No change in substance use disorders or overdose after implementation of state Earned Income Tax Credit (EITC).

BACKGROUND: Inadequate income is associated with higher likelihood of experiencing a substance use disorder (SUD). This study tests whether the earned income tax credit (EITC), which issues supplemental income for workers with children in the U.S., is associated with lower rates of SUD and fatal overdose. METHODS: We examined the effects of state-level refundable EITC presence and generosity (i.e., state EITC rate as a % of federal rate) on SUD-related outcomes (SUD prevalence and intentional and unintentional fatal overdose) using a difference-in-difference methodology, with both two-way fixed-effects models and event study plots. Several sensitivity analyses were conducted to assess the robustness of findings. Five data sources were used to create a combined state-level longitudinal dataset. RESULTS: We did not find significant effects of refundable EITC presence or generosity on unintentional or intentional fatal overdose or SUD prevalence in two-way models. Event study models detected a very slight upward shift in SUD prevalence following refundable EITC implementation (not seen in sensitivity analyses) and no significant effects of EITC implementation on any of the fatal overdose outcomes. CONCLUSIONS: Evidence regarding income support programs is being highly sought by policy makers as income support programs have become increasingly popular policy levers since the start of the COVID-19 pandemic. Our study indicates EITC policies likely have no impact on SUD or overdose, however, other income support programs without family restrictions are important to investigate further.

Cumulative Payments Through the Earned Income Tax Credit Program in Childhood and Criminal Conviction During Adolescence in the US.

Importance: Childhood poverty is associated with poor health and behavioral outcomes. The Earned Income Tax Credit (EITC), first implemented in 1975, is the largest cash transfer program for working families with low income in the US. Objective: To assess whether cumulative EITC payments received during childhood are associated with the risk of criminal conviction during adolescence. Design, Setting, and Participants: In this cohort study, the analytic sample consisted of US children enrolled in the 1979 National Longitudinal Study of Youth. The children were born between 1979 and 1998 and were interviewed as adolescents (age 15-19 years) between 1994 and 2016. Data analyses were performed from May 2021 to September 2022. Exposure: Cumulative simulated EITC received by the individual's family from birth through age 14 years. Main Outcomes and Measures: The main outcome was dichotomous, self-reported conviction for a crime during adolescence (age 14-18 years). A cumulative, simulated measure of mean EITC benefits received by a child's family from birth through age 14 years was derived from federal, state, and family-size differences in EITC eligibility and payments during the study period to capture EITC benefit variation due to differences in policy parameters but not endogenous factors such as changes in household income. Logistic regression models with fixed effects for state and year and robust SEs clustered by mother estimated relative risk of adolescent conviction. Models were adjusted for state-, mother-, and child-level covariates. Results: The analytical sample consisted of 5492 adolescents born between 1979 and 1998; 2762 (50.3%) were male, 1648 (30.0%) were Black, 1125 (20.5%) were Hispanic, and 2719 (49.5%) were not Black or Hispanic. Each additional $1000 of EITC received during childhood was associated with an 11% lower risk of self-reported criminal conviction during adolescence (adjusted odds ratio, 0.89; 95% CI, 0.84-0.95). Adjusted risk differences were larger among boys (-14.2 self-reported convictions per 1000 population [95% CI, -22.0 to -6.3 per 1000 population]) than among girls (-6.2 per 1000 population [95% CI, -10.7 to -1.6 per 1000 population]). Conclusions and Relevance: The findings suggest that income support from the EITC may be associated with reduced youth involvement with the criminal justice system in the US. Cost-benefit analyses of the EITC should consider these longer-term and indirect outcomes.

Earned Income Tax Credit and Youth Violence: Findings from the Youth Risk Behavior Surveillance System.

Family- and neighborhood-level poverty are associated with youth violence. Economic policies may address this risk factor by reducing parental stress and increasing opportunities. The federal Earned Income Tax Credit (EITC) is the largest cash transfer program in the US providing support to low-income working families. Many states have additional EITCs that vary in structure and generosity. To estimate the association between state EITC and youth violence, we conducted a repeated cross-sectional analysis using the variation in state EITC generosity over time by state and self-reported data in the Youth Risk Behavior Surveillance System (YRBSS) from 2005 to 2019. We estimated the association for all youth and then stratified by sex and race and ethnicity. A 10-percentage point greater state EITC was significantly associated with 3.8% lower prevalence of physical fighting among youth, overall (PR: 0.96; 95% CI 0.94-0.99), and for male students, 149 fewer (95% CI: -243, -55) students per 10,000 experiencing physical fighting. A 10-percentage point greater state EITC was significantly associated with 118 fewer (95% CI: -184, -52) White students per 10,000 experiencing physical fighting in the past 12 months while reductions among Black students (75 fewer; 95% CI: -176, 26) and Hispanic/Latino students (14 fewer; 95% CI: -93, 65) were not statistically significant. State EITC generosity was not significantly associated with measures of violence at school. Economic policies that increase financial security and provide financial resources may reduce the burden of youth violence; further attention to their differential benefits among specific population subgroups is warranted.

Short-Term Effects of Tax Credits on Rates of Child Maltreatment Reports in the United States.

OBJECTIVES: Poverty and low income are associated with increased risk for child maltreatment. The Earned Income Tax Credit (EITC) and Child Tax Credit (CTC) are among the largest antipoverty programs in the United States. We estimated associations between income transfer payments via the EITC and CTC and child maltreatment reports in the period shortly after families receive payments from these programs. METHODS: We linked weekly EITC and CTC refund data from the Internal Revenue Service to state-specific child maltreatment report data from 48 states and the District of Columbia during the 2015 through 2018 tax seasons (January - April). We leveraged the natural experiment of a legislated change in the timing of EITC and CTC transfer payments to low-income families and quasi-experimental methods to estimate the association between EITC and CTC payments and child maltreatment reports. RESULTS: EITC and CTC payments were associated with lower state-level rates of child maltreatment reports. For each additional $1000 in per-child EITC and CTC tax refunds, state-level rates of reported child maltreatment declined in the week of and 4 weeks following refund payments by an overall estimated 5.0% (95% confidence interval = 2.3%-7.7%). CONCLUSIONS: Federal income assistance programs are associated with immediate reductions in child maltreatment reporting. These results are particularly relevant at this time, as expansions to such programs continue to be discussed at the state and federal levels.

The Earned Income Tax Credit and Intimate Partner Violence.

Intimate partner violence (IPV) is a serious public health problem in the United States with adverse consequences for affected individuals and families. Recent reviews of the literature suggest that economic policies should be further investigated as part of comprehensive strategies to address IPV. The Earned Income Tax Credit (EITC) is the nation's largest anti-poverty program for working parents, and especially benefits low-income women with children, who experience an elevated risk of IPV. The EITC may prevent IPV by offering financial resources; such resources may help individuals experiencing IPV leave abusive relationships or address IPV risk factors, thereby preventing entry into abusive relationships. However, the association between EITC generosity and IPV has not been previously examined. We used state-level and individual-level datasets to examine the association between EITC generosity and IPV. Our state-level data source was the nationally representative National Crime Victimization Survey (NCVS; N = ~ 95,000 households per year). For NCVS, we used a difference-in-difference approach to investigate the relationship between state EITC generosity and IPV rates. We also used individual-level longitudinal data from the Fragile Families and Child Well-being Study (n = 13,422 person-waves). Using this cohort of US families at higher risk for IPV, we evaluated associations between estimated EITC benefits based on the mother's state of residence and number of children and self-reported IPV. In both state- and individual-level analyses, no significant association between state EITC benefits and IPV was found. Factors that may account for these null findings include program ineligibility for individuals who separate from abusive spouses. Future research efforts should more closely examine EITC policy implementation processes and the lived experience of participating in anti-poverty programs for people experiencing IPV.

Association of State-Level Earned Income Tax Credits With Rates of Reported Child Maltreatment, 2004-2017.

Poverty is an important predictor of child maltreatment. Social policies that strengthen the economic security of low-income families, such as the Earned Income Tax Credit (EITC), may reduce child maltreatment by impeding the pathways through which poverty leads to it. We used variations in the presence and generosity of supplementary EITCs offered at the state level and administrative child maltreatment data from the National Child Abuse and Neglect Data System (NCANDS) to examine the effect of EITC policies on state-level rates of child maltreatment from 2004 through 2017. Two-way fixed effects models indicated that a 10-percentage point increase in the generosity of refundable state EITC benefits was associated with 241 fewer reports of neglect per 100,000 children (95% Confidence Interval [CI] [-449, -33]). An increase in EITC generosity was associated with fewer reports of neglect both among children ages 0-5 (-324 per 100,000; 95% CI [-582, -65]) and children ages 6-17 (-201 per 100,000; 95% CI [-387, -15]). Findings also suggested associations between the EITC and reductions in other types of maltreatment (physical abuse, emotional abuse); however, those did not gain statistical significance. Economic support policies may reduce the risk of child maltreatment, especially neglect, and improve child wellbeing.

State earned income tax credits and suicidal behavior: A repeated cross-sectional study.

Suicide is an increasingly common cause of death in the United States and recent increases in suicide rates disproportionately impact low income individuals. We sought to assess the impact of income support in the form of state earned income tax credit policies on suicide-related behaviors. This state-level study used repeated cross-sectional data from vital records and the National Survey of Drug Use and Health data representative at the state-level. The population included adults who either died by suicide or were selected for in-person NSDUH interviews between 2008 and 2018. Exposure was measured as the generosity of a refundable state earned income tax credit policy measured as a percentage of the federal policy. Outcomes assessed were suicidal ideation, suicidal planning, non-fatal suicide attempt, suicide deaths, and combined fatal and non-fatal suicide attempts. Analyses were performed between April and June 2020. A 10 percentage-point increase in the generosity of state earned income tax credit was associated with lower frequency of non-fatal suicide attempts (prevalence ratio [PR] = 0.96; 95% CI: 0.93-0.99), combined fatal and non-fatal suicide attempts (PR = 0.96; 95% CI: 0.93-0.99), and suicide deaths (PR = 0.99; 95% CI: 0.99-1.00). This translates to 4 fewer suicide attempts per 10,000 population each year. Generous state earned income tax credit policies are associated with reductions in the frequency of most severe suicidal behavior. Income support policies may be one way to reduce suicide attempts and death, especially among low-income adults.

Association of State Minimum Wage Rates and Health in Working-Age Adults Using the National Health Interview Survey.

States adopt minimum wages to improve workers' economic circumstances and well-being. Many studies, but not all, find evidence of health benefits from higher minimum wages. This study used a rigorous "triple difference" strategy to identify the associations between state minimum wages and adult obesity, body mass index (weight (kg)/height (m)2), hypertension, diabetes, fair or poor health, and serious psychological distress. National Health Interview Survey data (United States, 2008-2015) on adults aged 25-64 years (n = 131,430) were linked to state policies to estimate the prevalence odds ratio or mean difference in these outcomes associated with a $1 increase in current and 2-year lagged minimum wage among less-educated adults overall and by sex, race/ethnicity, and age. In contrast to prior studies, there was no association between current minimum wage and health; however, 2-year lagged minimum wage was positively associated with the likelihood of obesity (prevalence odds ratio = 1.08, 95% confidence interval: 1.00, 1.16) and with elevated body mass index (mean difference = 0.27, 95% confidence interval: 0.04, 0.49). In subgroup models, current and 2-year lagged minimum wage were associated with a higher likelihood of obesity among male and non-White or Hispanic adults. The associations with hypertension also varied by sex and the timing of the exposure.

State earned income tax credits and general health indicators: A quasi-experimental national study 1993-2016.

OBJECTIVE: To assess the relationship between the presence and generosity of state-level Earned Income Tax Credits (EITC) and multiple self-reported measures of general health. DATA SOURCES: Data on state-level tax credits and covariates were obtained from the National Bureau of Economic Research and University of Kentucky Center for Poverty Research, respectively. These data were merged with Behavioral Risk Factor Surveillance System survey records from 1993-2016. STUDY DESIGN: Using difference-in-differences approaches and survey-weighted Poisson regression that accounted for clustering of observations and included state and year fixed-effects, we assessed relationships between EITC and self-reported overall health, frequent mental distress, and frequent poor physical health in the prior 30 days. Covariates included state minimum wage, state GDP, and adoption of Medicaid expansion. Sensitivity analyses revealed that parallel trends were plausible; there were no significant lead and lag effects. DATA EXTRACTION METHODS: Analyses were restricted to respondents with no more than a high school diploma or equivalent because less-educated adults are more likely to be low-wage earners and therefore qualify for EITC. PRINCIPAL FINDINGS: Among adults with no education beyond high school (n = 2 884 790), each additional 10-percentage-point increase in the generosity of state EITC-relative to the federal credit-was associated with fewer reports of frequent mental distress (-97.3 per 100 000; 95% CI: -237.2, 42.6) and frequent poor physical health (-149.6 per 100 000; 95% CI: -284.4, -14.9). When restricted to individuals interviewed during the three months when tax rebates are commonly disbursed, the magnitude of the association between EITC and prevalence of reported frequent mental distress was greater (-329.7 per 100 000; 95% CI: -636.0, -23.5). CONCLUSIONS: The generosity of state EITC policies is positively associated with significant reductions in frequent mental distress and poor physical health, especially during months when the credit is received. Interventions to reduce poverty may positively impact health by reducing material hardship and stress.

State Earned Income Tax Credit policies and intimate partner homicide in the USA, 1990-2016.

Economic insecurity is a risk factor for intimate partner homicide (IPH). The Earned Income Tax Credit (EITC) is the largest cash transfer programme to low-income working families in the USA. We hypothesised that EITCs could provide financial means for potential IPH victims to exit abusive relationships and establish self-sufficiency. We conducted a national, quasiexperimental study of state EITCs and IPH rates in 1990-2016 using a difference-in-differences approach. The national rate of IPH decreased from 1.9 per 100 000 adult women in 1990 to 1.3 per 100 000 in 2016. We found no statistically significant association between state EITC generosity and IPH rates (coefficient indicating change in IPH rates per 100 000 adult female years for additional 10% in amount of state EITC, measured as the percentage of federal EITC: 0.02, 95% CI -0.03 to 0.08). Financial control associated with abuse and current EITC eligibility rules may prevent potential IPH victims from accessing the EITC.

Low-income workers' perceptions of wages, food acquisition, and well-being.

Although studies have demonstrated an association between increased economic resources and improvements in food security and health, there is a paucity of qualitative research regarding the relationships between household resources, food security, and health. Policy changes related to increasing low wages are potential opportunities to understand changes to material resources. The aims of this analysis were to describe how low-wage workers perceive household resources in relation to food acquisition and to explore how workers in low-wage jobs connect food and diet to perceptions of health and well-being. We analyzed 190 transcripts from 55 workers in low-wage jobs who were living in households with children who were part of the Seattle Minimum Wage Study (up to three in-depth qualitative interviews and one phone survey per participant, conducted between 2015 and 2017). We coded and analyzed interviews using Campbell's food acquisition framework and best practices for qualitative research. Participants relied on a combination of wages, government assistance, and private assistance from community or family resources to maintain an adequate food supply. Strategies tended to focus more on maintaining food quality than food quantity. Restricted resources also limited food-related leisure activities, which many participants considered important to quality of life. Although many low-wage workers would like to use additional income to purchase higher quality foods or increase food-related leisure activities, they often perceive trade-offs that limit income-based adjustments to food-spending patterns. Future studies should be specifically designed to examine food choices in response to changes in income.

The Culture Of Health In Early Care And Education: Workers' Wages, Health, And Job Characteristics.

Little is known about the health of the 2.2 million early care and education (ECE) workers responsible for the care, well-being, and success of the approximately ten million children younger than age six enrolled in ECE, or the extent to which ECE environments and employers play a role in workers' health. The purpose of this analysis was to describe the health of an ECE worker sample by wage and by job and center characteristics and to begin to explore the relationships between these factors and workers' health. Our data indicate that ECE workers earn low wages and experience poor mental well-being and high rates of food insecurity. Lower-wage workers worked at centers with more children enrolled in subsidy programs and were more likely to work at centers that did not offer health insurance, paid sick leave, or parental or family leave. Policies and programs that raised workers' wages or mandated the provision of meals to both children and workers could better support teacher health and the quality of ECE for children. Our results suggest that the culture of health in ECE settings and equity-related outcomes could be improved by helping centers provide support and flexibility to teachers (for example, offsetting workers' benefit costs or reducing teacher-to-child ratios to reduce stress) who are managing their own health in the context of demanding work.

Trends and Divergences in Childhood Income Dynamics, 1970-2010.

Earnings and income variability have increased since the 1970s, particularly at the bottom of the income distribution. Considerable evidence suggests that childhood income levels-captured as average or point-in-time yearly income-are associated with numerous child and adult outcomes. The importance to child development of stable proximal processes during childhood suggests that income variability may also be important, particularly if it is unpredictable, unintentional, or does not reflect an upward trend in family income. Using the Panel Study of Income Dynamics, this study documents trends since the 1970s in three dimensions of childhood income dynamics: level, variability, and growth (n=7991). The analysis reveals that income variability during childhood has grown over time, while income growth rates have not. In addition, the economic context of childhood has diverged substantially by socioeconomic status, race, and family structure, with the most disadvantaged children facing a double-whammy of low income and high variability.

An Introduction to Household Economic Instability and Social Policy.

This special issue of Social Service Review presents original research on the determinants and consequences of economic instability, with a focus on the interplay between instability and social policy. To frame that discussion, we define economic instability as repeated changes in employment, income, or financial well-being over time, particularly changes that are not intentional, predictable, or part of upward mobility. We also present a conceptual framework for how instability occurs in multiple domains of family life and how social policy has the potential to both buffer and exacerbate instability in employment and family structure. The articles in the volume engage many of these domains, including employment and program instability, and multiple areas of social policy, including workplace regulations and child-care subsidies. They also point to paths for future research, which we summarize in the final section of this introduction.

Intrayear household income dynamics and adolescent school behavior.

Economic life for most American households is quite dynamic. Such income instability is an understudied aspect of households' economic contexts that may have distinct consequences for children. We examine the empirical relationship between household income instability, as measured by intrayear income change, and adolescent school behavior outcomes using a nationally representative sample of households with adolescents from the Survey of Income and Program Participation 2004 panel. We find an unfavorable relationship between income instability and adolescent school behaviors after controlling for income level and a large set of child and family characteristics. Income instability is associated with a lower likelihood of adolescents being highly engaged in school across the income spectrum and predicts adolescent expulsions and suspensions, particularly among low-income, older, and racial minority adolescents.

Covered today, sick tomorrow? Trends and correlates of children's health insurance instability.

Many children with health insurance will experience gaps in coverage over time, potentially reducing their access to and use of preventive health care services. This article uses the Survey of Income and Program Participation to examine how the stability of children's health insurance changed between 1990 and 2005 and to identify dynamic aspects of family life associated with transitions in coverage. Children's health insurance instability has increased since the early 1990s, due to greater movement between insured and uninsured states and between private and public insurance coverage. Changes in the employment and marital status of the family head are highly associated with an increased risk of a child losing and gaining public and private coverage, largely in hypothesized directions. The exception is that marital dissolution and job loss are associated with an increased probability of a child losing public insurance, despite there being no clear policy explanation for such a relationship.

Maternal employment and the health of low-income young children.

This study examines whether maternal employment affects the health status of low-income, elementary-school-aged children using instrumental variables estimation and experimental data from a welfare-to-work program implemented in the early 1990s. Maternal report of child health status is predicted as a function of exogenous variation in maternal employment associated with random assignment to the experimental group. IV estimates show a modest adverse effect of maternal employment on children's health. Making use of data from another welfare-to-work program we propose that any adverse effect on child health may be tempered by increased family income and access to public health insurance coverage, findings with direct relevance to a number of current policy discussions. In a secondary analysis using fixed effects techniques on longitudinal survey data collected in 1998 and 2001, we find a comparable adverse effect of maternal employment on child health that supports the external validity of our primary result.

Welfare policies and very young children: experimental data on stage-environment fit.

The authors examined the effects of welfare programs that increased maternal employment and family income on the development of very young children using data from 5 random-assignment experiments. The children were 6 months to 3 years old when their mothers entered the programs; cognitive and behavioral outcomes were measured 2-5 years later. While there were no overall program impacts, positive or negative, on the development of children in this age group, there was a pair of domain- and age-specific effects: The programs decreased positive social behavior among 1-year-olds and increased school achievement among 2-year-olds. After exploring several explanations for these results, the authors suggest that the contextual changes engendered by the programs, including children's exposure to center-based child care, interacted differentially with specific developmental transitions.