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Welfare Reform and the Health of Young Children
A Sentinel Survey in 6 US Cities
John T. Cook, PhD;
Deborah A. Frank, MD;
Carol Berkowitz, MD;
Maureen M. Black, PhD;
Patrick H. Casey, MD;
Diana B. Cutts, MD;
Alan F. Meyers, MD, MPH;
Nieves Zaldivar, MD;
Anne Skalicky, MPH;
Suzette Levenson, MEd, MPH;
Tim Heeren, PhD
Arch Pediatr Adolesc Med. 2002;156:678-684.
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.
From the Divisions of General Pediatrics (Drs Cook and Meyers) and
Growth and Development (Dr Frank), Department of Pediatrics, School of Medicine,
Boston Medical Center, and the Data Coordinating Center (Mss Skalicky and
Levenson) and the Department of Biostatistics (Dr Heeren), School of Public
Health, Boston University, Boston, Mass; the Department of Pediatrics, Los
Angeles County Harbor–University of California, Los Angeles, Medical
Center, Torrance (Dr Berkowitz); the Department of Pediatrics, University
of Maryland School of Medicine, Baltimore (Dr Black); the Center for Applied
Research and Evaluation, Department of Pediatrics, University of Arkansas
for Medical Sciences, Little Rock (Dr Casey); the Department of Pediatrics,
Hennepin County Medical Center, Minneapolis, Minn (Dr Cutts); and Mary's Center
for Maternal and Child Care, Washington, DC (Dr Zaldivar).
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