Teachers College, Columbia University, New York, New York.
Duke University, Durham, North Carolina.
JAMA Netw Open. 2023 Sep 5;6(9):e2335237. doi: 10.1001/jamanetworkopen.2023.35237.
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.
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.
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.
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.
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).
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.
ClinicalTrials.gov Identifier: NCT03593356.
贫困儿童更有可能经历更糟糕的健康结果，包括受伤、慢性疾病、更差的营养和更差的睡眠。减少贫困在多大程度上改善这些结果尚不清楚。
评估为期 3 年、每月无条件现金转移对出生时健康的贫困儿童的健康、营养、睡眠和医疗保健利用的影响。
设计、地点和参与者：这项纵向随机临床试验于 2018 年 5 月至 2019 年 6 月期间招募了 1000 对母婴二人组。二人组从美国 4 个城市的 12 家医院的产后病房招募：纽约州纽约市；内布拉斯加州奥马哈市；路易斯安那州新奥尔良市；明尼苏达州明尼阿波利斯/圣保罗市。入选标准包括年收入低于联邦贫困线、法定同意年龄、会说英语或西班牙语、居住在招募州、以及将被送回母亲监护的新生儿保育室的婴儿。数据分析于 2022 年 7 月至 2023 年 8 月进行。
母亲被随机分配接受高现金礼物（每月 333 美元，或每年 3996 美元）或低现金礼物（每月 20 美元，或每年 240 美元）。
这里报告的主要预先注册结果包括儿童健康和医疗保健指数和儿童睡眠障碍。次要预先注册结果包括儿童食用健康和不健康食物的情况。
共纳入 1000 对母婴二人组，其中 400 人随机分配到高现金礼物组，600 人分配到低现金礼物组。参与者主要是黑人（42%）和西班牙裔（41%）；857 名母亲参加了所有 3 轮数据收集。我们没有发现高现金和低现金礼物组之间在母亲对儿童健康的评估（效应大小[ES]范围，0.01-0.08；SE 范围，0.02-0.07）、睡眠（ES 范围，0.01-0.10；SE，0.07）或医疗保健利用（ES 范围，0.01-0.11；SE 范围，0.03-0.07）方面存在统计学上可检测到的差异。然而，高现金礼物组的母亲报告称，2 岁儿童食用新鲜农产品的比例更高，这是唯一一次进行测量（ES，0.17；SE，0.07；P=0.03）。
在这项研究中，向贫困母亲提供无条件现金转移并没有改善他们对孩子健康、睡眠或医疗保健利用的报告。然而，这种规模的稳定收入支持改善了幼儿食用新鲜农产品的情况。健康的新生儿往往会成长为健康的学步儿童，减少贫困对儿童健康和睡眠的影响可能要到以后的生活中才能完全显现出来。
ClinicalTrials.gov 标识符：NCT03593356。
