R.A. Fisher, eugenics, and the campaign for family allowances in interwar Britain.

Ronald Aylmer Fisher (1890-1962) is today remembered as a giant of twentieth-century statistics, genetics and evolutionary theory. Alongside his influential scientific contributions, he was also, throughout the interwar years, a prominent figure within Britain's eugenics movement. This essay provides a close examination of his eugenical ideas and activities, focusing particularly upon his energetic advocacy of family allowances, which he hoped would boost eugenic births within the more 'desirable' middle and upper classes. Fisher's proposals, which were grounded in his distinctive explanation for the decay of civilizations throughout human history, enjoyed support from some influential figures in Britain's Eugenics Society and beyond. The ultimate failure of his campaign, though, highlights tensions both between the eugenics and family allowances movements, and within the eugenics movement itself. I show how these social and political movements represented a crucial but heretofore overlooked context for the reception of Fisher's evolutionary masterwork of 1930, The Genetical Theory of Natural Selection, with its notorious closing chapters on the causes and cures of national and racial decline.

More money, fewer lives: the cost effectiveness of welfare reform in the United States.

OBJECTIVES: We evaluated the economic benefits of Temporary Assistance to Needy Families (TANF) relative to the previous program, Aid to Families with Dependent Children (AFDC). METHODS: We used pooled mortality hazard ratios from 2 randomized controlled trials-Connecticut Jobs First and the Florida Transition Program, which had follow-up from the early and mid-1990s through December 2011-and previous estimates of health and economic benefits of TANF and AFDC. We entered them into a Markov model to evaluate TANF's economic benefits relative to AFDC and weigh them against the potential health threats of TANF. RESULTS: Over the working life of the average cash assistance recipient, AFDC would cost approximately $28000 more than TANF from the societal perspective. However, it would also bring 0.44 additional years of life. The incremental cost effectiveness of AFDC would be approximately $64000 per life-year saved relative to TANF. CONCLUSIONS: AFDC may provide more value as a health investment than TANF. Additional attention given to the neediest US families denied cash assistance could improve the value of TANF.

The Effects of Collateral Consequences of Criminal Involvement on Employment, Use of Temporary Assistance for Needy Families, and Health.

Criminal convictions are often associated with collateral consequences that limit access to the forms of employment and social services on which disadvantaged women most frequently rely--regardless of the severity of the offense. These consequences may play an important role in perpetuating health disparities by socioeconomic status and gender. We examined the extent to which research studies to date have assessed whether a criminal conviction might influence women's health by limiting access to Temporary Assistance for Needy Families (TANF) and employment, as a secondary, or "collateral" criminal conviction-related consequence. We reviewed 434 peer-reviewed journal articles retrieved from three electronic article databases and 197 research reports from three research organizations. Two reviewers independently extracted data from each eligible article or report using a standardized coding scheme. Of the sixteen eligible studies included in the review, most were descriptive. None explored whether receiving TANF modified health outcomes, despite its potential to do so. Researchers to date have not fully examined the causal pathways that could link employment, receiving TANF, and health, especially for disadvantaged women. Future research is needed to address this gap and to understand better the potential consequences of the criminal justice system involvement on the health of this vulnerable population.

Impact of welfare reform on mortality: an evaluation of the Connecticut jobs first program, a randomized controlled trial.

OBJECTIVES: We examined whether Jobs First, a multicenter randomized trial of a welfare reform program conducted in Connecticut, demonstrated increases in employment, income, and health insurance relative to traditional welfare (Aid to Families with Dependent Children). We also investigated if higher earnings and employment improved mortality of the participants. METHODS: We revisited the Jobs First randomized trial, successfully linking 4612 participant identifiers to 15 years of prospective mortality follow-up data through 2010, producing 240 deaths. The analysis was powered to detect a 20% change in mortality hazards. RESULTS: Significant employment and income benefits were realized among Jobs First recipients relative to traditional welfare recipients, particularly for the most disadvantaged groups. However, although none of these reached statistical significance, all participants in Jobs First (overall, across centers, and all subgroups) experienced higher mortality hazards than traditional welfare recipients. CONCLUSIONS: Increases in income and employment produced by Jobs First relative to traditional welfare improved socioeconomic status but did not improve survival.

Child allowances, fertility, and chaotic dynamics.

This paper analyzes the dynamics in an overlapping generations model with the provision of child allowances. Fertility is an increasing function of child allowances and there exists a threshold effect of the marginal effect of child allowances on fertility. We show that if the effectiveness of child allowances is sufficiently high, an intermediate-sized tax rate will be enough to generate chaotic dynamics. Besides, a decrease in the inter-temporal elasticity of substitution will prevent the occurrence of irregular cycles.

[Social exclusion and health inequity: a case study based on a cash distribution program (Bolsa Família) in Brazil]. / Processos de exclusão social e iniquidades em saúde: um estudo de caso a partir do Programa Bolsa Família, Brasil.

OBJECTIVE: To understand the impact of Bolsa Família (PBF), a federal cash transfer program, and to analyze its effects on social inclusion and exclusion processes experienced by low-income families in Brazil, with a focus on the program's potential to help overcome health inequity. METHODS: This qualitative investigation used a case study methodology including observant participation, review of documents, and semi-structured interviews with current and former PBF beneficiaries, as well as with the program's local managers. The study was conducted in a small city in the state of Rio de Janeiro with a high social exclusion index and 100% coverage by the Family Health Strategy (Estratégia Saúde da Família, ESF) program. The economic, political, social, and cultural dimensions of social exclusion and inclusion processes were used to guide data collection and analysis. RESULTS: The program facilitated social inclusion of low-income families, especially in the economic and social dimensions. Nevertheless, it did not produce the changes desired by the beneficiaries in the work dimension. The effects on the political dimension were limited by the insufficient social engagement of the PBF. The interviewees underscored the positive effects of the ESF, which allowed them to exercise their right to health by granting them wider access to primary health care services. However, these effects appeared to be unrelated to the PBF. CONCLUSIONS: The results reveal effects, limitations, and challenges of the PBF towards modifying the social determinants of health inequity, in order to promote more effective changes in the social exclusion/inclusion dynamics affecting low-income families.

Prevalence, characteristics, and poverty status of Supplemental Security Income multirecipients.

"Multirecipients" are people who receive Supplemental Security Income (SSI) payments while living with other recipients (not including an SSI-eligible spouse). Using Social Security Administration records matched to Current Population Survey data for 2005, this article examines multirecipients' personal, family, household, and economic characteristics. I find that no more than 20 percent of the 2005 SSI population were multirecipients. Most multirecipients were adults, lived with one other recipient, and/or shared their homes with related recipients. Multirecipients were generally less likely to be poor than SSI recipients as a whole; but those who were children, lived with one other recipient, and/or shared their homes with a nonrecipient were more likely to be poor. Implementing sliding-scale SSI benefit reductions for children in multirecipient households would affect about 23 percent of multirecipients, or about 5 percent of all SSI recipients.

Caseworker-recipient interaction: welfare office differences, economic trajectories, and child outcomes.

Drawing on developmental and policy research, this study examined whether 3 dimensions of caseworker-recipient interaction in welfare offices functioned as critical ecological contexts for recipient families. The sample consisted of 1,098 families from 10 welfare offices in National Evaluation of Welfare to Work Strategies (NEWWS). In multilevel analyses, caseworker support, caseload size, and emphasis on employment predicted 5-year quarterly trajectories of earnings, income, and welfare receipt. Recipients in offices characterized by high support had steeper increases in earnings and income; those in offices with high caseload size had steeper decreases in income and welfare receipt; and those in offices with high emphasis on employment had steeper decreases in welfare receipt. These economic trajectories were associated with children's reading and math achievement and internalizing behavior at ages 8-10.

Resource and cost adjustment in the design of allocation funding formulas in public health programs.

CONTEXT: Multiple federal public health programs use funding formulas to allocate funds to states. OBJECTIVE: To characterize the effects of adjusting formula-based allocations for differences among states in the cost of implementing programs, the potential for generating in-state resources, and income disparities, which might be associated with disease risk. SETTING: Fifty US states and the District of Columbia. INTERVENTION: Formula-based funding allocations to states for 4 representative federal public health programs were adjusted using indicators of cost (average salaries), potential within-state revenues (per-capita income, the Federal Medical Assistance Percentage, per-capita aggregate home values), and income disparities (Theil index). MAIN OUTCOME: Percentage of allocation shifted by adjustment, the number of states and the percentage of US population living in states with a more than 20% increase or decrease in funding, maximum percentage increase or decrease in funding. RESULTS: Each adjustor had a comparable impact on allocations across the 4 program allocations examined. Approximately 2% to 8% of total allocations were shifted, with adjustments for variations in income disparity and housing values having the least and greatest effects, respectively. The salary cost and per-capita income adjustors were inversely correlated and had offsetting effects on allocations. With the exception of the housing values adjustment, fewer than 10 states had more than 20% increases or decreases in allocations, and less than 10% of the US population lived in such states. CONCLUSIONS: Selection of adjustors for formula-based funding allocations should consider the impacts of different adjustments, correlations between adjustors and other data elements in funding formulas, and the relationship of formula inputs to program objectives.

Autism rates associated with nutrition and the WIC program.

OBJECTIVES: Autism rates in the United States are increasing at a rate of 15% per year. Autistic children are diagnosed by age 3 when they have problems communicating and interacting socially. This study uses nutritional epidemiology and an ecologic study design to link the possible cause of autism to nutrition by creating autism rates for the 50 states of America and comparing them with published measures of infant nutrition such as duration of exclusive breast-feeding and participation in the Women, Infants, and Children (WIC) program. The percentage of infants with measles, mumps, and rubella (MMR) inoculations was also compared with the autism rates. Study DESIGN: Autism rates for each state were established. The percentage of infants who participate in the WIC program for low-income families was calculated for each of the 50 states as well as 21 New Jersey and 30 Oregon counties and compared with their autism rates. An ecologic study design with correlation coefficients is limited, but it is useful for generating hypotheses to be tested. RESULTS: The states with the highest WIC participation have significantly lower autism rates (p < 0.02). A similar pattern was observed in 21 New Jersey counties (p < 0.02) and 30 Oregon counties (p < 0.05). In contrast, there was a direct correlation with the increasing percentage of women exclusively breast-feeding from 2000-2004 (p < 0.001). Infants who were solely breast-fed had diets that contained less thiamine, riboflavin, and vitamin D than the minimal daily requirements (MDR). There was no correlation of MMR inoculations with the autism rate. CONCLUSION: The mothers who are exclusively breast-feeding should also continue their prenatal vitamins or their equivalent and make better dietary choices. These results suggest that autism may be nutritionally related to a possible deficiency of riboflavin or the cognitive vitamins such as thiamine or vitamin D. However, due to an ecologic study design there is a potential for fallacy because individuals were not examined. The results suggest the need for a robust observational study in advance of, and to confirm the need for, an intervention study.

A profile of social security child beneficiaries and their families: sociodemographic and economic characteristics.

Using a rich dataset that links the Census Bureau's Survey of Income and Program Participation calendar-year 2004 file with Social Security benefit records, this article provides a portrait of the sociodemographic and economic characteristics of Social Security child beneficiaries. We find that the incidence ofbenefit receipt in the child population differs substantially across individual and family-level characteristics. Average benefit amounts also vary across subgroups and benefit types. The findings provide a better understanding of the importance of Social Security to families with beneficiary children. Social Security is a major source of family income for many child beneficiaries, particularly among those with low income or family heads with lower education and labor earnings.

Longitudinal Understanding of Child Maltreatment Report Risks.

BACKGROUND: Child maltreatment reports (CMR) are both common and strongly associated with various negative outcomes. OBJECTIVE: To examine CMR risks by child age, early childhood context, current/cumulative economic status (welfare receipt), race, and other risk factors with a longitudinal dataset. PARTICIPANTS AND SETTING: The CAN sample included 2,111 children having a CMR ≤ age 3, suggestive of a harmful early childhood context. The AFDC sample included 1,923 children having AFDC but no CMR ≤ age 3, suggestive of early childhood protective factors despite poverty. METHODS: We estimated the CMR likelihood at each age from 1-17 years based on various risk factors while following up children from 1995-2009. RESULTS: During follow-up, CMR likelihoods were substantially higher for the CAN sample than for the AFDC sample. The age-CMR relationship was strongly negative for the CAN sample (OR = 0.87, 95% CI = 0.86-0.88). This relationship was weaker for the AFDC sample (OR = 0.92, 0.89-0.95) and became non-significant for children who exited welfare. Current welfare receipt remained a strong predictor of CMR likelihoods for both CAN (OR = 2.32, 1.98-2.71) and AFDC (OR = 2.08, 1.61-2.68) samples. Prior welfare receipt moderately increased CMR likelihoods among those not currently on welfare. Controlling for other risk factors, White children had the highest likelihood of CMR. Other child and parent level vulnerabilities also increased CMR risk over time. CONCLUSIONS: This study highlights the importance of longitudinal analytic approaches and the utility of cross-sector administrative data in improving our ability to understand and predict CMRs over time.

Evaluation of a savings-led family-based economic empowerment intervention for AIDS-affected adolescents in Uganda: A four-year follow-up on efficacy and cost-effectiveness.

BACKGROUND: Children who have lost a parent to HIV/AIDS, known as AIDS orphans, face multiple stressors affecting their health and development. Family economic empowerment (FEE) interventions have the potential to improve these outcomes and mitigate the risks they face. We present efficacy and cost-effectiveness analyses of the Bridges study, a savings-led FEE intervention among AIDS-orphaned adolescents in Uganda at four-year follow-up. METHODS: Intent-to-treat analyses using multilevel models compared the effects of two savings-led treatment arms: Bridges (1:1 matched incentive) and BridgesPLUS (2:1 matched incentive) to a usual care control group on the following outcomes: self-rated health, sexual health, and mental health functioning. Total per-participant costs for each arm were calculated using the treatment-on-the-treated sample. Intervention effects and per-participant costs were used to calculate incremental cost-effectiveness ratios (ICERs). FINDINGS: Among 1,383 participants, 55% were female, 20% were double orphans. Mean age was 12 years at baseline. At 48-months, BridgesPLUS significantly improved self-rated health, (0.25, 95% CI 0.06, 0.43), HIV knowledge (0.21, 95% CI 0.01, 0.41), self-concept (0.26, 95% CI 0.09, 0.44), and self-efficacy (0.26, 95% CI 0.09, 0.43) and lowered hopelessness (-0.28, 95% CI -0.43, -0.12); whereas Bridges improved self-rated health (0.26, 95% CI 0.08, 0.43) and HIV knowledge (0.22, 95% CI 0.05, 0.39). ICERs ranged from $224 for hopelessness to $298 for HIV knowledge per 0.2 standard deviation change. CONCLUSIONS: Most intervention effects were sustained in both treatment arms at two years post-intervention. Higher matching incentives yielded a significant and lasting effect on a greater number of outcomes among adolescents compared to lower matching incentives at a similar incremental cost per unit effect. These findings contribute to the evidence supporting the incorporation of FEE interventions within national social protection frameworks.

The State Children's Health Insurance Program (SCHIP) and prepregnancy coverage of teenage mothers.

BACKGROUND: The 1997 State Children's Health Insurance Program (SCHIP) program allowed states to expand Medicaid to uninsured children through age 18 in families under 200% of the federal poverty level. Prepregnancy insurance coverage of adolescents may help reduce unintended pregnancies, address other medical issues, and allow for early and adequate prenatal care for those carrying to term. OBJECTIVES: We tested the effects of SCHIP implementation on insurance coverage for teenage mothers and investigated whether these effects varied by type of state SCHIP program--Medicaid expansion, stand-alone program, or some combination of these. RESEARCH DESIGN: We used Pregnancy Risk Assessment Monitoring System data from 1996 through 2000 and difference-in-differences analysis to analyze coverage changes for teenage mothers (age <20) relative to those for mothers aged 20-24 years old, a group whose Medicaid eligibility was not affected by SCHIP policies. POPULATION STUDIED: Our raw sample of teenage and older mothers in Alaska, Oklahoma, South Carolina, Florida, Maine, New York, and West Virginia equaled 23,171 (811,638 weighted). RESULTS: SCHIP implementation was associated with an almost 10 percentage point increase in prepregnancy coverage among teens under age 17. Although there were increases in both public and private coverage only the latter was statistically significant. The only statistically significant increase in Medicaid coverage, equal to almost 16 percentage points, was among 18-year-olds in states with Medicaid expansion programs. CONCLUSIONS: The temporary extension of SCHIP allows time to consider how to maintain the program's potentially positive effect on the reproductive health of adolescents.

Welfare reform, time limits, and infant health.

This paper offers evidence that welfare time limits contributed to a deterioration of infant health. We use the fact that the dates at which TANF recipients were first subject to timing out varied by state. We show that by 2000 there was a marked difference in TANF duration spells depending on whether the state employed the 60-month Federally imposed time limit, or a shorter limit, differences that were not present under AFDC. There were significant increases in infant mortality when time limits became binding in a state. These increases occurred primarily among mothers who could have plausibly timed-out of TANF: poorly educated and unmarried women with at least one previous live-birth. There is some evidence that the population of mothers affected by time limits were less likely to seek prenatal care in the first trimester, suggesting a possible role for reduced medical care in explaining the deterioration in infant health.

Nonprice competition and quality of care in managed care: the New York SCHIP market.

OBJECTIVE: To examine the effect of nonprice competition among managed care plans on the quality of care in the New York SCHIP market. DATA SOURCES: U.S. Census 2000; 2002 New York State Managed Care Plan Performance Report; and 2001 New York State Managed Care Annual Enrollment Report. STUDY DESIGN: Each market is defined as a county, and competition is measured as the number of plans in a market. Quality of care is measured in percentages using three Consumer Assessment of Health Plans Survey and three Health Plan Employer Data and Information Set scores. Two-stage least squares is applied to address the endogeneity between competition and the quality of care, using population as an instrument. PRINCIPAL FINDINGS: We find a negative association between competition and quality of care. An additional managed care plan is significantly associated with a decrease of 0.40-2.31 percentage points in four out of six quality measures. After adjusting for production cost, a positive correlation is observed between price and quality measures across different pricing regions. CONCLUSIONS: It seems likely that pricing policy is a constraint on quality production, although it may not be interpreted as a causal relationship and further study is needed.

From statistical associations to causation: what developmentalists can learn from instrumental variables techniques coupled with experimental data.

In this article, the authors aim to make accessible the careful application of a method called instrumental variables (IV). Under the right analytic conditions, IV is one promising strategy for answering questions about the causal nature of associations and, in so doing, can advance developmental theory. The authors build on prior work combining the analytic approach of IV with the strengths of random assignment design, whether the experiment is conducted in the lab setting or in the "real world." The approach is detailed through an empirical example about the effects of maternal education on children's cognitive and school outcomes. With IV techniques, the authors address whether maternal education is causally related to children's cognitive development or whether the observed associations reflect some other characteristic related to parenting, income, or personality. The IV estimates show that maternal education has a positive effect on the cognitive test scores of children entering school. The authors conclude by discussing opportunities for applying these same techniques to address other questions of critical relevance to developmental science.

Public dental expenditures and dental visits among children in the U.S., 1996-2004.

OBJECTIVES: Congress created the State Children's Health Insurance Program (SCHIP) in 1997 as an expansion of the Medicaid program to provide health insurance to children whose family income is above the Medicaid eligibility standards-generally up to 200% of the federal poverty level (FPL). This article examines changes in the utilization of dental services during a period of increasing public funding of dental services. METHODS: Public dental expenditure estimates came from the Centers for Medicare & Medicaid Services (CMS), and a breakdown of these expenditures by patient age and income level was based on the Medical Expenditure Panel Survey (MEPS). RESULTS: According to CMS, funding for dental SCHIP and dental SCHIP expansion grew from $0 prior to 1998 to $517 million in 2004. According to the MEPS, between 1996 and 2004 there was an increase in the number and percent of children 2 to 20 years of age who reported a dental visit during the past year. These increases were most notable among children in the 100% to 200% FPL category. Approximately 900,000 more children in this income group visited a dentist in 2003-2004 than in 1996-1997. Children in this income group reported an increase in the amount of mean dental charges paid for by Medicaid and a real increase in mean dental charges per patient from $217 to $310. CONCLUSIONS: Recent increases in the public funding of dental services targeted to children in the 100% to 200% FPL category were related to increased utilization of dental services among these children from 1996 to 2004.