Download This Paper
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Twenty Year Outcomes of an Unconditional Cash Transfer
26 Pages Posted: 16 Mar 2022
More...Abstract
Importance: During an ongoing longitudinal cohort study, a casino opening created a natural cash transfer experiment: Some participating families received income supplements, and others did not. The children in this study are now adults.
Objective: To assess the long-term impact of family income supplements in childhood on adult mental health, substance use, and functional outcomes.Design: 20+ year longitudinal observational study conducted from 1993 to 2016, with an embedded natural experiment.Setting: Southeastern United States, mixed urban-rural population-based sample.
Participants: 1420 participants (49% female) ages 9, 11, or 13 at intake in 1992. Participants were assessed up to 11 times per person to age 30 (11,230 person-observations). Twenty-five percent (N=349) are American Indians.Exposures: In 1996, a Southeastern US tribe implemented a cash transfer program of ~$5,000 annually per person, distributed to every enrolled tribal member.Main outcome measure: Participants were followed up at ages 25 and 30 (1266 of 1381 living participants, 91.7%; 2012 to 2016) to assess mental health functioning, substance use, and functional outcomes (physical health, risky/illegal behaviors, financial, social functioning).
Results: Study participants whose families received income supplements during childhood reported improved adulthood outcomes including fewer anxiety and depressive symptoms, better physical health and financial well-being, and fewer risky/illegal behaviors compared to others. Analyses adjusted for sex, cohort, and childhood covariates prior to the casino opening including family low socioeconomic status, family instability, household income, low birthweight, body mass index, and childhood anxiety, depressive, and behavioral symptoms. In the case of anxiety and depressive symptoms, the absolute effect of the cash transfer was double the size of that of SES (which was statistically significant at p <0.01 in both cases). The strongest benefit of the transfer occurred in children of families who received the transfers for the longest duration and who received a larger transfer due to having two American Indian parents.
Conclusions and Relevance: In this natural experiment, a family cash transfer in childhood had positive effects on adult functioning. The findings support the long-term effects of programs like the child tax credit or universal basic income that provide cash directly to families with children.
Funding Information: The research reported in this publication was supported by the National Institute of Mental Health (R01MH117559, R01MH104576), the National Institute on Drug Abuse (R01DA040726, R01DA11301, and P30DA23026), and National Institute of Child Health and Development (R01HD093651).
Declaration of Interests: The authors declare no competing interest.
Ethics Approval Statement: Before interviews, all participants signed informed consent forms approved by the Duke University Medical Center ethical review boards. Participants received compensation for their time ($100 for most recent waves).
Keywords: cash transfer, natural experiment, mental health, substance, longitudinal
Suggested Citation: Suggested Citation