Something for the Poor
Health Selection into Eviction: Adverse Birth Outcomes and Children’s Risk of Eviction through Age 5
Gabriel Schwartz et al.
American Journal of Epidemiology, forthcoming
Abstract:
Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. In this paper, we test whether infants experiencing an adverse birth outcome — low birthweight or prematurity, as well as lengthy hospital stays — are more likely to be evicted in early childhood, through age 5. We analyze 5,655 observations contributed by 2,115 participants in the Fragile Families and Child Wellbeing Study — a national, randomly sampled cohort of infants born in large US cities between 1998 and 2000 — living in rental housing at baseline. We fit proportional hazards models using piecewise logistic regression, controlling for an array of confounders and applying inverse probability of selection weights. We find that being born low birthweight/preterm is associated with a 1.74-fold increase in children’s hazard of eviction (95%CI=1.02,2.95), while lengthy neonatal hospital stays were independently associated with a relative hazard of 2.50 (CI=1.15,5.44) compared to uncomplicated births. Given recent findings that unstable housing during pregnancy is associated with adverse birth outcomes, our results suggest eviction and health may be cyclical and co-constitutive. Children experiencing adverse birth outcomes are vulnerable to eviction and require additional supports.
The Health Impacts of Eviction: Evidence from the National Longitudinal Study of Adolescent to Adult Health
Morgan Hoke & Courtney Boen
Social Science & Medicine, March 2021
Abstract:
Eviction represents an urgent social and economic issue in the United States, with nearly two million evictions occurring annually in the U.S. Still, the population health impacts of evictions, as well as the pathways linking eviction to health, are not well documented or understood, particularly among young adults. Using nationally-representative, longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (1994-2008) (n=9,029), the present study uses a combination of analytic methods — including prospective lagged dependent variable regression models, inverse probabilities of treatment weighting, longitudinal first difference models, causal mediation techniques — to comprehensively assess whether and how evictions relate to depressive risk and self-rated health across early adulthood, paying particular attention to the stress-related pathways linking eviction and health. Results provide robust evidence of positive longitudinal associations between eviction and depressive risk, in particular. In the prospective regression models, young adults who experienced recent eviction had more depressive symptoms and worse self-rated health than those who were not evicted, net a host of background characteristics. Using treatment weighting techniques, results showed that young adults who experienced eviction had more depressive symptoms than those who were not evicted (5.921 vs. 4.998 depressive symptoms, p=0.003). Perceived social stress mediated nearly 18 percent of the associations between eviction and the depressive symptoms (p<0.001). In the first difference models, young people who experienced eviction between survey waves experienced greater increases in depressive symptoms over time compared to those who were not evicted, net of changes in other indicators of socioeconomic status and residential instability. Taken together, our results suggest that the recent surges in evictions in the U.S. serve as a potent threat to population health during the emerging adult period, with especially devastating consequences for low-income individuals and communities of color.
Association of Eviction With Adverse Birth Outcomes Among Women in Georgia, 2000 to 2016
Gracie Himmelstein & Matthew Desmond
JAMA Pediatrics, forthcoming
Design: This case-control study compared birth outcomes of infants whose mothers were evicted during gestation with those whose mothers were evicted at other times. Participants included infants born to mothers who were evicted in Georgia from January 1, 2000, to December 31, 2016. Data were analyzed from March 1 to October 4, 2020.
Results: A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10 135 births to women who had an eviction action during pregnancy and 78 727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, −26.88 [95% CI, −39.53 to 14.24] g) and gestational age (difference, −0.09 [95% CI, −0.16 to −0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, −0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, −57.51 to −11.97) and 35.80 (95% CI, −52.91 to −18.69) g, respectively.
Benefits Cliffs, Disincentive Deserts, and Economic Mobility
Craig Richardson & Zachary Blizard
Journal of Poverty, forthcoming
Abstract:
This paper highlights a bigger problem than benefits cliffs for people receiving government assistance, which we call “disincentive deserts.” These “deserts” are long ranges of work effort with 90–100% effective marginal tax rates (EMTRs). Using a tax/federal benefits simulator developed for Forsyth County, NC, we show that EMTRs for individuals receiving benefits range between 90% and 100% through a vast range of income. A rational individual would never work more than part-time, according to indifference curve theory. We discuss opportunities for the private sector to reconsider rewards for employees, since wage increases may harm some low-income workers because of cuts in their government benefits.
Impact of the supplemental nutritional assistance program on diet‐related disease morbidity among older adults
Layla Booshehri & Jerome Dugan
Health Services Research, forthcoming
Data Source/Study Setting: 2008‐2013 Medical Expenditure Panel Survey, a nationally representative population‐based complex sample survey.
Study Design: A difference‐in‐regression‐discontinuity (DRD) design is used to assess the impacts of SNAP on diet‐related disease morbidity. The primary outcomes were the prevalence rate of hypertension, coronary heart disease, stroke, diabetes, and cancer. We also conducted supplemental analysis to examine potential co‐occurring trends in medical utilization.
Principal Findings: In the full sample, SNAP eligibility was associated with a significant decline in diabetes (−3.71 percentage points [pp]; P < .05). Non‐Hispanic (NH) White respondents reported trends similar to the full sample; however, NH Black respondents reported large declines in hypertension (−13.95 pp; P < .01) and Hispanic respondents reported declines in the prevalence of angina (−6.94 pp; P < .05) and stroke (−4.48 pp; P < .05).
Examining the bidirectional relationship between food insecurity and healthcare spending
Karl Johnson et al.
Health Services Research, forthcoming
Data Source: Nationally representative sample of the civilian noninstitutionalized population of the United States (2016‐2017 Medical Expenditure Panel Survey [MEPS]).
Study Design: In a retrospective longitudinal cohort, we conducted two sets of analyses: (a) two‐part models to examine the association between food insecurity in 2016 and health care expenditures in 2017; and (b) logistic regression models to examine the association between health care expenditures in 2016 and food insecurity in 2017. We adjusted for demographic and socioeconomic variables as well as 2016 health care expenditures and food insecurity.
Principal Findings: Food insecurity in 2016, compared with being food secure, was associated with both a higher odds of having any health care expenditures in 2017 (OR 1.29, 95% CI: 1.04 to 1.60) and greater total expenditures ($1738.88 greater, 95% CI: $354.10 to $3123.57), which represents approximately 25% greater expenditures. Greater 2016 health care expenditures were associated with slightly higher odds of being food insecure in 2017 (OR 1.007 per $1000 in expenditures, 95% CI: 1.002 to 1.012, P =0.01). Exploratory analyses suggested that poor health status may underlie the relationship between food insecurity and health care expenditures.
Price Consciousness at the Peak of “Impatience”
Mary Zaki & Jessica Todd
Journal of Human Resources, forthcoming
Abstract:
Past studies consistently document that consumption among low-income households spikes after income receipt and then subsequently declines. Using two approaches to analyzing linked survey and administrative data on food purchases, we find that SNAP recipients are most price-conscious and engage in their most successful price-saving efforts soon after benefit receipt. This contrasts with prior literature that posits recipients mistakenly feel “flush” with money after benefit receipt and injects forethought and savviness among SNAP recipients into the prevailing narrative that they lack self-control and capability. The frequency of benefit receipt may act as a savings commitment device that funds price-saving efforts.
Do additional SNAP benefits matter for child weight?: Evidence from the 2009 benefit increase
Katelin Hudak & Elizabeth Racine
Economics & Human Biology, forthcoming
Abstract:
We know that youth who live in low-income households tend to have lower nutritional health outcomes — including higher rates of obesity — when compared to their higher-income counterparts. The Supplemental Nutrition Assistance Program (SNAP) is the largest U.S. federal nutrition program and has been found to improve food security and to serve as an income support. It is less clear how SNAP may affect obesity in low-income youth. From a policy perspective, it is essential to understand how the largest federal nutrition assistance program influences the health of children and adolescents. We use the exogenous increase in SNAP benefits that was a part of the American Recovery and Reinvestment Act (ARRA) to identify how a change in benefits is linked with obesity in youth. We find evidence that the ARRA increase in SNAP benefits is associated with healthier weight outcomes in three of the four age groups examined. SNAP-eligible toddlers are less likely to be overweight and adolescents are less likely to be obese. These findings can help policy makers understand how additional SNAP benefits from the Families First Coronavirus Response Act may influence weight outcomes in children and adolescents.
Tax Filing and Take-Up: Experimental Evidence on Tax Preparation Outreach and EITC Participation
Jacob Goldin et al.
NBER Working Paper, January 2021
Abstract:
Governments and non-profits devote substantial resources to increasing take-up of the Earned Income Tax Credit (EITC) through educational outreach. We study a different approach: policies that encourage tax filing. In a large field experiment, we find that IRS letters about free tax preparation modestly increased filing, with a large share of the new filers claiming the EITC. The results suggest policies that increase filing can be an effective way to increase take-up of tax-administered social benefits, even policies that do not raise awareness or directly target the benefit in other ways.