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Pediatrics Jun 2018Given a large and consistent literature revealing a link between housing and health, publicly supported housing assistance programs might play an important role in...
CONTEXT
Given a large and consistent literature revealing a link between housing and health, publicly supported housing assistance programs might play an important role in promoting the health of disadvantaged children.
OBJECTIVE
To summarize and evaluate research in which authors examine housing assistance and child health.
DATA SOURCES
PubMed, Web of Science, PsycInfo, and PAIS (1990-2017).
STUDY SELECTION
Eligible studies were required to contain assessments of public housing, multifamily housing, or vouchers in relation to a health outcome in children (ages 0-21); we excluded neighborhood mobility interventions.
DATA EXTRACTION
Study design, sample size, age, location, health outcomes, measurement, program comparisons, analytic approach, covariates, and results.
RESULTS
We identified 14 studies, including 4 quasi-experimental studies, in which authors examined a range of health outcomes. Across studies, the relationship between housing assistance and child health remains unclear, with ∼40% of examined outcomes revealing no association between housing assistance and health. A sizable proportion of observed relationships within the quasi-experimental and association studies were in favor of housing assistance (50.0% and 37.5%, respectively), and negative outcomes were less common and only present among association studies.
LIMITATIONS
Potential publication bias, majority of studies were cross-sectional, and substantial variation in outcomes, measurement quality, and methods to address confounding.
CONCLUSIONS
The results underscore a need for rigorous studies in which authors evaluate specific housing assistance programs in relation to child outcomes to establish what types of housing assistance, if any, serve as an effective strategy to reduce disparities and advance equity across the lifespan.
Topics: Child; Child Health; Humans; Public Assistance; Public Housing
PubMed: 29765008
DOI: 10.1542/peds.2017-2742 -
Pediatrics Nov 2021To determine the association between states' total spending on benefit programs and child maltreatment outcomes.
BACKGROUND
To determine the association between states' total spending on benefit programs and child maltreatment outcomes.
METHODS
This was an ecological study of all US states during federal fiscal years 2010-2017. The primary predictor was states' total annual spending on local, state, and federal benefit programs per person living ≤100% federal poverty limit, which was the sum of (1) cash, housing, and in-kind assistance, (2) housing infrastructure, (3) child care assistance, (4) refundable Earned Income Tax Credit, and (5) Medical Assistance Programs. The main outcomes were rates of maltreatment reporting, substantiations, foster care placements, and fatalities after adjustment for relevant confounders. Generalized estimating equations adjusted for federal spending and estimated adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs).
RESULTS
States' total spending was inversely associated with all maltreatment outcomes. For each additional $1000 states spent on benefit programs per person living in poverty, there was an associated -4.3% (adjusted IRR: 0.9573 [95% CI: 0.9486 to 0.9661]) difference in reporting, -4.0% (adjusted IRR: 0.903 [95% CI: 0.9534 to 0.9672]) difference in substantiations, -2.1% (adjusted IRR: 0.9795 [95% CI: 0.9759 to 0.9832]) difference in foster care placements, and -7.7% (adjusted IRR: 0.9229 [95% CI: 0.9128 to 0.9330]) difference in fatalities. In 2017, extrapolating $1000 of additional spending for each person living in poverty ($46.5 billion nationally, or 13.3% increase) might have resulted in 181 850 fewer reports, 28 575 fewer substantiations, 4168 fewer foster care placements, and 130 fewer fatalities.
CONCLUSIONS
State spending on benefit programs was associated with reductions in child maltreatment, which might offset some benefit program costs.
Topics: Adolescent; Child; Child Abuse; Confidence Intervals; Foster Home Care; Housing; Humans; Incidence; Medical Assistance; Poverty; Public Assistance; Public Expenditures; Time Factors; United States
PubMed: 34663680
DOI: 10.1542/peds.2021-050685 -
Journal of Youth and Adolescence Jul 2017In recent years, scholars have pointed to the politically demobilizing effects of means-tested assistance programs on recipients. In this study, we bridge the insights...
In recent years, scholars have pointed to the politically demobilizing effects of means-tested assistance programs on recipients. In this study, we bridge the insights from policy feedback literature and adolescent political socialization research to examine how receiving means-tested programs shapes parent influence on adolescent political participation. We argue that there are differences in pathways to political participation through parent political socialization and youth internal efficacy beliefs for adolescents from households that do or do not receive means-tested assistance. Using data from a nationally representative sample of 536 Black, Latino, and White adolescents (50.8% female), we find that adolescents from means-tested assistance households report less parent political socialization and political participation. For all youth, parent political socialization predicts adolescent political participation. Internal political efficacy is a stronger predictor of political participation for youth from a non-means-tested assistance household than it is for youth from a household receiving means-tested assistance. These findings provide some evidence of differential paths to youth political participation via exposure to means-tested programs.
Topics: Adolescent; Female; Humans; Male; Parent-Child Relations; Parenting; Political Activism; Public Assistance; Socialization; United States
PubMed: 28054201
DOI: 10.1007/s10964-016-0624-x -
Journal of Nutritional Science 2023This scoping review aimed to identify the breadth of healthcare-based food assistance programmes in the United States and organize them into a typology of programmes to... (Review)
Review
This scoping review aimed to identify the breadth of healthcare-based food assistance programmes in the United States and organize them into a typology of programmes to provide implementation guidance to aspiring food assistance programmers in healthcare settings. We searched PubMed, Cochrane, and CINAHL databases for peer-reviewed articles published between 1 January 2010 and 31 December 2021, and mined reference lists. We used content analysis to extract programmatic details from each intervention and to qualitatively analyse intervention components to develop a typology for healthcare institutions in the United States. Eligible articles included descriptions of patient populations served and programmatic details. Articles were not required to include formal evaluations for inclusion in this scoping review. Our search resulted in 8706 abstracts, which yielded forty-three articles from thirty-five interventions. We identified three distinct programme types: direct food provision, referral, and voucher programmes. Programme type was influenced by programme goals, logistical considerations, such as staffing, food storage or refrigeration space, and existence of willing partner CBOs. Food provision programmes ( 13) were frequently permanent and leveraged partnerships with community-based organisations (CBOs) that provide food. Referral programmes ( 8) connected patients to CBOs for federal or local food assistance enrollment. Voucher programmes ( 14) prioritised provision of fruits and vegetables ( 10) and relied on a variety of clinic staff to refer patients to months-long programmes. Healthcare-based implementers can use this typology to design and maintain programmes that align with the needs of their sites and patient populations.
Topics: Humans; United States; Food Assistance; Delivery of Health Care; Health Facilities
PubMed: 38155805
DOI: 10.1017/jns.2023.111 -
Archives of Gerontology and Geriatrics 2022Public assistance programs guarantee a minimum living standard, promoting independence for impoverished citizens. Although public assistance eligibility is mainly based...
BACKGROUND
Public assistance programs guarantee a minimum living standard, promoting independence for impoverished citizens. Although public assistance eligibility is mainly based on economic factors like poverty, psychosocial factors may be important in initiating and terminating participation. We explored factors governing commencement and termination of public assistance by the older Japanese population between 2013 and 2016.
METHODS
We used panel data from the Japan Gerontological Evaluation Study (JAGES), conducted in 2013 and 2016. Fixed-effects regression was used to examine variables in 2013 that were related to receiving public assistance in 2016. The Tokyo Metropolitan Institute of Gerontology -competence index (TMIG-CI) was used to assess higher-level activities of daily living (ADL, i.e., instrumental ADL, intellectual activity, and social role). The role of individual perceptions of community social cohesion (community trust, mutual help, and attachment), and sociodemographic factors were considered.
RESULTS
While 215 people (0.5%) started receiving public assistance between 2013 and 2016, almost 50% stopped participating. People with higher perceived mutual community help were 1.21 times (95% confidence interval [CI]: 1.02-1.46) more likely to commence public assistance three years later. Public assistance recipients who felt community attachment to their resident community, and had social roles were 1.16 (95% CI: 1.06-1.28) and 1.15 (95% CI: 1.01-1.30) times more likely to give up public assistance three years later, respectively, independent of socioeconomic statuses.
CONCLUSION
Psychosocial factors, including maintaining good relationships with community residents, could be important in accessing and terminating public assistance services.
Topics: Activities of Daily Living; Geriatrics; Humans; Japan; Longitudinal Studies; Public Assistance
PubMed: 34971872
DOI: 10.1016/j.archger.2021.104615 -
AJS; American Journal of Sociology Mar 2015The historic increase in U.S. incarceration rates made the transition from prison to community common for poor, prime-age men and women. Leaving prison presents the...
The historic increase in U.S. incarceration rates made the transition from prison to community common for poor, prime-age men and women. Leaving prison presents the challenge of social integration--of connecting with family and finding housing and a means of subsistence. The authors study variation in social integration in the first months after prison release with data from the Boston Reentry Study, a unique panel survey of 122 newly released prisoners. The data indicate severe material hardship immediately after incarceration. Over half of sample respondents were unemployed, two-thirds received public assistance, and many relied on female relatives for financial support and housing. Older respondents and those with histories of addiction and mental illness were the least socially integrated, with weak family ties, unstable housing, and low levels of employment. Qualitative interviews show that anxiety and feelings of isolation accompanied extreme material insecurity. Material insecurity combined with the adjustment to social life outside prison creates a stress of transition that burdens social relationships in high-incarceration communities.
Topics: Adult; Boston; Female; Financial Support; Housing; Humans; Male; Middle Aged; Prisoners; Public Assistance; Social Adjustment; Stress, Psychological; Unemployment; Young Adult
PubMed: 26421345
DOI: 10.1086/681301 -
Paediatric and Perinatal Epidemiology Nov 2022
Topics: Humans; Infant; Poverty; United States; Public Assistance; Infant Formula
PubMed: 35830298
DOI: 10.1111/ppe.12913 -
Journal of Health Politics, Policy and... Apr 2021This article provides a detailed picture of the mindset of Americans about Medicaid work requirements and the important roles that perception of deservingness and racial...
CONTEXT
This article provides a detailed picture of the mindset of Americans about Medicaid work requirements and the important roles that perception of deservingness and racial bias play in public attitudes.
METHODS
The authors conducted a large original survey to investigate public attitudes toward work requirements. They analyzed the predictors of overall support for work requirements, correlates of who should be exempt from them, and attitudes toward work supports that make compliance with work requirements easier.
FINDINGS
The authors found that public opinion is split relatively evenly when it comes to Medicaid work requirements in the abstract. When Americans are confronted with the complexities of the issue, important nuances emerge. The authors also found consistent evidence that support for work requirements is higher among conservatives, those who see Medicaid as a short-term program, and racially resentful non-Hispanic whites. They show that groups that have historically been framed as deserving see high levels of support for their exemption (e.g., the disabled and senior citizens). Finally, the authors found that Americans are supportive of policies that provide individuals with help when transitioning into the workforce.
CONCLUSIONS
Americans' views of Medicaid and the populations it serves are complex and continue to be influenced by perceptions of deservingness and race.
Topics: Attitude to Health; History, 20th Century; Humans; Medicaid; Public Assistance; Public Opinion; Surveys and Questionnaires; United States; Work
PubMed: 32955553
DOI: 10.1215/03616878-8802198 -
International Journal For Equity in... Aug 2020Tackling poverty requires reconsideration of quantitative factors related to "who" is poor and by "how much" and qualitative factors addressing "what poverty means in...
BACKGROUND
Tackling poverty requires reconsideration of quantitative factors related to "who" is poor and by "how much" and qualitative factors addressing "what poverty means in these individuals' lives". Greater understanding is required concerning the types of access actually used by families in poverty in attempts to meet their basic needs. Poverty must be addressed based on the question: "Inequality of what?" It is in reflecting on the realities of such groups when their basic needs are not met that public policies can be improved and implemented with legitimate priorities.
OBJECTIVE
Describe coverage and access to public health, education and social assistance services and the related effects on the quality of life of families in extreme poverty.
METHODS
An exploratory mixed methods study was conducted applying Amartya Sen's "Basic Capability Equality" framework, with: 1) 27 interviews with managers and professionals from public services serving territories with extreme poverty; 2) Survey with a systematic proportionate stratified sample of 336 heads of households in extreme poverty from a total 2605 families. The resulting data was analyzed with thematic content analysis and descriptive statistics, respectively.
RESULTS
The managers and professionals described the lives of families in extreme poverty with phrases such as, "These people suffer. Sadness weighs on their lives!" and "Depression is the most common illness". Their precarious circumstances and inadequate access were cited as causes. Quality of life was considered bad or very bad by 41.4% of heads of households. A total income of less than one-third of the minimum wage was received by 56.9% of the sample. One or more people were unemployed in the family in 55.8% of cases. For 53.3% of heads of households, public services "did not meet any or few of their needs". The main social determinants of health were described as: alcohol and drugs (68.8%); lack of good health care (60.7%); and absence of income/work (37.5%). The following were identified as solutions to improve their quality of life: (1) health (40.5%); (2) education (37.8%); and (3) employment (44.6%).
CONCLUSIONS
The social determinants of poverty and health must be addressed jointly through intersectoral public policies and egalitarian mechanisms that promote investment in social protection.
Topics: Adult; Brazil; Cities; Educational Status; Employment; Family Characteristics; Female; Health Equity; Humans; Income; Male; Poverty; Public Assistance; Public Policy; Quality of Life; Social Conditions; Social Determinants of Health; Social Welfare; Socioeconomic Factors; Substance-Related Disorders; Urban Population
PubMed: 32762684
DOI: 10.1186/s12939-020-01243-y -
Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity.JAMA Pediatrics Feb 2024Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in...
IMPORTANCE
Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity.
OBJECTIVE
To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023.
EXPOSURES
Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs.
MAIN OUTCOMES AND MEASURES
Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year.
RESULTS
A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term).
CONCLUSIONS AND RELEVANCE
These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States' eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.
Topics: Child; Humans; Child Abuse; Cross-Sectional Studies; Ethnicity; Hispanic or Latino; Poverty; United States; Black or African American; White; Public Assistance
PubMed: 38109092
DOI: 10.1001/jamapediatrics.2023.5521