Background: A growing proportion of cancer survivors experience financial toxicity. However, the psychological burden of cancer costs and associated mental health outcomes require further investigation. We assessed prevalence and predictors of self-reported financial worry and mental health outcomes among cancer survivors. Patients and methods: Data from the 2013–2018 National Health Interview Survey (NHIS) for adults reporting a cancer diagnosis were used. Multivariable ordinal logistic regressions defined adjusted odds ratios (AORs) of reporting financial worry by relevant sociodemographic variables, and sample weight-adjusted prevalence of financial worry was estimated. The association between financial worry and psychological distress, as defined by the six-item Kessler Psychological Distress Scale was also assessed. Results: Among 13,361 survey participants (median age 67; 60.0% female), 9567 (71.6%) self-reported financial worry, including worries regarding costs of paying for children’s college education (62.7%), maintaining one’s standard of living (59.7%), and medical costs due to illness or accident (58.3%). Female sex, younger age, and Asian American race were associated with increased odds of financial worry (P < 0.05 for all). Of 13,218 participants with complete responses to K6 questions, 701 (5.3%) met the threshold for severe psychological distress. Participants endorsing financial worry were more likely to have psychological distress (6.6 vs. 1.2%, AOR 2.89, 95% CI 2.03–4.13, P< 0.001) with each additional worry conferring 23.9% increased likelihood of psychological distress. Conclusions: A majority of cancer survivors reported financial worry, which was associated with greater odds of reporting psychological distress. Policies and guidelines are needed to identify and mitigate financial worries and psychologic distress among patients with cancer, with the goal of improving psychological well-being and overall cancer survivorship care.

The American Voices Project (AVP) relies on immersive interviews to deliver a comprehensive portrait of life across the country. The interview protocol blends qualitative, survey, administrative, and experimental approaches to collecting data on such topics as family, living situations, community, health, emotional well-being, living costs, and income. The AVP is based on a nationally representative sample of hundreds of communities in the United States. Within each of these sites, a representative sample of addresses is selected. In March 2020, recruitment and interviewing began to be carried out remotely (instead of face-to-face), and questions were added on the pandemic, health and health care, race and systemic racism, employment and earnings, schooling and childcare, and new types of safety net usage (including new stimulus programs). The "Monitoring the Crisis" series-which is co-sponsored by the Stanford Center on Poverty and Inequality, the Federal Reserve Bank of Atlanta, and the Federal Reserve Bank of Boston-uses AVP interviews conducted during recent months to provide timely reports on what's happening throughout the country as the pandemic and recession play out. To protect respondents' anonymity, all quotations presented in this series are altered slightly by changing inconsequential details.

Many regions around the world suffer from a lack of authoritatively-collected data on factors critical to understanding human well-being. This challenges our ability to understand the progress society is making towards reducing poverty, improving lifespans, or otherwise improving livelihoods. A growing body of research is exploring how deep learning algorithms can be used to produce novel estimates of sparse development data, and how access to such data can impact development efforts. This dissertation contributes to this literature in three parts. First, using Landsat 8 satellite imagery and data from the Armed Conflict Location & Event Data Project, convolutional neural networks are trained to predict locations where conflict is likely to result in fatalities for one year. Second, building on the findings in chapter 1, this dissertation explores the potential to extend predictions to a time series using both yearly and six month intervals. Finally, chapter 3 introduces GeoQuery, a dynamic web application which utilizes a High Performance Computing cluster and novel parallel geospatial data processing methods to overcome challenges associated with integrating, and distributing geospatial data within research communities.

COVID-19 has affected daily life in unprecedented ways. Using a longitudinal dataset linking biometric and survey data from several cohorts of young adults before and during the pandemic (N=685), we document large disruptions to physical activity, sleep, time use, and mental health. At the onset of the pandemic, average steps decline from 9,400 to 4,600 steps per day, sleep increases by about 25-30 minutes per night, time spent socializing declines by over half to less than 30 minutes, and screen time more than doubles to over 5 hours per day. The proportion of participants at risk of clinical depression increases to 65%, over twice the rate in the same population prior to the pandemic. Our analyses suggest that disruption to physical activity is a leading risk factor for depression during the pandemic. However, restoration of those habits–either naturally or through policy intervention–has limited impact on restoring mental well-being.

Issues related to professional sport transcend far beyond the world of sport itself. Previous research on the topic of sport and suicide has found that a significant association exists between the success of professional sport teams and the well-being of people in general. Data on suicide rates in United States’ metropolitan areas were analyzed from 2006 to 2007 and from 2009 to 2010 to measure the association between suicide rates and the success of professional sport teams in these same metropolitan areas. Results from statistical analyses reveal that the successes of professional sport teams are significantly related to lower suicide rates, while the only game in town hypothesis was not supported.

Despite being the longest relationships across the lifespan, the sibling dyad is the most under-studied relationship in the family system. Researchers have documented the harmful and beneficial effects of sibling relationships and family dynamics on individual well-being. Extending this research to middle childhood, the current study examined family functioning, sibling relational dynamics, and self-reported adjustment and internalizing symptoms among 8- to 11-year-old children. Path analyses revealed significant direct effects between conflictual family functioning and children’s psychological well-being. Significant interactions between family functioning and sibling dynamics suggested that congruent relational dynamics at multiple levels of the family system had a cumulative impact on the child’s well-being. Findings from the current study highlight the role of family functioning and the unique contributions of sibling relationships to children’s functioning, suggesting that consideration of sibling relational dynamics may improve treatment planning by pointing out additional targets for intervention and/or potential sources of support.

Increased automation, globalization, and longevity demand new thinking by employers and employees regarding productivity. Throughout the lifespan, fuller engagement in education and paid and unpaid productive activities can generate a wealth of benefits, including better health and well-being, greater financial security, and a more vital society. We review challenges and opportunities to advance long, healthy, and productive lives. When possible, we review inequities by gender, race, ethnicity, and other social determinants of health to reveal heterogeneity within the growing U.S. population and workforce. We conclude with implications for research, social policy, advocacy, education, and practice.

The nonprofit Urban Institute is a leading research organization dedicated to developing evidence-based insights that improve people's lives and strengthen communities. For 50 years, Urban has been the trusted source for rigorous analysis of complex social and economic issues; strategic advice to policymakers, philanthropists, and practitioners; and new, promising ideas that expand opportunities for all. Our work inspires effective decisions that advance fairness and enhance the well-being of people and places.

Increased automation, globalization, and longevity demand new thinking by employers and employees regarding productivity. Throughout the lifespan, fuller engagement in education and paid and unpaid productive activities can generate a wealth of benefits, including better health and well-being, greater financial security, and a more vital society. We review challenges and opportunities to advance long, healthy, and productive lives. When possible, we review inequities by gender, race, ethnicity, and other social determinants of health to reveal heterogeneity within the growing U.S. population and workforce. We conclude with implications for research, social policy, advocacy, education, and practice.

When it comes to studying the impacts of decision making, the research has been largely focused on examining the fairness of the decisions, the long-term effects of the decision pipelines, and utility-based perspectives considering both the decision-maker and the individuals. However, there has hardly been any focus on precarity which is the term that encapsulates the instability in people's lives. That is, a negative outcome can overspread to other decisions and measures of well-being. Studying precarity necessitates a shift in focus-from the point of view of the decision-maker to the perspective of the decision subject. This centering of the subject is an important direction that unlocks the importance of parting with aggregate measures to examine the long-term effects of decision making. To address this issue, in this paper, we propose a modeling framework that simulates the effects of compounded decision-making on precarity over time. Through our simulations, we are able to show the heterogeneity of precarity by the non-uniform ruinous aftereffects of negative decisions on different income classes of the underlying population and how policy interventions can help mitigate such effects.

Objective: We analyze fertility preferences among women at risk of pregnancy with children ages five or younger as a function of two food security metrics: perceptions of household hunger and child stunting (height for age z scores ≤ −2.0) in order to convey a robust picture of food insecurity. Methods: We use data from the 2016 Tanzania Demographic and Health Surveys to analyze this research question. Multinomial generalized logit models with cluster-adjusted standard errors are used to determine the association between different dimensions of food insecurity and individual-level fertility preferences. Results: On average, women who experience household hunger are 19% less likely to want more children compared to women who do not experience household hunger (AOR: 0.81, p = 0.02) when controlling for education, residence, maternal age, number of living children, and survey month. Adjusting for the same covariates, having at least one child ≤ 5 years old who is stunted is associated with 13% reduced odds of wanting more children compared to having no children stunted (AOR: 0.87, p = 0.06). Conclusions for Practice: In the context of a divided literature base, this research aligns with the previous work identifying a preference among women to delay or avoid pregnancy during times of food insecurity. The similarity in magnitude and direction of the association between food insecurity and fertility preferences across the two measures of food insecurity suggest a potential association between lived or perceived resource insecurity and fertility aspirations. Further research is needed in order to establish a mechanism through which food insecurity affects fertility preferences. Significance Statement: Individual fertility preferences are sensitive to dynamic multi-level factors in a woman’s life. While qualitative research has explored the effect that food insecurity and associated resource constraints have on fertility preferences, results are conflicting. Here, we quantitatively examine how individual woman’s fertility preferences associate with two measures of food insecurity and qualitatively compare the associations across food insecurity measures. We establish that two food insecurity measures- household hunger and child stunting- capture similar populations and have similar associations with fertility preferences. This is a critical step forward in understanding the dynamic relationship between resource availability, child well-being, and fertility preferences.

Latinos make up the nation’s largest ethnic minority group. The majority of Latinos are U.S. born, making the progress and well-being of Latinos no longer just a question of immigrant assimilation but also of the effectiveness of U.S. educational institutions and labor markets in equipping young Latinos to move out of the working class and into the middle class. One significant headwind to progress among Latinos is recessions. Economic outcomes of Latinos are far more sensitive to the business cycle than are outcomes for non-Hispanic whites. Latinos also have higher poverty rates than whites, although the gap had been falling prior to the pandemic. Deep holes in the pandemic safety net further imperiled Latino progress in 2020 and almost surely will in 2021 as well. Policies that would help working-class and poor Latinos include immigration reform and education reform and broader access to affordable health care.

Individuals living in every region of the world are increasingly vulnerable to negative health outcomes due to extreme heat exposure. Children, in particular, may face long-term consequences associated with heat stress that affect their educational attainment and later life health and well-being. Retrospective individual-level analyses are useful for determining the effects of extreme heat exposure on health outcomes. Typically, future risk is inferred by extrapolating these effects using future warming scenarios that are applied uniformly over space and time without consideration of topographical or climatological gradients. We propose an alternative approach using a stochastic weather generator. This approach employs a 1 °C warming scenario to produce an ensemble of plausible future weather scenarios, and subsequently a distribution of future health risks. We focus on the effect of global warming on fetal development as measured by birth weight in Ethiopia. We demonstrate that predicted changes in birth weight are sensitive to the evolution of temperatures not quantified in a uniform warming scenario. Distributions of predicted changes in birth weight vary in magnitude and variability depending on geographic and socioeconomic region. We present these distributions alongside results from the uniform warming scenario and discuss the spatiotemporal variability of these predicted changes.

We exploit the introduction of sulfa drugs in 1937 to identify the causal impact of exposure to pneumonia in infancy on later life well-being and productivity in the United States. Using census data from 1980-2000, we find that cohorts born after the introduction of sulfa experienced increases in schooling, income, and the probability of employment, and reductions in disability rates. These improvements were larger for those born in states with higher pre-intervention levels of pneumonia as these were the areas that benefited most from the availability of sulfa drugs. These estimates are, in general, larger and more robust to specification for men than for women. With the exception of cognitive disability and poverty for men, the estimates for African Americans are smaller and less precisely estimated than those for whites. This is despite our finding that African Americans experienced larger absolute reductions in pneumonia mortality after the arrival of sulfa. We suggest that pre-Civil Rights barrers may have inhibited their translating improved endowments into gains in education and employment.

Objective: To contextualize experiences of activities during the day and investigate whether the contour of the day is correlated with well-being during activities. Methods: Drawing on American Time Use Surveys, we employ sequence and cluster analyses to create distinct typologies of daily life patterns, and bivariate analyses to describe whether well-being across activities varies by these typologies. Results: We identified four typologies characterized by different primary activity of the day: leisure (22.7%), TV (22.4%), housework (47.5%), and work (7.5%). Individuals in the work and leisure clusters tend to report more positive well-being and individuals in the housework and TV clusters tend to report more negative well-being in experiences of activities during the day. We also found that well-being experiences in the same activity differed across individuals in the different typologies. Conclusion: Understanding the daily life patterns of older adults may be important, given its correlation with well-being during activities.

BACKGROUND This study examines trends in affluence ‒ as indicated by high household income ‒ by household structure over the 1959 to 2017 period. I contrast the experiences of married couple households, whose share of all households declined substantially over time, with those of single-parent households, cohabiting couples, individuals living alone, and people living with non-relatives. METHODS I use data from multiple censuses and the American Community Survey and logistic regression. RESULTS Levels of absolute affluence rose substantially for all household types, reflecting rising living standards. Married-couple households were the most likely to be affluent and single-parent households were the least. Moreover, the affluence gap between married couple households and all others widened. Married couples fared better because they experienced larger increases in wages and other important sources of income, such as from investments and retirement. CONCLUSIONS The findings suggest that married-couple households benefit from a collective work strategy and economies of scale that increase their likelihood of affluence. Positive selectivity into marriage may also have increased over time. CONTRIBUTION This study provides timely new information on changing gaps in affluence by household structure during a period of substantial change in household living arrangements and economic well-being.

Many veterans rely on the Supplemental Nutrition Assistance Program (SNAP). We study the change in the veterans’ reliance on SNAP in response to the GI Bill, the veterans’ financial aid for higher education. Using the unanticipated increase in educational benefits due to the Post-9/11 GI Bill and employing a difference-in-differences approach, we estimate that the benefit increase lowered veteran SNAP participation by about 28%, the effect being larger among new veterans. These findings reflect changes in the veterans’ choices that are attributable to wealth effects, SNAP eligibility criteria, and human capital accumulation. SNAP eligibility typically expires when the veteran attends college, and a larger educational benefit increases the veterans’ probability of college attendance. Furthermore, a college degree increases future earnings, which reduces the veterans’ SNAP reliance in the longer run. Quantifying these relationships provides insights into how financial aid for education in general improves veterans’ economic well-being and may help break some veterans’ dependence on SNAP and similar welfare programs.

Objective: To contextualize experiences of activities during the day and investigate whether the contour of the day is correlated with well-being during activities. Methods: Drawing on American Time Use Surveys, we employ sequence and cluster analyses to create distinct typologies of daily life patterns, and bivariate analyses to describe whether well-being across activities varies by these typologies. Results: We identified four typologies characterized by different primary activity of the day: leisure (22.7%), TV (22.4%), housework (47.5%), and work (7.5%). Individuals in the work and leisure clusters tend to report more positive well-being and individuals in the housework and TV clusters tend to report more negative well-being in experiences of activities during the day. We also found that well-being experiences in the same activity differed across individuals in the different typologies. Conclusion: Understanding the daily life patterns of older adults may be important, given its correlation with well-being during activities.

Prior research has shown improvements in low-income individuals' financial well-being as a consequence of the Affordable Care Act's Medicaid expansion. Given the connection between financial well-being and housing, we investigate the extent to which the provision of Medicaid to previously ineligible, low-income childless adults affects their household composition. Using a staggered adoption difference-in-differences design on an urban sample of individuals with less than a high school degree, we find that 26 to 39 year olds experience a significant 4.2% decline in the number of individuals living in the household, which is due to living with fewer extended family members. At the same time, 26 to 39 year olds experience a relatively smaller decline in the number of rooms (1.8%), leading to a 3.1% reduction in the level of household crowding, as measured by persons per bedroom. These reductions in household crowding are strongest for Hispanic individuals and those living in areas with above-median housing costs. In comparison, there are no significant impacts on household composition for 40 to 64 year olds as a consequence of the policy.

Recent events have brought racial inequities to the forefront of many conversations. At the Center for Household Financial Stability, we have documented underlying racial economic disparities that may be contributing to heightened tensions. As the dialogue continues, you may be wondering about the magnitude of economic racial gaps in your state. In comparing state-level racial socioeconomic well-being trends—focusing on median household income, poverty status and health insurance—to national benchmarks, three key findings emerged: Median Black/white income gaps vary considerably, but in all states white median household income is greater than Black median household income. Racial poverty gaps and poverty rates fluctuated widely (e.g., Puerto Rico had a Black-white gap of 6 percentage points but high poverty, while Maryland had a gap of 7 percentage points but fairly low poverty). Across states, racial health insurance gaps were comparatively smaller; yet, Black people had lower health insurance rates than whites in all states.