Ettinger de Cuba Stephanie, Coleman Sharon M, Bovell-Ammon Allison, Cutts Diana, Sandel Megan, Ochoa Eduardo, Ruemmele Carley, Gupta Barnes Shailly, Bruce Charlotte, Scully Kate, Black Maureen M, Frank Deborah A, Lê-Scherban Félice
Boston University School of Public Health, Boston, Massachusetts.
Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
JAMA Netw Open. 2025 Jun 2;8(6):e2518335. doi: 10.1001/jamanetworkopen.2025.18335.
Understanding associations of cash payments with family health and material hardships can inform national policy design to support families' economic stability, including an expanded child tax credit (CTC).
To (1) describe family characteristics, including tax filing and banking status by expanded CTC receipt, and (2) examine longitudinal changes in caregiver and child health and material hardships, including housing stability and food security.
DESIGN, SETTING, AND PARTICIPANTS: In this longitudinal cohort study, data were drawn from the Children's HealthWatch COVID Follow-up Study, a study of families surveyed at baseline and 2 waves (January 2018 to March 2020). Primary caregivers of children (≤48 months) participated in English or Spanish in emergency departments or primary care clinics in 4 US cities (Little Rock, Arkansas; Boston, Massachusetts; Minneapolis, Minnesota; and Philadelphia, Pennsylvania). Follow-up surveys were conducted from September 2020 to June 2021 and September 2021 to June 2022. Data were analyzed from March to April 2025.
Caregiver-reported CTC receipt.
Caregivers reported whether they had a bank account (ie, were banked), filed taxes, and demographic characteristics. Caregivers also reported child physical health, caregiver physical and mental health, household food insecurity, and housing stability, including rent status (current vs. behind). Adjusted multivariable logistic regression via generalized estimating equations to account for repeated measures was used to assess associations of CTC receipt with health outcomes and hardships over time.
In this cohort of 5813 caregivers (mean [SD] age, 29 [6] years; 1934 non-Latine Black [34.7%]; 2127 Latine [38.3%]; 1275 non-Latine White [22.8%]), 2519 (44.2%) had education beyond high school and 4177 (73.4%) were US born. Of the 879 surveyed after the CTC was implemented, the majority (663 [75.0%]) reported receiving it. Compared with nonrecipient families, a greater proportion of CTC recipients were married or partnered (308 of 663 recipients [47.5%]; 1845 of 5150 nonrecipients [36.6%]), had filed taxes (631 of 662 recipients [95.3%] vs 84 of 194 nonrecipients [43.3%]), were banked (581 of 661 recipients [87.9%] vs 103 of 194 nonrecipients [53.1%]), or were non-Latine White (183 of 663 recipients [28.5%] vs 1092 of 5150 nonrecipients [22.1%]). CTC recipients had significantly lower adjusted odds of hardships, including food insecurity (adjusted odds ratio [aOR], 0.61; 95% CI, 0.47-0.78), housing instability (aOR, 0.64; 95% CI, 0.49-0.83), and being behind on rent (aOR, 0.62; 95%CI 0.48-0.80). Caregivers had lower adjusted odds of anxiety (aOR, 0.67; 95% CI, 0.51-0.89).
In this cohort study, CTC recipient families were more likely than nonrecipients to be food secure, stably housed, current on rent, and have caregivers in good mental health, reinforcing associations of increased financial resources with family health and basic needs.
了解现金支付与家庭健康和物质困难之间的关联，可为国家政策设计提供参考，以支持家庭的经济稳定，包括扩大儿童税收抵免（CTC）。
（1）描述家庭特征，包括按是否收到扩大后的儿童税收抵免来划分的报税和银行账户状况；（2）研究照顾者和儿童健康以及物质困难的纵向变化，包括住房稳定性和食品安全。
设计、背景和参与者：在这项纵向队列研究中，数据取自儿童健康观察新冠疫情随访研究，该研究对基线和两波随访（2018年1月至2020年3月）期间接受调查的家庭进行了研究。美国4个城市（阿肯色州小石城；马萨诸塞州波士顿；明尼苏达州明尼阿波利斯；宾夕法尼亚州费城）急诊科或初级保健诊所中48个月及以下儿童的主要照顾者以英语或西班牙语参与了研究。随访调查于2020年9月至2021年6月以及2021年9月至2022年6月进行。数据于2025年3月至4月进行分析。
照顾者报告的儿童税收抵免接收情况。
照顾者报告他们是否有银行账户（即是否开户）、报税情况以及人口统计学特征。照顾者还报告了儿童身体健康、照顾者身心健康、家庭粮食不安全状况以及住房稳定性，包括租金支付状态（当前是否拖欠）。通过广义估计方程进行调整的多变量逻辑回归以考虑重复测量，用于评估随着时间推移儿童税收抵免接收情况与健康结局和困难之间的关联。
在这个由5813名照顾者组成的队列中（平均[标准差]年龄为29[6]岁；1934名非拉丁裔黑人[34.7%]；2127名拉丁裔[38.3%]；1275名非拉丁裔白人[22.8%]），2519名（44.2%）接受过高中以上教育，4177名（73.4%）出生在美国。在儿童税收抵免实施后接受调查的879人中，大多数（663人[75.0%]）报告收到了该抵免。与未收到抵免的家庭相比，更多收到儿童税收抵免的家庭是已婚或有伴侣关系（663名接收者中的308名[47.5%]；5150名未接收者中的1845名[36.6%]）、报过税（662名接收者中的631名[95.3%]对194名未接收者中的84名[43.3%]）、开过户（661名接收者中的581名[87.9%]对194名未接收者中的103名[53.1%]），或者是非拉丁裔白人（663名接收者中的183名[28.5%]对5150名未接收者中的1092名[22.1%]）。收到儿童税收抵免的家庭面临困难的调整后几率显著较低，包括粮食不安全（调整后优势比[aOR]，0.61；95%置信区间，0.47 - 0.78）、住房不稳定（aOR，0.64；95%置信区间，0.49 - 0.83）以及租金拖欠（aOR，0.62；95%置信区间0.48 - 0.80）。照顾者焦虑的调整后几率较低（aOR，0.67；95%置信区间，0.51 - 0.89）。
在这项队列研究中，收到儿童税收抵免的家庭比未收到抵免的家庭更有可能粮食安全、住房稳定、按时缴纳租金，并且照顾者心理健康状况良好，这强化了财政资源增加与家庭健康和基本需求之间的关联。
