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不佳。这些原因很多 考虑到了包括低收入在内的不平等现象。但是，贫困家庭的收入不仅 低，但也往往不稳定和不可预测。这种不稳定性造成了不确定性， 他们是否能够保障自己未来的福祉。根据非稳态负荷 框架，长期激活生理应激反应将导致“磨损” 身体，增加心血管疾病和与年龄有关的代谢疾病的风险， 促进认知能力下降和痴呆，加速细胞衰老。 本R 01将研究收入不稳定对心理和生理的因果影响。 穷人的健康。我们的具体目标是：1）确定收入不稳定的因果影响， 心理健康（如抑郁、焦虑）、压力生物标志物（如皮质醇）和身体健康 （2）将目标1中确定的影响分解为以下影响： 可预测和不可预测的不稳定性，并与平均值增加的影响进行比较 收入水平，以及3）调查对健康产生影响的渠道， 包括经济和行为渠道，并估计关键调节的影响， 因素（如年龄、性别、基线心理健康）。 试验将在孟加拉国西南部进行。我们将操纵收入不稳定 通过改变以现金支付工资的参与者的工作小时数（从而改变收入）， 程序.第一治疗组的受试者将有固定的工作时间表， 每一个时间，每一个时间，每一个时间。第二个治疗组的工作时间和收入将随时间变化。 时间，但波动将提前知道。最后，工作时间和 第三治疗组的收入将不可预测地波动。每只手臂都将 与对照组相比，对照组接受调查，但没有提供额外的工作。重要的是我们 将改变收入不稳定性，同时保持平均收入水平不变， 把不稳定性的影响与水平效应分开。 该研究将创造1，867个新工作岗位，这些工作岗位在经济衰退期间是无法提供的 工作稀缺的季节。干预措施的设计是为了让就业机会 并不能使他们比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.