Estimating Potential Reductions in Premature Mortality in New York City From Raising the Minimum Wage to $15

County Characteristics and Veteran Suicide in the United States, 2011-2018

INTRODUCTION

Few studies have examined county-level hotspots of veteran suicide and associated place-based contributors, limiting development of targeted community-level prevention strategies. The objectives of this national spatial analysis of all veteran suicides were to identify areas of the United States with higher-than-expected veteran suicide rates and determine county-level social and economic characteristics associated with areas of higher risk.

METHODS

Using Bayesian hierarchical modeling, county-level standardized mortality ratios for veteran suicide deaths were estimated for time periods 2011-2018, 2011-2014, and 2015-2018. Adjusted relative risk, accounting for community characteristics, for each county was then estimated and associations between community characteristics and veteran suicide risk were examined. Analyses were conducted in 2023-2024.

RESULTS

Risk of veteran suicide is predominantly concentrated in the Mountain West and West. Significant predictors of risk across all time periods were per capita number of firearm retailers (2011-2018 relative risk [RR]=1.065 [95% credible interval [CI] 1.030-1.102]), the proportion of residents who moved in the past year (2011-2018 RR=1.060 [95% CI 1.039-1.081]), the proportion of residents who live alone (2011-2018 RR=1.067 [95% CI 1.046-1.089]), the proportion of residents in rental housing (2011-2018 RR=1.041 [95% CI 1.018-1.065]), and the proportion of married residents (2011-2018 RR=0.915 [95% CI 0.890-0.941]).

CONCLUSIONS

This study contributes to a comprehensive public health approach to veteran suicide prevention by identifying where resources are needed most, and which place-based intervention targets have the largest potential for impact. Findings suggest that public health efforts to address suicide among veterans should address community-level firearm access and identify ways to alleviate deleterious effects of social fragmentation.

Tenant Right-to-Counsel and Adverse Birth Outcomes in New York, New York

Importance

In 2017, New York, New York, launched the United States' first right-to-counsel program, guaranteeing lawyers to low-income tenants in select zip codes, which was associated with reducing eviction risk by half. Given documented associations between evictions during pregnancy and adverse birth outcomes, the right-to-counsel program may be associated with improved birth outcomes.

Objective

To measure associations between zip code-level right-to-counsel access and risk of adverse birth outcomes, including preterm birth and low birth weight, among infants born to Medicaid-insured birthing parents.

Design, Setting, and Participants

This retrospective cohort study leveraged the staggered rollout of New York's right-to-counsel program from January 2016 to February 2020 as a natural experiment using a population-based sample of live births to Medicaid-insured birthing parents residing in New York, New York. Data were analyzed from February 2022 to September 2024.

Exposure

Zip code right-to-counsel status 9 months prior to birth.

Main Outcomes and Measures

Adverse birth outcomes were measured using individual birth records from the New York Bureau of Vital Statistics. Outcomes included dichotomous indicators of low birth weight (<2500 g), preterm birth (<37 weeks' gestation), and a composite of both. Difference-in-differences linear probability models controlled for year, month, and zip code and included clustered standard errors.

Results

Among 260 493 live births (mean [SD] birthing parent age, 29 [6] years) from January 2016 to February 2020, 43 081 births (17%) were to birthing parents residing in zip codes where right-to-counsel was available during pregnancy. Exposure to right-to-counsel during pregnancy was associated with statistically significant reductions in infants' probability of adverse birth outcomes, with reductions of 0.73 (95% CI, 0.06-1.41) percentage points in low birth weight, 0.91 (95% CI, 0.10-1.71) percentage points in preterm birth, and 0.96 (95% CI, 0.09-1.84) percentage points in the composite outcome in treated vs untreated zip codes.

Conclusions and Relevance

This cohort study found that right-to-counsel was associated with reduced risk of adverse birth outcomes among Medicaid-insured birthing parents. These findings suggest that eviction prevention via right-to-counsel may have benefits that extend beyond the courtroom and across the life-course.

The Association Between State Minimum Wage and Firearm Homicides, 2000-2020

INTRODUCTION

Recent research has indicated an association between both poverty and income inequality and firearm homicides. Increased minimum wages may serve as a strategy for reducing firearm violence by increasing economic security among workers earning low wages and reducing the number of families living in poverty. This study aimed to examine the association between state minimum wage and firearm homicides in the U.S. between 2000 and 2020.

METHODS

State minimum wage, obtained from Temple's Law Atlas and augmented by legal research, was conceptualized using the Kaitz Index. State-level homicide counts were obtained from 2000 to 2020 multiple-cause-of death mortality data from the National Vital Statistics System. Log-linear regressions were conducted to model the associations between state minimum wage and firearm homicides, stratifying by demographic groups. Analyses were conducted in 2023.

RESULTS

A 1% point increase in a state's Kaitz Index was associated with a 1.3% (95% CI: -2.1% to -0.5%) decrease in a state's firearm homicide rate. When interacted with quartile of firearm ownership, the Kaitz Index was associated with decreases in firearm homicide in all except the lowest quartile. These findings were largely consistent across stratifications.

CONCLUSIONS

Changing a state's minimum wage, whereby a full-time minimum wage worker's salary is closer to a state's median income, may be an option for reducing firearm homicides.

Analysis of Exertion-Related Injuries and Fatalities in Laborers in the United States

Laborers are particularly vulnerable to exertional injuries and illnesses, as they often engage in heavy physical work for prolonged hours, yet no studies have examined the top causes of catastrophic exertional injuries and fatalities among this population. The purpose of the investigation was to characterize the top causes of exertional injury and fatality within open access, Occupational Safety and Health Administration (OSHA) reportable data. A secondary analysis of OSHA reported injury and fatality data was performed through open access records from OSHA Severe Injury Reports (2015-2022) and OSHA fatality inspection data (2017-2020), respectively. The research team characterized each reported injury and fatality as "exertion-related" or "non-exertion-related. Injury and fatality rates were reported per 100,000 equivalent full-time worker years and included 95% confidence intervals (95% CI). Of 58,648 cases in the OSHA Severe Injury Report database from 2015-2020, 1682 cases (2.9%) were characterized as exertional (0.20 injuries per 100,000 full-time worker years, 95% CI: 0.19, 0.22). Heat-related injuries encompassed 91.9% of the exertional injuries (n = 1546). From the 2017-2022 OSHA fatality inspection database, 89 (1.9%) of 4598 fatalities were characterized as exertion-related (fatality rate: 0.0160 per 100,000 full-time equivalent workers, 95% CI: 0.009, 0.0134). The exertion-related fatalities primarily consisted of heat-related cases (87.6%). Exertion-related injuries and fatalities were most reported in Southeast states, in the construction and excavation industry, and among nonunionized workers. As heat stress continues to be recognized as an occupational health and safety hazard, this analysis further highlights the need for targeted interventions or further evaluation of the impact of heat stress on construction and excavation workers, nonunionized workers, and workers in Southeastern states.

Estimation of Potential Deaths Averted From Hypothetical US Income Support Policies

Question

How many deaths among working-age US adults can hypothetical income support policies, such as universal basic income, the modified LIFT Act, poverty alleviation, and negative income tax, potentially avert?

Findings

In this multicohort modeling study that simulated US adults age 18 to 64 years over 5 to 40 years, broad income support policies, like universal basic income, were estimated to avert the most deaths among working-age adults, although targeted approaches, like poverty alleviation, may also avert thousands of deaths among low-income populations. Results were sensitive to several inputs, primarily the income group–specific mortality rates used.

Meaning

The results of this study suggest that income support policies may prevent thousands of deaths among working-age US adults.

Importance

Income has a negative, nonlinear association with all-cause mortality. Income support policies may prevent deaths among low-income populations by raising their incomes.

Objective

To estimate the deaths that could be averted among working-age adults age 18 to 64 years with hypothetical income support policies in the US.

Design, Setting, and Population

An open, multicohort life-table model was developed that simulated working-age adults age 18 to 64 years in the US over 5 to 40 years. Publicly available household income data and previous estimates of the income-mortality association were used to generate mortality rates by income group. Deterministic sensitivity analyses were conducted to evaluate the effect of parameter uncertainty and various model assumptions on the findings.

Interventions

In addition to a no-intervention scenario, 4 hypothetical income support policies were modeled: universal basic income, modified LIFT Act, poverty alleviation, and negative income tax.

Main Outcome and Measures

The main outcome was the number of deaths averted, which was calculated by subtracting the number of deaths experienced in the no-intervention scenario from the number of deaths experienced with the various income support policies.

Results

Base-case assumptions used average mortality rates by age, sex, and income group, a 20-year time horizon, and a 3-year lag time. Universal basic income worth $12 000 per year per individual was estimated to avert the most deaths among working-age adults (42 000-104 000 per year), followed by a negative income tax that guaranteed an income of 133% of the federal poverty level (19 000-67 000 per year). A modified LIFT Act that provided $6000 to individuals with annual household incomes less than $100 000 was estimated to avert 17 000 to 52 000 deaths per year. A targeted approach that alleviated poverty was estimated to prevent 12 000 to 32 000 deaths among the lowest-income, working-age adult population. Results were most sensitive to several inputs and assumptions, primarily the income-based mortality rates, analytic time horizon, and assumed time lag between when a policy was implemented and when individuals experienced the mortality benefit of having higher incomes.

Conclusions and Relevance

In this modeling study, 4 hypothetical income support policies were estimated to avert thousands of deaths among working-age US adults every year. Additional research is needed to understand the true association of income gains with mortality. Discussions about the costs and benefits of income support policies should include potential gains in health.

Pandemic or Not, Worker Subjective Wellbeing Pivots About the Living Wage Point: A Replication, Extension, and Policy Challenge in Aotearoa New Zealand

Recent pre-pandemic research suggests that living wages can be pivotal for enhancing employee attitudes and subjective wellbeing. This article explores whether or not the present COVID-19 pandemic is impacting pivotal links between living wages and employee attitudes and subjective wellbeing, with replication indicating robustness. Twin cohorts each of 1,000 low-waged workers across New Zealand (NZ), one pre- (2018), and one present-pandemic (2020) were sample surveyed on hourly wage, job attitudes, and subjective wellbeing as linked to changes in the world of work associated with the pandemic (e.g., job security, stress, anxiety, depression, and holistic wellbeing). Using locally estimated scatter-point smoothing, job attitudes and subjective wellbeing scores tended to pivot upward at the living wage level in NZ. These findings replicate earlier findings and extend these into considering subjective wellbeing in the context of a crisis for employee livelihoods and lives more generally. Convergence across multiple measures, constructs, and contexts, suggests the positive impacts of living wages are durable. We draw inspiration from systems dynamics to argue that the present government policy of raising legal minimum wages (as NZ has done) may not protect subjective wellbeing until wages cross the living wage Rubicon. Future research should address this challenge.

Modelling Maternal Depression: An Agent-Based Model to Examine the Complex Relationship between Relative Income and Depression

Depression is a major public health concern among expectant mothers in Canada. Income inequality has been linked to depression, so interventions for reducing income inequality may reduce the prevalence of maternal depression. The current study aims to simulate the effects of government transfers and increases to minimum wage on depression in mothers. We used agent-based modelling techniques to identify the predicted effects of income inequality reducing programs on maternal depression. Model parameters were identified using the All Our Families cohort dataset and the existing literature. The mean age of our sample was 30 years. The sample was also predominantly white (78.6%) and had at least some post-secondary education (89.1%). When income was increased by just simulating an increase in minimum wage, the proportion of depressed mothers decreased by 2.9% (p < 0.005). Likewise, simulating the Canada Child Benefit resulted in a 5.0% decrease in the prevalence of depression (p < 0.001) and Ontario’s Universal Basic Income pilot project resulted in a simulated 5.6% decrease in the prevalence of depression (p < 0.001). We also assessed simulated changes to the mother’s social networks. Progressive income policies and increasing social networks are predicted to decrease the probability of depression.

A qualitative analysis of SNAP and minimum wage policies as experienced by workers with lower incomes

Work-related policies, including minimum wage and food assistance work requirements, can affect food security for people with lower incomes. This study conducted 112 qualitative interviews to understand participant policy experiences in two contexts (Raleigh, North Carolina and Minneapolis, Minnesota). Participants experienced frequent, destabilizing changes to their United States Department of Agriculture Supplemental Nutrition Assistance Program benefits, which they identified as part of a broader safety net. Raleigh workers described an unsupportive policy environment; Minneapolis workers reaped few benefits from an ongoing wage increase. Many workers face complex financial tradeoffs; more sophisticated evaluations should consider broader policy contexts and long-range effects.

Treatment design, health outcomes, and demographic categories in the literature on minimum wages and health

This literature review analyzes studies from the US, Canada, the UK, and Europe from inception to April 1, 2021 and focuses on treatment designs, health outcomes, demographic categories and data issues. Study designs are classified as treatment-effect-on-the-treated (7 studies), intent-to-treat (37), and what may be called possible-effects-on-anyone (10). Treatment-effects-on-the-treated designs are best for addressing the longstanding question: does income affect health or vice versa? I argue that they are also better for estimating the overall effect of minimum wages on health. Health outcomes are grouped into seven broad categories, such as overall physiological health and behavior, and 33 narrow categories, such as self-rated health and smoking. Demographic categories include gender, race/ethnicity, and age. The preponderance of evidence suggests that studies relying on the treatment-effect-on-the-treated and possible-effects-on-anyone designs find minimum wages improve health; there is no preponderance of evidence for overall health within intent-to-treat designs. With respect to specific health outcomes and demographic categories, there is no preponderance of evidence, except for improving infant and child health. One data issue concerns whether either intent-to-treat or possible-effects-on-everyone studies are reliable given that likely more than 70 % of people in their samples earn substantially above minimum wages thereby favoring the null hypothesis. Treatment-effect-on-the-treated designs are likely the best designs, and findings are largely consistent in showing that minimum wages improve some measures of health, for example, financial anxiety.

The determinants of racial disparities in obesity: baseline evidence from a natural experiment

This paper uses baseline data from an observational study to estimate the determinants of racial and gender disparities in obesity. Samples of low-income workers in Minneapolis and Raleigh reveal that respondents in Minneapolis have lower Body Mass Indices (BMIs) than respondents in Raleigh. There are large, statistically significant race and gender effects in estimates of BMI that explain most of the disparity between the two cities. Accounting for intersectionality - the joint impacts of being Black and a woman - reveals that almost all the BMI gaps between Black women in Minneapolis and Raleigh can be explained by age and education differences.

A Difference-in-Difference Study Evaluating the Effect of Minimum Wage Policy on Body Mass Index and Related Health Behaviors

Minimum wage laws are a promising policy lever to promote health equity, but few rigorous evaluations have tested whether and how minimum wage policy affects health outcomes. This paper describes an ongoing difference-in-difference study evaluating the health effects of the 2017 Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/hr. We present: (1) the conceptual model guiding the study including mediating mechanisms, (2) the study design, and (3) baseline findings from the study, and (4) the analytic plan for the remainder of the study. This prospective study follows a cohort of 974 low-wage workers over four years to compare outcomes among low-wage workers in Minneapolis, Minnesota, and those in a comparison city (Raleigh, North Carolina). Measures include height/weight, employment paystubs, two weeks of food purchase receipts, and a survey capturing data on participant demographics, health behaviors, and household finances. Baseline findings offer a profile of individuals likely to be affected by minimum wage laws. While the study is ongoing, the movement to increase local and state minimum wage is currently high on the policy agenda; evidence is needed to determine what role, if any, such policies play in improving the health of those affected.

The tipping point: could increasing the subminimum wage reduce poverty-related antenatal stressors in U.S. women?

PURPOSE

Tipped workers, primarily women of reproductive-age, can be paid a "subminimum wage" 71% lower than the federal minimum wage, contributing to economic hardship. Poverty-related antenatal stress has deleterious health effects for women and their children. The purpose of this study was to investigate the effects of increasing the state-level subminimum wage (currently $2.13 per hour) on poverty-related antenatal stress for women in the United States.

METHODS

Utilizing a difference-in-differences approach comparing state wage policies over time, we estimated the impact of increases in the subminimum wage on poverty-related antenatal stress using data from 35 states participating in the Pregnancy Risk Assessment Monitoring System between 2004 and 2014, linked to state-level wage laws, census, and antipoverty policy data.

RESULTS

The effect of increasing the subminimum wage on poverty-related stress differed by year and sociodemographics. Wage increases in 2014 were associated with the largest decreases in stress for unmarried women of color with less than a college degree, a population that we estimated would have experienced a 19.7% reduction in stress from 2004 to 2014 if subminimum wage was equivalent to the federal minimum wage.

CONCLUSIONS

Increasing the subminimum wage can reduce poverty-related stress and may be a potential intervention for reducing poor health outcomes.

The effect of income-based policies on mortality inequalities in Scotland: a modelling study

BACKGROUND

The unequal distribution of income is a fundamental determinant of health inequalities. Decision making around economic policies could be enhanced by showing their potential health effects. We used scenario modelling to assess the effects of 12 income-based policies on years of life lost (YLL) and inequalities in YLL in Scotland for the 2017-21 period.

METHODS

In this modelling study, we used EUROMOD version H1.0+, a tax-benefit microsimulation model, to estimate the effects of hypothetical fiscal policies on household income for Scottish households in the 2014/15 Family Resources Survey (n=2871). The effects were modelled excluding housing costs. Income change from baseline was estimated for each quintile of the 2016 Scottish Index of Multiple Deprivation (SIMD) after weighting to account for differential non-response to the Family Resources Survey, and incomes were equivalised according to the Organisation for Economic Co-operation and Development's modified equivalence scale. A regression analysis of cross-sectional data was used to estimate the relationship between income change and all-cause mortality, followed up by a sensitivity analysis to account for uncertainties around the assumptions on effect size. Informing Interventions to reduce health Inequalities (Triple I), a health inequalities scenario modelling tool, was used to estimate policy effects on YLL and government spending after five years of theoretical implementation. The Triple I model used population estimates for 2016 stratified by sex, 5-year age group, and SIMD quintile, which were obtained from the National Records of Scotland. Preliminary estimates of relative policy costs were calculated from the EUROMOD-derived combined effects of each policy on tax bills, National Insurance contributions, and benefits receipts for Scottish households.

FINDINGS

Taxation-based policies did not substantially affect household incomes, whereas benefits-based policies had large effects across the quintiles. The best policy for improving health and narrowing health inequalities was a 50% increase to means-tested benefits (approximately 105 177 [4·7%] YLL fewer than the baseline of 2·2 million, and a 7·9% reduction in relative index of inequality). Effects on YLL and health inequalities were inversely correlated in response to changes in taxation policy. Citizen's Basic Income (CBI) schemes also substantially narrowed inequalities (3·7% relative index of inequality for basic scheme, 5·9% for CBI with additional payments for individuals with disability), and modestly reduced YLL (0·7% for the basic scheme and 1·4% with additional payments). The estimated government spending associated with a policy was proportional to its effect on YLL, but less closely related to its effect on inequalities in YLL.

INTERPRETATION

Policies that affect incomes could potentially have marked effects on health and health inequalities in Scotland. Our projections suggest that the most effective policies for reducing health inequalities appeared to be those that disproportionately increased incomes in the most deprived areas. Although modelling was subject to various assumptions, the approach can be useful to inform decisions around addressing the upstream determinants of health inequalities.

FUNDING

None.

States with higher minimum wages have lower STI rates among women: Results of an ecological study of 66 US metropolitan areas, 2003-2015

Prior research has found that places and people that are more economically disadvantaged have higher rates and risks, respectively, of sexually transmitted infections (STIs). Economic disadvantages at the level of places and people, however, are themselves influenced by economic policies. To enhance the policy relevance of STI research, we explore, for the first time, the relationship between state-level minimum wage policies and STI rates among women in a cohort of 66 large metropolitan statistical areas (MSAs) in the US spanning 2003-2015. Our annual state-level minimum wage measure was adjusted for inflation and cost of living. STI outcomes (rates of primary and secondary syphilis, gonorrhea and chlamydia per 100,000 women) were obtained from the CDC. We used multivariable hierarchical linear models to test the hypothesis that higher minimum wages would be associated with lower STI rates. We preliminarily explored possible socioeconomic mediators of the minimum wage/STI relationship (e.g., MSA-level rates of poverty, employment, and incarceration). We found that a $1 increase in the price-adjusted minimum wage over time was associated with a 19.7% decrease in syphilis rates among women and with an 8.5% drop in gonorrhea rates among women. The association between minimum wage and chlamydia rates did not meet our cutpoint for substantive significance. Preliminary mediation analyses suggest that MSA-level employment among women may mediate the relationship between minimum wage and gonorrhea. Consistent with an emerging body of research on minimum wage and health, our findings suggest that increasing the minimum wage may have a protective effect on STI rates among women. If other studies support this finding, public health strategies to reduce STIs among women should include advocating for a higher minimum wage.

State minimum wage laws and newly diagnosed cases of HIV among heterosexual black residents of US metropolitan areas

This ecologic cohort study explores the relationship between state minimum wage laws and rates of HIV diagnoses among heterosexual black residents of U.S metropolitan areas over an 8-year span. Specifically, we applied hierarchical linear modeling to investigate whether state-level variations in minimum wage laws, adjusted for cost-of-living and inflation, were associated with rates of new HIV diagnoses among heterosexual black residents of metropolitan statistical areas (MSAs; n=73), between 2008 and 2015. Findings suggest that an inverse relationship exists between baseline state minimum wages and initial rates of newly diagnosed HIV cases among heterosexual black individuals, after adjusting for potential confounders. MSAs with a minimum wage that was $1 higher at baseline had a 27.12% lower rate of newly diagnosed HIV cases. Exploratory analyses suggest that income inequality may mediate this relationship. If subsequent research establishes a causal relationship between minimum wage and this outcome, efforts to increase minimum wages should be incorporated into HIV prevention strategies for this vulnerable population.

Disparities in Preventable Hospitalizations Among Public Housing Developments

INTRODUCTION

This study assesses preventable hospitalization rates among New York City residents living in public housing developments compared with all New York City residents and residents in low-income areas. Additionally, preventable hospitalization rates by development (one or multiple buildings in close proximity and served by the same management office) were determined.

METHODS

The 2010-2014 New York City hospital discharge data were geocoded and linked with New York City Housing Authority records using building-level identifiers. Preventable hospitalizations resulting from ambulatory care-sensitive conditions were identified for public housing residents, citywide, and residents of low-income areas. Age-adjusted overall and ambulatory care-sensitive, condition-specific preventable hospitalization rates (11 outcomes) were determined and compared across groups to assess potential disparities. Additionally, rates were ranked and compared among public housing developments by quartiles. The analysis was conducted in 2016 and 2017.

RESULTS

The age-adjusted rate of preventable hospitalization was significantly higher among public housing residents than citywide (rate ratio [RR]=2.67, 95% CI=2.65, 2.69), with the greatest disparities in hospitalizations related to diabetes (RR=3.12, 95% CI=3.07, 3.18) and asthma (RR=4.14, 95% CI=4.07, 4.21). The preventable hospitalization rate was also higher among residents of public housing than low-income areas (RR=1.33, 95% CI=1.31, 1.35). There were large differences between developments ranked in the top and bottom quartiles of preventable hospitalization (RR=1.81, 95% CI=1.76, 1.85) with the largest difference related to chronic obstructive pulmonary disease (RR=3.38, 95% CI=3.08, 3.70).

CONCLUSIONS

Preventable hospitalization rates are high among public housing residents, and vary significantly by development and condition. By providing geographically granular information, geocoded hospital discharge data can serve as a valuable tool for health assessment and engagement of the healthcare sector and other stakeholders in interventions that address health inequities.

Minimum wages and public health: A literature review

We evaluate evidence for the effectiveness of raising minimum wages on various measures of public health within the US, Canada, the UK, and Europe. We search four scientific websites from the inception of the research through May 20, 2018. We find great variety (20+) in measured outcomes among the 33 studies that pass our initial screening. We establish quality standards in a second screening resulting in 15 studies in which we create outcome-based groups. Outcomes include four broad measures (general overall health, behavior, mental health, and birth weight) and eight narrow measures (self-reported health, "bad" health days, unmet medical need, smoking, problem-drinking, obesity, eating vegetables, and exercise). We establish criteria for "stronger" findings for outcomes and methods. Stronger findings include: $1 increases in minimum wages are associated with 1.4 percentage point (4% evaluated at mean) decreases in smoking prevalence; failure to reject null hypotheses that minimum wages have no effects for most outcomes; and no consistent evidence that minimum wages harm health. One "suggestive" finding is that the best-designed studies have well-defined treatment (or likely affected) and control (unaffected) groups and contain longitudinal data. The major methodological weaknesses afflicting many studies are the lack of focus on persons likely affected by minimum wages and omission of "falsification tests" on persons likely unaffected. An additional weakness is lack of attention to how findings might differ across populations such as teenagers, adults, men, women, continuously employed and unemployed persons. Research into health effects of minimum wages is in its infancy and growing rapidly. We present a list of "better practices" for future research.

Economic Vulnerability Among US Female Health Care Workers: Potential Impact of a $15-per-Hour Minimum Wage

OBJECTIVES

To investigate racial/ethnic and gender inequities in the compensation and benefits of US health care workers and assess the potential impact of a $15-per-hour minimum wage on their economic well-being.

METHODS

Using the 2017 Annual Social and Economic Supplement to the Current Population Survey, we compared earnings, insurance coverage, public benefits usage, and occupational distribution of male and female health care workers of different races/ethnicities. We modeled the impact of raising the minimum wage to $15 per hour with different scenarios for labor demand.

RESULTS

Of female health care workers, 34.9% of earned less than $15 per hour. Nearly half of Black and Latina female health care workers earned less than $15 per hour, and more than 10% lacked health insurance. A total of 1.7 million female health care workers and their children lived in poverty. Raising the minimum wage to $15 per hour would reduce poverty rates among female health care workers by 27.1% to 50.3%.

CONCLUSIONS

Many US female health care workers, particularly women of color, suffer economic privation and lack health insurance. Achieving economic, gender, and racial/ethnic justice will require significant changes to the compensation structure of health care.

State-level minimum wage and heart disease death rates in the United States, 1980-2015: A novel application of marginal structural modeling

Despite substantial declines since the 1960's, heart disease remains the leading cause of death in the United States (US) and geographic disparities in heart disease mortality have grown. State-level socioeconomic factors might be important contributors to geographic differences in heart disease mortality. This study examined the association between state-level minimum wage increases above the federal minimum wage and heart disease death rates from 1980 to 2015 among 'working age' individuals aged 35-64 years in the US. Annual, inflation-adjusted state and federal minimum wage data were extracted from legal databases and annual state-level heart disease death rates were obtained from CDC Wonder. Although most minimum wage and health studies to date use conventional regression models, we employed marginal structural models to account for possible time-varying confounding. Quasi-experimental, marginal structural models accounting for state, year, and state × year fixed effects estimated the association between increases in the state-level minimum wage above the federal minimum wage and heart disease death rates. In models of 'working age' adults (35-64 years old), a $1 increase in the state-level minimum wage above the federal minimum wage was on average associated with ~6 fewer heart disease deaths per 100,000 (95% CI: -10.4, -1.99), or a state-level heart disease death rate that was 3.5% lower per year. In contrast, for older adults (65+ years old) a $1 increase was on average associated with a 1.1% lower state-level heart disease death rate per year (b = -28.9 per 100,000, 95% CI: -71.1, 13.3). State-level economic policies are important targets for population health research.

Family Economic Security Policies and Child and Family Health

In this review, we examine the effects of family economic security policies (i.e., minimum wage, earned income tax credit, unemployment insurance, Temporary Assistance to Needy Families) on child and family health outcomes, summarize policy generosity across states in the USA, and discuss directions and possibilities for future research. This manuscript is an update to a review article that was published in 2014. Millions of Americans are affected by family economic security policies each year, many of whom are the most vulnerable in society. There is increasing evidence that these policies impact health outcomes and behaviors of adults and children. Further, research indicates that, overall, policies which are more restrictive are associated with poorer health behaviors and outcomes; however, the strength of the evidence differs across each of the four policies. There is significant diversity in state-level policies, and it is plausible that these policy variations are contributing to health disparities across and within states. Despite increasing evidence of the relationship between economic policies and health, there continues to be limited attention to this issue. State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child well-being. The mounting evidence will help to guide future research and policy making for evolving toward a more nurturing society for family and child health and well-being.

The impact of minimum wages on population health: evidence from 24 OECD countries

This study examines the relationship between minimum wages and several measures of population health by analyzing data from 24 OECD countries for a time period of 31 years. Specifically, I test for health effects as a result of within-country variations in the generosity of minimum wages, which are measured by the Kaitz index. The paper finds that higher levels of minimum wages are associated with significant reductions of overall mortality rates as well as in the number of deaths due to outcomes that have been shown to be more prevalent among individuals with low socioeconomic status (e.g., diabetes, disease of the circulatory system, stroke). A 10% point increase of the Kaitz index is associated with significant declines in death rates and an increase in life expectancy of 0.44 years. Furthermore, I provide evidence for potential channels through which minimum wages impact population health by showing that more generous minimum wages impact outcomes such as poverty, the share of the population with unmet medical needs, the number of doctor consultations, tobacco consumption, calorie intake, and the likelihood of people being overweight.

Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100

Numerous examples exist in population health of work that erroneously forces the causes of health to sum to 100%. This is surprising. Clear refutations of this error extend back 80 years. Because public health analysis, action, and allocation of resources are ill served by faulty methods, I consider why this error persists. I first review several high-profile examples, including Doll and Peto's 1981 opus on the causes of cancer and its current interpretations; a 2015 high-publicity article in Science claiming that two thirds of cancer is attributable to chance; and the influential Web site "County Health Rankings & Roadmaps: Building a Culture of Health, County by County," whose model sums causes of health to equal 100%: physical environment (10%), social and economic factors (40%), clinical care (20%), and health behaviors (30%). Critical analysis of these works and earlier historical debates reveals that underlying the error of forcing causes of health to sum to 100% is the still dominant but deeply flawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity.

The Effect of Minimum Wages on Adolescent Fertility: A Nationwide Analysis

OBJECTIVES

To investigate the effect of minimum wage laws on adolescent birth rates in the United States.

METHODS

I used a difference-in-differences approach and vital statistics data measured quarterly at the state level from 2003 to 2014. All models included state covariates, state and quarter-year fixed effects, and state-specific quarter-year nonlinear time trends, which provided plausibly causal estimates of the effect of minimum wage on adolescent birth rates.

RESULTS

A $1 increase in minimum wage reduces adolescent birth rates by about 2%. The effects are driven by non-Hispanic White and Hispanic adolescents.

CONCLUSIONS

Nationwide, increasing minimum wages by $1 would likely result in roughly 5000 fewer adolescent births annually.

The Effect of an Increased Minimum Wage on Infant Mortality and Birth Weight

OBJECTIVES

To investigate the effects of state minimum wage laws on low birth weight and infant mortality in the United States.

METHODS

We estimated the effects of state-level minimum wage laws using a difference-in-differences approach on rates of low birth weight (< 2500 g) and postneonatal mortality (28-364 days) by state and month from 1980 through 2011. All models included state and year fixed effects as well as state-specific covariates.

RESULTS

Across all models, a dollar increase in the minimum wage above the federal level was associated with a 1% to 2% decrease in low birth weight births and a 4% decrease in postneonatal mortality.

CONCLUSIONS

If all states in 2014 had increased their minimum wages by 1 dollar, there would likely have been 2790 fewer low birth weight births and 518 fewer postneonatal deaths for the year.

Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports

Introduction

Since the 1990s, the use of health impact assessments (HIAs) has grown for considering the potential health impacts of proposed policies, plans, programs, and projects in various sectors. Evaluation of HIA impacts is needed for understanding the value of HIAs, improving the methods involved in HIAs, and potentially expanding their application. Impact evaluations examine whether HIAs affect decisions and lead to other effects.

Methods

I reviewed HIA impact evaluations identified by literature review and professional networking. I abstracted and synthesized data on key findings, success factors, and challenges from 5 large evaluations conducted in the United States, Europe, Australia, and New Zealand and published from 2006 through 2015. These studies analyzed impacts of approximately 200 individual HIAs.

Results

Major impacts of HIAs were directly influencing some decisions, improving collaboration among stakeholders, increasing awareness of health issues among decision makers, and giving community members a stronger voice in local decisions. Factors that contributed to successful HIAs included engaging stakeholders, timeliness, policy and systems support for conducting HIAs, having people with appropriate skills on the HIA team, obtaining the support of decision makers, and providing clearly articulated, feasible recommendations. Challenges that may have reduced HIA success were poor timeliness, underestimation of time and resources needed, difficulty in accessing relevant data, use of jargon in HIA reports, difficulty in involving decision makers in the HIA process, and absence of a requirement to conduct HIAs.

Conclusion

HIAs can be useful to promote health and mitigate adverse impacts of decisions made outside of the health sector. Stakeholder interactions and community engagement may be as important as direct impacts of HIAs. Multiple factors are required for HIA success. Further work could strengthen the role of HIAs in promoting equity, examine HIA impacts in specific sectors, and document the role of HIAs in a “health in all policies” approach.