人个人尤其有害。

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.