WIC Participation and Relative Quality of Household Food Purchases: Evidence from FoodAPS

We examine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the quality of household food purchases using the National Household Food Acquisition and Purchase Survey (FoodAPS) and propensity score matching. A healthy purchasing index (HPI) is used to measure nutritional quality of household food purchases. WIC foods explain the improvement in quality of food purchases, not self‐selection of more nutrition‐conscious households into the program. The improvement in purchase quality was driven entirely by WIC participating households who redeemed WIC foods during the interview week. There was no significant difference between WIC participants who did not redeem WIC foods and eligible nonparticipants. In this sample, there is no evidence that lack of access to clinics has adverse effects on participation nor is there evidence that HPI depends on supermarket access. A supervised machine learning process supports our main conclusion on the importance of WIC foods.     

Effects of Federal Nutrition Program on Birth Outcomes

Using a nationally representative sample of the birth cohort of the Early Childhood Longitudinal Study, we examine the impact on birth outcomes of the largest federal nutrition program in the United States: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). By identifying a set of strong and valid instrumental variables for WIC participation, we are able to address the fundamental problem in the literature—selection bias. Similar to recent studies, we find that WIC does not affect average birth weight and average gestational week after correcting for selection bias using the instrumental variable method. However, WIC participation has significantly reduced the probability of very premature birth and (very) low birth weight after controlling selection bias by bivariate probit models. Our results indicate that rather than affecting the average outcomes, WIC is more effective for births that are at high risk. The potential benefits of WIC program can be realized by increasing its focus on more disadvantaged mothers.     

Food Stamp Program Participation of Refugees and Immigrants

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) dramatically changed the availability of food stamps to immigrants, but not to refugees. However, refugee usage of food stamps in the post-reform era has declined more than usage of either other immigrants or native citizens. We investigate food stamp program participation of immigrants and refugees to ascertain if the resulting decline was an unintended effect of the reform or is due to some other phenomena. We use data from the Immigration and Naturalization Service to construct an instrument for refugees. We find that refugees are more likely than other immigrants to use food stamps. While PRWORA clearly reduced non-refugee immigrant food stamp participation, the post-reform era decline in refugee usage is fully attributable to a strong refugee response to changing labor market conditions. We also find that refugees' use of food stamps declines rapidly with time in the United States, unlike that of other immigrants.     

Does children’s marriage matter for parents' mental health？Evidence from China

How to effectively alleviate mental disorders among elderly individuals is an important issue. Children are important financial and spiritual supporters of parents. However, whether there are upward spillovers from children to parents remains understudied. Using the instrumental variable (IV) method and data from the China Health and Retirement Longitudinal Study, this paper estimates the causal effect of children's marriage on the mental health of older parents. The IV estimation results demonstrate that having unmarried children is associated with a significant deterioration in parental mental health, especially in older, less educated, poor and male groups. Further evidence suggests that having unmarried children leads to significant changes in parents' economic behaviors, including labor supply, consumption, and savings; this indicates that parents are more likely to actively respond to their children’s unmarried status by increasing labor supply, reducing consumption and increasing savings rather than by engaging in negative behaviors.     

Development for children's environmental health in South Africa: Past gains and future opportunities

In poorly resourced countries children may face multiple health risks associated with environmental hazards and under-development. It is estimated that exposure to harmful environmental factors (e.g. air pollution, poor water quality and harmful chemicals) accounts for 33% of the global burden of disease, with the highest burden being borne by children. While accelerated housing and settlement development over the past two decades has benefitted hundreds of thousands of young children in South Africa, large numbers continue to face major environmental threats to their health, some of which have hitherto been neglected. Such children are likely to be particularly vulnerable to the unfolding ramifications of climate change. In this light greater urgency and momentum is needed to improve living conditions and other socio-environmental determinants of children's health in South Africa and other under-resourced countries. Children should be a central focus for policy and development as our global society strives to meet the Sustainable Development Goals.     

Identifying the Effects of WIC on Food Insecurity Among Infants and Children

The Women, Infants, and Children (WIC) Program is considered a crucial component of the social safety net in the United States, yet there is limited supporting evidence on the effects of WIC on the nutritional well‐being and food security of infants and young children. Using data from the National Health and Nutrition Examination Survey, we apply recently developed partial identification methods to jointly account for unobserved counterfactual outcomes and systematic underreporting of WIC participation. Under nonparametric assumptions, we find that WIC reduces the prevalence of child food insecurity by at least 3.6 percentage points (20%).     

THE IMPACT OF HEALTH ON POVERTY: EVIDENCE FROM THE SOUTH AFRICAN INTEGRATED FAMILY SURVEY

This paper examines the impact of health status on poverty status, accounting for the endogeneity of health status. Using exogenous measures of health status from the South African Integrated Health Survey, we instrument for health status while allowing for covariation among the unobservables influencing both health and household poverty status. Health status, as captured by the body mass index, is shown to strongly influence poverty status. Households that contain more unhealthy individuals are 60 per cent more likely to be income poor than households that contain fewer unhealthy individuals, and this finding appears invariant to the choice of poverty line.     

Pregnancy outcomes for medicaid patients in mandatory managed care: The Pennsylvania HealthChoices program

A number of states have adopted mandatory managed care to provide health services to Medicaid patients, raising concerns that the care provided may be of lower quality than care provided under traditional fee‐for‐service arrangements. In this article, we study the effect of Pennsylvania's mandatory managed care program, HealthChoices, on health outcomes and the cost of care for pregnant Medicaid patients. Using difference‐in‐differences, we find evidence that the adoption of managed care resulted in fewer preventable complications, particularly for more severely ill mothers, but no general reduction in costs except in the highest decile of the cost distribution.     

Working Women in an Urban Setting: Traders,Vendors and Food Security in Accra

Data collected from a 1997 household survey carried out in Accra, Ghana are used to look at the crucial role that women play as income earners and securing access to food in urban areas. One-third of the households surveyed are headed by women. For all households, women's labor force participation is high with 75% of all households having at least one working woman. The high number of female-headed households and the large percentage of working women in the sample provide a good backdrop for looking at how women earn and spend income differently than men in an urban area. Livelihood strategies for both men and women are predominantly labor based and dependent on social networks. For all households in the sample, food is still the single most important item in the total budget. Yet, important and striking differences between men's and women's livelihoods and expenditure patterns exist. Compared to men, women are less likely to be employed as wage earners, and more likely to work as street food vendors or petty traders. Women earn lower incomes, but tend to allocate more of their budget to basic goods for themselves and their children, while men spend more on entertainment for themselves only. Despite lower incomes and additional demands on their time as housewives and mothers, female-headed households, petty traders and street food vendors have the largest percentage of food-secure households. Women may be achieving household food security, but at what cost? This paper explores differences in income, expenditure and consumption patterns in an effort to answer this question, and suggests ways that urban planners and policy makers can address special concerns to working women in urban areas.     

Modelling the influence of caring for the elderly on migration: estimates and evidence from Indonesia

In a society where children are expected to support the elderly, the ill health of an elderly parent is likely to influence an individual's propensity to migrate. Using data from the Indonesian Family Life Survey, we examine the manner in which the responsibility to care for an elderly parent who is in poor health affects the migration decisions of working-age adults. Our analysis suggests that individuals will be less likely to migrate if they have elderly parents who are in poor health. These findings are robust to specifications using alternative measures of poor health.     

Rasch Analyses of Very Low Food Security among Households and Children in the Three City Study

The longitudinal Three City Study (TCS) of low‐income families with children measures food hardships using fewer and some different questions from the standard U.S. instrument, the Household Food Security Survey Module (HFSSM) in the Current Population Survey (CPS). We use a Rasch measurement model to identify thresholds of very low food security among households and among children in the TCS that are comparable to thresholds from the HFSSM. We also use the TCS to empirically investigate the determinants of food insecurity and of these specific food insecurity outcomes, estimating a multivariate behavioral Rasch model that is adapted to address longitudinal data. The estimation results indicate that participation in the Supplemental Nutrition Assistance Program and the Temporary Assistance for Needy Families program reduce food insecurity, while poverty and disability among caregivers increase it. Besides its longitudinal structure, the TCS measures many more characteristics about households than the CPS. Our estimates reveal that financial assistance through social networks and a household's own financial assets reduce food insecurity, while its outstanding loans increase insecurity.     

The Effects of Food Stamps on Obesity

Poverty has historically been associated with a decrease in food consumption. This at least partially changed in 1964 when the Food Stamp Act began guaranteeing food for those in poverty. Since the act's passage, the prevalence of obesity has increased dramatically, particularly among those with low incomes. This article examines the effects of the Food Stamp Program on the prevalence of obesity using 1979 National Longitudinal Survey of Youth data. Results indicate that food stamps have significant positive effects on obesity and the obesity gap for females, but these effects are relatively small, and consequently, such benefits are approximated to have played a minor role in increasing obesity at the aggregate level.     

Impacts of publicly funded health insurance for adults on children's academic achievement

Publicly funded adult health insurance through the Affordable Care Act (ACA) has had positive effects on low-income adults. We examine whether the ACA's Medicaid expansions influenced child development and family functioning in low-income households. We use a difference-in-differences framework that exploits cross-state policy variation and focus on children in low-income families from a nationally representative, longitudinal sample followed from kindergarten to fifth grade. The ACA Medicaid expansions improved children's reading test scores by ~2% (0.04 SD). Potential mechanisms for these effects within families are more time spent reading at home, less parental help with homework, and eating dinner together. We find no effects for children's math test scores or socioemotional skill development.     

Beyond Income: What Else Predicts Very Low Food Security Among Children?

We examine characteristics and correlates of households in the United States that are most likely to have children at risk of inadequate nutrition—those that report very low food security (VLFS) among their children. Using 11 years of the Current Population Survey, plus data from the National Health and Nutrition Examination Survey (NHANES), we describe these households in great detail with the goal of trying to understand how these households differ from households without such severe food insecurity. While household income certainly plays an important role in determining VLFS among children, we find that even after flexibly controlling for income‐to‐poverty rates some household characteristics and patterns of program participation have important additional explanatory power. Finally, our examination of the NHANES data suggests an important role for both mental and physical health of adults in the household in determining the food security status of children.     

Health insurance generosity and conditional coverage: Evidence from medicaid managed care in Kentucky

This article estimates the impact of the introduction of Medicaid managed care (MMC) on the formal Medicaid participation of children. We employ a quasi‐experimental approach exploiting the location‐specific timing of MMC implementation in Kentucky. Using data from the March Current Population Survey from 1995 to 2003, our findings suggest that the introduction of MMC increases the likelihood of being uninsured and decreases formal Medicaid participation. This finding is consistent with an increase in “conditional coverage,” waiting until medical care is needed to sign up or re‐enroll in Medicaid. These effects are concentrated among low‐income children and absent for high‐income children. We find no evidence of “crowd‐in,” substituting private coverage for Medicaid. These results are robust to multiple placebo tests and imply the potential for less formal participation (i.e., more conditional coverage) among the Affordable Care Act‐Medicaid expansion population (which is likely to be primarily covered under MMC) than is typically predicted.     

Variations in housing satisfaction and health status in four lower socio-economic housing typologies in the eThekwini Municipality in KwaZulu-Natal

A study was done in the Durban Area, South Africa amongst residents (n?=?300) of four lower socio-economic housing typologies: Reconstruction and Development Programme (RDP) houses, informal settlements (IS), traditional rural houses (TR) and inner-city apartments (IC). Respondents living in IC were most satisfied with their dwellings, those living in RDP houses and in IS were the least satisfied. People living in the IC perceived their health best, while those living in IS perceived it as worst. Major reasons for dissatisfaction with housing were pest infestation in their dwelling in the past 12 months, inadequate toilet facilities, high temperature, unclean neighbourhood, poor ventilation and dust. Pest infestation and poor ventilation were mentioned most frequently by flat dwellers whilst RDP, IS and TR households complained about inadequate toilet facilities. For many people living in low socio-economic housing, both housing and service provision remain inadequate.     

Nutrition education tools for primary school children in the Vaal region

South Africa's high prevalence of malnutrition severely affects children's well-being and ability to learn. According to the World Bank, malnutrition is found in households from all spheres of life, since caregivers are not well informed about healthy food choices and feeding practices. A long-term solution to the problem is to encourage people to grow food and improve their incomes, but a quicker solution is to provide health and nutrition education and services to encourage healthy food choices. This paper describes the development of nutrition education tools (NETs) as part of a nutrition education programme for primary school children (Grades 1 to 3) from low-income households in South Africa. The study used the Food and Agriculture Organization's framework for nutrition education to develop simple, cost-effective, appropriate and applicable NETs.     

Does government health insurance reduce job lock and job push?

I study job lock and job push, twin phenomena believed to be partially due to employment-contingent health insurance (ECHI). Using variation in Medicaid eligibility among household members of male workers to identify changes in those workers' reliance on ECHI, I estimate notable job lock and job push effects. For married male workers, a 15 percentage point increase in the likelihood a household member is eligible for Medicaid increases the rate of voluntary job exits over a four-month period by 14%. For job push, the same increase in a household member's likelihood of Medicaid eligibility reduces the transition rate into jobs with ECHI among all male workers by 8%.     

AIDS Home- and Community-Based Waivers: Effects on Use of Services,Expenditures, and Survival

State Medicaid home- and community-based waiver programs for persons with AIDS (PWAs) were implemented with the expectation that PWAs would use these services in lieu of more expensive hospital-based care. If so, Medicaid spending per PWA should decline, and program costs fall. We analyze Florida Medicaid claims data for PWAs from December 1995 through December 1997 to determine how participation in the waiver program affects the use of inpatient services, the receipt of antiretroviral combination therapies (available to Medicaid recipients throughout the study period), monthly expenditures, and survival of PWAs. We find that waiver participants are more likely to receive combination therapies but less likely to use hospital-based care than nonparticipants; white men and sicker patients are more likely to join the waiver program than other eligible PWAs; monthly expenditures for waiver participants are 52% lower than for nonparticipants; and waiver participation does not affect survival.     

The health of left-behind children in rural China

Child health is not only a key indicator of overall quality of public health, but also vital for the future economic development of a country. In recent years, with unprecedented urbanization of China, many children in rural areas have been left behind while their parents migrate to urban areas to seek employment opportunities. Thus, it is considerably important for us to understand the effects of lack of parental care on the health status of left-behind children. Using data from China Health and Nutrition Survey (CHNS), we find that the left-behind children in rural areas are significantly 20.0% more likely to get sick or develop chronic conditions than those living with their parents. We also find that girls are more vulnerable than boys and younger children are more vulnerable than older children to lack of parental care.