The color of welfare sanctioning: exploring the individual and contextual roles of race on TANF case closures and benefit reductions

The promise and pitfalls of a strength-based approach to child poverty and neurocognitive development: Implications for policy

There has been significant progress in understanding the effects of childhood poverty on neurocognitive development. This progress has captured the attention of policymakers and promoted progressive policy reform. However, the prevailing emphasis on the harms associated with childhood poverty may have inadvertently perpetuated a deficit-based narrative, focused on the presumed shortcomings of children and families in poverty. This focus can have unintended consequences for policy (e.g., overlooking strengths) as well as public discourse (e.g., focusing on individual rather than systemic factors). Here, we join scientists across disciplines in arguing for a more well-rounded, "strength-based" approach, which incorporates the positive and/or adaptive developmental responses to experiences of social disadvantage. Specifically, we first show the value of this approach in understanding normative brain development across diverse human environments. We then highlight its application to educational and social policy, explore pitfalls and ethical considerations, and offer practical solutions to conducting strength-based research responsibly. Our paper re-ignites old and recent calls for a strength-based paradigm shift, with a focus on its application to developmental cognitive neuroscience. We also offer a unique perspective from a new generation of early-career researchers engaged in this work, several of whom themselves have grown up in conditions of poverty. Ultimately, we argue that a balanced strength-based scientific approach will be essential to building more effective policies.

"I don´t put people into boxes, but…" A free-listing exercise exploring social categorisation of asylum seekers by professionals in two German reception centres

Newly arriving asylum seekers in Germany mostly live in large reception centres, depending on professionals in most aspects of their daily lives. The legal basis for the provision of goods and services allows for discretionary decisions. Given the potential impact of social categorisation on professionals' decisions, and ultimately access to health and social services, we explore the categories used by professionals. We ask of what nature these categorisations are, and weather they align with the public discourse on forced migration. Within an ethnographic study in outpatient clinics of two refugee accommodation centres in Germany, we conducted a modified free-listing with 40 professionals (physicians, nurses, security-personnel, social workers, translators) to explore their categorisation of asylum seekers. Data were qualitatively analysed, and categories were quantitatively mapped using Excel and the Macro "Flame" to show frequencies, ranks, and salience. The four most relevant social categorisations of asylum seekers referred to "demanding and expectant," "polite and friendly" behaviour, "economic refugees," and "integration efforts". In general, sociodemographic variables like gender, age, family status, including countries and regions of origin, were the most significant basis for categorisations (31%), those were often presented combined with other categories. Observations of behaviour and attitudes also influenced categorisations (24%). Professional considerations, e.g., on health, education, adaption or status ranked third (20%). Social categorisation was influenced by public discourses, with evaluations of flight motives, prospects of staying in Germany, and integration potential being thematised in 12% of the categorisations. Professionals therefore might be in danger of being instrumentalised for internal border work. Identifying social categories is important since they structure perception, along their lines deservingness is negotiated, so they potentially influence interaction and decision-making, can trigger empathy and support as well as rejection and discrimination. Larger studies should investigate this further. Free-listing provides a suitable tool for such investigations.

Policy solutions to eliminate racial and ethnic child health disparities in the USA

Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.

State Public Assistance Spending and Survival Among Adults With Cancer

Importance

Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations.

Objective

To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity.

Design, Setting, and Participants

This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023.

Exposure

Differential state-level public assistance spending.

Main Outcome and Measure

The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage.

Results

A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects).

Conclusions and Relevance

This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.

Temporary Assistance For Needy Families: Sanctioning And Child Support Compliance Among Black Families In Illinois

Temporary Assistance for Needy Families (TANF) is a federal cash welfare program for low-income, working families with children in the United States that requires participation with child support enforcement, if one parent is noncustodial, to receive the cash benefit. Cash assistance has been linked to improved child health and academic achievement, but sanctions to benefits can increase health risks. Our community-engaged, mixed-methods research project sought to identify barriers to TANF among families with young children in Illinois. In this study we analyzed TANF sanctions related to child support enforcement, using analysis of TANF administrative data and semistructured interviews with TANF customers. We conducted logistic regression and Fisher's test to explore demographic differences in sanctioning and sanction types. Black families were 111 percent more likely than White families to receive at least one sanction in 2018-19. Black families who were enrolled in TANF received more sanctions for child support noncompliance (2018: 42 percent; 2019: 50 percent) than White families (2018: 30 percent; 2019: 34 percent). Mothers who were survivors of intimate partner violence voiced particular challenges with child support compliance. Policy recommendations include shifting to alternative cash assistance models and removing pass-through funding so that families receive the full child support benefit.

Interlinking Structural Racism and Heteropatriarchy: Rethinking Family Structure's Effects on Child Outcomes in a Racialized, Unequal Society

In the field of family science and in the broader family policy discourse, debate is ongoing about the importance of family structure for child outcomes. Missing from this debate is a full integration of how the foundational pillars of White supremacy, namely structural racism and heteropatriarchy, impact both family formation and child outcomes, especially among diversely configured Black families. From a critical intersectional lens, we argue that conceptual models used to explain racialized child outcomes based on family structure effects are problematic because they compare family structure statuses without accounting for structural racism and interlinked heteropatriarchal conditions. We present a new conceptual model that integrates structural racism and heteropatriarchy to examine the salience of family structure statuses for child outcomes and discuss approaches to research design, empirical measurement, and interpretation in order to bring this new model into practice.

Domestic violence during the pandemic: ‘By and for’ frontline practitioners’ mediation of practice and policies to support racially minoritised women

This article analyses 26 interviews with frontline female practitioners from domestic violence and abuse (DVA) services for racially minoritised women in England and Wales, exploring how these practitioners – who are from the same racially minoritised communities as the women they support – responded to the challenges of the COVID-19 crisis. These specific practitioner perspectives offer valuable insights into the specific ways in which the pandemic exacerbated the intersectional vulnerabilities of minoritised women experiencing DVA. Interpreted through a standpoint feminist lens, the findings reveal how frontline practitioners used bureaucratic discretion both to meet minoritised women’s changed needs during the pandemic in order to enhance their safety and to challenge the exclusions and intersectional inequalities underpinning pandemic policies. The study illuminates the institutional dimensions of frontline practitioner responses to the pandemic and contribute to debates within the street-level bureaucracy scholarship about the nature of bureaucratic discretion exercised by frontline practitioners.

Women's Lived Experiences with Temporary Assistance for Needy Families (TANF): How TANF Can Better Support Women's Wellbeing and Reduce Intimate Partner Violence

Women experiencing poverty are more likely to face intimate partner violence (IPV), poor health, and stigma. IPV survivors are overrepresented among those who receive Temporary Assistance for Needy Families (TANF), a conditional cash program serving families experiencing poverty. More generous TANF policies may be protective against IPV, but a greater insight into TANF's effect could be gleaned through a contemporaneous study that examines intersecting determinants of wellbeing and engages community interpretation of findings. Using an adapted Family Stress Model framework and analyzing data through an intersectional and community-based lens, we explore the impact of TANF on women's wellbeing through in-depth, semi-structured interviews during the COVID-19 pandemic with 13 women who had TANF experience in three U.S. states. Data were analyzed using thematic analysis in MAXQDA and researchers facilitated three member-checking events to enhance validity of result interpretation. Four themes emerged: (1) Low cash and conditional benefits provided limited short-term "relief" but contributed to poverty and hard choices; (2) TANF benefit levels and conditions increased women's dependence on others, straining relationships; (3) Women undertook extraordinary measures to access TANF, largely to fulfill their roles as mothers; and (4) TANF stigma creates psychological stress, differentially experienced by African Americans. Increasing TANF cash benefits and other cash transfers for those experiencing poverty, adopting solely state funded TANF programs, increasing funding for TANF administration, addressing TANF stigma and racialized narratives, and allowing optional child support participation or a larger "pass-through" of child support are important steps toward making TANF more protective against IPV.

Association between Temporary Assistance for Needy Families (TANF) and child maltreatment among a cohort of fragile families

BACKGROUND

Child maltreatment disproportionately affects families experiencing poverty and structural discrimination, including African American (AA) families. The generosity of Temporary Assistance for Needy Families (TANF) may reduce child maltreatment disparities.

OBJECTIVE

Our aim is to understand TANF's impact on the mother's perpetration of child maltreatment and whether the effect differs across AA and White mothers.

PARTICIPANTS AND SETTING

Participants are 2457 primary caregiving mothers participating in waves 3 (2001-2003), 4 (2003-2006), and 5 (2007-2010) of the U.S.-based Fragile Families and Child Wellbeing birth cohort study.

METHODS

We use a difference-in-differences study design to estimate overall and race-specific effects of TANF policies on caregivers' self-report of child neglect and physical and psychological maltreatment measured by the Child-Parent Conflict Tactics Scale. State-level TANF policy exposures include the TANF-to-Poverty Ratio (TPR), maximum cash benefits, time limits, sanctions, diversion payments, and family caps.

RESULTS

A $100 increase in TANF benefits was associated with a reduction of 1.8 reported physical abuse events (Beta = -1.80, 95% CI (-3.29, -0.31)). Imposing a time limit on TANF receipt was associated with an increase of 2.3 reported physical abuse events (Beta = 2.27, 95% CI (0.04, 4.50)). No significant differences were found for AA mothers versus White mothers.

CONCLUSIONS AND RELEVANCE

Increasing TANF cash benefits should be prioritized to reduce poverty-related child maltreatment disparities. TANF time limits should be reconsidered.

The impact of temporary assistance for needy families, minimum wage, and Earned Income Tax Credit on Women's well-being and intimate partner violence victimization

Women experiencing poverty and women of color disproportionately experience intimate partner violence (IPV) victimization. Economic policies targeting women at this intersection of poverty and IPV, including Temporary Assistance for Needy Families (TANF), Minimum Wage (MW), and Earned Income Tax Credits (EITCs), may be powerful violence prevention tools. Using data from waves 1 (1998-2000) through 4 (2007-2010) of the U.S.-based Fragile Families and Child Well-being (FFCW) birth cohort study, we apply a difference-in-difference (DD) study design to estimate both the overall and race-specific effects of state-level economic policies on non-physical IPV and several intermediate outcomes. In DD models analyzing the difference in violence outcomes by intervention group (i.e., TANF exposure based on women's educational attainment, ≤high school vs >high school) and by race (African American (AA) vs White) few state-level TANF policies were associated with IPV victimization and the MW had no differential effect, but the refundable EITC was protective against IPV. Of the few TANF policies associated with IPV - sanctions and the ratio of families receiving TANF for every 100 families in poverty (the TANF-to-Poverty Ratio (TPR)) - those linked with fewer TANF restrictions seemed to increase coercive victimization, especially among AA women. With regard to intermediate variables, we found no overall impact of economic policies on depression or economic hardship, while monetary benefits and the TPR, were associated with a decrease in employment. The effect of TANF policies by race on intermediate outcomes was complex and analyses suggest that while White women are more likely to be employed when TANF time limits are in place, they also experience larger increases in economic hardship events compared to AA women. Research into the effects of cash transfer conditionality on mediators, including economic instability, perceived stress, bargaining power, and coercive IPV to interfere with TANF compliance, is needed.

Association of Work Requirements With Supplemental Nutrition Assistance Program Participation by Race/Ethnicity and Disability Status, 2013-2017

IMPORTANCE

Increased work requirements have been proposed throughout federal safety net programs, including the Supplemental Nutrition Assistance Program (SNAP). Participation in SNAP is associated with reduced food insecurity and improved health.

OBJECTIVES

To determine whether SNAP work requirements are associated with lower rates of program participation and to examine whether there are racial/ethnic disparities or spillover effects for people with disabilities, who are not intended to be affected by work requirements.

DESIGN, SETTING, AND PARTICIPANTS

This nationally representative, pooled cross-sectional study examined how changes in SNAP work requirements at state and local levels in the US are associated with changes in food voucher program participation. The study combined information on state and local SNAP work requirements with repeated cross-sections from the 2012 through 2017 American Community Survey (with outcomes covering 2013 to 2017). The analytical approaches were based on difference-in-difference and triple-difference methods, after controlling for other economic and social factors. The sample included low-income adults without dependents, stratified by racial/ethnic group and disability status. The study also included parents who would otherwise meet work requirement criteria as a comparison group to estimate triple-difference models. This accounted for otherwise unobserved factors affecting trends in SNAP participation within local areas. Data were analyzed from January 2019 through March 2020.

EXPOSURE

Residence in areas where SNAP work requirements apply.

MAIN OUTCOMES AND MEASURES

The primary outcome is SNAP participation measured by whether anyone in the household received food vouchers at any point over the prior 12 months.

RESULTS

The final analytical sample included 866 000 low-income adults (weighted mean [SE] age, 33.6 [0.01] years; 42.5% [SE, 0.07%] men). The racial/ethnic breakdown was 56.5% (SE, 0.07%) non-Hispanic white respondents, 19.4% (SE, 0.06%) non-Hispanic black respondents, 17.7% (SE, 0.06%) Hispanic respondents, 2.5% (SE, 0.02%) Asian respondents, and 3.9% (SE, 0.03%) respondents of other or multiple races. In final triple-difference models, work requirements were associated with a 4.0 percentage point decrease in participation (95% CI, -0.048 to -0.032; P < .001) for childless adults without disability, equivalent to a 21.2% reduction in SNAP participation (95% CI, -25.5% to -17.0%). For childless adults with disability, work requirements were associated with a 4.0 percentage point reduction (95% CI, -0.058 to -0.023; P < .001), equivalent to 7.8% fewer SNAP participants with disability (95% CI, -11.2% to -4.4%). When the final models were stratified by race/ethnicity, benefit reductions were larger for non-Hispanic black adults (7.2 percentage points; 95% CI, -0.092 to -0.051; P < .001) and Hispanic adults (5.5 percentage points; 95% CI, -0.072 to -0.038; P < .001) than for non-Hispanic white adults (2.6 percentage points; 95% CI, -0.035 to -0.016; P < .001).

CONCLUSIONS AND RELEVANCE

Because of the association of SNAP with food security and health, work requirements that lead to benefit loss may create nutritional and health harm for low-income Americans. These findings suggest that there may be racially disparate consequences and unintended harm for those with disability.

Selection Processes in Prison-Based Treatment Referrals: A Street-Level Bureaucracy Perspective

Studies indicated that detainees are not always allocated to treatment programs based on official guidelines. Street-level bureaucracy theory suggests that this is because government employees do not always perform policies as prescribed. This study aimed to assess whether this also applies to the allocation of offenders to treatment in Dutch penitentiary institutions, and aimed to determine which factors influenced this. The proposed questions were addressed by studying a group of 541 male prisoners who participated in the Dutch prison-based Prevention of Recidivism program. Results showed that official guidelines were, in most cases, not leading when referring detainees to programs. Instead, treatment referrals were influenced by a broad range of risk factors, as well as the length of an offender's sentence.

Severity of household food insecurity and lifetime racial discrimination among African-American households in South Carolina

OBJECTIVES

In 2014, 30% of African-American households with children had low or very low food security, a rate double that of white households with children. A household has low food security if its members experience food shortages and reductions in food quality attributable to a lack of household resources or access and very low food security if its members also experience reductions in food intake and disrupted eating patterns. Households that are either low or very low food secure are known collectively as food insecure. We examined the association between the severity of household food insecurity and reports of lifetime racial discrimination among a sample of food-insecure African-American households in South Carolina.

DESIGN

Data were collected from 154 African-American respondents. Food insecurity was measured using the US Department of Agriculture's Household Food Security Survey Module. Lifetime racial discrimination was measured using the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV). We used logistic regression to test the association between severity of food insecurity (low vs. very low food secure), PEDQ-CV score and PEDQ-CV subscales. All models were adjusted for demographic and socioeconomic variables.

RESULTS

A one-unit increase in the frequency of lifetime racial discrimination was associated with a 5% increase in the odds of being very low food secure (odds ratio (OR) 1.05, P < .05). More reports of discrimination that were stigmatizing or devaluing (OR 1.16, P < .05), took place at a workplace or school (OR 1.15, P < .05) or were threatening or aggressive (OR 1.39, P < .05) increased the odds of being very low food secure. More reports of racial discrimination that were excluding or rejecting did not significantly increase the odds of being very low food secure (OR 1.07, P > .05).

CONCLUSIONS

Severity of household food insecurity is associated with lifetime racial discrimination among African-American households in South Carolina.

The Great Recession and America's Geography of Unemployment

BACKGROUND

The Great Recession of 2007-2009 was the most severe and lengthy economic crisis in the U.S. since the Great Depression. The impacts on the population were multi-dimensional, but operated largely through local labor markets.

OBJECTIVE

To examine differences in recession-related changes in county unemployment rates and assess how population and place characteristics shaped these patterns.

METHODS

We calculate and decompose Theil Indexes to describe recession-related changes in the distribution of unemployment rates between counties and states. We use exploratory spatial statistics to identify geographic clusters of counties that experienced similar changes in unemployment. We use spatial regression to evaluate associations between county-level recession impacts on unemployment and demographic composition, industrial structure, and state context.

RESULTS

The recession was associated with increased inequality between county labor markets within states, but declining between-state differences. Counties that experienced disproportionate recession-related increases in unemployment were spatially clustered and characterized by large shares of historically disadvantaged racial and ethnic minority populations, low educational attainment, and heavy reliance on pro-cyclical industries. Associations between these sources of vulnerability were partially explained by unobserved state-level factors.

CONCLUSIONS

The local consequences of macroeconomic trends are associated with county population characteristics, as well as the structural contexts and policy environments in which they are embedded. The recession placed upward pressure on within-state inequality between local labor market conditions.

CONTRIBUTION

To present new estimates of the recession's impact on local labor markets, quantify how heterogeneous impacts affected the distribution of unemployment prevalence, and identify county characteristics associated with disproportionately large recession-related increases in unemployment.