Welfare Reform and the Quality of Young Children's Home Environments.

This study investigates the effects of welfare reform-a major policy shift in the United States that increased low-income mothers' employment and reliance on earnings instead of cash assistance-on the quality of the home environments mothers provide for their preschool-age children. Using empirical methods designed to identify plausibly causal effects, we estimate the effects of welfare reform on validated survey and observational measures of maternal behaviors that support children's cognitive skills and emotional adjustment and the material goods that parents purchase to stimulate their children's skill development. The results suggest that welfare reform did not affect the amount of time and material resources mothers devoted to cognitively stimulating activities with their young children. However, it significantly decreased emotional support provision scores, by approximately 0.3-0.4 standard deviations. The effects appear to be stronger for mothers with lower human capital. The findings provide evidence that welfare reform came at a cost to children in the form of lower quality parenting. They also underscore the importance of considering quality, and not just quantity, in assessing the effects of maternal work-incentive policies on parenting and children's home environments.

Small-for-Gestational-Age and Vocabulary and Achievement Test Scores at Age 9 Among Children Born at Term in a Contemporary U.S. Sample.

INTRODUCTION: Children that are small-for-gestational-age (SGA) at birth are at an increased risk for cognitive impairment, even if born at term (37-41 weeks). This study examined associations between sex-specific SGA and vocabulary and achievement tests in 9 year old children born at term using a contemporary population-based US sample. METHODS: A secondary data analysis was conducted on a sample of 2144 children born at term in 1998-2000 who participated in a US birth cohort study that oversampled non-marital births, which in the U.S. are associated with socioeconomic disadvantage and racial minority status. Vocabulary and achievement tests were administered to participants at age 9. Unadjusted and adjusted Ordinary Least Squares and logistic regression models of associations between SGA and test scores were estimated. RESULTS: Sex-specific SGA was associated with 2-5 point lower test scores and 1-2 times the odds of scores less than 85 (> 1 SD below the national mean) across most outcomes. In adjusted models, measures of SGA were associated with low scores on the Woodcock-Johnson Applied Problems test (OR 2.257; 95% CI 1.434, 3.551) and the Woodcock-Johnson Passage Comprehension test (OR 1.554; 95% CI 1.132, 2.134). CONCLUSION: The findings validate previous studies of SGA at term and cognitive outcomes and provide further evidence using a contemporary high-risk population-based US sample. The findings suggest that SGA children born at term should be recruited for early interventions to promote improved cognitive functioning in school.

This study expands and updates the relatively small literature on SGA and developmental outcomes among children born at term. This was done by estimating associations between sex-specific SGA status and vocabulary and achievement tests of 9-year-old children born at term who were part of a national US birth cohort study. The cohort study over-sampled non-marital births, which in the United States are associated with socioeconomic disadvantage and racial minority status.

Gestational Age at Term and Teacher-Reported Attention-Deficit Hyperactivity Disorder Symptom Patterns.

OBJECTIVE: The objective of this study was to estimate associations between gestational age and teacher-reported attention-deficit hyperactivity disorder (ADHD)-related symptom patterns at age 9 years among children born at term (37-41 weeks). STUDY DESIGN: A secondary data analysis of approximately 1400 children in the Fragile Families and Child Wellbeing study, a US birth cohort study that oversampled nonmarital births, was conducted. At age 9 years, students were evaluated by their teachers using the Conners Teacher Rating Scale-Revised Short Form that included subscales for symptoms of hyperactivity, ADHD, oppositional behavior, and cognitive problems/inattention. Unadjusted and adjusted negative binomial and logistic regression models of associations between gestational age and teacher-reported scores were estimated. RESULTS: Each week of gestational age at term was associated with hyperactivity scores that were 6% lower (adjusted incidence rate ratio [IRR]: 0.94; 95% CI: 0.89-0.99) and ADHD and cognitive problems/inattention scores that were 5% lower (adjusted IRR: 0.95; 95% CI: 0.91-0.98 in both cases). Early-term birth (37-38 weeks) was associated with 23% higher hyperactivity scores (adjusted IRR: 1.23; 95% CI:1.07-1.41), 17% higher ADHD scores (adjusted IRR: 1.17; 95% CI: 1.05-1.30), and ∼50% higher odds of scoring 1.5+ SDs above the sample mean for hyperactivity (aOR: 1.51; 95% CI: 1.05-2.18) when compared with birth at 39-41 weeks. There were no significant associations between gestational age and oppositional behavior scores. CONCLUSION: The findings add to growing evidence supporting current recommendations for delaying elective deliveries to at least 39 weeks and suggest that regular screenings for ADHD symptoms are important for children born at 37- to 38-weeks gestation.

Infant Health and Future Childhood Adversity.

Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child's ACE exposures at age 5, controlling for factors that preceded the child's birth, including the mother's sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents' criminal justice system involvement and domestic violence or sexual abuse. ACEs included 4 categories of child maltreatment (physical, sexual, psychological abuse, neglect) and 5 categories of household dysfunction (father absence, substance use, mental illness, caregiver treated violently, incarceration). Results 3.3% of the children were characterized as having a disabling health condition that was likely present at birth. Logistic regression estimates indicate that having a disabling infant health condition was associated with 83% higher odds of the child experiencing 2 or more ACEs (AOR 1.83, CI 1.14-2.94) and 73% higher odds of the child experiencing 3 or more ACEs (AOR 1.73, CI 1.07-2.77) at age 5. Conclusions for Practice The finding of strong links between disabling infant health conditions and ACEs at age 5 suggests that child health and ACEs play intertwining and mutually reinforcing roles during the early lifecourse and highlights the critical importance of investing in systems that simultaneously promote optimal child development and address childhood adversity.

Effects of Maternal Work Incentives on Youth Crime.

This study exploits differences in the implementation of welfare reform across states and over time to identify causal effects of maternal work incentives, and by inference employment, on youth arrests between 1988 and 2005, the period of time during which welfare reform unfolded. We consider both serious and minor crimes as classified by the Federal Bureau of Investigation, consider differential effects by the youth's gender and age, investigate the extent to which effects were stronger in states with more stringent work incentive policies and larger welfare caseload declines, and use a number of different model specifications to assess robustness and patterns. We find that welfare reform led to reduced arrests for minor crime among youth ages 15-17 years by 9-11 %, with similar estimates for males and females, but that it did not affect youth arrests for serious crimes. The results from this study add to a scant knowledge base about the effects of maternal employment on adolescent behavior by exploiting a large-scale social experiment that greatly increased employment of low-skilled women. The results also provide some support for the widely-embraced argument that welfare reform would discourage undesirable social behavior, not only of mothers, but also of the next generation.

Maternal depression as a risk factor for family homelessness.

OBJECTIVES: We estimated the effects of maternal depression during the postpartum year, which is often an unexpected event, on subsequent homelessness and risk of homelessness in a national sample of urban, mostly low-income mothers. METHODS: We used logistic regression models to estimate associations between maternal depression during the postpartum year and both homelessness and risk of homelessness 2 to 3 years later, controlling for maternal and family history of depression, prenatal housing problems, and other covariates. Risk factors for homelessness included experiencing evictions or frequent moves and moving in with family or friends and not paying rent. RESULTS: We found robust associations between maternal depression during the postpartum year and subsequent homelessness and risk of homelessness, even among mothers who had no history of mental illness, whose own mothers did not have a history of depressive symptoms, and who had no previous housing problems. CONCLUSIONS: This study provides robust evidence that maternal mental illness places families with young children at risk for homelessness, contributes to the scant literature elucidating directional and causal links between mental illness and homelessness, and contributes to a stagnant but important literature on family homelessness.

Chronic health conditions and adolescents' social connectedness.

This study investigated associations between chronic developmental/behavioral and physical health conditions and social connectedness of adolescents using rich population-based data from a national U.S. birth cohort study. Potentially disabling health conditions were reported by caregivers and categorized by our team as developmental/behavioral or physical. Social connectedness was assessed using a validated scale that measured adolescents' reports of positive social connectedness across relevant contexts (family, friends, school). Of the 3,207 adolescents included, over one third had at least one chronic health condition. Unadjusted and adjusted linear and logistic regression models of associations between the presence of chronic health conditions (any developmental/behavioral health condition and any physical health condition, compared to no conditions) and adolescents' social connectedness outcomes were estimated. Compared to those with no chronic health conditions, adolescents with developmental/behavioral health conditions had lower odds of high positive social connectedness scores (adjusted odds ratio [AOR]: 0.80; CI [0.67, 0.94]), having friends they really care about (AOR: 0.76; CI [0.61, 0.94]), having people who care (AOR: 0.65; CI [0.50, 0.84]), and having people with whom to share good news (AOR: 0.77; CI [0.63, 0.94]). Adolescents with chronic physical health conditions had lower odds of reporting having people who care about them (AOR: 0.72; CI [0.55, 0.94]). The findings point to the need for interventions designed to foster the development of positive interpersonal relationships, reduce loneliness, and increase positive social identity among adolescents with chronic health conditions, particularly those with developmental/behavioral health conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Paternal depression in the postpartum year and children's behaviors at age 5 in an urban U.S. birth cohort.

OBJECTIVE: To investigate associations between postpartum depression in fathers and children's behaviors at age 5 in a national high-risk U.S. sample. STUDY DESIGN: A secondary data analysis of 1,796 children in a national birth cohort study that oversampled non-marital births was conducted. Paternal depression was assessed 1 year after the child was born and children's behaviors were assessed by their primary caregivers when the children were 5 years old. Unadjusted and adjusted negative binomial regression models of associations between paternal depression and child behavior scores and logistic regression models of associations between paternal depression and high scores (at least 1.5 or 2.0 standard deviations above the mean) were estimated. RESULTS: In negative binomial regression models that adjusted for child, paternal, and family characteristics and maternal depression, paternal depression was associated with a 17% higher total externalizing behavior score (Incidence Rate Ratio (IRR): 1.17; 95% Confidence Interval (CI): 1.07-1.27), a 17% higher aggressive subscale score (IRR: 1.17; 95% CI: 1.08-1.27), and an 18% higher delinquent subscale score (IRR: 1.18; 95% CI: 1.03-1.35). In adjusted logistic regression models for scores ≥2.0 standard deviations above the mean, paternal depression was associated with high total externalizing scores (e.g., Odds Ratio (OR): 3.09; 95% CI: 1.77-5.41), high aggressive behavior scores (OR: 2.40; 95% CI: 1.30-4.43), and high delinquent behavior scores (OR: 2.08; 95% CI: 1.01-4.27). There were suggestive but non-robust associations between paternal depression and attention problems and no associations between paternal depression and internalizing behaviors or social problems. CONCLUSION: Fathers' depression at age 1 was associated with children's externalizing behaviors at age 5, an important developmental stage when children transition to school. These findings suggest a need to identify and support fathers with depressive symptoms to promote optimal child development.

Small for gestational age and age at menarche in a contemporary population-based U.S. sample.

Children born small for gestational age (SGA) may be at risk for earlier puberty and adverse long-term health sequelae. This study investigates associations between SGA and age at menarche using secondary data on 1,027 female children in a population-based U.S. birth cohort that over-sampled non-marital births, which in the U.S. is a policy-relevant population. SGA was defined as <10th percentile of weight for gestational age compared to the national U.S. distribution. We estimated unadjusted and adjusted Ordinary Least Squares (OLS) models of associations between SGA and age at menarche in years, as well as unadjusted and adjusted logistic regression models of associations between SGA and early menarche (before age 11). SGA was not significantly associated with earlier age at menarche, even when adjusting for maternal sociodemographic characteristics, prenatal smoking, and maternal pre-pregnancy overweight and obesity. Similarly, SGA was not significantly associated with the odds of menarche occurring before age 11. However, maternal non-Hispanic Black race-ethnicity, Hispanic ethnicity, and pre-pregnancy obesity all had independent associations with average earlier age at menarche and menarche before age 11. Thus, maternal risk factors appear to play more influential roles in determining pubertal development.

Effects of prenatal care on child health at age 5.

The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child's development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Using data from a national urban birth cohort study in the US, we estimate the effects of prenatal care on four markers of child health at age 5-maternal-reported health status, asthma diagnosis, overweight, and height. Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children's health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime healthcare on child health.

Effects of Welfare Reform on Positive Health and Social Behaviors of Adolescents.

This paper explores a missing link in the literature on welfare reform in the U.S.-the effects on positive health and social behaviors of adolescents, who represent the next generation of potential welfare recipients. Previous research on welfare reform and adolescents has focused almost exclusively on negative behaviors and found that welfare reform led to decreases in high school dropout and teenage fertility among girls, but increases in delinquent behaviors and substance use, particularly among boys. Using nationally representative data on American high school students in 1991-2006 and a quasi-experimental research design, we estimated the effects of welfare reform implementation on eating breakfast, regular fruit/vegetable consumption, regular exercise, adequate sleep, time spent on homework, completion of assignments, participation in community activities or volunteering, participation in school athletics, participation in other school activities, and religious service attendance. We found no robust evidence that welfare reform affected any of these adolescent behaviors. In concert with the past research on welfare reform in the U.S. and adolescents, the findings do not support the implicit assumption underlying welfare reform that strong maternal work incentives would increase responsible behavior in the next generation and suggest that welfare reform had overall adverse effects on boys, who have been falling behind girls in terms of high school completion for decades.

Effects of Welfare Reform on Education Acquisition of Adult Women.

Education beyond traditional ages for schooling is an important source of human capital acquisition among adult women. Welfare reform, which began in the early 1990s and culminated in the passage of the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, promoted work rather than education acquisition for this group. Exploiting variation in welfare reform across states and over time and using relevant comparison groups, we undertake a comprehensive study of the effects of welfare reform on adult women's education acquisition. We first estimate effects of welfare reform on high school drop-out of teenage girls, both to improve upon past research on this issue and to explore compositional changes that may be relevant for our primary analyses of the effects of welfare reform on education acquisition among adult women. We find that welfare reform significantly reduced the probability that teens from disadvantaged families dropped out of high school, by about 15%. We then estimate the effects of welfare reform on adult women's school enrollment and conduct numerous specification checks, investigate compositional selection and policy endogeneity, explore lagged effects, stratify by TANF work incentives and education policies, consider alternative comparison groups, and explore the mediating role of work. We find robust and convincing evidence that welfare reform significantly decreased the probability of college enrollment among adult women at risk of welfare receipt, by at least 20%. It also appears to have decreased the probability of high school enrollment among this group, on the same order of magnitude. Future research is needed to determine the extent to which this behavioral change translates to future economic outcomes.

Effects of welfare reform on household food insecurity across generations.

This study estimates the effects of welfare reform in the 1990s, which permanently restructured and contracted the cash assistance system in the U.S., on food insecurity-a fundamental form of material hardship-of the next generation of households. An implicit goal underlying welfare reform was the disruption of an assumed intergenerational transmission of disadvantage; however, little is known about the effects of welfare reform on the well-being of the next generation of adults. Using intergenerational data from the Panel Study of Income Dynamics and a variation on a difference-in-differences framework, this study exploits 3 sources of variation in childhood exposure to welfare reform: (1) risk of exposure across birth cohorts; (2) variation of exposure within cohorts because different states implemented welfare reform in different years; and (3) variation between individuals with the same exposure who were more likely and less likely to rely on welfare. We found that exposure to welfare reform led to decreases in food insecurity of the next generation of households, by about 10% for a 5-year increase in exposure, with stronger effects for individuals exposed for longer durations during childhood, individuals exposed in early childhood (0-5 years), and women. We also found smaller favorable effects for individuals whose mothers had less than a high school education, indicating that in terms of food insecurity, welfare reform led to relative disadvantages among the most disadvantaged and thus could be exacerbating socioeconomic and health inequalities.

Adolescent Chronic Health Conditions and School Disconnectedness.

OBJECTIVE: The objective of this study was to examine associations between chronic health conditions and school disconnectedness, trouble getting along with others at school, and peer victimization at age 15. METHOD: We conducted a secondary analysis of population-based data from the Fragile Families and Child Wellbeing birth cohort to investigate associations between chronic developmental/behavioral and physical health conditions and school disconnectedness, trouble getting along with others at school, and peer victimization of adolescents using mother-reported child health conditions and youth-reported relationships/experiences at school ascertained from standardized scales. Associations were examined using linear and logistic regression models adjusting for confounding factors. RESULTS: Of the 2874 adolescents included, more than one-third had at least 1 chronic health condition. Compared with those with no chronic health conditions, adolescents with developmental/behavioral health conditions felt more disconnected from school (by 0.22 SDs), had more trouble getting along with others at school (0.22 SD), and were more victimized by peers at school (0.20 SD). Teens with physical health conditions also felt more disconnected from school (0.10 SD), had more trouble getting along with others at school (0.12 SD), and were more victimized by peers (0.12 SD). One noteworthy difference was that adolescents with developmental/behavioral conditions were more likely than those with no conditions to report trouble getting along with teachers, but adolescents with physical health conditions were not. CONCLUSION: Chronic health conditions were associated with disconnectedness from school and negative school social interactions in this study of US urban youth, suggesting that targeted resources and interventions for this population are needed.

Effects of Welfare Reform on Vocational Education and Training.

Exploiting variation in welfare reform across states and over time and using relevant comparison groups, this study estimates the effects of welfare reform on an important source of human capital acquisition among women at risk for relying on welfare: vocational education and training. The results suggest that welfare reform reduced enrollment in full-time vocational education and had no significant effects on part-time vocational education or participation in other types of work-related courses, though there appears to be considerable heterogeneity across states with respect to the strictness of educational policy and the strength of work incentives under welfare reform. In addition, we find evidence of heterogeneous effects by prior educational attainment. We find no evidence that the previously-observed negative effects of welfare reform on formal education (including college enrollment), which we replicated in this study, have been offset by increases in vocational education and training.

Gestational Age at Term and Educational Outcomes at Age Nine.

OBJECTIVES: To estimate associations between gestational age (GA) and teacher-reported academic outcomes at age 9 years among children born at term (37-41 weeks). METHODS: A secondary data analysis of 1405 children participating in a national US birth cohort study was conducted. At age 9 years, students were evaluated by their teachers in the areas of mathematics, science and social studies, and language and literacy. Unadjusted and adjusted logistic regression models of associations between GA and teacher-reported academic outcomes were estimated and neonatal morbidities were explored as potential pathways. RESULTS: A continuous measure of GA in weeks was significantly associated with above-average rankings in all areas. The associations were similar across outcomes (eg, mathematics [odds ratio (OR): 1.13; confidence interval (CI): 1.02-1.25], science and social studies [OR: 1.13; CI: 1.01-1.26], and language and literacy [OR: 1.16; CI: 1.05-1.28]) in a model that adjusted for child sex, maternal characteristics, and obstetric risk factors and delivery complications. Other specifications indicate a positive association between late term (41 weeks) and mathematics and a negative association between early term (37-38 weeks) and language and literacy, compared with term (39-40). The associations did not appear to operate through neonatal morbidity. CONCLUSIONS: The findings highlight the importance of GA, even at term. Whereas current guidelines suggest waiting until at least 39 weeks to deliver when possible, our findings add to a small group of studies suggesting that GA through 41 weeks is associated with improvements in some educational outcomes.

INTERGENERATIONAL EFFECTS OF WELFARE REFORM: ADOLESCENT DELINQUENT AND RISKY BEHAVIORS.

This study investigates effects of welfare reform in the United States on the next generation. Most previous studies of effects of welfare reform on adolescents focused on high-school dropout of girls or fertility; little is known about how welfare reform has affected other teenage behaviors or boys. We use a difference-in-difference-in-differences framework to identify gender-specific effects of welfare reform on skipping school, fighting, damaging property, stealing, hurting others, smoking, alcohol, marijuana, and other illicit drugs. Welfare reform led to increases in delinquent behaviors of boys as well as increases in substance use of boys and girls, with substantially larger effects for boys.

Mental illness as a risk factor for uninsurance among mothers of infants.

The objective of this study was to assess the extent to which maternal prenatal mental illness is associated with mothers' health insurance status 12-18 months after giving birth. The sample consisted of 2,956 urban, mostly unwed, mothers who gave birth in 20 large U.S. cities between 1998 and 2000 and participated in the Fragile Families and Child Wellbeing birth cohort study. Multinomial logistic regression models were used to assess associations between maternal prenatal mental illness and whether the mother had private, public, or no insurance one year after the birth. Covariates included the mother's and child's physical health status, the father's physical and mental health status, and numerous other maternal, paternal, and family characteristics. Potential mediating factors were explored. The results showed that mothers with prenatal diagnosed mental illness were almost half as likely as those without mental illness diagnoses to have private insurance (vs. no insurance) one year after the birth. Among mothers who did not have a subsequent pregnancy, those with prenatal mental illness were less likely than those without mental illness diagnoses to have public insurance than to be uninsured. Screening positive for depression or anxiety at one year decreased the likelihood that the mother had either type of insurance. Policies to improve private mental health care coverage and public mental health services among mothers with young children may yield both private and social benefits. Encounters with the health care and social service systems experienced by pregnant and postpartum women present opportunities for connecting mothers to needed mental health services and facilitating their maintenance of health insurance.

School and Community Involvement of Adolescents With Chronic Health Conditions.

PURPOSE: To investigate associations between chronic health conditions and participation in school and community activities at age 15 years. METHODS: Secondary analysis of data from an urban U.S. birth cohort study was conducted to investigate associations between chronic health conditions and participation in specific types of school and community activities. Logistic regression was used to adjust for potentially confounding factors. RESULTS: Over one third of the teens had a chronic health condition. Having a chronic developmental or behavioral health condition (vs. no chronic developmental or behavioral health condition) was associated with lower odds of participation in sports (odds ratio [OR], .714; 95% confidence interval [CI], .577-.883), volunteer activities (OR, .751; 95% CI, 0.611-.924), and any activities (OR, .690; 95% CI, .516-.921), after adjusting for potential confounders. The associations for having a chronic physical health condition were less consistent. CONCLUSIONS: Chronic developmental or behavioral conditions of teens are negatively associated with school and community participation, particularly sports and volunteering, both of which can substantially enhance their development. Schools can play a role in promoting participation by offering activities designed for students with disabilities that may also include typical students or by referring families to such activities in the community. Clinicians can play a role by educating families about the benefits of extracurricular activities, providing information about laws and regulations requiring schools and other organizations to provide accommodations, and linking families to activities and programs in their community.

Infant health production functions: what a difference the data make.

We examine the extent to which infant health production functions are sensitive to model specification and measurement error. We focus on the importance of typically unobserved but theoretically important variables (typically unobserved variables, TUVs), other non-standard covariates (NSCs), input reporting, and characterization of infant health. The TUVs represent wantedness, taste for risky behavior, and maternal health endowment. The NSCs include father characteristics. We estimate the effects of prenatal drug use, prenatal cigarette smoking, and first trimester prenatal care on birth weight, low birth weight, and a measure of abnormal infant health conditions. We compare estimates using self-reported inputs versus input measures that combine information from medical records and self-reports. We find that TUVs and NSCs are significantly associated with both inputs and outcomes, but that excluding them from infant health production functions does not appreciably affect the input estimates. However, using self-reported inputs leads to overestimated effects of inputs, particularly prenatal care, on outcomes, and using a direct measure of infant health does not always yield input estimates similar to those when using birth weight outcomes. The findings have implications for research, data collection, and public health policy.