The Impact of a Poverty Reduction Intervention on Infant Brain Activity

Early childhood poverty is a risk factor for lower school achievement, reduced earnings, and poorer health, and has been associated with differences in brain structure and function. Whether poverty causes differences in neurodevelopment, or is merely associated with factors that cause such differences, remains unclear. Here, we report estimates of the causal impact of a poverty reduction intervention on brain activity in the first year of life. We draw data from a subsample of the Baby's First Years study, which recruited 1,000 diverse low-income mother–infant dyads. Shortly after giving birth, mothers were randomized to receive either a large or nominal monthly unconditional cash gift. Infant brain activity was assessed at approximately 1 y of age in the child's home, using resting electroencephalography (EEG; n = 435). We hypothesized that infants in the high-cash gift group would have greater EEG power in the mid- to high-frequency bands and reduced power in a low-frequency band compared with infants in the low-cash gift group. Indeed, infants in the high-cash gift group showed more power in high-frequency bands. Effect sizes were similar in magnitude to many scalable education interventions, although the significance of estimates varied with the analytic specification. In sum, using a rigorous randomized design, we provide evidence that giving monthly unconditional cash transfers to mothers experiencing poverty in the first year of their children's lives may change infant brain activity. Such changes reflect neuroplasticity and environmental adaptation and display a pattern that has been associated with the development of subsequent cognitive skills

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Child Care for Families Raising Children with Disabilities: The Role of Federal Policy in Equitable Access

Despite consistent evidence that families with children with disabilities face great difficulty in balancing employment and caregiving, little is known about the role federal policies play in supporting employment of parents of children with disabilities. This study examines whether child care arrangements differ by disability status.Despite consistent evidence that families with children with disabilities face great difficulty in balancing employment and caregiving, little is known about the role federal policies play in supporting employment of parents of children with disabilities. For a variety of reasons, finding appropriate child care for children with disabilities may be more challenging and may cost more than for other families. Yet, access to affordable child care is crucial for parents to work outside of the home. Several federal policies are intended to increase access to child care for these families. Yet, whether they are effective in doing so remains unclear. If families’ need for child care is not met by existing policies and programs, then this may dampen their economic wellbeing. If it is sufficient, then such policies may reduce families’ use of other public benefits, including decreased reliance on childhood Supplemental Security Income (SSI) benefits. This project asks: (1) how and whether parents of young children with disabilities are accessing child care; and (2) to what extent current child care policies for young children with disabilities —and, thus, access to appropriate, affordable child care—are supporting parental employment. Findings can provide information to SSA, other federal agencies, and additional stakeholders about the extent to which current federal child care supports are effectively supporting parental employment for parents of children with disabilitiesCenter for Financial Security, Retirement and Disability Consortium, U.S. Social Security Administration

WI22-04: All in the Family: Parents of Children with Disabilities and Retirement

Parents of children with disabilities face a unique set of tradeoffs in retirement decisions. They may be more constrained in their ability to save for retirement in their prime labor-market years, and, once they reach retirement, may require greater economic resources to support their families while balancing caregiving responsibilities. A variety of benefits from the Social Security Administration (SSA) have the potential to provide economic stability for these families, including parental retirement benefits and childhood disability benefits. Income from SSA benefits may be particularly salient for this group, given the constraints faced by parents of children with disabilities as they save for retirement. However, despite the importance of this issue for many U.S. families, little is known about how parents raising children with disabilities think about their financial options when planning for retirement, their retirement behavior, and the adequacy of current policy in supporting families’ well-being. This mixed-methods study uses both nationally representative data from the National Longitudinal Survey of Youth 1979 (NLSY) and semi-structured interviews with parents to address this gap. It will inform policymakers about (1) the economic security of families who may rely on SSA retirement and disability benefits, and (2) how and whether SSA benefit structure and other current policy may influence retirement decisions for parents of children with disabilities

WI23-04: Parents of Children with Disabilities in Retirement: Economic Well-Being and Benefit Adequacy

Income from the Social Security Administration (SSA) has the potential to provide substantial economic support for the increasing number of families with retirement-age adults who have caregiving responsibilities for their children with disabilities. Despite the potentially crucial role of SSA benefits, the economic well-being experiences of retired parents of children with disabilities and their experiences related to economic well-being have largely been excluded from the research literature.Income from the Social Security Administration (SSA)—through retirement, disability, and family benefits from the Old Age, Survivors, and Disability Insurance (OASDI) program and payments from the Supplemental Security Income (SSI) program—have the potential to provide substantial economic support for families with a retired householder caring for a child with a disability. Using a mixed-methods approach, this study aims to understand how households with retired adults and children with disabilities are faring economically, and how families perceive the adequacy of SSA benefits and supports for meeting family needs. We find that families with retired adults caring for children with disabilities are disproportionately likely to experience economic hardships, such as food insecurity, and that their overall economic well-being is often precarious. We further find that income from SSA is “vital” for many of these families, particularly for single-parent families; yet, for some families, SSA income does not fully alleviate hardship. Further, children's future financial and caregiving needs are a substantial concern for parents across an array of financial circumstances. We discuss policy mechanisms that could potentially support the economic wellbeing of these families and address structural disadvantages in the labor market that may lead to inequities in retirement savings. These include the following: accounting for a child’s disability in eligibility and benefit calculations for parents, for SSA benefits and other public programs; reconsidering asset limits for SSA recipients; and examining opportunities to reduce benefits cliffs. Findings also indicate potential opportunities to support family access to economic supports through enhanced information-sharing and case management as well as through connecting families to community supports.U.S. Social Security Administration - Retirement and Disability Consortiu

Intimate Partner Violence Screening in the Prenatal Period: Variation by State, Insurance, and Patient Characteristics

Objective To measure the proportion of women screened for IPV during prenatal care; to assess the predictors of prenatal IPV screening. Methods We use the CDC’s 2012 Pregnancy Risk Assessment Monitoring System, representative of births in 24 states and New York City (N = 28,581). We calculated descriptive and logistic regressions, weighted to deal with state-clustered observations. Results 49.2% of women in our sample reported being screened for IPV while pregnant. There were higher screening rates among women of color, and those who had not completed high school, never been married, received WIC benefits, initiated prenatal care in the first trimester, and were publicly insured. State screening rates varied (29.9–62.9%). Among states, mandated perinatal depression screening or training was positively associated with IPV screening. 3.6% of women in our sample reported prenatal IPV but were not screened during pregnancy. Conclusions for Practice Current efforts have not led to universal screening. We need to better understand when and why providers do not screen pregnant patients for IPV

WI22-06: Understanding Racial and Ethnic Differences in SSA and Means-Tested Benefit Receipt and Their Anti-Poverty Effects for Children in Multigenerational Families

A growing share of children reside in households with caregivers, often their grandparents, who are not their biological parents or in three-generation households that include one or both of their parents as well as one or more grandparents. Such arrangements are especially common among Black and Latinx households and among low-income households in which one or more members receives Old Age, Survivors, Disability Insurance, or Supplemental Security Income (SSI). Access to such benefits may have important implications for the well-being of children in these households, but little is known about the mix of benefits such families utilize or the ways in which Social Security Administration program use varies by race/ethnicity. Using administrative data from the state of Wisconsin from 2010-2019, this study describes the reported income sources among low-income households with children who have been involved in safety net programs. About two-thirds of grandparent households in these data receive some income from Social Security, as well as nearly half of three-generation households, twice the rate of the sample overall. Social Security programs reduce the poverty rate for grandparent households by nearly 18 points and 8 points for three-generation households. In these data, Black families with children are especially supported by Social Security programs, reducing the poverty rate for these households by over 7 points, nearly twice the reduction among similar white families with children. SSI is especially important in reducing poverty for children in these Black households. Low-income households with children rely on a range of support programs beyond wages, but Social Security programs are a critical source of income for many

The impact of a poverty reduction intervention on infant brain activity.

Early childhood poverty is a risk factor for lower school achievement, reduced earnings, and poorer health, and has been associated with differences in brain structure and function. Whether poverty causes differences in neurodevelopment, or is merely associated with factors that cause such differences, remains unclear. Here, we report estimates of the causal impact of a poverty reduction intervention on brain activity in the first year of life. We draw data from a subsample of the Baby's First Years study, which recruited 1,000 diverse low-income mother-infant dyads. Shortly after giving birth, mothers were randomized to receive either a large or nominal monthly unconditional cash gift. Infant brain activity was assessed at approximately 1 y of age in the child's home, using resting electroencephalography (EEG; n = 435). We hypothesized that infants in the high-cash gift group would have greater EEG power in the mid- to high-frequency bands and reduced power in a low-frequency band compared with infants in the low-cash gift group. Indeed, infants in the high-cash gift group showed more power in high-frequency bands. Effect sizes were similar in magnitude to many scalable education interventions, although the significance of estimates varied with the analytic specification. In sum, using a rigorous randomized design, we provide evidence that giving monthly unconditional cash transfers to mothers experiencing poverty in the first year of their children's lives may change infant brain activity. Such changes reflect neuroplasticity and environmental adaptation and display a pattern that has been associated with the development of subsequent cognitive skills