Antipoverty programs mitigate socioeconomic disparities in brain structure and psychopathology among U.S. youths

Low socioeconomic status (SES) in childhood is associated with altered neural development and elevated risk for psychopathology. Can public policies that increase financial resources for families with low income—including cash assistance programs and the presence of Medicaid expansion—reduce these socioeconomic disparities in brain development and mental health? Addressing this question has not been previously possible, because neuroimaging studies are typically conducted in a single community. We leverage a unique opportunity provided by the Adolescent Behavior and Cognitive Development (ABCD) study, which provided harmonized neuroimaging data from 11,534 youth across 21 sites (in 17 states) that differed in cost of living and anti-poverty policy climates. Lower SES was associated with smaller hippocampal volume, higher internalizing psychopathology, and greater exposure to stressful life events, but the magnitude of these associations varied significantly across states. The association of SES with hippocampal volume was about 37% smaller in states where cost of living was high but that provided more generous cash benefits for lower SES families as compared to states with less generous benefits. In high cost of living states where antipoverty programs were more generous, the association between SES and hippocampal volume resembled that of low cost of living states. Similar patterns were observed for internalizing psychopathology and stressful life events. These findings demonstrate that macroeconomic conditions moderate the degree to which family income influences children’s neurodevelopment and mental health and that anti-poverty policies exert a buffering effect against the negative impacts of low SES.

Means-Tested Safety Net Programs and Hispanic Families: Evidence from Medicaid, SNAP, and WIC

Hispanic families have historically used means-tested assistance less than high-poverty peers, and one explanation for this may be that anti-immigrant politics and policies are a barrier to program participation. We document the participation of Hispanic children in three antipoverty programs by age and parental citizenship and the correlation of participation with state immigrant-based restrictions. Hispanic citizen children with citizen parents participate in Supplemental Nutrition Assistance Program (SNAP) and Medicaid more than Hispanic citizen children with noncitizen parents. Foreign-born Hispanic mothers use Medicaid less than their socioeconomic status would suggest. However, little evidence exists that child participation in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) varies by mother’s nativity: foreign-born mothers of Hispanic infants participate in WIC at higher rates than U.S.-born Hispanic mothers. State policies that restrict immigrant program use correlate to lower SNAP and Medicaid uptake among citizen children of foreign-born Hispanic mothers. WIC participation may be greater because it is delivered through nonprofit clinics, and WIC eligibility for immigrants is largely unrestricted.

Poverty, depression, and anxiety: Causal evidence and mechanisms

Why are people who live in poverty disproportionately affected by mental illness? We review the interdisciplinary evidence of the bidirectional causal relationship between poverty and common mental illnesses—depression and anxiety—and the underlying mechanisms. Research shows that mental illness reduces employment and therefore income, and that psychological interventions generate economic gains. Similarly, negative economic shocks cause mental illness, and antipoverty programs such as cash transfers improve mental health. A crucial step toward the design of effective policies is to better understand the mechanisms underlying these causal effects.

Poverty Alleviation and Interhousehold Transfers: Evidence from BRAC’s Graduation Program in Bangladesh

Poor households often rely on transfers from their social networks for consumption smoothing, yet there is limited evidence on how antipoverty programs affect informal transfers. This paper exploits the randomized rollout of BRAC’s ultra-poor graduation program in Bangladesh and panel data covering over 21,000 households over seven years to study the program’s effects on interhousehold transfers. The program crowds out informal transfers received by the targeted households, but this is driven mainly by outside-village transfers. Treated ultra-poor households become more likely to both give and receive transfers to/from wealthier households within their village; and less likely to receive transfers from their employers. As a result, the reciprocity of their within-village transfers increases. The findings imply that, within rural communities, there is positive assortative matching by socio-economic status. A reduction in poverty enables households to engage more in reciprocal transfer arrangements and lowers the interlinkage of their labor with informal insurance.

The Social Welfare Policy Landscape and Child Protective Services: Opportunities for and Barriers to Creating Systems Synergy

Contemporary child welfare policies in the United States are well-suited for prevention of child abuse but fail to account for the relationship between family financial hardship and neglect, that is, the lack of safe and consistent care. We argue that rates of child neglect have been stagnant because of two failures: (1) lack of recognition of financial hardship as a causal mechanism of neglect and (2) federal policy that purposefully omits alleviation of financial hardship as a solution to the occurrence of neglect. Because U.S. antipoverty programs operate independently of one another, our siloed policy structure misses opportunities for the alleviation of child maltreatment and, worse, creates negative and unintended consequences in child welfare. We present a model for change: systems synergy for the promotion of safe and consistent care that makes reduction of child maltreatment the responsibility of every social service program in the United States.

Diaper need is associated with risk for food insecurity in a statewide sample of WIC participants

Diaper need is a form of material hardship that acutely affects families with young children, is not currently addressed by US antipoverty programs, and has received little public or scientific attention. This study examined the association between diaper need and risk for food insecurity in a statewide sample of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Families enrolled in Vermont WIC in August 2019 were invited to an online survey. Generalized linear models were used to estimate the relationship between risk for food insecurity measured by the Hunger Vital Sign tool and diaper need, with and without adjustment for household factors. Follow-up questions asked those with diaper need what they do when they run out of diapers and those without diaper need how they access enough diapers. Complete data were available for 501 households. Over half (52.3%) were at risk for food insecurity and nearly one-third (32.5%) reported diaper need. The odds of experiencing risk for food insecurity were 3.852 (95% CI=2.557, 5.803) times greater for families with diaper need than for families that had enough diapers. The association persisted with adjustment for location, age of respondent, number of children in diapers, and length of time participating in WIC (adjusted OR=4.036, 95% CI=2.645, 6.160). Strategies to avoid running out of diapers included borrowing, stretching supplies, switching to cloth or underwear, and buying on credit. It is possible that public health interventions that address diaper need may reduce food insecurity in households with children.

The evolution of infant mortality inequality in the United States, 1960–2016

What is the relationship between infant mortality and poverty in the United States and how has it changed over time? We address this question by analyzing county-level data between 1960 and 2016. Our estimates suggest that level differences in mortality rates between the poorest and least poor counties decreased meaningfully between 1960 and 2000. Nearly three-quarters of the decrease occurred between 1960 and 1980, coincident with the introduction of antipoverty programs and improvements in medical care for infants. We estimate that declining inequality accounts for 18% of the national reduction in infant mortality between 1960 and 2000. However, we also find that level differences between the poorest and least poor counties remained constant between 2000 and 2016, suggesting an important role for policies that improve the health of infants in poor areas.

Appalachian War on Poverty and the Working Class

In 1964, President Lyndon B. Johnson announced an unconditional “war on poverty.” On one of his first publicity tours promoting his antipoverty legislation, he traveled to cities and towns in Appalachia, which would become crucial areas for promoting and implementing the legislation. Johnson soon signed the Economic Opportunity Act, a piece of legislation that provided a structure for communities to institute antipoverty programs, from vocational services to early childhood education programs, and encouraged the creation of new initiatives. In 1965, Johnson signed the Appalachian Regional Development Act, making Appalachia the only region targeted by federal antipoverty legislation, through the creation of the Appalachian Regional Commission. The Appalachian War on Poverty can be described as a set of policies created by governmental agencies, but also crucial to it was a series of community movements and campaigns, led by working-class people, that responded to antipoverty policies. When the War on Poverty began, the language of policymakers suggested that people living below the poverty line would be served by the programs. But as the antipoverty programs expanded and more local people became involved, they spoke openly and in political terms about poverty as a working-class issue. They drew attention to the politics of class in the region, where elites and absentee landowners became wealthy on the backs of working people. They demanded meaningful participation in shaping the War on Poverty in their communities, and, increasingly, when they used the term “poor people,” they did so as a collective class identity—working people who were poor due to a rigged economy. While many public officials focused on economic development policies, men and women living in the region began organizing around issues ranging from surface mining to labor rights and responding to poor living and working conditions. Taking advantage of federal antipoverty resources and the spirit of change that animated the 1960s, working-class Appalachians would help to shape the antipoverty programs at the local and regional level, creating a movement in the process. They did so as they organized around issues—including the environment, occupational safety, health, and welfare rights—and as they used antipoverty programs as a platform to address the systemic inequalities that plagued many of their communities.

The Ku Klux Klan and the War on Poverty

Chapter three traces the history of the Ku Klux Klan in Mississippi from Reconstruction to the 1960s, before exploring the wave of white supremacist violence that exploded across the state of Mississippi in 1967. This renewed wave of Ku Klux Klan attacks was directed at the state’s antipoverty programs, and in particular at white men and women involved in those programs. The chapter traces the rhetoric used in Klan literature in opposing the war on poverty, which claimed the programs were part of a move toward federal dictatorship. The language fused the core myths and fears on which white segregationists drew—miscegenation, the spread of venereal disease, interracial sex, the threat of black power, and liberal welfare policies that benefitted African Americans. It also illustrates how gender shaped both the Klan violence and its ideology, as attacks on white women teaching in Head Start classes intensified.