Association of family income supplements in adolescence with development of psychiatric and substance use disorders in adulthood among an American Indian population

Family cash transfers in childhood and birthing persons and birth outcomes later in life

Much literature in the US documents an intergenerational transmission of birthing person and perinatal morbidity in socioeconomically disadvantaged groups. A separate line of work indicates that family cash transfers may improve life chances of low-income families well into adulthood. By exploiting a quasi-random natural experiment of a large family cash transfer among a southeastern American Indian (AI) tribe in rural North Carolina, we examine whether a "perturbation" in socioeconomic status during childhood improves birthing person/perinatal outcomes when they become parents themselves. We acquired birth records on 6805 AI and non-AI infants born from 1995 to 2018. Regression methods to examine effect modification tested whether the birthing person's American Indian (AI) status and exposure to the family cash transfer during their childhood years corresponds with improvements in birthing person and perinatal outcomes. Findings show an increase in age at childbearing (coef: 0.15 years, 95% confidence interval [CI]: 0.05, 0.25) and a decrease in pre-pregnancy body mass index (BMI; coef: -0.42, 95% CI: -0.76, -0.09) with increased duration of cash transfer exposure during childhood. The odds of large-for-gestational age at delivery, as well as mean infant birthweight, is also reduced among AI births whose birthing person had relatively longer duration of exposure to the cash transfer. We, however, observe no relation with other birthing person/perinatal outcomes (e.g., tobacco use during pregnancy, preterm birth). In this rural AI population, cash transfers in one generation correspond with improved birthing person and infant health in the next generation.

Intergenerational Effects of a Family Cash Transfer on the Home Environment

OBJECTIVE

A natural experiment that provided income supplements to families has been associated with beneficial outcomes for children that persisted into adulthood. The children in this study are now adults, and many are parents.

METHOD

The study builds on the longitudinal, representative Great Smoky Mountains study conducted from 1993 to 2020. At follow-up in their late 30s, 1,094 of the 1,348 living participants (81.2%) were assessed. Of these participants (67.6%), 739 were parents. A tribe in the area implemented a cash transfer program of approximately $5,000 annually per person to every tribal member based on the profits received from operating a casino. Ten aspects of the home environment of participants were assessed (eg, family chaos, substance use, and food insecurity) as well as a composite measure across all home environment indicators. The proposed analyses were preregistered (https://osf.io/ex638).

RESULTS

Of the 739 parents assessed, 192 (26.0%) were American Indians. Parents whose families received cash transfers during childhood did not differ from parents whose families did not receive cash transfers on any of the home environment indicators or the composite measure. At the same time, there was little evidence of elevated risk for participants in either group in measures of parental mental health, substance use, and violence.

CONCLUSION

A family cash transfer in childhood that had long-term effects on individual functioning did not impact the home environment of participants who became parents. Rather, parents in both groups were providing home environments generally conducive to their children's growth and development.

STUDY PREREGISTRATION INFORMATION

Intergenerational Effects of a Family Cash Transfer on the Home Environment; https://osf.io/; ex638.

Major stress in early childhood strengthens the association between peripheral inflammatory activity and corticostriatal responsivity to reward

BACKGROUND

Severe, chronic stress during childhood accentuates vulnerability to mental and physical health problems across the lifespan. To explain this phenomenon, the neuroimmune network hypothesis proposes that childhood stressors amplify signaling between peripheral inflammatory cells and developing brain circuits that support processing of rewards and threats. Here, we conducted a preliminary test of the basic premises of this hypothesis.

METHODS

180 adolescents (mean age = 19.1 years; 68.9 % female) with diverse racial and ethnic identities (56.1 % White; 28.3 % Hispanic; 26.1 % Asian) participated. The Childhood Trauma Interview was administered to quantify early adversity. Five inflammatory biomarkers were assayed in antecubital blood - C-reactive protein, tumor necrosis factor-a, and interleukins-6, -8, and -10 - and were averaged to form a composite score. Participants also completed a functional MRI task to measure corticostriatal responsivity to the anticipation and acquisition of monetary rewards.

RESULTS

Stress exposure and corticostriatal responsivity interacted statistically to predict the inflammation composite. Among participants who experienced major stressors in the first decade of life, higher inflammatory activity covaried with lower corticostriatal responsivity during acquisition of monetary rewards. This relationship was specific to participants who experienced major stress in early childhood, implying a sensitive period for exposure, and were evident in both the orbitofrontal cortex and the ventral striatum, suggesting the broad involvement of corticostriatal regions. The findings were independent of participants' age, sex, racial and ethnic identity, family income, and depressive symptoms.

CONCLUSIONS

Collectively, the results are consistent with hypotheses suggesting that major stress in childhood alters brain-immune signaling.

Psychometric properties of the family assessment task parental monitoring scenario among adolescents receiving substance use treatment

INTRODUCTION

The Family Assessment Task (FAsTask) is an observer-rated parent-child interaction task used in adolescent substance use intervention. The parental monitoring component of the FAsTask is thought to provide an objective assessment of parental monitoring that can guide treatment planning and circumvent the potential limitations of self-report measures. Yet, the factor structure, measurement invariance, and concurrent validity of the parental monitoring FAsTask has not been evaluated; doing so is essential to effectively guide clinical care. This study examined if the parental monitoring FAsTask can be reliably administered across adolescent age and sex, and to identify which components of the parental monitoring FAsTask are most consistently associated with adolescent substance use.

METHODS

The study pooled data from 388 adolescent-caregiver dyads across six separate clinical trials (adolescents [Mage = 15.7, 57.5% male, 61.9% White, 31.2% Latine]; caregivers [Mage = 42.14, 88.7% female, 72.7% White, 24.2% Latine]). Dyads completed the FAsTask and the Timeline Followback at baseline, prior to randomization. Analyses proceeded in three steps. First, exploratory factor analysis (EFA) was conducted in half of the sample, followed by a confirmatory factor analysis (CFA) in the second half of the sample. Second, measurement invariance was tested as a function of adolescent age and biological sex. Third, a series of structural equation models were used to assess the associations of each factor with alcohol use, binge drinking, and cannabis use.

RESULTS

EFA and CFA indicated the presence of four factors (labeled Supervised/Structured, Active Monitoring, Task Engagement, and Parental Rules/Strategies). Evidence of measurement invariance was found across adolescent age and sex. The Supervision/Structure was negatively associated with adolescent alcohol use, binge drinking, and cannabis use.

CONCLUSIONS

The parental monitoring FAsTask demonstrates validity and retains its structure across adolescent age and sex. Items focused on parental supervision and structure are most strongly associated with adolescent substance use and may best inform clinical care for adolescent substance use.

Reflections on resilience

Resilience research has long sought to understand how factors at the child, family, school, community, and societal levels shape adaptation in the face of adversities such as poverty and war. In this article we reflect on three themes that may prove to be useful for future resilience research. First is the idea that mental and physical health can sometimes diverge, even in response to the same social process. A better understanding of explanations for this divergence will have both theoretical and public health implications when it comes to efforts to promote resilience. Second is that more recent models of stress suggest that stress can accelerate aging. Thus, we suggest that research on resilience may need to also consider how resilience strategies may need to be developed in an accelerated fashion to be effective. Third, we suggest that if psychological resilience interventions can be conducted in conjunction with efforts to enact system-level changes targeted at adversities, this may synergize the impact that any single intervention can have, creating a more coordinated and effective set of approaches for promoting resilience in young people who confront adversity in life.

The Effect of Income and Wealth on Behavioral Strategies, Personality Traits, and Preferences

Individuals living in either harsh or favorable environments display well-documented psychological and behavioral differences. For example, people in favorable environments tend to be more future-oriented, trust strangers more, and have more explorative preferences. To account for such differences, psychologists have turned to evolutionary biology and behavioral ecology, in particular, the literature on life-history theory and pace-of-life syndrome. However, critics have found that the theoretical foundations of these approaches are fragile and that differences in life expectancy cannot explain vast psychological and behavioral differences. In this article, we build on the theory of optimal resource allocation to propose an alternative framework. We hypothesize that the quantity of resources available, such as income, has downstream consequences on psychological traits, leading to the emergence of behavioral syndromes. We show that more resources lead to more long-term orientation, more tolerance of variance, and more investment in low marginal-benefit needs. At the behavioral level, this translates, among others, into more large-scale cooperation, more investment in health, and more exploration. These individual-level differences in behavior, in turn, account for cultural phenomena such as puritanism, authoritarianism, and innovation.

Casino-based cash transfers and fertility among the Eastern Band of Cherokee Indians in North Carolina: A time-series analysis

Fertility decline remains a key concern among high-income countries. Prior research indicates that income supplementation through unconditional cash transfers (UCT) may correspond with increased fertility. We examine whether a casino-based UCT, in the form of per capita (percap) payments to members of the Eastern Band of Cherokee Indians (EBCI) corresponds with an acute increase in fertility. We use North Carolina vital statistics datasets from 1990 to 2006 and apply time-series analysis methods to examine the relation between specific months of percap payments (exposure) and monthly number of conceptions that result in live births (outcome) among the EBCI. We control for autocorrelation and monthly counts of births (arrayed by conception cohorts) among white women (ineligible for UCT receipt) in the study region. Results indicate an increase in conceptions that result in live births at 1 and 3 months after percap receipt among EBCI women aged ≥20 years (exposure month lag 1 coefficient = 1.74, p = 0.03; exposure month lag 3 coefficient = 1.60, p = 0.04). Exploratory analyses indicate that the observed fertility increase concentrates among primiparae EBCI women. We do not find any association between percap payment timing and births to EBCI women aged <20 years.

Social Determinants of Health: An Overview for the Primary Care Provider

Social determinants of health (SDoH) are reflected in how people live (access to health care, economic stability, built environment, food security, climate), learn (the educational environment), work (occupational environment), and play/socialize (social context and digital domain). All of these day-to-day conditions play a vital role in a patient's overall health, and a primary care provider should be prepared to understand their role to screen, assess, and address SDoH in clinical practice.

Poverty and Health Inequities in Children Investigated by Child Protective Services

The objective of our study was to examine the association between poverty and child health outcomes in school-age children referred to child protective services. We conducted a secondary analysis of children aged 5 to 9 years in the Second National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal observational data set of children referred to protective services for maltreatment (2008-2012). We analyzed the association of poverty, defined as family income below the federal poverty level (FPL), with caregiver report of the child's overall health, primary care, and emergency department visits using Pearson's chi-squared test. Children below FPL compared with children above it had poorer overall health (29.8% vs 18.0%, P = .03). We also conducted a longitudinal multivariable logistic regression analysis and found poverty was associated with the child's poorer overall health at 36 months (odds ratios 2.78, 95% confidence interval 1.55-5.01). Future studies and interventions to improve health in this at-risk population should target poverty.

Associations between early poverty exposure and adolescent well-being: The role of childhood negative emotionality

Using a longitudinal design (Wave 1 n = 164, Mage = 3.57 years, 54% female, predominantly White and French-speaking), the current study sought to answer two questions: 1) does poverty influence children's negative emotionality through heightened family-level, poverty-related stress? and 2) is negative emotionality, in turn, predictive of adolescent internalizing symptoms, externalizing behaviors, cognitive abilities, and physical health? Results confirmed an indirect pathway from family poverty to child emotionality through poverty-related stress. In addition, negative emotionality was associated with adolescent internalizing symptoms, attention difficulties, and physical health, but not externalizing symptoms, even when controlling for early poverty exposure.

Predicting Adolescent Mental Health Outcomes Across Cultures: A Machine Learning Approach

Adolescent mental health problems are rising rapidly around the world. To combat this rise, clinicians and policymakers need to know which risk factors matter most in predicting poor adolescent mental health. Theory-driven research has identified numerous risk factors that predict adolescent mental health problems but has difficulty distilling and replicating these findings. Data-driven machine learning methods can distill risk factors and replicate findings but have difficulty interpreting findings because these methods are atheoretical. This study demonstrates how data- and theory-driven methods can be integrated to identify the most important preadolescent risk factors in predicting adolescent mental health. Machine learning models examined which of 79 variables assessed at age 10 were the most important predictors of adolescent mental health at ages 13 and 17. These models were examined in a sample of 1176 families with adolescents from nine nations. Machine learning models accurately classified 78% of adolescents who were above-median in age 13 internalizing behavior, 77.3% who were above-median in age 13 externalizing behavior, 73.2% who were above-median in age 17 externalizing behavior, and 60.6% who were above-median in age 17 internalizing behavior. Age 10 measures of youth externalizing and internalizing behavior were the most important predictors of age 13 and 17 externalizing/internalizing behavior, followed by family context variables, parenting behaviors, individual child characteristics, and finally neighborhood and cultural variables. The combination of theoretical and machine-learning models strengthens both approaches and accurately predicts which adolescents demonstrate above average mental health difficulties in approximately 7 of 10 adolescents 3-7 years after the data used in machine learning models were collected.

The Intergenerational Transmission of Maladaptive Parenting and its Impact on Child Mental Health: Examining Cross-Cultural Mediating Pathways and Moderating Protective Factors

Using a sample of 1338 families from 12 cultural groups in 9 nations, we examined whether retrospectively remembered Generation 1 (G1) parent rejecting behaviors were passed to Generation 2 (G2 parents), whether such intergenerational transmission led to higher Generation 3 (G3 child) externalizing and internalizing behavior at age 13, and whether such intergenerational transmission could be interrupted by parent participation in parenting programs or family income increases of > 5%. Utilizing structural equation modeling, we found that the intergenerational transmission of parent rejection that is linked with higher child externalizing and internalizing problems occurs across cultural contexts. However, the magnitude of transmission is greater in cultures with higher normative levels of parent rejection. Parenting program participation broke this intergenerational cycle in fathers from cultures high in normative parent rejection. Income increases appear to break this intergenerational cycle in mothers from most cultures, regardless of normative levels of parent rejection. These results tentatively suggest that bolstering protective factors such as parenting program participation, income supplementation, and (in cultures high in normative parent rejection) legislative changes and other population-wide positive parenting information campaigns aimed at changing cultural parenting norms may be effective in breaking intergenerational cycles of maladaptive parenting and improving child mental health across multiple generations.

Impact of Guaranteed Income on Health, Finances, and Agency: Findings from the Stockton Randomized Controlled Trial

The purpose of this experiment was to test the effects of a $500 per month guaranteed income for 2 years on health and financial outcomes. A mixed-methods randomized controlled trial in Stockton, CA, USA enrolled 131 individuals to the treatment condition and 200 to control to receive a guaranteed income from February 2019 to January 2021. Quantitative data collection began 3 months prior to allocation at 6-month intervals concluding 6 months after withdrawal of the intervention. Qualitative data collection included 105 interviews across 3 stages. The primary outcomes were income volatility, physical and mental health, agency, and financial wellbeing. The treatment condition reported lower rates of income volatility than control, lower mental distress, better energy and physical functioning, greater agency to explore new opportunities related to employment and caregiving, and better ability to weather pandemic-related financial volatility. Thus, this study provides causal evidence of positive health and financial outcomes for recipients of guaranteed income. As income volatility is related to poor health outcomes, provision of a guaranteed income is a potentially powerful public health intervention.

Child Poverty and Health: The Role of Income Support Policies

Policy Points Child poverty is associated with both short- and long-term health and well-being, and income support policies can be used to improve child health. This article reviews the types of income support policies used in the United States and the evidence of the effectiveness of these policies in improving child health, highlighting areas for future research and policy considerations specific to income support policies.

The role of stress phenotypes in understanding childhood adversity as a transdiagnostic risk factor for psychopathology

Childhood adversity is a leading transdiagnostic risk factor for psychopathology, being associated with an estimated 31-62% of childhood-onset disorders and 23-42% of adult-onset disorders (Kessler et al., 2010). Major unresolved theoretical challenges stem from the nonspecific and probabilistic nature of the links between childhood adversity and psychopathology. The links are nonspecific because childhood adversity increases risk, through a range of mechanisms, for diverse forms of psychopathology and are probabilistic because not all individuals exposed to childhood adversity develop psychopathology. In this article, we propose a path forward by focusing on stress phenotypes, defined as biobehavioral patterns activated in response to stressors that can disrupt future functioning when persistent (e.g., reward seeking, social withdrawal, aggression). This review centers on the accumulating evidence that psychopathology appears to be more strongly predicted by behavior and biology during states of stress. Building on this observation, our theoretical framework proposes that we can model pathways from childhood adversity to psychopathology with greater specificity and certainty by understanding stress phenotypes, defined as patterns of behavior and their corresponding biological substrates that are elicited by stressors. This approach aims to advance our conceptualization of mediating pathways from childhood adversity to psychopathology. Understanding stress phenotypes will bring us closer to "precision mental health," a person-centered approach to identifying, preventing, and treating psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Designing a generic, adaptive protocol resource for the measurement of health impact in cash transfer pilot and feasibility studies and trials in high-income countries

INTRODUCTION

In the context of the COVID-19 pandemic, upstream interventions that tackle social determinants of health inequalities have never been more important. Evaluations of upstream cash transfer trials have failed to capture comprehensively the impacts that such systems might have on population health through inadequate design of the interventions themselves and failure to implement consistent, thorough research measures that can be used in microsimulations to model long-term impact. In this article, we describe the process of developing a generic, adaptive protocol resource to address this issue and the challenges involved in that process. The resource is designed for use in high-income countries (HIC) but draws on examples from a UK context to illustrate means of development and deployment. The resource is capable of further adaptation for use in low- and middle-income countries (LMIC). It has particular application for trials of Universal Basic Income but can be adapted to those covering other kinds of cash transfer and welfare system changes.

METHODS

We outline two types of prospective intervention based on pilots and trials currently under discussion. In developing the remainder of the resource, we establish six key principles, implement a modular approach based on types of measure and their prospective resource intensity, and source (validated where possible) measures and baseline data primarily from routine collection and large, longitudinal cohort studies. Through these measures, we seek to cover all areas of health impact identified in our theoretical model for use in pilot and feasibility studies.

RESULTS

We find that, in general, self-reported measures alongside routinely collected linked respondent data may provide a feasible means of producing data capable of demonstrating comprehensive health impact. However, we also suggest that, where possible, physiological measures should be included to elucidate underlying biological effects that may not be accurately captured through self-reporting alone and can enable modelling of long-term health outcomes. In addition, accurate self-reported objective income data remains a challenge and requires further development and testing. A process of development and implementation of the resource in pilot and feasibility studies will support assessment of whether or not our proposed health outcome measures are acceptable, feasible and can be used with validity and reliability in the target population.

DISCUSSION

We suggest that while Open Access evaluation instruments are available and usable to measure most constructs of interest, there remain some areas for which further development is necessary. This includes self-reported wellbeing measures that require paid licences but are used in a range of nationally important longitudinal studies instead of Open Access alternatives.

Child Tax Credit, Spending Patterns, and Mental Health: Mediation Analyses of Data from the U.S. Census Bureau's Household Pulse Survey during COVID-19

This study examined the relationship between the receipt of COVID-19 child tax credit and adult mental health problems in the United States, and we explored whether and the extent to which a wide range of spending patterns of the credit-15 patterns regarding basic necessities, child education, and household expenditure-mediated the relationship. We used COVID-19-specialized data from the U.S. Census Bureau's Household Pulse Survey, a representative population sample (N = 98,026) of adult respondents (18 and older) who participated between 21 July 2021 and 11 July 2022. By conducting mediation analyses with logistic regression, we found relationships between the credit and lower levels of anxiety (odds ratio [OR] = 0.914; 95% confidence interval [CI] = 0.879, 0.952). The OR was substantially mediated by spending on basic necessities such as food and housing costs (proportion mediated = 46% and 44%, respectively). The mediating role was relatively moderate in the case of spending on child education and household expenditure. We also found that spending the credit on savings or investments reduces the effect of the child tax credit on anxiety (-40%) while donations or giving to family were not a significant mediator. Findings on depression were consistent with anxiety. The child tax credit-depression relationships were substantially mediated by spending on food and housing (proportion mediated = 53% and 70%). These mediation analyses suggested that different patterns of credit spending are important mediators of the relationship between the receipt of the child tax credit and mental illnesses. Public health approaches to improve adult mental health during and after the COVID-19 pandemic need to consider the notable mediating role of spending patterns.

Potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people: A conceptual framework and lines of enquiry for research and policy

Mental health is inextricably linked to both poverty and future life chances such as education, skills, labour market attachment and social function. Poverty can lead to poorer mental health, which reduces opportunities and increases the risk of lifetime poverty. Cash transfer programmes are one of the most common strategies to reduce poverty and now reach substantial proportions of populations living in low- and middle-income countries. Because of their rapid expansion in response to the COVID-19 pandemic, they have recently gained even more importance. Recently, there have been suggestions that these cash transfers might improve youth mental health, disrupting the cycle of disadvantage at a critical period of life. Here, we present a conceptual framework describing potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people. Furthermore, we explore how theories from behavioural economics and cognitive psychology could be used to more specifically target these mechanisms and optimise the impact of cash transfers on youth mental health and life chances. Based on this, we identify several lines of enquiry and action for future research and policy.

Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems

Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population. Structurally, legal instruments and human rights law provide a robust framework to challenge the pervasive drivers of disadvantage linked to caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour. Actions need to consider the historical, economic, and political contexts in which the effects of racism, xenophobia, and discrimination affect health. We propose several specific actions: a commission that explores how we action the approaches laid out in this paper; building a conversation and a series of events with international multilateral agency stakeholders to raise the issue and profile of racism, xenophobia, and discrimination within health; and using our multiple platforms to build coalitions, expand knowledge, highlight inequities, and advocate for change across the world.

Cumulative Payments Through the Earned Income Tax Credit Program in Childhood and Criminal Conviction During Adolescence in the US

IMPORTANCE

Childhood poverty is associated with poor health and behavioral outcomes. The Earned Income Tax Credit (EITC), first implemented in 1975, is the largest cash transfer program for working families with low income in the US.

OBJECTIVE

To assess whether cumulative EITC payments received during childhood are associated with the risk of criminal conviction during adolescence.

DESIGN, SETTING, AND PARTICIPANTS

In this cohort study, the analytic sample consisted of US children enrolled in the 1979 National Longitudinal Study of Youth. The children were born between 1979 and 1998 and were interviewed as adolescents (age 15-19 years) between 1994 and 2016. Data analyses were performed from May 2021 to September 2022.

EXPOSURE

Cumulative simulated EITC received by the individual's family from birth through age 14 years.

MAIN OUTCOMES AND MEASURES

The main outcome was dichotomous, self-reported conviction for a crime during adolescence (age 14-18 years). A cumulative, simulated measure of mean EITC benefits received by a child's family from birth through age 14 years was derived from federal, state, and family-size differences in EITC eligibility and payments during the study period to capture EITC benefit variation due to differences in policy parameters but not endogenous factors such as changes in household income. Logistic regression models with fixed effects for state and year and robust SEs clustered by mother estimated relative risk of adolescent conviction. Models were adjusted for state-, mother-, and child-level covariates.

RESULTS

The analytical sample consisted of 5492 adolescents born between 1979 and 1998; 2762 (50.3%) were male, 1648 (30.0%) were Black, 1125 (20.5%) were Hispanic, and 2719 (49.5%) were not Black or Hispanic. Each additional $1000 of EITC received during childhood was associated with an 11% lower risk of self-reported criminal conviction during adolescence (adjusted odds ratio, 0.89; 95% CI, 0.84-0.95). Adjusted risk differences were larger among boys (-14.2 self-reported convictions per 1000 population [95% CI, -22.0 to -6.3 per 1000 population]) than among girls (-6.2 per 1000 population [95% CI, -10.7 to -1.6 per 1000 population]).

CONCLUSIONS AND RELEVANCE

The findings suggest that income support from the EITC may be associated with reduced youth involvement with the criminal justice system in the US. Cost-benefit analyses of the EITC should consider these longer-term and indirect outcomes.

Long-term Outcomes of Childhood Family Income Supplements on Adult Functioning

Importance

During an ongoing longitudinal cohort study, a casino opening created a natural cash transfer experiment. Some participating families received income supplements, and others did not. The children in this study are now adults.

Objective

To assess the long-term outcomes of family income supplements received in childhood.

Design, Setting, and Participants

This community-representative longitudinal cohort study set in western North Carolina assessed 1266 participants aged 9, 11, and 13 years at intake up to 11 times up to age 30 years from January 1993 to December 2015. Data were analyzed from January to December 2021.

Exposures

In 1996, a southeastern American Indian tribe implemented a cash transfer program of approximately $5000 annually per person for tribal members. Participants were compared on whether their family ever received the cash transfers (American Indian vs non-American Indian), the duration of the transfers, and annual amount based on the number of parents.

Main Outcomes and Measures

Participants were followed up at ages 25 and 30 years to assess mental health symptoms, substance use symptoms, and functional outcomes (physical health, risky or illegal behaviors, and financial and social functioning).

Results

Of 1266 included participants, 320 (25.3%) were American Indian and 581 (49.7%) were female. Participants whose families received cash transfers during childhood reported fewer anxiety symptoms (relative risk [RR], 0.33; 95% CI, 0.25-0.44), depressive symptoms (RR, 0.51; 95% CI, 0.42-0.62), and cannabis symptoms (RR, 0.47; 95% CI, 0.27-0.82). They also reported improved physical health (RR, 0.66; 95% CI, 0.55-0.80) and financial functioning (RR, 0.78; 95% CI, 0.67-0.89) and fewer risky or illegal behaviors (RR, 0.57; 95% CI, 0.46-0.72) compared with those who did not receive the cash transfer. This pattern was supported by a series of heterogeneity analyses in which children whose families received the transfers for the longest duration and whose families received the largest transfer (due to having multiple American Indian parents) had the lowest levels of symptoms and the highest levels of functioning.

Conclusions and Relevance

In this natural experiment, a family cash transfer in childhood was associated with positive adult functioning 20 years later. The findings support programs like the child tax credit or universal basic income that provide cash directly to families with children.

Cost of resilience: Childhood poverty, mental health, and chronic physiological stress

Childhood poverty is associated with elevated internalizing symptoms. Nevertheless, some children exposed to poverty evince remarkable resilience, demonstrating lower than expected levels of psychological distress. However, recent work suggests that coping with adversity can lead to undesirable physical health consequences. Specifically, successful adaptation in the context of early adversity, including socioeconomic disadvantage, appears to be associated with elevated chronic physiological stress and ill health. The current study adds to this emerging literature by examining in a longitudinal context whether low levels of internalizing symptoms in the face of childhood poverty is accompanied by elevated chronic physiological stress (allostatic load) during childhood, as well as over time from childhood to adulthood. Results (n = 341; M=9.2 years, 49 % female; 94 % Caucasian) show that childhood poverty was prospectively associated with higher allostatic load during adolescence, controlling for baseline allostatic load. Furthermore, greater duration of childhood poverty led to steeper, more elevated allostatic load trajectories from childhood to adulthood, for youth with lower levels of internalizing symptoms. Efforts to manage adverse sequelae of early adversity likely yield a complex array of benefits and costs.

Disentangling the "who" and "when" of parents' depressive symptoms: A daily diary study analysis

Parents' depressive symptoms vary across days, but factors predicting this fluctuation are not well understood. The present study utilized ecological momentary assessments to capture 1620 days of parents' lived experience in a diverse sample of 146 mothers and fathers from Appalachia who reported on daily fluctuation in family chaos, family financial hardship, and lack of social support, as well as depressive symptoms every day for 14 consecutive days. Data were analyzed using a multilevel modeling framework. Results reveal that on days when parents experience higher family chaos, higher family financial hardship, and lower social support than they typically do, they also experience greater depressive symptoms. Daily linkages between low social support and depressive symptoms were uniform across families. In contrast, daily linkages between depressive symptoms and family financial hardship and chaos were strongest among families who experienced chronic levels of adversity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and meta-analysis

BACKGROUND

Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16-64 years).

METHODS

For this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, PsycINFO, ASSIA, EconLit, and RePEc on Feb 5, 2020, for randomised controlled trials (RCTs) and quantitative non-randomised studies. We had no date limits for our search. We included English-language studies measuring effects of individual or household income change on any mental health or wellbeing outcome. We used Cochrane risk of bias (RoB) tools. We conducted three-level random-effects meta-analyses, and explored heterogeneity using meta-regression and stratified analyses. Synthesis without meta-analysis was based on effect direction. Critical RoB studies were excluded from primary analyses. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered with PROSPERO, CRD42020168379.

FINDINGS

Of 16 521 citations screened, 136 were narratively synthesised (12·5% RCTs) and 86 meta-analysed. RoB was high: 30·1% were rated critical and 47·1% serious or high. A binary income increase lifting individuals out of poverty was associated with 0·13 SD improvement in mental health measures (95% CI 0·07 to 0·20; n=42 128; 18 studies), considerably larger than other income increases (0·01 SD improvement, 0·002 to 0·019; n=216 509, 14 studies). For wellbeing, increases out of poverty were associated with 0·38 SD improvement (0·09 to 0·66; n=101 350, 8 studies) versus 0·16 for other income increases (0·07 to 0·25; n=62 619, 11 studies). Income decreases from any source were associated with 0·21 SD worsening of mental health measures (-0·30 to -0·13; n=227 804, 11 studies). Effect sizes were larger in low-income and middle-income settings and in higher RoB studies. Heterogeneity was high (I²=79-87%). GRADE certainty was low or very low.

INTERPRETATION

Income changes probably impact mental health, particularly where they move individuals out of poverty, although effect sizes are modest and certainty low. Effects are larger for wellbeing outcomes, and potentially for income losses. To best support population mental health, welfare policies need to reach the most socioeconomically disadvantaged.

FUNDING

Wellcome Trust, Medical Research Council, Chief Scientist Office, and European Research Council.

Propensity score weighted associations between financial strain and subsequent inflammatory biomarkers of aging among a representative sample of U.S. older adults

BACKGROUND

Despite known socioeconomic disparities in aging-related outcomes, the underlying physiologic mechanisms are understudied. This study applied propensity score weighting to estimate the effect of financial strain on inflammation-related aging biomarkers among a national sample of older adults.

METHODS

Financial strain severe enough to lack money for housing, utilities, medical/prescription bills or food was measured among 4,593 community-dwelling National Health and Aging Trends Study participants aged ≥ 65 years in 2016. Inverse probability propensity score weights were generated based on 2015 background characteristics, including age, gender, race/ethnicity, income to poverty ratio, education, occupation, home ownership, retirement, Sect. 8 housing, Medicaid, food/energy assistance, childhood health, marital status, and U.S. region. Sampling weights additionally accounted for study design and non-response.

RESULTS

In propensity score-weighted analyses adjusting for age, gender, race/ethnicity, 2017 income to poverty ratio and education, those with 2016 financial strain had 15% higher IL-6 (p = 0.026) and 20% higher CRP levels (p = 0.002) in 2017 than those who were not strained, but did not differ with regard to hemoglobin A1c or CMV. In weighted comparisons, those with financial strain did not differ from those without with regard any 2015 background characteristics.

CONCLUSIONS

These results strengthen the etiologic evidence suggesting that financial strain increases inflammatory biomarkers among older adults. Importantly, inflammation is likely a key physiologic pathway contributing to socioeconomic disparities. Therefore, research is needed to address financial strain.

Material resources and well-being - Evidence from an Ethiopian housing lottery

Do better material conditions improve well-being and mental health? Or does any positive relationship merely reflect that well-being promotes economic success? We compare winners and losers from a large Ethiopian housing lottery in a preregistered analysis. Winners gain access to better housing, experience a substantial increase in wealth, and report higher levels of overall life satisfaction and lower levels of financial distress. However, we find no average effects of winning on psychological distress. Our results suggest that not all aspects of well-being and mental health are equally sensitive to economic conditions.

Higher socioeconomic status and less parental psychopathology improve prognosis in youths with bipolar disorder

BACKGROUND

To identify prospectively ascertained individual and family factors that are associated with improvement in Bipolar Disorder (BD) among youths who initially presented with poor course.

METHODS

82 youths with BD with persistent poor mood symptomatology ("predominantly ill course") were compared to 70 youths with BD who at intake had poor course, but showed improvement during the follow-up ("ill with improving course"), (ages 12.3 ± 3.3, vs. 11.7 ± 3.3 years old, at intake). Improvement was measured by the percentage of time euthymic during a mean follow-up of 12.8 years. Youths and parents were interviewed to assess psychopathology, functioning, treatment, and familial functioning and psychopathology.

RESULTS

Compared to the ill group, since intake, the improving group showed significantly lower subthreshold depression and hypo/mania, Attention Deficit Hyperactivity Disorder, and Disruptive Behavior Disorders. Parental Socioeconomic Status (SES) remained unchanged over time in the ill group, but progressively increased in the improving group. Importantly, the change in SES predated the improvement in the mood trajectory. The most influential variables that predicted improvement were higher SES, and absence of parental BD and Substance Use Disorder (SUD). Parental SUD also negatively affected the parental SES, which was directly associated with worse mood course.

LIMITATIONS

Predominantly self-reported White samples may limit generalizability; other factors potentially associated with outcome (e.g., treatment adherence), were not ascertained.

CONCLUSIONS

In addition to treating mood/comorbid psychopathology in symptomatic BD youths, to improve their prognosis, it is crucial to address their parent's BD and SUD and promote parental education/employment.

Demographic and Clinical Presentations of Youth using Enhanced Mental Health Services in Six Indigenous Communities from the ACCESS Open Minds Network

OBJECTIVE

In many Indigenous communities, youth mental health services are inadequate. Six Indigenous communities participating in the ACCESS Open Minds (AOM) network implemented strategies to transform their youth mental health services. This report documents the demographic and clinical presentations of youth accessing AOM services at these Indigenous sites.

METHODS

Four First Nations and two Inuit communities contributed to this study. Youth presenting for mental health services responded to a customized sociodemographic questionnaire and presenting concerns checklist, and scales assessing distress, self-rated health and mental health, and suicidal thoughts and behaviors.

RESULTS

Combined data from the First Nations sites indicated that youth across the range of 11-29 years accessed services. More girls/women than boys/men accessed services; 17% identified as LBGTQ+. Most (83%) youth indicated having access to at least one reliable adult and getting along well with the people living with them. Twenty-five percent of youth reported difficulty meeting basic expenses. Kessler (K10) distress scores indicated that half likely had a moderate mental health problem and a fourth had severe problems. Fifty-five percent of youth rated their mental health as fair or poor, while 50% reported suicidal thoughts in the last month. Anxiety, stress, depression and sleep issues were the most common presenting problems. Fifty-one percent of youth either accessed services themselves or were referred by family members. AOM was the first mental health service accessed that year for 68% of youth.

CONCLUSIONS

This report is the first to present a demographic and clinical portrait of youth presenting at mental health services in multiple Indigenous settings in Canada. It illustrates the acceptability and feasibility of transforming youth mental health services using core principles tailored to meet communities' unique needs, resources, and cultures, and evaluating these using a common protocol. Data obtained can be valuable in evaluating services and guiding future service design. Trial registration name and number at Clinicaltrials.gov: ACCESS Open Minds/ACCESS Esprits ouverts, ISRCTN23349893.

Early Childhood Socioeconomic Status and Cognitive and Adaptive Outcomes at the Transition to Adulthood: The Mediating Role of Gray Matter Development Across Five Scan Waves

BACKGROUND

Early low socioeconomic status (SES) is associated with poor outcomes in childhood, many of which endure into adulthood. It is critical to determine how early low SES relates to trajectories of brain development and whether these mediate relationships to poor outcomes. We use data from a unique 17-year longitudinal study with five waves of structural brain imaging to prospectively examine relationships between preschool SES and cognitive, social, academic, and psychiatric outcomes in early adulthood.

METHODS

Children (n = 216, 50% female, 47.2% non-White) were recruited from a study of early onset depression and followed approximately annually. Family income-to-needs ratios (SES) were assessed when children were ages 3 to 5 years. Volumes of cortical gray and white matter and subcortical gray matter collected across five scan waves were processed using the FreeSurfer Longitudinal pipeline. When youth were ages 16+ years, cognitive function was assessed using the NIH Toolbox, and psychiatric diagnoses, high-risk behaviors, educational function, and social function were assessed using clinician administered and parent/youth report measures.

RESULTS

Lower preschool SES related to worse cognitive, high-risk, educational, and social outcomes (|standardized B| = 0.20-0.31, p values < .003). Lower SES was associated with overall lower cortical (standardized B = 0.12, p < .0001) and subcortical gray matter (standardized B = 0.17, p < .0001) volumes, as well as a shallower slope of subcortical gray matter growth over time (standardized B = 0.04, p = .012). Subcortical gray matter mediated the relationship of preschool SES to cognition and high-risk behaviors.

CONCLUSIONS

These novel longitudinal data underscore the key role of brain development in understanding the long-lasting relations of early low SES to outcomes in children.

Associations between indicators of socioeconomic position and DNA methylation: a scoping review

BACKGROUND

Socioeconomic position (SEP) is a major determinant of health across the life course. Yet, little is known about the biological mechanisms explaining this relationship. One possibility widely pursued in the scientific literature is that SEP becomes biologically embedded through epigenetic processes such as DNA methylation (DNAm), wherein the socioeconomic environment causes no alteration in the DNA sequence but modifies gene activity in ways that shape health.

METHODS

To understand the evidence supporting a potential SEP-DNAm link, we performed a scoping review of published empirical findings on the association between SEP assessed from prenatal development to adulthood and DNAm measured across the life course, with an emphasis on exploring how the developmental timing, duration, and type of SEP exposure influenced DNAm.

RESULTS

Across the 37 identified studies, we found that: (1) SEP-related DNAm signatures varied across the timing, duration, and type of SEP indicator; (2) however, longitudinal studies examining repeated SEP and DNAm measures are generally lacking; and (3) prior studies are conceptually and methodologically diverse, limiting the interpretability of findings across studies with respect to these three SEP features.

CONCLUSIONS

Given the complex relationship between SEP and DNAm across the lifespan, these findings underscore the importance of analyzing SEP features, including timing, duration, and type. To guide future research, we highlight additional research gaps and propose four recommendations to further unravel the relationship between SEP and DNAm.

Policy Implications of the COVID-19 Pandemic on Food Insecurity in Rural America: Evidence from Appalachia

Rural communities are disproportionally affected by food insecurity, making them vulnerable to the consequences of supply disruptions caused by the COVID-19 pandemic. While access to food was initially diminished due to food supply disruptions, little is known about the mechanisms through which federal emergency assistance programs impacted food access in rural populations. Through a series of five focus groups in spring 2021, we examined the impact of the COVID-19 pandemic on food access in a rural Appalachian community in Kentucky. Data were analyzed using a Grounded Theory Approach. Findings revealed the following four primary themes: food scarcity in grocery stores; expanded federal food assistance; expanded community food resources; and expanded home gardening. Participants provided details regarding the way increased federal assistance, especially expanded benefits within the Supplemental Nutrition Assistance Program, allowed them to purchase greater quantities of nutritious food. This study unveils the specific impacts of the COVID-19 pandemic on one rural population, including the influence of some social determinants of health on food insecurity. Policymakers and stakeholders should recognize the layered protection of multiple federal emergency assistance programs against food insecurity and the potential for long-term population health promotion in rural areas.

The mental health effects of a Universal Basic Income: A synthesis of the evidence from previous pilots

INTRODUCTION

Amongst its advocates, one of the key arguments for a Universal Basic Income (UBI) is its potential to improve population mental health. However, while previous authors have variously examined the potential effects of UBI on income, employment and labour market demand, the direct mental health consequences of previous pilots have been less frequently examined. The purpose of this paper is therefore to conduct a review of the literature on UBI and to re-examine the existing research with a mental health focus.

METHODS

Six electronic databases were used to conduct a review of the literature. We searched for empirical research studies of any design, conducted since the year 2000 in High Income Countries, exploring the effects of interventions similar to a UBI on the mental health of children or working-age adults. Grey literature and government reports were also included.

RESULTS

A total of 1566 articles were screened of which seven peer reviewed studies and eight governmental reports were ultimately selected for inclusion. None of the identified studies directly compared the impact of individual payments with those made on a household basis, or the effects of payments which were truly universal. However, several studies evaluated the mental health outcomes associated with payments provided unconditionally, and consistently reported clear and significant improvements in mental wellbeing. Potential mediating factors included improved time with family and friends, a reduction in perceived stigma and a renewed sense of hope for the future.

CONCLUSIONS

Our review has produced evidence to suggest that prophesies surrounding the mental health benefits of a UBI are at least partially justified. However, future studies should aim to be conducted at an area level, with an adequately powered sample size, and investigate interventions of a considerable duration using a longitudinal design.

Getting On in Gotham: The Midtown Manhattan Study and Putting the "Social" in Psychiatry

In the spring of 1962, a series of alarming headlines greeted American newspaper readers. From "New York Living for Nuts Only" and "One in Five Here Mentally Fit" to "Scratch a New Yorker, and What Do You Find?" and "City Gets Mental Test, Results are Real Crazy," the stories highlighted the shocking and, to some, incredible statistics that fewer than one in five (18.5%) Manhattanites had good mental health. Approximately a quarter of them had such bad mental health that they were effectively incapacitated, often unable to work or function socially. The headlines were gleaned from Mental Health in the Metropolis (1962), the first major output of the Midtown Manhattan Study, a large-scale, interdisciplinary project that surveyed the mental health of 1660 white Upper East Side residents between the ages of 20 and 59. One of the most significant social psychiatry projects to emerge following the Second World War, the Midtown Manhattan Study endeavored to "test the general hypothesis that biosocial and sociocultural factors leave imprints on mental health which are discernible when viewed from the panoramic perspective provided by a large population." Despite initial media and academic interest, however, the Midtown Manhattan Study's findings were soon forgotten, as American psychiatry turned its focus to individual-rather than population-psychopathology, and turned to the brain-rather than the environment-for explanations. Relying on archival sources, contemporary medical and social scientific literature, and oral history interviews, this article explains why the Midtown Manhattan Study failed to become more influential, concluding that its emphasis on the role of social isolation and poverty in mental illness should be taken more seriously today.

Walking the talk on multi-level interventions: The power of parsimony

There is strong consensus regarding the need for multi-level interventions (MLIs) to address today's complex health problems. Several longstanding social ecological frameworks are commonly referred to in guiding MLI development. The specificity and comprehensiveness of these frameworks unwittingly suggest that the totality of included influences are important in all health contexts. Not surprisingly, when viewed as requiring intervention at all levels of influence, MLIs are often considered to be infeasible due to sizeable cost and logistical barriers. Thus, efforts to develop and evaluate MLIs have been extremely limited, and comparatively few examples are found in the health literature. We argue that operational frameworks to identify which levels matter in which contexts - henceforth, referred to as parsimony - could accelerate the field towards broader use of MLIs. We suggest a hypothetical operational framework informed by complexity theory and pragmatic approaches that could enable us to conceptualize, design and evaluate MLIs to consider where reflexive and recursive process mechanisms that cross levels should be targeted by MLI. The approach also emphasizes sustainability of MLIs. Without developing parsimony-based operational frameworks to move us forward, we fear that little will change, and we will simply continue to talk, without proceeding to the walk.

Modelling the size, cost and health impacts of universal basic income: What can be done in advance of a trial?

Opposition to Universal Basic Income (UBI) is encapsulated by Martinelli’s claim that ‘an affordable basic income would be inadequate, and an adequate basic income would be unaffordable’. In this article, we present a model of health impact that transforms that assumption. We argue that UBI can affect higher level social determinants of health down to individual determinants of health and on to improvements in public health that lead to a number of economic returns on investment. Given that no trial has been designed and deployed with that impact in mind, we present a methodological framework for assessing prospective costs and returns on investment through modelling to make the case for that trial. We begin by outlining the pathways to health in our model of change in order to present criteria for establishing the size of transfer capable of promoting health. We then consider approaches to calculating cost in a UK context to estimate budgetary burdens that need to be met by the state. Next, we suggest means of modelling the prospective impact of UBI on health before asserting means of costing that impact, using a microsimulation approach. We then outline a set of fiscal options for funding any shortfall in returns. Finally, we suggest that fiscal strategy can be designed specifically with health impact in mind by modelling the impact of reform on health and feeding that data cyclically back into tax transfer module of the microsimulation.

Prevalence and Childhood Precursors of Opioid Use in the Early Decades of Life

IMPORTANCE

Opioid use disorder and opioid deaths have increased dramatically in young adults in the US, but the age-related course or precursors to opioid use among young people are not fully understood.

OBJECTIVE

To document age-related changes in opioid use and study the childhood antecedents of opioid use by age 30 years in 6 domains of childhood risk: sociodemographic characteristics; school or peer problems; parental mental illness, drug problems, or legal involvement; substance use; psychiatric illness; and physical health.

DESIGN, SETTING, AND PARTICIPANTS

This community-representative prospective longitudinal cohort study assessed 1252 non-Hispanic White individuals and American Indian individuals in rural counties in the central Appalachia region of North Carolina from January 1993 to December 2015. Data were analyzed from January 2019 to January 2020.

EXPOSURES

Between ages 9 and 16 years, participants and their parents were interviewed up to 7 times using the Child and Adolescent Psychiatric Assessment and reported risk factors in 6 risk domains.

MAIN OUTCOMES AND MEASURES

Participants were assessed again at ages 19, 21, 25, and 30 years for nonheroin opioid use (any and weekly) and heroin use using the structured Young Adult Psychiatric Assessment.

RESULTS

Of 1252 participants, 342 (27%) were American Indian. By age 30 years, 322 participants had used a nonheroin opioid (24.2%; 95% CI, 21.8-26.5), 155 had used a nonheroin opioid weekly (8.8%; 95% CI, 7.2-10.3), and 95 had used heroin (6.6%; 95% CI, 5.2-7.9). Childhood risk markers for later opioid use included male sex, tobacco use, depression, conduct disorder, cannabis use, having peers exhibiting social deviance, parents with legal involvement, and elevated systemic inflammation. In final models, childhood tobacco use, depression, and cannabis use were most robustly associated with opioid use in young adulthood (ages 19 to 30 years). Chronic depression and dysthymia were strongly associated with any nonheroin opioid use (OR. 5.43; 95% CI, 2.35-12.55 and OR, 7.13; 95% CI, 1.99-25.60, respectively) and with weekly nonheroin opioid use (OR, 8.89; 95% CI, 3.61-21.93 and OR, 11.51; 95% CI, 3.05-42.72, respectively). Among young adults with opioid use, those with heroin use had the highest rates of childhood psychiatric disorders and comorbidities.

CONCLUSIONS AND RELEVANCE

Childhood tobacco use and chronic depression may be associated with impaired reward system functioning, which may increase young adults' vulnerability to opioid-associated euphoria. Preventing and treating early substance use and childhood mental illness may help prevent later opioid use.

Examining the ethical underpinnings of universal basic income as a public health policy: prophylaxis, social engineering and 'good' lives

At a time of COVID-19 pandemic, universal basic income (UBI) has been presented as a potential public health 'upstream intervention'. Research indicates a possible impact on health by reducing poverty, fostering health-promoting behaviour and ameliorating biopsychosocial pathways to health. This novel case for UBI as a public health measure is starting to receive attention from a range of political positions and organisations. However, discussion of the ethical underpinnings of UBI as a public health policy is sparse. This is depriving policymakers of clear perspectives about the reasons for, restrictions to and potential for the policy's design and implementation. In this article, we note prospective pathways to impact on health in order to assess fit with Rawlsian, capabilities and perfectionist approaches to public health policy. We suggest that Raz' pluralist perfectionist approach may fit most comfortably with the prospective pathways to impact, which has implications for allocation of resources.

Designing trials of Universal Basic Income for health impact: identifying interdisciplinary questions to address

BACKGROUND

A large body of evidence indicates the importance of upstream determinants to health. Universal Basic Income (UBI) has been suggested as an upstream intervention capable of promoting health by affecting material, biopsychosocial and behavioural determinants. Calls are emerging across the political spectrum to introduce an emergency UBI to address socioeconomic insecurity. However, although existing studies indicate effects on health through cash transfers, UBI schemes have not previously been designed specifically to promote health.

METHODS

In this article, we scope the existing literature to set out a set of interdisciplinary research challenges to address in designing a trial of the effectiveness of UBI as a population health measure.

RESULTS

We present a theoretical model of impact that identifies three pathways to health impact, before identifying open questions related to regularity, size of payment, needs-based supplements, personality and behaviour, conditionality and duration.

CONCLUSIONS

These results set, for the first time, a set of research activities required in order to maximize health impact in UBI programmes.

Examining the dynamics between young people's mental health, poverty and life chances in six low- and middle-income countries: protocol for the CHANCES-6 study

PURPOSE

Poverty and poor mental health are closely related and may need to be addressed together to improve the life chances of young people. There is currently little evidence about the impact of poverty-reduction interventions, such as cash transfer programmes, on improved youth mental health and life chances. The aim of the study (CHANCES-6) is to understand the impact and mechanisms of such programmes.

METHODS

CHANCES-6 will employ a combination of quantitative, qualitative and economic analyses. Secondary analyses of longitudinal datasets will be conducted in six low- and middle-income countries (Brazil, Colombia, Liberia, Malawi, Mexico and South Africa) to examine the impact of cash transfer programmes on mental health, and the mechanisms leading to improved life chances for young people living in poverty. Qualitative interviews and focus groups (conducted among a subset of three countries) will explore the views and experiences of young people, families and professionals with regard to poverty, mental health, life chances, and cash transfer programmes. Decision-analytic modelling will examine the potential economic case and return-on-investment from programmes. We will involve stakeholders and young people to increase the relevance of findings to national policies and practice.

RESULTS

Knowledge will be generated on the potential role of cash transfer programmes in breaking the cycle between poor mental health and poverty for young people, to improve their life chances.

CONCLUSION

CHANCES-6 seeks to inform decisions regarding the future design and the merits of investing in poverty-reduction interventions alongside investments into the mental health of young people.

Is There Empirical Evidence on How the Implementation of a Universal Basic Income (UBI) Affects Labour Supply? A Systematic Review

The objective of this article is to determine, as conclusively as possible, if the implementation of a Universal Basic Income (UBI) would lead to a significant reduction in the working age population labour supply. If this were true, implementation of a UBI may not be sustainable. To do this, we will compile empirical evidence from studies over the last few decades on the effects of implementation of a UBI on employment. We apply the PRISMA methodology to better judge their validity, which ensures maximum reliability of the results by avoiding biases and making the work reproducible. Given that the methodologies used in these studies are diverse, they are reviewed to contextualize the results taking into account the possible limitations detected in these methodologies. While many authors have been writing about this issue citing experiences or experiments, the added value of this article is that it performs a systematic review following a widely tested scientific methodology. Over 1200 documents that discuss the UBI/employment relationship have been reviewed. We found a total of 50 empirical cases, of which 18 were selected, and 38 studies with contrasted empirical evidence on this relationship. The results speak for themselves: Despite a detailed search, we have not found any evidence of a significant reduction in labour supply. Instead, we found evidence that labour supply increases globally among adults, men and women, young and old, and the existence of some insignificant and functional reductions to the system such as a decrease in workers from the following categories: Children, the elderly, the sick, those with disabilities, women with young children to look after, or young people who continued studying. These reductions do not reduce the overall supply since it is largely offset by increased supply from other members of the community.

Social determinants of health and survival in humans and other animals

The social environment, both in early life and adulthood, is one of the strongest predictors of morbidity and mortality risk in humans. Evidence from long-term studies of other social mammals indicates that this relationship is similar across many species. In addition, experimental studies show that social interactions can causally alter animal physiology, disease risk, and life span itself. These findings highlight the importance of the social environment to health and mortality as well as Darwinian fitness-outcomes of interest to social scientists and biologists alike. They thus emphasize the utility of cross-species analysis for understanding the predictors of, and mechanisms underlying, social gradients in health.

Mitigating loss of health insurance and means tested benefits in an unconditional cash transfer experiment: Implementation lessons from Stockton's guaranteed income pilot

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Cash transfers, universal basic income, and guaranteed income have re-emerged as potential solutions to income volatility.

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Methods used in Stockton's guaranteed income experiment, are testing how GI can exist alongside existing safety net benefits.

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A multi-tiered approach to mitigating potential means tested benefits loss is both effective and ethically sound.

Income dividends and subjective survival in a Cherokee Indian cohort: a quasi-experiment

Persons with high temporal discounting tend to value immediate gratification over future gains. Low self-reported lifespan (SRL)-an individual's assessment of a relatively short future lifespan-concentrates in low-income populations and may reflect high temporal discounting. We use casino-based cash dividends among the Eastern Band of Cherokee Indians (EBCI) as a quasi-experiment to test whether large income gains among EBCI members translate into increased SRL. We used SRL data for EBCI and White youth, aged 19 to 28, participating in two waves of the Life Time Trajectory of Youth (LTI-Y) survey from 2000 to 2010. We controlled for unobserved confounding across individuals, time, and region through a longitudinal design using a difference-in-difference analytic approach (N = 294). We conducted all analyses separately by gender and by quartile of socioeconomic status. Cash dividends correspond with a 15.23 year increase in SRL among EBCI men below the lowest socio-economic quartile at baseline relative to Whites (standard error = 5.39, p < .01). Results using other socio-economic cut-points support improved SRL among EBCI men (but not women). The large magnitude of this result among EBCI men indicates that a non-trivial cash dividend to a low-income population may confer long-term benefits on perceptions of future lifespan and, in turn, reduce temporal discounting.Abbreviations: EBCI: Eastern Band of Cherokee Indians; SES: Socioeconomic Status; LTI-Y: Life Trajectory Interview for Youth; GSMS: Great Smoky Mountains Study; SRL: Self-Reported Lifespan; SSS: Subjective Social Status.

The public health effects of interventions similar to basic income: a scoping review

Universal, unconditional basic income is attracting increasing policy and academic interest. Income is a key health determinant, and a basic income could affect health through its effect on other determinants, such as employment. However, there is little evidence of its potential effects on public health, because no studies of interventions which meet the definition of basic income have been done. However, there is evidence from studies of interventions with similarities to basic income. Therefore, we aimed to identify these studies and to consider what can be learned from them about the potential effects of such interventions on health and socioeconomic outcomes. We did a systematic scoping review of basic income-like interventions, searching eight bibliographic and eight specialist databases from inception to July, 2019, with extensive hand searching. We included publications in English of quantitative and qualitative studies done in upper-middle-income or high-income countries, of universal, permanent, or subsistence-level interventions providing unconditional payments to individuals or families. We sought to identify the range of outcomes reported by relevant studies, and report health, education, employment, and social outcomes. We extracted and tabulated relevant data and narratively reported effects by intervention and outcome. We identified 27 studies of nine heterogeneous interventions, some universal and permanent, and many evaluated using randomised controlled trials or robust quasi-experimental methods. Evidence on health effects was mixed, with strong positive effects on some outcomes, such as birthweight and mental health, but no effect on others. Employment effects were inconsistent, although mostly small for men and larger for women with young children. There was evidence of spill-over effects in studies measuring effects on large populations. In conclusion, little evidence exists of large reductions in employment, and some evidence suggests positive effects on some other outcomes, including health outcomes. Evidence for macro-level effects is scarce. Quasi-experimental and dynamic modelling approaches are well placed to investigate such effects.

Examining income dynamics and externalizing and internalizing trajectories through a developmental psychopathology lens: A nationally representative study

Prior research has documented elevations in levels of internalizing and externalizing behaviors among children in lower income families in comparison to more advantaged peers. However, most studies focus on behavior problems at a single point in time or within a short developmental period. Associations between income dynamics and developmental trajectories of behavior problems over time are less understood. To address this, the current study uses data from the National Longitudinal Study of Youth (N = 7,476; 50.8% male) to examine how income dynamics (annual income and income volatility) across three distinct developmental periods from early childhood to early adolescence relate to trajectories of externalizing and internalizing problems. Group-based mixture modeling revealed a five-group trajectory model for externalizing behavior and a four-group trajectory model for internalizing behavior. Higher cumulative annual income predicted greater likelihood of belonging to the low-stable group compared to the other, more problematic groups for both externalizing and internalizing trajectories. In addition, income losses predicted higher risk of membership in any group other than the low-stable group for internalizing and externalizing behavior. Developmental period-specific income dynamics, though not as consistent as cumulative dynamics, also predicted trajectory group membership.

Population-Based Approaches to Mental Health: History, Strategies, and Evidence

There is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: (a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, (b) public health practice interventions that can be implemented by public health department officials, and (c) health care system interventions that can be implemented by hospital and health care system leaders.