Effects of a monthly unconditional cash transfer starting at birth on family investments among US families with low income.

How does unconditional income for families in poverty affect parental investments for their young children? Mothers in four US metropolitan areas were randomized to receive a monthly unconditional cash transfer of either $333 per month (high) or $20 per month (low) for the first several years after childbirth. During the first 3 years, high-cash gift households spent more money on child-specific goods and more time on child-specific early learning activities than the low-cash gift group. Few changes were evident in other core household expenditures. Compared with low-cash gift families, high-cash gift families reported lower rates of public benefit receipt and fewer were residing in poverty, although mean income and wealth remain low for the majority of families by year 3. No statistically significant differences were evident in mothers' participation in paid work, children's time in childcare or mothers' subjective wellbeing.

Contraception use and satisfaction among mothers with low income: Evidence from the Baby's First Years study.

OBJECTIVES: Low income can lead to limited choice of and access to contraception. We examine whether an unconditional cash transfer (UCT) impacts contraceptive use, including increased satisfaction with and reduced barriers to preferred methods, for individuals with low income. STUDY DESIGN: Baby's First Years is a randomized control study of a monthly UCT to families with low incomes. The study enrolled 1000 mothers at the time of childbirth across four US sites in 2018-2019; 400 were randomized to receive a UCT of $333/mo and 600 were randomized to receive $20/mo for the first years of their child's life. We use intent-to-treat analyses to estimate the impact of the cash transfer on contraception use, satisfaction with contraception method, and barriers to using methods of choice. RESULTS: Over 65% of mothers reported using some type of contraception, and three-quarters reported using the method of their choice. We find no impact of the UCT on mothers' choice of, satisfaction with, or barriers to contraception. However, the cash transfer was associated with trends toward using multiple methods and greater use of short-term hormonal methods. CONCLUSIONS: We find high levels of satisfaction with current contraceptive use among mothers of young children with low income. Receipt of monthly UCTs did not impact contraception methods, perceived barriers to use, or satisfaction. Yet, 25% were not using the method of their choice, despite the provision of cash, indicating that this cash amount alone may not be sufficient to impact contraceptive use or increase satisfaction. IMPLICATIONS: Satisfaction with contraception use among low-income populations may be higher than previously documented. Nevertheless, provision of modest financial resources alone may not sufficiently address access, availability, and satisfaction for individuals with low-incomes of childbearing age. This suggests the importance of exploring how other nonfinancial factors influence reproductive autonomy, including contraceptive use.

Unconditional Cash Transfers and Maternal Assessments of Children's Health, Nutrition, and Sleep: A Randomized Clinical Trial.

Importance: Children experiencing poverty are more likely to experience worse health outcomes, including injury, chronic illness, worse nutrition, and poorer sleep. The extent to which poverty reduction improves these outcomes is unknown. Objective: To evaluate the effect of a 3-year, monthly unconditional cash transfer on health, nutrition, sleep, and health care utilization among children experiencing poverty who were healthy at birth. Design, Setting, and Participants: This longitudinal randomized clinical trial recruited 1000 mother-infant dyads between May 2018 and June 2019. Dyads were recruited from postpartum wards in 12 hospitals in 4 US cities: New York, New York; Omaha, Nebraska; New Orleans, Louisiana; and Minneapolis/St Paul, Minnesota. Eligibility criteria included an annual income less than the federal poverty line, legal age for consent, English or Spanish speaking, residing in the state of recruitment, and an infant admitted to the well-baby nursery who will be discharged to the mother's custody. Data analysis was conducted from July 2022 to August 2023. Intervention: Mothers were randomly assigned to receive either a high-cash gift ($333/mo, or $3996/y) or a low-cash gift ($20/mo, or $240/y) for the first several years of their child's life. Main Outcomes and Measures: Primary preregistered outcomes reported here include an index of child health and medical care and child sleep disturbances. Secondary preregistered outcomes reported include children's consumption of healthy and unhealthy foods. Results: A total of 1000 mother-infant dyads were enrolled, with 400 randomized to the high-cash gift group and 600 to the low-cash gift group. Participants were majority Black (42%) and Hispanic (41%); 857 mothers participated in all 3 waves of data collection. We found no statistically detectable differences between the high-cash and low-cash gift groups in maternal assessments of children's health (effect size [ES] range, 0.01-0.08; SE range, 0.02-0.07), sleep (ES range, 0.01-0.10; SE, 0.07), or health care utilization (ES range, 0.01-0.11; SE range, 0.03-0.07). However, mothers in the high-cash gift group reported higher child consumption of fresh produce at child age 2 years, the only time point it was measured (ES, 0.17; SE, 0.07; P = .03). Conclusions and Relevance: In this study, unconditional cash transfers to mothers experiencing poverty did not improve reports of their child's health, sleep, or health care utilization. However, stable income support of this magnitude improved toddlers' consumption of fresh produce. Healthy newborns tend to grow into healthy toddlers, and the impacts of poverty reduction on children's health and sleep may not be fully borne out until later in life. Trial Registration: ClinicalTrials.gov Identifier: NCT03593356.

The Effect of a U.S. Poverty Reduction Intervention on Maternal Assessments of Young Children's Health, Nutrition, and Sleep: A Randomized Control Trial.

Importance: Children experiencing poverty are more likely to experience worse health outcomes during the first few years of life, including injury, chronic illness, worse nutrition, and poorer sleep. The extent to which a poverty reduction intervention improves children's health, nutrition, sleep, and healthcare utilization is unknown. Objective: To determine the effect of a 3-year, monthly unconditional cash transfer on health, nutrition, sleep, and healthcare utilization of children experiencing poverty who are healthy at birth. Design: Longitudinal randomized control trial. Setting: Mother-infant dyads were recruited from postpartum wards in 12 hospitals in four cities across the U.S. Participants: 1,000 mothers were enrolled in the study. Eligibility criteria included: an annual income below the federal poverty line, being of legal age for consent, speaking English or Spanish, residing in the state of recruitment, and having an infant admitted to the well-baby nursery with plans to be discharged to the custody of the mother. Intervention: Mothers were randomly assigned to receive either a high-cash gift ($333 per month, or $3,996 per year; n=400) or a low-cash gift ($20 per month, or $240 per year; n=600) for the first several years of their child's life. Main Outcomes and Measures: Pre-registered maternal assessments of the focal child's health, nutrition, sleep, and healthcare utilization were collected at children's ages 1, 2, and 3. Results: Enrolled participants were majority Black (42%) and Hispanic (41%). 857 mothers participated in all three waves of data collection. We found no statistically detectable differences between the high-cash and low-cash gift groups in maternal assessments of children's overall health, sleep, or healthcare utilization. However, mothers in the high-cash gift group reported higher child consumption of fresh produce compared with mothers in the low-cash gift group at age 2, the only time point it was measured (ß=0.17, SE=0.07, p=0.03). Conclusions and Relevance: In this RCT, unconditional cash transfers to mothers experiencing poverty did not improve their reports of their child's health, sleep, or healthcare utilization. However, stable income support of this magnitude improved toddler's consumption of fresh produce. Healthy newborns tend to grow into healthy toddlers, and the impacts of poverty reduction on children's health and sleep may not be fully borne out until later in life. Trial Registration: Baby's First Years (BFY; ID NCT03593356) https://clinicaltrials.gov/ct2/show/NCT03593356?term=NCT03593356&draw=2&rank=1.

Unconditional Cash and Family Investments in Infants: Evidence from a Large-Scale Cash Transfer Experiment in the U.S.

Economists have limited causal evidence on how families receiving unconditional income would spend those funds. We examine financial and time investments in infants among families living in poverty from a large-scale, multi-site randomized controlled study of monthly unconditional cash. We find increased spending on child-specific goods and mothers' early-learning activities with their infants. The marginal propensity to consume child-focused items from the cash transfer exceeded that from other income, consistent with the behavioral cues in the design. We find no statistically detectable offsets in household earnings or impacts on pre-registered outcomes related to expenditures, labor supply, childcare or subjective well-being.

Romantic Unions and Mental Health: The Role of Relationship Churning.

The stress process perspective suggests that romantic relationship transitions can be stressors that impair mental health. Research on romantic relationships and mental health has ignored one common stressor, on-again/off-again relationships, or churning. Using five waves of data from the Fragile Families and Child Wellbeing Study (N = 3,176), we examine associations between relationship churning and mothers' mental health. We find that mothers experiencing relationship churning have worse mental health than mothers in stably together relationships, net of characteristics associated with selection into relationship instability; these associations persist over four years. Mothers experiencing relationship churning have similar mental health as their counterparts who experience union dissolution (with or without repartnering). Current relationship status and quality explain some of the differences between churning and stably together mothers. Findings emphasize attending to multiple types of family stressors-even stressors and instability in ongoing relationships-and the micro-level ecological factors that shape mental health.

"I Used to Get WIC But Then I Stopped": How WIC Participants Perceive the Value and Burdens of Maintaining Benefits.

This study examines how individuals assess administrative burdens and how these views change over time within the context of the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), which provides food to pregnant and breastfeeding women and children under age five. Using interview data from the Baby's First Years: Mothers' Voices study (n. = 80), we demonstrate how the circumstances of family life, shifiing food needs and preferences, and the receipt of other resources shape how mothers perceive the costs and benefits of program participation. We find that mothers' perceptions of WIC's costs and benefits vary over time and contribute to program participation trajectories, so many eligible people do not participate; need alone does not drive participation decisions.

"If I don't have credit, I don't have anything": Perspectives on the credit scoring system among mothers with low incomes.

This mixed-methods study examines consumer perspectives on the credit scoring system drawn from in-depth interviews with 72 mothers with low incomes and national survey data from the National Financial Capability Study. Interviewees express strong awareness of credit scoring and a desire to have good credit. National survey data corroborate these findings, showing that most mothers with low incomes are knowledgeable about their credit scores. They know what behaviors improve credit standing and recognize the tradeoffs between present consumption and longer-run goals. They do not reject the credit scoring system's legitimacy and seek to work within this system to pursue their financial goals, despite obstacles to success. This evidence enriches our understanding of the perspectives and values that motivate consumer financial behaviors and highlights the systemic challenges to people's financial well-being that are embedded in a seemingly widely accepted credit scoring system.

"I Don't Like All Those Fees" Pragmatism About Financial Services Among Low-Income Parents.

Basic financial services facilitate people's ability to manage their finances, save, and receive payments from employers or the government. Drawing on survey data as well as qualitative interviews with 80 mothers with limited incomes, we find that parents take a pragmatic view and use a wide range of financial services to meet their needs including fintech, prepaid cards, and mobile phone-based solutions, as well as traditional banks. Mistrust in institutions is an important factor in shaping the services mothers avoid. Structural factors, like employers' payment methods, also play a role in financial service use. These low-income parents of young children are actively using a range of financial services, much broader than those provided by traditional banks. Many mothers engaged in complex financial management practices to receive income and pay their bills. This opens room for potentially costly errors and is, at least, taxing their cognitive bandwidth. Researchers must attend to the diverse set of financial services with which parents engage and investigate how this affects families' financial wellbeing and inclusion.

Unconditional cash transfers and maternal substance use: findings from a randomized control trial of low-income mothers with infants in the U.S.

BACKGROUND: Policy debates over anti-poverty programs are often marked by pernicious stereotypes suggesting that direct cash transfers to people residing in poverty encourage health-risking behaviors such as smoking, drinking, and other substance use. Causal evidence on this issue is limited in the U.S. Given the prominent role of child allowances and other forms of cash assistance in the 2021 American Rescue Plan and proposed Build Back Better legislation, evidence on the extent to which a monthly unconditional cash gift changes substance use patterns among low-income mothers with infants warrants attention, particularly in the context of economic supports that can help improve early environments of children. METHOD: We employ a multi-site, parallel-group, randomized control trial in which 1,000 low-income mothers in the U.S. with newborns were recruited from hospitals shortly after the infant's birth and randomly assigned to receive either a substantial ($333) or a nominal ($20) monthly cash gift during the early years of the infant's life. We estimate the effect of the unconditional cash transfer on self-report measures of maternal substance use (i.e., alcohol, cigarette, or opioid use) and household expenditures on alcohol and cigarettes after one year of cash gifts. RESULTS: The cash gift difference of $313 per month had small and statistically nonsignificant impacts on group differences in maternal reports of substance use and household expenditures on alcohol or cigarettes. Effect sizes ranged between - 0.067 standard deviations and + 0.072 standard deviations. The estimated share of the $313 group difference spent on alcohol and tobacco was less than 1%. CONCLUSIONS: Our randomized control trial of monthly cash gifts to mothers with newborn infants finds that a cash gift difference of $313 per month did not significantly change maternal use of alcohol, cigarettes, or opioids or household expenditures on alcohol or cigarettes. Although the structure of our cash gifts differs somewhat from that of a government-provided child allowance, our null effect findings suggest that unconditional cash transfers aimed at families living in poverty are unlikely to induce large changes in substance use and expenditures by recipients. TRIAL REGISTRATION: Registered on Clinical Trials.gov NCT03593356 in July of 2018.

The impact of a poverty reduction intervention on infant brain activity.

Early childhood poverty is a risk factor for lower school achievement, reduced earnings, and poorer health, and has been associated with differences in brain structure and function. Whether poverty causes differences in neurodevelopment, or is merely associated with factors that cause such differences, remains unclear. Here, we report estimates of the causal impact of a poverty reduction intervention on brain activity in the first year of life. We draw data from a subsample of the Baby's First Years study, which recruited 1,000 diverse low-income mother-infant dyads. Shortly after giving birth, mothers were randomized to receive either a large or nominal monthly unconditional cash gift. Infant brain activity was assessed at approximately 1 y of age in the child's home, using resting electroencephalography (EEG; n = 435). We hypothesized that infants in the high-cash gift group would have greater EEG power in the mid- to high-frequency bands and reduced power in a low-frequency band compared with infants in the low-cash gift group. Indeed, infants in the high-cash gift group showed more power in high-frequency bands. Effect sizes were similar in magnitude to many scalable education interventions, although the significance of estimates varied with the analytic specification. In sum, using a rigorous randomized design, we provide evidence that giving monthly unconditional cash transfers to mothers experiencing poverty in the first year of their children's lives may change infant brain activity. Such changes reflect neuroplasticity and environmental adaptation and display a pattern that has been associated with the development of subsequent cognitive skills.

Follow up for COVID-19 in Belfast City Hospital.

BACKGROUND: During the COVID-19 pandemic of Spring 2020, Belfast City Hospital functioned as Belfast's Nightingale facility. Evidence published during this time focused mainly on the acute management of the condition. Guidance on follow up and long-term management for patients recovering from COVID-19 was sparse. A specialist COVID-19 follow up service was devised in Belfast City Hospital led by a respiratory physician with physiotherapy and psychology input. METHODS: Data was collected on all patients admitted to Belfast Nightingale unit. Patients admitted to Intensive Care at any stage in their admission were followed up separately by Intensive Care. Initial consultation was via telephone call for all eligible patients six weeks post discharge, followed by face-to-face consultation for those with symptoms at next available appointment, and a further face-to-face consultation at twelve weeks post hospital discharge. Patients were seen by respiratory physician, physiotherapy and psychology at each appointment. All patients who had initial changes on chest radiograph had 12 week follow up radiograph requested as per British Thoracic Society guidelines. RESULTS: 29 patients were followed up after hospitalisation with COVID-19. Of these, 10 were brought for face-to-face consultations. Patients at clinic were all functionally independent with a median Medical Research Council dyspnoea score of 2 and a subjective assessment of their current health of median 50, on a visual analogue scale 0-100. Fatigue was common with all patients. Depression, anxiety and post-traumatic stress disorder were all reported from psychological review. Chest radiograph showed signs of improvement in 100% of clinic attendees. 90% of patients seen in clinic had normal or chronic obstructive patterns on spirometry, with one patient having a reduced transfer factor. CONCLUSION: Majority of patients did not require face-to-face review and were recovering well. Of the 10 patients seen in the respiratory led clinic, the main issues reported were fatigue and psychological issues. Respiratory symptoms were significantly improving in 9 out of the 10 patients seen. All patients have been introduced to psychology service whilst at clinic and will continue to receive necessary support.

Baby's First Years: Design of a Randomized Controlled Trial of Poverty Reduction in the United States.

Childhood economic disadvantage is associated with lower cognitive and social-emotional skills, reduced educational attainment, and lower earnings in adulthood. Despite these robust correlations, it is unclear whether family income is the cause of differences observed between children growing up in poverty and their more fortunate peers or whether these differences are merely due to the many other aspects of family life that co-occur with poverty. Baby's First Years is the first randomized controlled trial in the United States designed to identify the causal impact of poverty reduction on children's early development. A total of 1000 low-income mothers of newborns were enrolled in the study and began receiving a monthly unconditional cash gift for the first several years of their children's lives. Mothers were randomly assigned to receive either a large monthly cash gift or a nominal monthly cash gift. All monthly gifts are administered via debit card and can be freely spent with no restrictions. Baby's First Years aims to answer whether poverty reduction in early childhood (1) improves children's developmental outcomes and promotes healthier brain functioning, and (2) improves family functioning and better enables parents to support child development. Here we present the rationale and design of the study as well as potential implications for science and policy.

Relationship Churning and Desistance From Intimate Abuse.

It is essential to understand how desistance from intimate abuse occurs so it can be facilitated for those experiencing it. Recognizing the category of churning relationships-in which partners separate and reunite-gives us analytic leverage in identifying the relationship dynamics that predict abuse desistance. Using data from the Fragile Families and Child Wellbeing Study, a longitudinal survey of parents in urban areas, we compare desistance among churners (who experience a breakup only) with those who repartner (who experience a breakup and a new partnership) and those who are stably together (who experience neither a breakup nor a new partnership). We examine whether abuse desistance patterns are distinct for those who breakup and reconcile versus those who breakup and form new partnerships-that is, we can separate out the association between abuse desistance and the breakup versus the new partnership. We find that, among those with a history of intimate abuse, churners and those who later repartner are overrepresented. However, among those who do experience abuse, the repartnered are most likely to experience desistance from intimate abuse, controlling for individual sociodemographic characteristics. In breaking up and entering a new relationship, the repartnered may be most successful in developing a healthier relationship dynamic than the churners who reunite with one another.

Intimate Partner Violence Screening in the Prenatal Period: Variation by State, Insurance, and Patient Characteristics.

Objective To measure the proportion of women screened for IPV during prenatal care; to assess the predictors of prenatal IPV screening. Methods We use the CDC's 2012 Pregnancy Risk Assessment Monitoring System, representative of births in 24 states and New York City (N = 28,581). We calculated descriptive and logistic regressions, weighted to deal with state-clustered observations. Results 49.2% of women in our sample reported being screened for IPV while pregnant. There were higher screening rates among women of color, and those who had not completed high school, never been married, received WIC benefits, initiated prenatal care in the first trimester, and were publicly insured. State screening rates varied (29.9-62.9%). Among states, mandated perinatal depression screening or training was positively associated with IPV screening. 3.6% of women in our sample reported prenatal IPV but were not screened during pregnancy. Conclusions for Practice Current efforts have not led to universal screening. We need to better understand when and why providers do not screen pregnant patients for IPV.

Parenting in On/Off Relationships: The Link Between Relationship Churning and Father Involvement.

Family systems theory points to the interconnected nature of dyadic relationships within the family unit, arguing for attention to how the parental relationship shapes their ties to and interactions with their children. Grounded in family systems theory, we consider how relationship churning-defined as being in an on-again/off-again relationship with the same partner-is associated with father involvement. We use data from the Fragile Families and Child Wellbeing Study to examine how father involvement among relationship churners compares with father involvement among those in three other relationship types (measured during the first five years of the focal child's life): stably together relationships, stably broken-up relationships, and repartnered relationships. First, we find that churning fathers remain more involved with their 9-year-old children than do parents who stably break up or repartner, but they are less involved than those who are stably together. Second, lower relationship quality among churners-and, to a lesser extent, repartnering and childbearing with a new partner-explains some of the differences in father involvement between churners and the stably together. Third, these differences are most apparent among parents not living together when father involvement is measured. Taken together, the focus on relationship churning extends prior research on the association between relationship transitions and father involvement by separating relationship instability from partner change.

Relationship Churning and Parenting Stress Among Mothers and Fathers.

Researchers have documented the consequences of relationship instability for parenting stress but have given little attention to within-partner relationship instability. In this study, the authors used data from the Fragile Families and Child Wellbeing Study (N = 3,544) to estimate the association between within-partner relationship instability (known as churning or on-again/off-again relationships) and parenting stress. First, they found that by the focal child's 5th birthday about 16% of biological parents experience churning. Second, compared to being stably together with or stably separated from the child's other parent, churning is associated with greater parenting stress for both mothers and fathers. Because parenting stress is the same or higher among churners compared to their counterparts who stably separate, this suggests that, more than a change in partner, relationship instability-whether within or across relationships-is tied to parenting stress.

Relationship Churning, Physical Violence, and Verbal Abuse in Young Adult Relationships.

Young adults' romantic relationships are often unstable, commonly including breakup-reconcile patterns. From the developmental perspective of emerging adulthood exploration, such relationship "churning" is expected; however, minor conflicts are more common in churning relationships. Using TARS data (N = 792), we test whether relationship churning is associated with more serious conflict: physical violence and verbal abuse. Those who are stably broken up (breakup only - no reconciliation) are similar to those who are stably together in their conflict experiences. In contrast, churners (i.e., those involved in on-off relationships) are twice as likely as those who are stably together or stably broken up to report physical violence and half again as likely to report the presence of verbal abuse in their relationships; this association between churning and conflict holds net of a host of demographic, personal, and relationship characteristics. These findings have implications for better understanding unhealthy relationship behaviors.

Discordance in couples' reporting of courtship stages: Implications for measurement and marital quality.

The symbolism of rituals creates a shared understanding of events among group members. In the context of romantic relationships, a shared understanding of relationship status transitions may be associated with greater commitment and higher quality relationships. We argue that couples with differing retrospective accounts of their premarital courtship may not have had clear discussions or rituals marking relationship turning points. We test the association between discordance in couples' reports of premarital courtship stages and marital quality using data from married couples in a national online survey (n=1504). We find that couple discordance is common, particularly among former premarital cohabitors and for the less institutionalized relationship stages of dating and stayovers, and is associated with lower marital quality. Implications for relationship measurement and the meaning of couple discordance are discussed.