A Driver in Health Outcomes: Developing Discrete Categories of Transportation Insecurity.

Research suggests that transportation is an important social determinant of health, because the ability to get around is consequential for accessing health care and nutritious food and for making social connections. We used an inductive mixed-methods approach and a quantitative k-means clustering approach to identify 5 categories of transportation insecurity using the validated 16-item Transportation Security Index. The resulting 5-category measure distinguished among respondents with qualitatively different experiences of transportation insecurity. Analyzing data from 2018 that were representative of the US adult population aged 25 years or older, we demonstrated a nonparametric association between transportation insecurity and 2 different health measures (self-rated health and depressive symptoms). There was a threshold relationship between self-rated health and any level of transportation insecurity. High transportation insecurity had a very strong relationship with depressive symptoms. The categorical Transportation Security Index will be useful for clinicians who wish to screen for transportation-related barriers to health care. It will also facilitate research investigating the influence of transportation insecurity on health outcomes and provide the basis for interventions designed to address health disparities.

Unconditional cash transfers and mental health symptoms among parents with low incomes: Evidence from the 2021 child tax credit.

The COVID-19 pandemic increased anxiety and depression in the U.S. population, particularly among low-income households, parents, and Black and Hispanic adults. To address the negative impacts of the pandemic, Congress temporarily expanded the Child Tax Credit (CTC) in 2021, providing a near-universal, unconditional cash transfer to families with children. Using a quasi-experimental, parameterized difference-in-differences research design, we examine the effects of the 2021 monthly CTC on symptoms of anxiety and depression in a large, national sample of parents with low incomes (N∼15,000). We study potential differences in the associations by race/ethnicity and consider whether CTC effects were stronger after a longer treatment period (for instance, due to greater dosage or delayed effects). We find some evidence that the monthly credit reduced parental anxiety and depression symptoms, although the results were not robust throughout all model specifications. Analyses stratified by race/ethnicity show stronger associations for non-Hispanic Black parents than for non-Hispanic White parents or Hispanic parents, although differences were small. We also find the credit reduced anxiety (but not depression) symptoms after three months of payments, suggesting that it took some time for the CTC to affect mental health symptoms. Overall, this study suggests that recurring cash transfers to families in poverty in the U.S. may have small beneficial effects on parental mental health.

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.

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.