Cook John T, Frank Deborah A, Berkowitz Carol, Black Maureen M, Casey Patrick H, Cutts Diana B, Meyers Alan F, Zaldivar Nieves, Skalicky Anne, Levenson Suzette, Heeren Tim
Boston Medical Center, Department of Pediatrics, 91 E Concord St, Fourth floor, Boston, MA 02118, USA.
Arch Pediatr Adolesc Med. 2002 Jul;156(7):678-84. doi: 10.1001/archpedi.156.7.678.
Welfare reform under the 1996 Personal Responsibility and Work Opportunity Reconciliation Act replaced entitlement to cash assistance for low-income families with Temporary Assistance to Needy Families, thereby terminating or decreasing cash support for many participants. Proponents anticipated that continued receipt of food stamps would offset the effects of cash benefit losses, although access to food stamps was also restricted.
To examine associations of loss or reduction of welfare with food security and health outcomes among children aged 36 months or younger at 6 urban hospitals and clinics.
A multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington, DC, from August 1998 through December 2000.
The caregivers of 2718 children aged 36 months or younger whose households received welfare or had lost welfare through sanctions were interviewed at hospital clinics and emergency departments.
Household food security status, history of hospitalization, and, for a subsample interviewed in emergency departments, whether the child was admitted to the hospital the day of the visit.
After controlling for potential confounding factors, children in families whose welfare was terminated or reduced by sanctions had greater odds of being food insecure (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.1-1.9), of having been hospitalized since birth (AOR, 1.3; 95% CI, 1.0-1.7) and, for the emergency department subsample, of being admitted the day of an emergency department visit (AOR, 1.9; 95% CI, 1.2-3.0) compared with those without decreased benefits. Children in families whose welfare benefits were decreased administratively because of changes in income or expenses had greater odds of being food insecure (AOR, 1.5; 95% CI, 1.1-2.2) and of being admitted the day of an emergency department visit (AOR, 2.8; 95% CI, 1.4-5.6). Receiving food stamps does not mitigate the effects of the loss or reduction of welfare benefits on food security or hospitalizations.
Terminating or reducing welfare benefits by sanctions, or decreasing benefits because of changes in income or expenses, is associated with greater odds that young children will experience food insecurity and hospitalizations.
1996年的《个人责任与工作机会协调法案》下的福利改革，用“贫困家庭临时援助”取代了低收入家庭的现金援助权利，从而终止或减少了对许多参与者的现金支持。尽管获得食品券的机会也受到限制，但支持者预计，继续领取食品券将抵消现金福利损失的影响。
研究在6家城市医院和诊所中，36个月及以下儿童的福利损失或减少与食品安全和健康结果之间的关联。
一项多地点回顾性队列研究，于1998年8月至2000年12月在5个州和华盛顿特区的城市医疗中心进行横断面调查。
对2718名36个月及以下儿童的照料者进行了访谈，这些儿童的家庭领取过福利或因制裁而失去了福利，访谈在医院诊所和急诊科进行。
家庭食品安全状况、住院史，对于在急诊科接受访谈的子样本，还包括儿童在就诊当天是否住院。
在控制了潜在的混杂因素后，因制裁而福利终止或减少的家庭中的儿童，与福利未减少的家庭中的儿童相比，粮食不安全的几率更高（调整优势比[AOR]为1.5；95%置信区间[CI]为1.1 - 1.9），自出生以来住院的几率更高（AOR为1.3；95%CI为1.0 - 1.7）；对于急诊科子样本，在急诊科就诊当天住院的几率更高（AOR为1.9；95%CI为1.2 - 3.0）。因收入或支出变化而行政性减少福利的家庭中的儿童，粮食不安全的几率更高（AOR为1.5；95%CI为1.1 - 2.2），在急诊科就诊当天住院的几率更高（AOR为2.8；95%CI为1.4 - 5.6）。领取食品券并不能减轻福利损失或减少对食品安全或住院情况的影响。
通过制裁终止或减少福利福利，或因收入或支出变化而减少福利，与幼儿面临粮食不安全和住院的几率增加有关。
