A Selection of 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.

Impacts of Pandemic-Era WIC Policy Changes on Participation Rates: A Quasi-Experimental Study

with Matthew M. Lee, Margaret McConnell, and Rita Hamad

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important US safety net program for low-income households that provides food assistance and nutrition education for pregnant and postpartum women and children under 5. WIC improves maternal and child health but only reaches about half of eligible individuals. State policy changes implemented during the COVID-19 pandemic aimed to increase WIC access, but few studies have examined the associations between these policies and WIC participation rates (total, women, children, infants). In this study, we used monthly serial cross-sectional national administrative data on WIC participation rates aggregated by state and a quasi-experimental difference-in-differences approach to assess the associations between state-level policy changes and WIC participation rates January 2017-March 2021 (N=2,550 state-months). We found that remote WIC benefit issuance increased participation rates for all groups (e.g., increases in total participation rates in states that allowed remote benefit issuance were 1.10 times higher [95%CI 1.05, 1.14] than in states that did not). No other individual policy changes were independently associated with participation rates. When examining a composite index that included all WIC policy changes, the increase in women’s participation rate was 1.02 times higher (95%CI 1.01, 1.03) for every additional policy change. Policymakers should consider removing barriers to safety net program participation.

Effect of Title IX on Bone Health

with Patricia Homan, Katherine Lee, 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.

Structural Classism and Health in the United States

with Patricia Homan and Megan M. Reynolds

Structural approaches to understanding health have shown the importance of capturing societal forces that shape health disparities along different social axes. Social class is one axis that has not yet been measured this way, despite its strong relationship to health. In this paper, we develop the concept of structural classism and construct a quantitative index that captures the domains of policies, labor force, economic inequality, and politics. We then link this index to individual self-rated health to understand how state-level structural classism shapes population health. In multilevel logistic regression models with data from the Behavioral Risk Factor Surveillance System in 2023 (N=392,581), we find that structural classism was associated with poor health for individuals with less than a college education (OR=0.97, 95%CI 0.94, 0.99) as well as individuals who graduated college (OR=0.94, 95%CI 0.90, 0.98). These results support the universal harm hypothesis, suggesting that structural classism harms overall population health.