Dignity of Work and at Work: The Relationship between Workplace Dignity and Health among Latino Immigrants during the COVID-19 Pandemic.

Latino immigrants living in the United States were highly vulnerable to the health and economic consequences brought on by the COVID-19 pandemic. We use the conceptual framing of workplace dignity, worth that is acknowledged based on performance of job responsibilities, to explore Latino immigrants' experiences during the early months of the pandemic. A qualitative study was conducted with La Clínica del Pueblo (La Clínica), a community health center serving low-income Latino immigrants. From June to December 2020, we conducted in-depth video interviews with 29 Latino immigrant clients to explore pandemic-related challenges, including workplace changes, discriminatory experiences, and effects on health. We conducted thematic analysis using Dedoose software. Nearly half of participants were undocumented immigrants. Most participants were unemployed or underemployed due to the pandemic and 26-49 years of age; one-third were still working, and one-quarter were 50 years or older. About half were cisgender women and two were transgender women. Employed participants experienced a lack of dignity through being socially isolated and stigmatized at work; receiving no compensation for their extra labor or for sick leave; and experiencing discriminatory labor practices. Unemployed participants experienced a lack of dignity in being the first to lose their jobs without government support; losing self-esteem; and not being rehired. Participants associated denial of dignity with worsening health conditions and increased anxiety and depression. Our study suggests that denial of workplace dignity-through job loss, underemployment, and poor working conditions-is linked to adverse health outcomes for Latino immigrants. More research should recognize workplace dignity as an important social determinant of health.

Health Insurance Coverage Predicts Health Care Use among Latine Immigrants in Two Policy Contexts.

This study analyzed electronic health record (EHR) data from 2016 through 2019 from a federally qualified health center (FQHC) serving predominantly low-income Latine immigrants in the Washington, D.C. metropolitan area to examine how changes in health insurance coverage relate to changes in health care use. Federally qualified health center clients were insured for an average of 59% to 63% of their annual visits, but about one-third had no coverage throughout the year. Findings from descriptive regression and within-client fixed effects models indicate that in years with higher proportions of insured visits, clients averaged more medical visits and interpreter services but fewer mental health and care coordination visits. Latine immigrant clients in D.C., a city with a universal health insurance option, had health insurance coverage for 89% of their visits, and averaged more medical and fewer coordination visits relative to those in a neighboring county in a state without a universal insurance option.

The Impacts of New York State's Paid Family Leave Policy on Parents' Sleep and Exercise.

OBJECTIVES: To assess changes in young parents' health behaviors following implementation of New York State's Paid Family Leave Program (NYSPFL). METHODS: We used synthetic control (N = 117,552) and difference-in-differences (N = 18,973) models with data from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2019 to provide individual-level estimates of the effects of NYSPFL on self-reported exercise in the past month and average daily sleep of adults aged 21-30 years living with one or more children under 18 years of age in New York and comparison states. RESULTS: Synthetic control model results indicate that the NYSPFL increased the likelihood of exercise in the past month among mothers, single parents, and low-income parents by 6.3-10.3% points (pp), whereas fathers showed a decrease in exercise (7.8 pp). Fathers, single parents, and those with two or more children showed increases in daily sleep between 14 and 21 min per day. CONCLUSIONS FOR PRACTICE: State paid family and medical leave laws may provide benefits for health behaviors among young parents with children under 18, particularly those in low-income and single-parent households.

Parent-Child Time During the COVID-19 Pandemic: Evidence from the American Time Use Survey.

OBJECTIVES: To examine how the time parents spent with their children changed during the COVID-19 pandemic. METHODS: Using nationally representative time-diary data from the American Time Use Survey, parents' time spent in and location of enriching (direct) and secondary (supervisory) childcare among a sample with at one child under 6 years (N = 2,862) and 6-12 years of age (N = 3,595) from May 2020 to December 2021 were compared to January 2019 to March 2020. RESULTS: Parents' time in secondary childcare at home increased substantially. Parents with children under age 6 increased their enriching childcare time, driven by mothers. Low-income parents with children aged 6-12 showed a decrease in enriching time with children, whereas higher-income parents with school-age children showed an increase. CONCLUSIONS FOR PRACTICE: Parents' time in supervisory childcare increased substantially, and gender and income disparities in enriching time spent engaged with children grew. Examining parent-child time use patterns is important to understand the pandemic's effects and can provide insight on how best to support children and families during the recovery.

The minimum wage and parent time use.

This study used a differences-in-differences strategy with national time diary data from 2003 to 2018 to examine the effects of minimum wage changes on parents' time with children and in child-related activities. Findings indicate that a $1 increase in the minimum wage was associated with a small increase (2.6%) in the likelihood parents with one or more children under age 16 spent time actively caring for or helping children on weekends, and in more total time with children (a 2% increase in secondary child care time). In general, coefficients were larger for mothers' time use, particularly non-employed mothers, with potential implications for gender disparities in caregiving. Unmarried parents and parents of color showed increases in their time spent in activities related to children's health (~55% increase). Mothers showed an increase (8%) in the likelihood they spent any time in child education-related activities, and increases in child care time appeared concentrated among parents whose youngest child was 6-15 years of age. Findings suggest that increases in state minimum wages may lead to small increases in parents' time investments in children, with some variation among subgroups.

The Earned Income Tax Credit and Short-Term Changes in Parents' Time Investments in Children.

This study examined whether the addition of household resources via the receipt of the U.S. Earned Income Tax Credit (EITC) affects short-term patterns of parents' time investments in children, including time spent engaged with children and in activities related to their education. Using difference-in-differences analyses that exploit seasonal variation in federal EITC outlays with nationally representative time-diary data from the 2003 to 2017 American Time Use Survey-Current Population Survey (ATUS-CPS; N = 61,355) merged with state-level data from the University of Kentucky Center for Poverty Research (UKCPR) National Welfare Database, I estimate the plausibly causal effects of predicted EITC receipt on various measures of parents' time investments in their children. I examine parents' time spent directly engaged with children in enriching activities like play and reading and in activities related to children's education among a low-socioeconomic sample (parents with less than a college degree). I find few associations between monthly federal EITC outlays and immediate changes in parents' time investments, although there was evidence that greater EITC outlays predicted small increases in mothers' time spent reading with or to children, particularly among mothers with young children, but also small decreases in fathers' time spent in activities with children, particularly school-age children. Findings suggest that increases in household resources, even relatively small and annual increases, may have short-term effects on parent-child interactions and time use.

Adolescents' Time During the First Year of the COVID-19 Pandemic: Evidence From the American Time Use Survey.

PURPOSE: The aim of this study is to examine where and with whom adolescents spent time during the first months of the COVID-19 pandemic compared to 2019. METHODS: Time diary data from the May 2019 to December 2020 waves of the American Time Use Survey were used to examine trends in where and with whom a sample of individuals aged 15-18 years (N = 437) spent their time. RESULTS: Only 13% of adolescents spent any time at school on a given day during the pandemic (May-December 2020), compared to 36% in the same period in 2019. Average time with friends decreased by 28%. Over the 7.5-month period, this amounts to an average of 204 fewer hours/34 fewer days in school and 86 fewer hours with friends. Time spent sleeping or sleepless did not change. DISCUSSION: Time at school and with friends decreased substantially during the first months of the pandemic.

Access to Early Care and Education in Rural Communities: Implications for Children's School Readiness.

This study links county-level early care and education (ECE) program, economic, and demographic data to child-level data from the Early Childhood Longitudinal Study-Kindergarten Cohort of 2010-2011 to examine geographic variation in ECE program participation and provision. We find that public ECE programs, particularly Head Start, occupy a larger role in nonmetropolitan communities than in metropolitan areas. By contrast, children in rural counties are less likely to attend private center-based ECE, and nonprofit childcare program expenditures in rural areas lag. We also find rural-metropolitan differences in school readiness diminish when geographic characteristics are controlled. Results suggest that county-level context and state-level policy features shape children's early experiences, and that public ECE investments are key in narrowing disparities in ECE attendance and in children's outcomes.

SNAP participation and the health and health care utilisation of low-income adults and children.

OBJECTIVE: This article examined whether participation in the Supplemental Nutrition Assistance Program (SNAP) produced changes to adult and child health and health care utilisation during a period of economic recession. DESIGN: Instrumental variables analysis relying on variation in state SNAP policies to isolate exogenous variation in household SNAP participation. SETTING: Nationally representative data on child and adult health from the 2008 to 2013 National Health Interview Survey. PARTICIPANTS: Participants were 92 237 adults and 45 469 children who were either eligible for SNAP based on household income and state eligibility rules or were low income but not eligible for SNAP benefits. RESULTS: For adults, SNAP participation increased the probability of reporting very good or excellent health, and for both adults and children, reduced needing but having to go without dental care or eyeglasses. The size of these benefits was especially pronounced for children. However, SNAP participation increased the probability of needing but not being able to afford prescription medicine, and increased psychological distress for adults and behavioural problems for children under age 10. CONCLUSIONS: SNAP's benefits for adult health and improved access to dental and vision care for adults and children suggest benefits from the program's expansions during the current COVID-induced crisis. Predicted negative effects of SNAP participation suggest the need for attention to program and benefit structure to avoid harm and the need for continued research to explore the causal effects of program participation.

Household economic instability: Constructs, measurement, and implications.

A growing body of research demonstrates the multiple dimensions and dynamism of family income and employment. The metrics of household economic instability and their associations with household characteristics and hardship require further examination in order to compare across studies, subgroups, and historical periods. This paper empirically examines and compares commonly used measures of income and employment instability, how these measures inter-relate, vary by household characteristics, and how they predict household hardship. Using longitudinal data from the 2008 panel of the Survey of Income and Program Participation (SIPP), and focusing on households with children, this study examined a range of descriptive measures of economic instability, including in income, earnings, public assistance benefits, and employment status, and how these measures related to each other. Results indicate that overall rates of income and employment instability were high, particularly among less-educated families, those with young children, and those who did not own a home. Economic instability, particularly decreases in employment, was associated with increased household hardship three months later. Findings also show that the source of income included in the instability measure affects the patterns identified and conclusions drawn, whereas the specific type of measure used matters less. Results highlight the instability of public assistance benefits and suggest that safety net programs must take economic instability into account when designing programs and benefits.

Neighborhood disadvantage and children's cognitive skill trajectories.

This study examined how neighborhood poverty is associated with children's trajectories of growth in math and reading skills in early elementary school, and how these associations vary by student characteristics, using multilevel growth models with nationally representative data from the 2011 Early Childhood Longitudinal Study-Kindergarten Cohort. About one-quarter (25.6%) of children lived in communities of concentrated poverty. Findings suggest that achievement gaps by neighborhood disadvantage are large and present before Kindergarten, shrink during the Kindergarten year, but then widen the year following, and remain relatively consistent in the first years of elementary school. Growth in math skills appeared to vary more with neighborhood poverty than growth in reading skills. There was limited evidence that the relationship between neighborhood poverty and test score trajectories varied by child race, ethnicity, early education and Kindergarten experience, and parents' immigration status, but growth differences across student characteristics were small. Policy and research implications are discussed.

"Hay que seguir en la lucha": An FQHC's Community Health Action Approach to Promoting Latinx Immigrants' Individual and Community Resilience.

Latinx immigrants have poorer access to health care, compared to non-Latinx Whites. Federally-Qualified Health Centers (FQHCs) provide clinical and community programing to address their clients' health needs. One mechanism by which FQHC's may strengthen Latinx immigrant well-being is by promoting their individual and community resilience. We partnered with La Clínica del Pueblo (La Clínica), an FQHC serving Latinx immigrants in Washington, DC and Prince George's County, Maryland. We conducted in-depth interviews in Spanish with 30 La Clínica clients to explore the daily adversities they faced, how they coped, and how La Clínica helped them cope. We conducted thematic analysis using Dedoose software. All participants were from Central America; 37% were undocumented. Participants were 18-78 years old, 70% cis-females, 23% cis-males (10% gay men), and 7% transgender. 57% reported a serious health issue, including diabetes. Participants identified three main adversities: immigration legal status, language, and isolation/depression. Residents of Prince George's, compared to DC, as well as sexual/gender minorities, reported more barriers to accessing health care. Sources of individual resilience for participants included fighting to improve their children's lives, relying on supportive networks, and using La Clínica as a safety net to overcome health access barriers. Sources of community resilience included La Clínica's safe spaces, support groups, referrals to outside legal service providers, and health promoter training. Latinx immigrants face multiple daily adversities, but we find evidence that La Clínica's community health action approach promotes their resilience. We offer a conceptual model for how FQHCs can foster resilience and strengthen immigrant health.

Supplemental Nutrition Assistance Program Participation Improves Children's Health Care Use: An Analysis of the American Recovery and Reinvestment Act's Natural Experiment.

OBJECTIVE: To examine the impact of increased Supplemental Nutrition Assistance Program (SNAP) benefit levels as provided by the American Recovery and Reinvestment Act (ARRA) beginning in April 2009 on the health care use and health care needs of participating children. METHODS: Difference-in-differences analysis compared changes in health care use and needs between children in SNAP-eligible households and those in low-income but SNAP-ineligible households before and after ARRA's implementation, using data from the nationally representative National Health Interview Survey (NHIS). Survey respondents reported on children's health care use and outstanding health care needs. Our sample included approximately 38,500 children in low-income households who completed the core NHIS, and a subsample of 15,000 sample children who reported additional information. RESULTS: Approximately 6% of low-income children had delayed care due to cost. Three percent and 4% of children in low-income households and low-income single-parent households, respectively, reported needing health care but not being able to afford it. The increase in SNAP benefits was associated with a 65% reduction in outstanding medication needs due to affordability among SNAP-eligible children, relative to low-income, ineligible children. There was also a reduction in the likelihood that children had seen a general doctor in the last year. Among children in single-parent households, SNAP benefit expansion was associated with a 3.2 percentage point decrease in needing but not being able to afford health care. CONCLUSIONS: Findings suggest that even a small increase in household resources leads to reductions in outstanding health care needs due to affordability, particularly among children.

Food Insecurity and Child Health.

OBJECTIVES: Food insecurity is an important public health problem facing children in the United States. Although a number of previous studies suggest that food insecurity has negative impacts on health, these studies have not dealt thoroughly with issues of selection bias. We use propensity scoring techniques to approximate the causal effects of food insecurity on children's health and health care use outcomes. METHODS: We use nationally representative data from the 2013-2016 waves of the National Health Interview Study (N = 29 341). Using inverse probability of treatment weighting, a propensity scoring method, we examine a broad range of child health outcomes and account for a comprehensive set of controls, focusing on a sample of children 2 to 17 years old. RESULTS: Household food insecurity was related to significantly worse general health, some acute and chronic health problems, and worse health care access, including forgone care and heightened emergency department use, for children. Compared to rates had they not been food insecure, children in food-insecure household had rates of lifetime asthma diagnosis and depressive symptoms that were 19.1% and 27.9% higher, rates of foregone medical care that were 179.8% higher, and rates of emergency department use that were 25.9% higher. No significant differences emerged for most communicable diseases, such as ear infections or chicken pox, or conditions that may develop more gradually, including anemia and diabetes. CONCLUSIONS: Policies used to reduce household food insecurity among children may also reduce children's chronic and acute health problems and health care needs.

Center-based early care and education and children's school readiness: Do impacts vary by neighborhood poverty?

Neighborhoods provide resources that may affect children's achievement or moderate the influences of other developmental contexts, such as early care and education (ECE). Using a sample (N ≈ 12,430) from the 2010-2011 Early Childhood Longitudinal Study-Kindergarten Cohort, merged with census tract-level poverty data from the 2008-2012 American Community Survey, this article examines associations between center-based ECE participation, neighborhood poverty, and children's academic skills and behavior at kindergarten entry. Findings suggest that children who attend center-based care in the year prior to kindergarten show higher math and reading scores across neighborhood contexts. Results provide limited evidence that neighborhood poverty moderates the associations between either Head Start or other types of center-based ECE participation and children's outcomes at kindergarten, with children in moderate-high poverty neighborhoods showing stronger positive associations between who participated in Head Start or center care participation and math and reading scores, respectively, compared to those participating in low-poverty neighborhoods. Research and policy implications are discussed. (PsycINFO Database Record

Associations between active shooter incidents and gun ownership and storage among families with young children in the United States.

The presence of firearms and their unsafe storage in the home can increase risk of firearm-related death and injury, but public opinion suggests that firearm ownership is a protective factor against gun violence. This study examined the effects of a recent nearby active shooter incident on gun ownership and storage practices among families with young children. A series of regression models, with data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort merged with the FBI's Active Shooter Incidents data collected in 2003-2006, were used to examine whether household gun ownership and storage practices differed in the months prior to and following an active shooter incident that occurred anywhere in the United States or within the same state. Approximately one-fifth of young children lived in households with one or more guns; of these children, only two-thirds lived in homes that stored all guns in locked cabinets. Results suggest that the experience of a recent active shooter incident was associated with an increased likelihood of storing all guns locked, with the magnitude dependent on the temporal and geographic proximity of the incident. The severity of the incident, defined as the number of fatalities, predicted an increase in storing guns locked. Findings suggest that public shootings change behaviors related to firearm storage among families with young children.

Parents' Depressive Symptoms and Gun, Fire, and Motor Vehicle Safety Practices.

OBJECTIVE: This study examined associations between mothers' and fathers' depressive symptoms and their parenting practices relating to gun, fire, and motor vehicle safety. METHODS: Using data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative sample of children birth to age five, linear probability models were used to examine associations between measures of parents' depressive symptoms and their use of firearms, smoke detectors, and motor vehicle restraints. Parents reported use of smoke detectors, motor vehicle restraints, and firearm ownership and storage. RESULTS: Results suggest mothers with moderate or severe depressive symptoms were 2 % points less likely to report that their child always sat in the back seat of the car, and 3 % points less likely to have at least one working smoke detector in the home. Fathers' depressive symptoms were associated with a lower likelihood of both owning a gun and of it being stored locked. Fathers' depressive symptoms amplified associations between mothers' depressive symptoms and owning a gun, such that having both parents exhibit depressive symptoms was associated with an increased likelihood of gun ownership of between 2 and 6 % points. CONCLUSIONS: Interventions that identify and treat parental depression early may be effective in promoting appropriate safety behaviors among families with young children.

Local food prices and their associations with children's weight and food security.

OBJECTIVES: Both obesity and food insecurity are important public health problems facing young children in the United States. A lack of affordable, healthy foods is one of the neighborhood factors presumed to underlie both food insecurity and obesity among children. We examine associations between local food prices and children's BMI, weight, and food security outcomes. METHODS: We linked data from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative study of children from infancy to age 5, to local food price data from the Council for Community and Economic Research (C2ER) Cost-of-Living Index (n = 11,700 observations). Using ordinary least squares (OLS), linear probability, and within-child fixed effects (FE) models, we exploit the variability in food price data over time and among children who move residences focusing on a subsample of households under 300% of the Federal Poverty Level. RESULTS: Results from ordinary least squares and FE models indicate that higher-priced fruits and vegetables are associated with higher child BMI, and this relationship is driven by the prices of fresh (versus frozen or canned) fruits and vegetables. In the FE models, higher-priced soft drinks are associated with a lower likelihood of being overweight, and surprisingly, higher fast food prices are associated with a greater likelihood of being overweight. CONCLUSIONS: Policies that reduce the costs of fresh fruits and vegetables may be effective in promoting healthy weight outcomes among young children.

A longitudinal analysis of maternal depressive symptoms and children's food consumption and weight outcomes.

OBJECTIVE: Maternal depressive symptoms negatively impact mothers' parenting practices and children's development, but the evidence linking these symptoms to children's obesity is mixed. DESIGN: We use a large sample to examine contemporaneous and lagged associations between maternal depressive symptoms and children's BMI, obesity and food consumption, controlling for background characteristics. SETTING: Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a longitudinal study of children from infancy through kindergarten in the USA, were collected at four waves from 2001 to 2007, when children were 9 months, 2 years, 4 years and 5½years of age, through surveys, child assessments and observations. SUBJECTS: A sub-sample of children from the ECLS-B is used (n 6500). RESULTS: Between 17 % and 19 % of mothers reported experiencing depressive symptoms; 17 % to 20 % of children were obese. Maternal depressive symptoms were associated with a small decrease in the likelihood her child was obese (0·8 percentage points) and with lower consumption of healthy foods. The duration of maternal depressive symptoms was associated with higher BMI (0·02 sd) among children whose parents lacked college degrees. CONCLUSIONS: Results indicate that mothers' depressive symptoms have small associations with children's food consumption and obesity. Among children whose parents lack college degrees, persistent maternal depressive symptoms are associated with slightly higher child BMI. Findings highlight the need to control for depression in analyses of children's weight. Interventions that consider maternal depression early may be useful in promoting healthy weight outcomes and eating habits among children.