Works in Progress

TANF Pregnancy Rules and Perinatal Health

with Rita Hamad, Susan Mumford, Kellie A. Komro, and Melvin D. Livingston, III

The U.S. has worse infant and maternal health outcomes compared to peer countries. Given the link between poverty and health, providing cash assistance during pregnancy may decrease risk of adverse health outcomes. The Temporary Assistance for Needy Families (TANF) program is an important part of the US social safety net, providing cash and resources for low-income families. However, states vary in whether they allow pregnant people to receive TANF benefits. Using data from the Pregnancy Risk Assessment Monitoring System, this study examines the association between state TANF program’s pregnancy-eligibility criteria and perinatal health. Using a difference-in-differences design, we compare differences in infant health (preterm birth, low birthweight) and maternal health (hypertensive disorders of pregnancy, gestational diabetes, health care use) between states that allowed pregnant people to participate in TANF to states that did not. Results forthcoming.

Effect of Title IX on Bone Health

with Patricia Homan, Annika Gompers, Ann Caroline Danielsen, Madeleine Pape, and Sarah Richardson

Title IX was a landmark national US policy implemented in 1972 that dramatically increased sports participation rates for adolescent girls. While research has shown beneficial long-term effects on physical activity rates, body mass index, and labor market outcomes, research on the effects on bone health is scarce. This is an important gap given women’s higher incidence of bone diseases and broken bones compared to men, and the known benefits of physical activity on bone health. This study uses data from the Midlife in the United States study and a difference-in-differences study design to assess the impact of Title IX on bone health in later life. Preliminary results show that when comparing women to men, before and after the passage of Title IX, exposure to Title IX in highschool significantly decreased the risk of broken bones and bone disease.

County-level COVID-19 Policies on Adult Health and Health Behaviors in the United States

with Emily Wright, Kaitlyn E. Jackson, Guangyi Wang, Mark J. Pletcher, Thomas W. Carton, and Rita Hamad

This study examined the association between US county COVID-19 policies and health and health behaviors. Counties enacted several policies during the COVID-19 pandemic to address the public health and economic crises, but little is known of these policies effects on health outcomes beyond COVID-19. To understand any unintended health effects of these policies, we linked the US COVID-19 County Policy Database with county-level individual health information from the Behavioral Risk Factor Surveillance System, 2020-2021. We constructed policy comprehensiveness scores based on county-level policies in the domains of containment/closure, economic response, and public health, as well as a total policy score that included all policies. We estimated associations between these policy comprehensiveness scores and health outcomes including number of poor physical and mental health days, alcohol use, cigarette smoking, and exercise. The analytic sample included 271,360 individuals who resided in UCCP counties during the study period. We found that more comprehensive containment/closure policy scores (i.e. closures of schools, restaurants, and other public spaces) and total policy scores were associated with lower likelihood of consuming alcohol and with fewer poor physical health days for the overall sample. In models stratified by sociodemographic and county contextual variables, we found that these associations varied across groups. For example, greater total policy comprehensiveness was associated with increased heavy alcohol use for male participants, but decreased heavy alcohol use for female participants. Our study suggests that policies intending to slow the spread of COVID-19 had beneficial impacts on other important health outcomes.

State-Level Structural Sexism and Cardiovascular Health in the United States

with Patricia Homan, Debora Kamin Mukaz, Kiarri N. Kershaw, and Nicole D. Fields

Research links structural sexism to health in the US, but its impacts on cardiovascular disease remain unknown. Using an index of state-level sexism linked to the 2020 Behavioral Risk Factor Surveillance System (n=358,470), we estimated gender-stratified, multilevel models to examine: 1) the associations between sexism and self-reported diabetes, heart attack, stroke, and overweight/obesity, 2) whether these associations are stronger or weaker with an exposure-outcome lag, and 3) if these associations differ by racialized identity. In concurrent analyses, men and women living in states with higher levels of structural sexism had worse health. For example, women living in states with the most structural sexism (Quartile 4) had higher odds of diabetes (OR=1.17; 95%CI: 1.07, 1.29; Ptrend <0.001), overweight/obesity (OR=1.15; 95%CI: 1.03, 1.28; Ptrend <0.001), and stroke (OR=1.18; 95%CI: 1.03, 1.34; Ptrend <0.001). Lagged models show similar patterns. Results from models stratified by racialized identity, show that higher levels of structural sexism were associated with worse cardiovascular outcomes only among White and Black women and men. Findings highlight the need to address structural sexism to improve cardiovascular health.