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Welfare reform and the health of young children: a sentinel survey in 6 US cities.
Arch Pediatr Adolesc Med. 2002 Jul; 156(7):678-84.AP

Abstract

CONTEXT

Welfare reform under the 1996 Personal Responsibility and Work Opportunity Reconciliation Act replaced entitlement to cash assistance for low-income families with Temporary Assistance to Needy Families, thereby terminating or decreasing cash support for many participants. Proponents anticipated that continued receipt of food stamps would offset the effects of cash benefit losses, although access to food stamps was also restricted.

OBJECTIVE

To examine associations of loss or reduction of welfare with food security and health outcomes among children aged 36 months or younger at 6 urban hospitals and clinics.

DESIGN AND SETTING

A multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington, DC, from August 1998 through December 2000.

PARTICIPANTS

The caregivers of 2718 children aged 36 months or younger whose households received welfare or had lost welfare through sanctions were interviewed at hospital clinics and emergency departments.

MAIN OUTCOME MEASURES

Household food security status, history of hospitalization, and, for a subsample interviewed in emergency departments, whether the child was admitted to the hospital the day of the visit.

RESULTS

After controlling for potential confounding factors, children in families whose welfare was terminated or reduced by sanctions had greater odds of being food insecure (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.1-1.9), of having been hospitalized since birth (AOR, 1.3; 95% CI, 1.0-1.7) and, for the emergency department subsample, of being admitted the day of an emergency department visit (AOR, 1.9; 95% CI, 1.2-3.0) compared with those without decreased benefits. Children in families whose welfare benefits were decreased administratively because of changes in income or expenses had greater odds of being food insecure (AOR, 1.5; 95% CI, 1.1-2.2) and of being admitted the day of an emergency department visit (AOR, 2.8; 95% CI, 1.4-5.6). Receiving food stamps does not mitigate the effects of the loss or reduction of welfare benefits on food security or hospitalizations.

CONCLUSION

Terminating or reducing welfare benefits by sanctions, or decreasing benefits because of changes in income or expenses, is associated with greater odds that young children will experience food insecurity and hospitalizations.

Authors+Show Affiliations

Boston Medical Center, Department of Pediatrics, 91 E Concord St, Fourth floor, Boston, MA 02118, USA. john.cook@bmc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12090835

Citation

Cook, John T., et al. "Welfare Reform and the Health of Young Children: a Sentinel Survey in 6 US Cities." Archives of Pediatrics & Adolescent Medicine, vol. 156, no. 7, 2002, pp. 678-84.
Cook JT, Frank DA, Berkowitz C, et al. Welfare reform and the health of young children: a sentinel survey in 6 US cities. Arch Pediatr Adolesc Med. 2002;156(7):678-84.
Cook, J. T., Frank, D. A., Berkowitz, C., Black, M. M., Casey, P. H., Cutts, D. B., Meyers, A. F., Zaldivar, N., Skalicky, A., Levenson, S., & Heeren, T. (2002). Welfare reform and the health of young children: a sentinel survey in 6 US cities. Archives of Pediatrics & Adolescent Medicine, 156(7), 678-84.
Cook JT, et al. Welfare Reform and the Health of Young Children: a Sentinel Survey in 6 US Cities. Arch Pediatr Adolesc Med. 2002;156(7):678-84. PubMed PMID: 12090835.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Welfare reform and the health of young children: a sentinel survey in 6 US cities. AU - Cook,John T, AU - Frank,Deborah A, AU - Berkowitz,Carol, AU - Black,Maureen M, AU - Casey,Patrick H, AU - Cutts,Diana B, AU - Meyers,Alan F, AU - Zaldivar,Nieves, AU - Skalicky,Anne, AU - Levenson,Suzette, AU - Heeren,Tim, PY - 2002/7/2/pubmed PY - 2002/8/3/medline PY - 2002/7/2/entrez SP - 678 EP - 84 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 156 IS - 7 N2 - CONTEXT: Welfare reform under the 1996 Personal Responsibility and Work Opportunity Reconciliation Act replaced entitlement to cash assistance for low-income families with Temporary Assistance to Needy Families, thereby terminating or decreasing cash support for many participants. Proponents anticipated that continued receipt of food stamps would offset the effects of cash benefit losses, although access to food stamps was also restricted. OBJECTIVE: To examine associations of loss or reduction of welfare with food security and health outcomes among children aged 36 months or younger at 6 urban hospitals and clinics. DESIGN AND SETTING: A multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington, DC, from August 1998 through December 2000. PARTICIPANTS: The caregivers of 2718 children aged 36 months or younger whose households received welfare or had lost welfare through sanctions were interviewed at hospital clinics and emergency departments. MAIN OUTCOME MEASURES: Household food security status, history of hospitalization, and, for a subsample interviewed in emergency departments, whether the child was admitted to the hospital the day of the visit. RESULTS: After controlling for potential confounding factors, children in families whose welfare was terminated or reduced by sanctions had greater odds of being food insecure (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.1-1.9), of having been hospitalized since birth (AOR, 1.3; 95% CI, 1.0-1.7) and, for the emergency department subsample, of being admitted the day of an emergency department visit (AOR, 1.9; 95% CI, 1.2-3.0) compared with those without decreased benefits. Children in families whose welfare benefits were decreased administratively because of changes in income or expenses had greater odds of being food insecure (AOR, 1.5; 95% CI, 1.1-2.2) and of being admitted the day of an emergency department visit (AOR, 2.8; 95% CI, 1.4-5.6). Receiving food stamps does not mitigate the effects of the loss or reduction of welfare benefits on food security or hospitalizations. CONCLUSION: Terminating or reducing welfare benefits by sanctions, or decreasing benefits because of changes in income or expenses, is associated with greater odds that young children will experience food insecurity and hospitalizations. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/12090835/Welfare_reform_and_the_health_of_young_children:_a_sentinel_survey_in_6_US_cities_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/vol/156/pg/678 DB - PRIME DP - Unbound Medicine ER -