Changes in the welfare caseload and the health of low-educated mothers

Welfare Reform and the Quality of Young Children's Home Environments

This study investigates the effects of welfare reform-a major policy shift in the United States that increased low-income mothers' employment and reliance on earnings instead of cash assistance-on the quality of the home environments mothers provide for their preschool-age children. Using empirical methods designed to identify plausibly causal effects, we estimate the effects of welfare reform on validated survey and observational measures of maternal behaviors that support children's cognitive skills and emotional adjustment and the material goods that parents purchase to stimulate their children's skill development. The results suggest that welfare reform did not affect the amount of time and material resources mothers devoted to cognitively stimulating activities with their young children. However, it significantly decreased emotional support provision scores, by approximately 0.3-0.4 standard deviations. The effects appear to be stronger for mothers with lower human capital. The findings provide evidence that welfare reform came at a cost to children in the form of lower quality parenting. They also underscore the importance of considering quality, and not just quantity, in assessing the effects of maternal work-incentive policies on parenting and children's home environments.

Effects of Welfare Reform on Positive Health and Social Behaviors of Adolescents

This paper explores a missing link in the literature on welfare reform in the U.S.-the effects on positive health and social behaviors of adolescents, who represent the next generation of potential welfare recipients. Previous research on welfare reform and adolescents has focused almost exclusively on negative behaviors and found that welfare reform led to decreases in high school dropout and teenage fertility among girls, but increases in delinquent behaviors and substance use, particularly among boys. Using nationally representative data on American high school students in 1991-2006 and a quasi-experimental research design, we estimated the effects of welfare reform implementation on eating breakfast, regular fruit/vegetable consumption, regular exercise, adequate sleep, time spent on homework, completion of assignments, participation in community activities or volunteering, participation in school athletics, participation in other school activities, and religious service attendance. We found no robust evidence that welfare reform affected any of these adolescent behaviors. In concert with the past research on welfare reform in the U.S. and adolescents, the findings do not support the implicit assumption underlying welfare reform that strong maternal work incentives would increase responsible behavior in the next generation and suggest that welfare reform had overall adverse effects on boys, who have been falling behind girls in terms of high school completion for decades.

What research evidence exists about physical activity in parents? A systematic scoping review

OBJECTIVES

Despite the known benefits of physical activity (PA) to physical and mental health, many people fail to achieve recommended PA levels. Parents are less active than non-parent contemporaries and constitute a large potential intervention population. However, little is known about the breadth and scope of parental PA research. This scoping review therefore aimed to provide an overview of the current evidence base on parental PA.

METHODS

Four databases (MEDLINE, Embase, PsycINFO and Scopus) were systematically searched to identify peer-reviewed articles focusing on parental PA from 2005 onwards, including interventional, observational or qualitative study designs. Title and abstract screening was followed by duplicate full-text screening. Data extracted for all articles (100% checked by a second reviewer) included study design, proportion of fathers and ages of children. For interventional/observational studies, PA assessment method and factors examined or targeted based on the socio-ecological model were extracted, and questions addressed in qualitative studies.

RESULTS

Of 14 913 unique records retrieved, 213 articles were included; 27 articles reported on more than one study design; 173 articles reported on quantitative (81 cross-sectional, 26 longitudinal and 76 interventional) and 58 on qualitative data. Most articles originated from North America (62%), and 53% included only mothers, while 2% included only fathers. Articles most frequently represented parents of infants (56% of articles), toddlers (43%), preschoolers (50%) and primary-school aged children (49%). Most quantitative articles only reported self-reported PA (70%). Observational articles focused on individual correlates/determinants (88%). Likewise, most interventions (88% of articles) targeted individual factors. Most qualitative articles explored PA barriers and facilitators (57%).

CONCLUSIONS

A range of quantitative and qualitative research has been conducted on parental PA. This review highlights opportunities for evidence synthesis to inform intervention development (such as barriers and facilitators of parental PA) and identifies gaps in the literature, for example, around paternal PA.

REVIEW REGISTRATION

osf.io/qt9up.

Effects of welfare reform on household food insecurity across generations

This study estimates the effects of welfare reform in the 1990s, which permanently restructured and contracted the cash assistance system in the U.S., on food insecurity-a fundamental form of material hardship-of the next generation of households. An implicit goal underlying welfare reform was the disruption of an assumed intergenerational transmission of disadvantage; however, little is known about the effects of welfare reform on the well-being of the next generation of adults. Using intergenerational data from the Panel Study of Income Dynamics and a variation on a difference-in-differences framework, this study exploits 3 sources of variation in childhood exposure to welfare reform: (1) risk of exposure across birth cohorts; (2) variation of exposure within cohorts because different states implemented welfare reform in different years; and (3) variation between individuals with the same exposure who were more likely and less likely to rely on welfare. We found that exposure to welfare reform led to decreases in food insecurity of the next generation of households, by about 10% for a 5-year increase in exposure, with stronger effects for individuals exposed for longer durations during childhood, individuals exposed in early childhood (0-5 years), and women. We also found smaller favorable effects for individuals whose mothers had less than a high school education, indicating that in terms of food insecurity, welfare reform led to relative disadvantages among the most disadvantaged and thus could be exacerbating socioeconomic and health inequalities.

Cash Transfers and Health

Financial resources are known to affect health outcomes. Many types of social policies and programs, including social assistance and social insurance, have been implemented around the world to increase financial resources. We refer to these as cash transfers. In this article, we discuss theory and evidence on whether, how, for whom, and to what extent purposeful cash transfers improve health. Evidence suggests that cash transfers produce positive health effects, but there are many complexities and variations in the outcomes. Continuing research and policy innovation-for example, universal basic income and universal Child Development Accounts-are likely to be productive.

INTERGENERATIONAL EFFECTS OF WELFARE REFORM: ADOLESCENT DELINQUENT AND RISKY BEHAVIORS

This study investigates effects of welfare reform in the United States on the next generation. Most previous studies of effects of welfare reform on adolescents focused on high-school dropout of girls or fertility; little is known about how welfare reform has affected other teenage behaviors or boys. We use a difference-in-difference-in-differences framework to identify gender-specific effects of welfare reform on skipping school, fighting, damaging property, stealing, hurting others, smoking, alcohol, marijuana, and other illicit drugs. Welfare reform led to increases in delinquent behaviors of boys as well as increases in substance use of boys and girls, with substantially larger effects for boys.

Incorporating Economic Policy Into A 'Health-In-All-Policies' Agenda

Recognizing the health effects of nonhealth policies, scholars and others seeking to improve Americans' health have advocated the implementation of a culture of health-which would call attention to and prioritize health as a key outcome of policy making across all levels of government and in the private sector. Adopting this "health-in-all-policies" lens, policy makers are paying increasing attention to health impacts as they debate policies in areas such as urban planning, housing, and transportation. Yet the health impacts of economic policies that shape the distribution of income and wealth are often overlooked. Pooling data from all fifty states for the period 1990-2010, we provide a broad portrait of how economic policies affect health. Overall, we found better health outcomes in states that enacted higher tax credits for the poor or higher minimum wage laws and in states without a right-to-work law that limits union power. Notably, these policies focus on increasing the incomes of low-income and working-class families, instead of on shaping the resources available to wealthier individuals. Incorporating these findings into a health-in-all-policies agenda will require leadership from the health sector, including a willingness to step into core and polarizing debates about redistribution.

Effects of Maternal Work Incentives on Youth Crime

This study exploits differences in the implementation of welfare reform across states and over time to identify causal effects of maternal work incentives, and by inference employment, on youth arrests between 1988 and 2005, the period of time during which welfare reform unfolded. We consider both serious and minor crimes as classified by the Federal Bureau of Investigation, consider differential effects by the youth's gender and age, investigate the extent to which effects were stronger in states with more stringent work incentive policies and larger welfare caseload declines, and use a number of different model specifications to assess robustness and patterns. We find that welfare reform led to reduced arrests for minor crime among youth ages 15-17 years by 9-11 %, with similar estimates for males and females, but that it did not affect youth arrests for serious crimes. The results from this study add to a scant knowledge base about the effects of maternal employment on adolescent behavior by exploiting a large-scale social experiment that greatly increased employment of low-skilled women. The results also provide some support for the widely-embraced argument that welfare reform would discourage undesirable social behavior, not only of mothers, but also of the next generation.

The Health of the Nation's Custodial Grandfathers and Older Single Fathers: Findings From the Behavior Risk Factor Surveillance System

Two important parent groups are solo grandfathers and single fathers raising children alone. The health of male caregivers raising children has received little attention by scholars. Investigating the health of single male caregivers raises awareness about their physical vulnerability. This study uses the 2012 Behavioral Risk Factor Surveillance System to compare health characteristics of 82 solo grandfathers with 396 single fathers aged 50 years and older. The findings suggest that grandfathers exhibited a high prevalence for various health conditions, including diabetes (44%), heart attack (27%), chronic obstructive pulmonary disease (23%), and stroke (6%). Almost half of grandfathers rated their health as fair/poor (47%), and nearly two in five had functional limitations (38%). Although older single fathers had better health characteristics than grandfathers, their health profile was poorer than population norms. Logistic regression analysis suggests that solo grandfathers are more at risk for poor health outcomes than older single fathers. Practice interventions to minimize health risks are discussed.

Effects of Maternal Work Incentives on Teen Drug Arrests

PURPOSE

This study exploits differences in the implementation of welfare reform across states and over time in the United States in the attempt to identify causal effects of welfare reform on youth arrests for drug-related crimes between 1990 and 2005, the period during which welfare reform unfolded.

METHODOLOGY

Using monthly arrest data from the U.S. Federal Bureau of Investigation's Uniform Crime Reports, we estimate the effects of welfare reform implementation on drug-related arrests among 15-17 year olds in the United States between 1990 and 2005. We use a difference-in-differences (DD) approach that exploits the implementation of welfare reform across states and over time to estimate effects for teens exposed to welfare reform.

FINDINGS

The findings, based on numerous different model specifications, suggest that welfare reform had no statistically significant effect on teen drug arrests. Most estimates were positive and suggestive of a small (3%) increase in arrests.

ORIGINALITY/VALUE

This study investigated the effects of a broad-based policy change that altered maternal employment, family income, and other family characteristics on youth drug arrests.

The Impact of Exceeding TANF Time Limits on the Access to Healthcare of Low-Income Mothers

The objective of this article is to estimate the relationship of exceeding Temporary Assistance for Needy Families (TANF) time limits, with health insurance, healthcare, and health outcomes. The authors use Heckman selection models that exploit variability in state time-limit duration and timing of policy implementation as identifying exclusion restrictions to adjust the effect estimates of exceeding time limits for possible correlations between the probability of exceeding time limits and unobservable factors influencing the outcomes. The authors find that exceeding time limits decreases the predicted probability of Medicaid coverage, increases the predicted probability of being uninsured, and decreases the predicted probability of annual medical provider contact.

Are Parental Welfare Work Requirements Good for Disadvantaged Children? Evidence From Age-of-Youngest-Child Exemptions

This paper assesses the impact of welfare reform’s parental work requirements on low-income children’s cognitive and social-emotional development. The identification strategy exploits an important feature of the work requirement rules—namely, age-of youngest- child exemptions—as a source of quasi-experimental variation in first-year maternal employment. The 1996 welfare reform law empowered states to exempt adult recipients from the work requirements until the youngest child reaches a certain age. This led to substantial variation in the amount of time that mothers can remain home with a newborn child. I use this variation to estimate the impact of work-requirement induced increases in maternal employment. Using a sample of infants from the Birth cohort of the Early Childhood Longitudinal Study, the reduced form and instrumental variables estimates reveal sizable negative effects of maternal employment. An auxiliary analysis of mechanisms finds that working mothers experience an increase in depressive symptoms, and are less likely to breastfeed and read to their children. In addition, such children are exposed to nonparental child care arrangements at a younger age, and they spend more time in these settings throughout the first year of life.

Do Social and Economic Policies Influence Health? A Review

Although social and economic policies are not considered part of health services infrastructure, such policies may influence health and disease by altering social determinants of health (SDH). We review social and economic policies in the US that have measured health outcomes among adults in four domains of SDH including housing and neighborhood, employment, family strengthening/marriage, and income supplementation. The majority of these policies target low-income populations. These social policies rarely consider health as their initial mission or outcomes. When measuring health, the programs document mental health and physical health benefits more than half the time, although some effects fade with time. We also find considerable segregation of program eligibility by gender and family composition. Policy makers should design future social policies to evaluate health outcomes using validated health measures; to target women more broadly across the socioeconomic spectrum; and to consider family caregiving responsibilities as ignoring them can have unintended health effects.

Health-related effects of welfare-to-work policies

Non-health related policies may have consequences for health that are more important than the outcomes they were originally designed to produce. In this paper we evaluate the effects of welfare-to-work programs (WTW) on physical and mental health status and a variety of health behaviors. The paper is based on data from the minimum income program of Madrid's Government (IMI). We match the program's administrative records (39,200 households)--covering the whole history of the program from the second half of 1990 to 2001--with a specific survey of former recipients who took part in different work-related activities conducted in 2001 (2300 households). We perform propensity score matching to find that both health status--including physical and mental health problems--and behaviors outcomes were modestly better for those individuals who had taken part in work-related activities. These results offer support for the contention that welfare-to-work policies may have positive unintended health effects.

Effects of Welfare Reform on Illicit Drug Use Of Adult Women

Exploiting changes in welfare policy across states and over time and comparing relevant population subgroups within an econometric difference-in-differences framework, we estimate the effects of welfare reform on adult women's illicit drug use from 1992 to 2002, the period during which welfare reform unfolded in the U.S. The analyses are based on all available and appropriate national datasets, each offering unique strengths and measuring a different drug-related outcome. We investigate self-reported illicit drug use (from the National Household Surveys on Drug Abuse and National Surveys on Drug Use and Health), drug-related prison admissions (from the National Corrections Reporting Program), drug-related arrests (from Federal Bureau of Investigation Uniform Crime Reports), and drug-related emergency department episodes (from the Drug Abuse Warning Network). We find robust evidence that welfare reform led to a 10-21% decline in illicit drug use among women at risk of relying on welfare, as well as associated declines in drug-related arrests (6-7%), drug-related hospital emergency department episodes (7-11%), and possibly drug-related prison admissions (11-19%). The findings indicate that an appropriately designed system with sufficient job opportunities for those are able to work can result in both increases in employment and decreases in drug use.

Effects of Welfare Reform on Education Acquisition of Adult Women

Education beyond traditional ages for schooling is an important source of human capital acquisition among adult women. Welfare reform, which began in the early 1990s and culminated in the passage of the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, promoted work rather than education acquisition for this group. Exploiting variation in welfare reform across states and over time and using relevant comparison groups, we undertake a comprehensive study of the effects of welfare reform on adult women's education acquisition. We first estimate effects of welfare reform on high school drop-out of teenage girls, both to improve upon past research on this issue and to explore compositional changes that may be relevant for our primary analyses of the effects of welfare reform on education acquisition among adult women. We find that welfare reform significantly reduced the probability that teens from disadvantaged families dropped out of high school, by about 15%. We then estimate the effects of welfare reform on adult women's school enrollment and conduct numerous specification checks, investigate compositional selection and policy endogeneity, explore lagged effects, stratify by TANF work incentives and education policies, consider alternative comparison groups, and explore the mediating role of work. We find robust and convincing evidence that welfare reform significantly decreased the probability of college enrollment among adult women at risk of welfare receipt, by at least 20%. It also appears to have decreased the probability of high school enrollment among this group, on the same order of magnitude. Future research is needed to determine the extent to which this behavioral change translates to future economic outcomes.

Neoliberalism, welfare policy and health: A qualitative meta-synthesis of single parents’ experience of the transition from welfare to work

Following the United States’ lead, the emergence of neoliberal welfare policy across the western world has resulted in employment programmes for single parents, who are predominantly single mothers. While some governments claim that employment will improve single parents’ incomes and well-being, researchers dispute that single parents can unproblematically move into the workforce, with net positive effects. While researchers have quantified the socio-economic effect of these programmes, in particular on participant health, no study has yet synthesized participants’ experiences of welfare-to-work. Here, I present a meta-synthesis of eight qualitative health-related studies of single parents’ (and exclusively single mothers’) welfare-to-work transition. I report that single mothers faced a combination of health and economic issues which made their transition from welfare to work difficult, including degrees of poor physical and mental health. For participants in the United States, these health issues were often compounded by a loss of health benefits on moving into low-wage employment. In countries where a return to employment was required before children reached school age, a lack of affordable and appropriate child care, especially for children with health problems, exacerbated these difficulties. As a result of scarce resources, single mothers in receipt of welfare benefits often relied on food banks or went without food. A return to the workforce did not alleviate this problem as additional child care and reduced government subsidies depleted the funds available for food. I conclude that welfare-to-work policies are underpinned by the neoliberal assumption that the market more efficiently distributes resources than the State. However, for the women in the studies examined here, labour market participation often depleted access to essential resources. Interventions to address the ‘problem’ of welfare dependency must recognize the complex interplay between work incentives and disincentives and the care-work of single mothers.

Effects of Welfare Reform on Vocational Education and Training

Exploiting variation in welfare reform across states and over time and using relevant comparison groups, this study estimates the effects of welfare reform on an important source of human capital acquisition among women at risk for relying on welfare: vocational education and training. The results suggest that welfare reform reduced enrollment in full-time vocational education and had no significant effects on part-time vocational education or participation in other types of work-related courses, though there appears to be considerable heterogeneity across states with respect to the strictness of educational policy and the strength of work incentives under welfare reform. In addition, we find evidence of heterogeneous effects by prior educational attainment. We find no evidence that the previously-observed negative effects of welfare reform on formal education (including college enrollment), which we replicated in this study, have been offset by increases in vocational education and training.

Experimental evidence of welfare reform impact on clinical anxiety and depression levels among poor women

In this paper, we employ a classical experiment to determine if welfare reform causes poor women to experience increased levels of clinical anxiety and depression. We organize our analyses around the insights provided by lifestyle change and ecosocial theories of illness. Our data come from the New Jersey Family Development Program (FDP), one of the most highly publicized welfare experiments in the U.S. A sample of 8393 women was randomly assigned into two groups, one which stressed welfare-to-work and the other which offered traditional welfare benefits. These women were followed from 1992 through 1996 and information on clinical diagnoses was collected quarterly from physician treatment claims to the government Medicaid program. Our intention-to-treat estimates show that for short-term welfare recipients FDP decreased the prevalence of anxiety by 40% and increased depression by 8%. For black women both anxiety and depression diagnoses declined while Hispanic women experienced a 68% increase in depression. We discuss several public policy implications which arise from our work.

Welfare reform and health of immigrant women and their children

We investigate the association between the 1996 welfare reform and health insurance, medical care use and health of low-educated, foreign-born, single mothers and their children. We find that welfare reform was associated with an eight to 11.5 percentage points increase in proportion uninsured among low-educated foreign-born, single mothers. We also find that the decline in welfare caseload since 1996 was associated with a 6.5 to 10 percentage points increase in the proportion of low-educated foreign-born, single mothers reporting delays in receiving medical care or receiving no care due to cost and a nine percentage points decline in visits to a health professional in the past 12 months. We do not find any consistent evidence that welfare reform affected the health insurance, medical care utilization and health of children living with single mothers.