title: Welfare reform and the health of young children: a sentinel survey in 6 US cities.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Boston Medical Center, Department of Pediatrics, 91 E Concord St, Fourth floor, Boston, MA 02118, USA. john.cook@bmc.org
authors.forename: John T
authors.initials: JT
authors.lastname: Cook
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Frank
authors.forename: Carol
authors.initials: C
authors.lastname: Berkowitz
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Casey
authors.forename: Diana B
authors.initials: DB
authors.lastname: Cutts
authors.forename: Alan F
authors.initials: AF
authors.lastname: Meyers
authors.forename: Nieves
authors.initials: N
authors.lastname: Zaldivar
authors.forename: Anne
authors.initials: A
authors.lastname: Skalicky
authors.forename: Suzette
authors.initials: S
authors.lastname: Levenson
authors.forename: Tim
authors.initials: T
authors.lastname: Heeren
mesh_terms: D000328:Adult; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002669:Child Welfare; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020380:Needs Assessment; D011203:Poverty; D011632:Public Assistance / Q000706:statistics & numerical data*; D012107:Research Design; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data