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.

项目总结/摘要 美国有超过1100万儿童生活在贫困中。也有大量的种族 儿童贫困的差距。2019年，8.3%的白色儿童和7.3%的亚裔儿童 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困中， 贫困经历过童年贫困的成年人更有可能有更糟糕的健康结果， 没有经历过童年贫困的成年人，包括报告良好的一般健康状况的几率降低50% 患心脏病的几率高出71%童年贫困对成年后健康的影响很大- 有记录可查，但很少有研究探讨经济政策对这种关系的长期影响。福利 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 需要资金支持自从各州开始实施福利改革以来，大约25年过去了， 从限制较少和更慷慨的福利分配形式，通过援助家庭， 受抚养儿童（AFDC）计划，以一个更具惩罚性和较不慷慨的形式，通过临时 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， 2020年，TANF仅为160万名儿童提供服务，表明福利福利分配大幅减少。由于 鉴于财政资源与健康之间的密切联系，经济政策可作为潜在的干预措施， 促进人口健康，减少社会经济（SES）健康差距。福利改革研究 已经发现这一政策变化对短期健康结果的重要影响，包括减少 获得医疗保险的机会和医疗保健利用率下降。这些发现表明， 由于福利改革而产生的长期健康结果，尽管这方面的研究有限。长期研究 其他安全网政策的影响，如食品券计划，发现更多的好处是 与更好的长期健康相关。我们建议填补这一空白的长期健康影响的研究， 社会福利改革。首先，我们评估了国家层面的变化，在儿童之间的关系， SES和自我评估的健康，慢性疾病，以及成年后的心理困扰，以了解如何状态 背景可能导致更大或更小的健康差距植根于儿童SES。根据其他调查结果， 研究检查成人健康差异的州一级变化，我们希望找到州一级的变化， 这种变化是由家庭经济地位较低的成年人造成的。其次，我们量化了 对儿童社会经济地位与自我评估的健康状况、慢性病之间的关系进行福利改革， 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因种族而异， 种族我们假设福利改革将对低社会经济地位人群的长期健康产生负面影响 样本，并为这些影响是特别有害的个人谁是西班牙裔和/或黑人。