The Effect of a U.S. Poverty Reduction Intervention on Maternal Assessments of Young Children’s Health, Nutrition, and Sleep: A Randomized Control Trial

Abstract

Importance: Children experiencing poverty are more likely to experience worse health outcomes during the first few years of life, including injury, chronic illness, worse nutrition, and poorer sleep. The extent to which a poverty reduction intervention improves children's health, nutrition, sleep, and healthcare utilization is unknown. Objective: To determine the effect of a 3-year, monthly unconditional cash transfer on health, nutrition, sleep, and healthcare utilization of children experiencing poverty who are healthy at birth. Design: Longitudinal randomized control trial Setting: Mother-infant dyads were recruited from postpartum wards in 12 hospitals in four cities across the U.S. Participants: 1,000 mothers were enrolled in the study. Eligibility criteria included: an annual income below the federal poverty line, being of legal age for consent, speaking English or Spanish, residing in the state of recruitment, and having an infant admitted to the well-baby nursery with plans to be discharged to the custody of the mother. Intervention: Mothers were randomly assigned to receive either a high-cash gift ($333 per month, or $3,996 per year; n=400) or a low-cash gift ($20 per month, or $240 per year; n=600) for the first several years of their child's life. Main Outcomes and Measures: Pre-registered maternal assessments of the focal child's health, nutrition, sleep, and healthcare utilization were collected at children's ages 1, 2, and 3. Results: Enrolled participants were majority Black (42%) and Hispanic (41%). 857 mothers participated in all three waves of data collection. We found no statistically detectable differences between the high-cash and low-cash gift groups in maternal assessments of children's overall health, sleep, or healthcare utilization. However, mothers in the high-cash gift group reported higher child consumption of fresh produce compared with mothers in the low-cash gift group at age 2, the only time point it was measured (β=0.17, SE=0.07, p=0.03). Conclusions and Relevance: In this RCT, unconditional cash transfers to mothers experiencing poverty did not improve their reports of their child's health, sleep, or healthcare utilization. However, stable income support of this magnitude improved toddler's consumption of fresh produce. Healthy newborns tend to grow into healthy toddlers, and the impacts of poverty reduction on children's health and sleep may not be fully borne out until later in life.

Prescription for Cash? Cash Support to Low‐Income Families in Maternal and Pediatric Health Care Settings

“…An ongoing trial of significant cash support to families of healthy full-term infants (the Baby's First Years study) led to moderate reductions in poverty but limited evidence of improvements in maternal self-reported stress or reports of children's sleep and nutrition. 72,73 Results from the Baby's First Years study highlight the challenge of simple interventions to address the complex determinants of poverty, including long-term financial stressors such as lack of stable and safe housing or employment. In addition to these persistent structural constraints, families experiencing health complications during pregnancy and early childhood also face increased shortterm financial burdens directly related to health care utilization, such as parking, transportation, childcare responsibilities for other children, and time off work.…”

“…An ongoing trial of significant cash support to families of healthy full‐term infants (the Baby's First Years study) led to moderate reductions in poverty but limited evidence of improvements in maternal self‐reported stress or reports of children's sleep and nutrition 72,73 . Results from the Baby's First Years study highlight the challenge of simple interventions to address the complex determinants of poverty, including long‐term financial stressors such as lack of stable and safe housing or employment.…”

Effect of Cash Benefits on Health Care Utilization and Health

“…[9][10][11][12][13][14][15][16] Prior randomized studies of income support in the US have had modest to no effects on health. [17][18][19][20][21][22][23][24][25][26][27][28] Several of these studies, however, have been limited by small sample size or 1-time payments, and none have leveraged administrative health care data, which have precise records of health care utilization and biomarkers that can broaden the understanding of the effects of income. Depending on their effects on access and health, cash benefits could increase or decrease health care utilization.…”