Duncan Greg J, Magnuson Katherine, Kunin-Batson Alicia S, Yoshikawa Hirokazu, Fox Nathan A, Halpern-Meekin Sarah, Ainsworth Nicholas J, Black Sarah R, Nelson Jennifer Mize, Nelson Timothy D, Georgieff Michael K, Karhson Debra, Gennetian Lisa A, Noble Kimberly G
University of California, Irvine.
University of Wisconsin-Madison, Madison.
JAMA Pediatr. 2025 Jun 16. doi: 10.1001/jamapediatrics.2025.1612.
Mothers and children in low-income households are more likely to experience worse mental and physical health than those from higher-income households.
To determine the effect of 4 years of monthly unconditional cash transfers on the mental health of mothers with low-income and the physical health of mothers and children.
DESIGN, SETTING, AND PARTICIPANTS: This was a parallel-group, randomized clinical trial conducted from May 2018 to July 2023. Mother-infant dyads were recruited (May 2018-June 2019) from postpartum wards in 12 hospitals in 4 cities: Omaha, Nebraska; Minneapolis/St Paul, Minnesota; New Orleans, Louisiana; and New York, New York. Data were analyzed from September 2023 to February 2025.
Mothers were randomly assigned to receive either a high-cash gift ($333 per month) or a low-cash gift ($20 per month) on debit cards. The cash gifts continued for the first 6 years of their children's lives. Data analyzed here were collected after 4 years of monthly transfers.
Outcomes were preregistered and measured around the child's fourth birthday. Maternal outcomes included depression, anxiety, and body mass index (BMI). Child outcomes included age- and sex-adjusted BMI percentile and maternal report of child health (overall health, times sick in the past year, and presence of chronic health conditions).
A total of 1000 mother-infant dyads (mean [SD] maternal age, 27.0 [5.8] years) were included in this study. Among those mothers, 400 were randomly assigned to receive the $333 high-cash gift and 600 received the $20 low-cash gift on debit cards. Data were available from 891 mother-child dyads. No statistically detectable group differences were found in maternal depressive symptoms (effect size [ES], 0.04; 95% CI, -0.08 to 0.17; P = .51), anxiety (ES, 0.12; 95% CI, -0.02 to 0.25; P = .09), or BMI (ES, -0.06; 95% CI, -0.21 to 0.09; P = .42). In addition, there were no statistically detectable group differences in child BMI percentile (ES, -0.03; 95% CI, -0.17 to 0.12; P = .73) or overall child health (ES, 0.08; 95% CI, -0.07 to 0.22; P = .30).
Monthly unconditional cash transfers totaling approximately $15 000 over 4 years to mothers with low incomes did not improve maternal mental health, maternal or child BMI, or maternal report of children's health. These results could reflect the absence of causal connections between cash transfers and health, the possibility that impacts of early childhood income may not appear until later in life, or that an 18% increase in income is insufficient to overcome the structural vulnerabilities associated with poverty that contribute to health.
ClinicalTrials.gov Identifier: NCT03593356.
与高收入家庭的母亲和儿童相比，低收入家庭的母亲和儿童更有可能经历较差的身心健康状况。
确定为期4年的每月无条件现金转移对低收入母亲的心理健康以及母亲和儿童的身体健康的影响。
设计、设置和参与者：这是一项平行组随机临床试验，于2018年5月至2023年7月进行。母婴二元组于2018年5月至2019年6月从内布拉斯加州奥马哈、明尼苏达州明尼阿波利斯/圣保罗、路易斯安那州新奥尔良和纽约市的12家医院的产后病房招募。数据于2023年9月至2025年2月进行分析。
母亲们被随机分配在借记卡上接受高现金礼物（每月333美元）或低现金礼物（每月20美元）。现金礼物在其子女生命的前6年持续发放。此处分析的数据是在每月转移4年后收集的。
结局在儿童四岁生日前后预先登记并进行测量。母亲的结局包括抑郁、焦虑和体重指数（BMI）。儿童的结局包括年龄和性别调整后的BMI百分位数以及母亲对儿童健康的报告（总体健康状况、过去一年生病次数以及是否存在慢性健康状况）。
本研究共纳入1000对母婴二元组（母亲平均年龄[标准差]为27.0[5.8]岁）。在这些母亲中，400人被随机分配接受333美元的高现金礼物，600人在借记卡上接受20美元的低现金礼物。891对母婴二元组有可用数据。在母亲的抑郁症状（效应大小[ES]，0.04；95%置信区间，-0.08至0.17；P = 0.51）、焦虑（ES，0.12；95%置信区间，-0.02至0.25；P = 0.09）或BMI（ES，-0.06；95%置信区间，-0.21至0.09；P = 0.42）方面未发现统计学上可检测到的组间差异。此外，在儿童BMI百分位数（ES，-0.03；95%置信区间，-0.17至0.12；P = 0.73）或儿童总体健康状况（ES，0.08；95%置信区间，-0.07至0.22；P = 0.30）方面也未发现统计学上可检测到的组间差异。
在4年时间里，向低收入母亲每月总计无条件现金转移约15000美元，并未改善母亲的心理健康、母亲或儿童的BMI，也未改善母亲对儿童健康的报告。这些结果可能反映出现金转移与健康之间不存在因果关系，幼儿期收入的影响可能要到晚年才会显现，或者收入增加18%不足以克服与贫困相关的导致健康问题的结构性脆弱性。
ClinicalTrials.gov标识符：NCT03593356。
