The Effect of a U.S. Poverty Reduction Intervention on Maternal Assessments of Young Children’s Health, Nutrition, and Sleep: A Randomized Control Trial

Abstract

AbstractImportanceChildren experiencing poverty are more likely to experience worse health outcomes during the first few years of life, including injury, chronic illness, worse nutrition, and poorer sleep. The extent to which a poverty reduction intervention improves children’s health, nutrition, sleep, and healthcare utilization is unknown.ObjectiveTo determine the effect of a 3-year, monthly unconditional cash transfer on health, nutrition, sleep, and healthcare utilization of children experiencing poverty who are healthy at birth.DesignLongitudinal randomized control trialSettingMother-infant dyads were recruited from postpartum wards in 12 hospitals in four cities across the U.S.Participants1,000 mothers were enrolled in the study. Eligibility criteria included: an annual income below the federal poverty line, being of legal age for consent, speaking English or Spanish, residing in the state of recruitment, and having an infant admitted to the well-baby nursery with plans to be discharged to the custody of the mother.InterventionMothers were randomly assigned to receive either a high-cash gift ($333 per month, or $3,996 per year;n=400) or a low-cash gift ($20 per month, or $240 per year;n=600) for the first several years of their child’s life.Main Outcomes and MeasuresPre-registered maternal assessments of the focal child’s health, nutrition, sleep, and healthcare utilization were collected at children’s ages 1, 2, and 3.ResultsEnrolled participants were majority Black (42%) and Hispanic (41%). 857 mothers participated in all three waves of data collection. We found no statistically detectable differences between the high-cash and low-cash gift groups in maternal assessments of children’s overall health, sleep, or healthcare utilization. However, mothers in the high-cash gift group reported higher child consumption of fresh produce compared with mothers in the low-cash gift group at age 2, the only time point it was measured (β=0.17, SE=0.07,p=0.03).Conclusions and RelevanceIn this RCT, unconditional cash transfers to mothers experiencing poverty did not improve their reports of their child’s health, sleep, or healthcare utilization. However, stable income support of this magnitude improved toddler’s consumption of fresh produce. Healthy newborns tend to grow into healthy toddlers, and the impacts of poverty reduction on children’s health and sleep may not be fully borne out until later in life.Trial RegistrationBaby’s First Years (BFY; IDNCT03593356)https://clinicaltrials.gov/ct2/show/NCT03593356?term=NCT03593356&draw=2&rank=1Key pointsQuestionDoes poverty reduction improve health, nutrition, and sleep in young children?FindingsIn this RCT of 1,000 mother-child dyads experiencing poverty, a monthly unconditional cash transfer did not improve children’s health or sleep in the first three years of life. However, the cash transfers led to increased consumption of fresh produce.MeaningAmong children experiencing poverty, a monthly cash gift affected healthy food intake, but not health or sleep. Most children had few health problems, though emergent medical care use was high.