The Effect of a Poverty Reduction Intervention on Early Health and Sleep Among Young Children in the United States

• In Event: Baby’s First Years: Early Findings from a Poverty Reduction Intervention in Early Childhood

Abstract

Children experiencing poverty are more likely to experience worse health outcomes, including injury, chronic illness, and poor sleep (Council on Community Pediatrics et al., 2016; Duh-Leong et al., 2020; Pomerantz et al., 2001), and are more likely to use emergency health services (Gindi & Jones, 2014). Numerous factors likely contribute to the associations between poverty and children’s poor health, including access to medical care, safe childcare, and the quality of housing and neighborhoods. One possible mechanism by which poverty impacts child sleep is via the sleep environment and routines (Hoyniak et al., 2020). Higher income may provide parents with greater opportunities to provide their children with safe housing, establish primary care, and implement predictable bedtime routines. We hypothesized that a monthly, unconditional cash transfer would improve maternal report of children’s health, healthcare utilization, and sleep for young children experiencing poverty.

Baby’s First Years (BFY) is a randomized controlled trial of poverty reduction conducted in four metropolitan areas across the United States. One thousand mothers living with low income were recruited after giving birth, and were then randomly assigned to receive a monthly, unconditional cash gift of either $333/month (n=400) or $20/month (n=600) for the first several years of their child’s life. Mothers completed questionnaires on their child’s health, healthcare utilization, and sleep at ages 1, 2, and 3. All outcomes and analyses were preregistered.

To measure health outcomes at ages 1, 2, and 3, mothers reported their child’s (1) overall health, and (2) if they had received any health condition or disability diagnosis since birth. Urgent/emergent medical care usage was measured via the following: (1) doctor visits due to illness; (2) doctor visits due to injury; (3) ER visits due to illness or injury; and (4) number of times visiting the ER in the past year. Preventative health care was indexed by being up-to-date on routine childhood vaccinations.
To measure children’s sleep quality, mothers completed the PROMIS Sleep Disturbance-Short Form at ages 1, 2, and 3 (Yu et al., 2012). The questionnaire consists of 4 items assessing the frequency of sleep-related difficulties over the last 7 days. Sleep environment was measured at ages 1 and 2 via two items from the CHAOS scale regarding bedtime routines and consistent bedtimes (Matheny et al., 1995).

Preliminary findings showed no statistically detectable differences between the low-cash and high-cash gift group across these child health or sleep outcome at ages 1, 2, or 3. Limitations of the present study include reliance on maternal report rather than the use of objective techniques such as actigraphy and medical records. Findings will be discussed in light of the fact that young children born in the well-baby nursery are generally healthy in early childhood, and that income-related health impacts may not emerge until later in children’s development.

Authors

• Jessica Sperber, Columbia University
  Presenting Author

• Lisa Gennetian, Duke University

• Emma Rose Hart, Teachers College, Columbia University

• Katherine Magnuson, University of Wisconsin - Madison

• Greg J Duncan, University of California, Irvine

• Sarah Halpern-Meekin, University of Wisconsin-Madison

• Hirokazu Yoshikawa, New York University

• Nathan A Fox, University of Maryland - College Park

• Kimberly G Noble, Teachers College, Columbia University