Sociologists have long struggled to explain the minority mental health paradox: that racial-ethnic minorities often report better mental health than non-Hispanic whites despite social environments that seem less conducive to well-being. Using data from the 2008–2013 Medical Expenditure Panel Survey (MEPS), this study provides a partial explanation for the paradox rooted in a very different disparity. Evidence from MEPS indicates that non-Hispanic whites consume more pharmaceuticals than racial-ethnic minorities for a wide variety of medical conditions. Moreover, non-Hispanic whites consume more pharmaceuticals that although effective in treating their focal indication, include depression or suicide as a side effect. In models that adjust for the use of such medications, the minority advantage in significant distress is reduced, in some instances to statistical nonsignificance. Although a significant black and Hispanic advantage in a continuous measure of distress remains, the magnitude of the difference is reduced considerably. The relationship between the use of medications with suicide as a side effect and significant distress is especially large, exceeding, for instance, the relationship between poverty and significant distress. For some minority groups, the less frequent use of such medications is driven by better health (as in the case of Asians), whereas for others, it reflects a treatment disparity (as in the case of blacks), although the consequences for the mental health paradox are the same. The implications of the results are discussed, especially with respect to the neglect of psychological side effects in the treatment of physical disease as well as the problem of multiple morbidities.

The share of children living with grandparents has increased in recent years. Previous studies have examined how time with grandparents is associated with child well-being, but we know little about how grandparents fare in their time with grandchildren. We used diary data from the American Time Use Study (ATUS) to examine the association between grandparents’ time in activities with grandchildren and multiple measures of their subjective well-being in those activities. We used a subsample of co-residential grandparents from the American Time Use Study (N = 868 individuals; 2474 activities), paying close attention to potential differences between three-generational families (those with parents, grandparents and grandchildren living together) and grandfamilies (which do not include the parent generation). We examined subjective well-being (happiness, meaning, sadness, tiredness and stress) in relation to family type (three-generational or grandfamily) and grandchild presence during the activity, as well as other characteristics of the activity (e.g., type of activity, duration, etc.) and of the grandparent (i.e., demographic variables). This is the first study to address grandparent SWB as affective response to activities in relation to presence of grandchildren during those activities. Results of multilevel models show that grandparents living with their grandchildren experienced more happiness and more meaningfulness when they engaged in activities with their grandchildren compared to spending time alone or with other people. This relationship was partially moderated by family type, such that grandfamily grandparents experienced less happiness in time with grandchildren than alone, relative to grandparents in three-generational families.

Jim Crow segregated African Americans and whites by law and practice. The causes and implications of the associated de jure and de facto residential segregation have received substantial attention from scholars, but there has been little empirical research on racial discrimination in public accommodations during this time period. We digitize the Negro Motorist Green Books, important historical travel guides aimed at helping African Americans navigate segregation in the pre-Civil Rights Act United States. We create a novel panel dataset that contains precise geocoded locations of over 4,000 unique businesses that provided non-discriminatory service to African American patrons between 1938 and 1966. Our analysis reveals several new facts about discrimination in public accommodations that contribute to the broader literature on racial segregation. First, the largest number of Green Book establishments were found in the Northeast, while the lowest number were found in the West. The Midwest had the highest number of Green Book establishments per black resident and the South had the lowest. Second, we combine our Green Book estimates with newly digitized county-level estimates of hotels to generate the share of non-discriminatory formal accommodations. Again, the Northeast had the highest share of non-discriminatory accommodations, with the South following closely behind. Third, for Green Book establishments located in cities for which the Home Owner’s Loan Corporation (HOLC) drew residential security maps, the vast majority (nearly 70 percent) are located in the lowest-grade, redlined neighborhoods. Finally, Green Book presence tends to correlate positively with measures of material well-being and economic activity.

The capacity to exercise choice for women and girls is an important development objective, but evidence on how health policies and programs affect decision-making is lacking in low-resource settings. This study aims to assess three different health interventions that may improve women’s and girls’ decision-making power in key life choices in sub-Saharan Africa. The first intervention consists of legal reforms that reduce restrictions on abortion, which may allow adolescent girls and young women to stay in school longer by delaying marriage and childbearing. I use a difference-in-differences approach to analyze the impact of expanding the legal grounds for abortion on marriage, birth, and schooling rates among adolescent girls and young women in 18 countries. The second intervention addresses financial barriers that might limit women’s ability to choose their preferred contraceptive methods. I use a propensity score approach combined with machine learning techniques to evaluate how free access to a broad contraceptive method mix affects women’s contraceptive choice in eight countries with high unmet needs for family planning. The third intervention distributes HIV self-tests through women with multiple sexual partners in Kenya. I use an instrumental variable approach to assess whether disclosing HIV-negative status affects women’s decision-making in intimate partner and transactional sex relationships. Each of these three analyses is presented as a different chapter with an overview that summarizes the results. Taken together, this study leverages rigorous econometric methods, fills important evidence gaps in the literature on gender and health, and informs policies to improve women’s and girls’ well-being in low-resource settings.

To reduce poverty and improve family well-being, the 20th century saw the creation and expansion of scores of federal programs offering assistance to low-income families with children. Major programs included Aid to Dependent Children (created in 1935, later known as AFDC and now Temporary Assistance for Needy Families or TANF), the Social Security survivor insurance program (1939), Food Stamps (1964, now known as the Supplemental Nutrition Assistance Program or SNAP), Medicaid (1965), rental assistance (1965), Supplemental Security Income (1972), the earned income tax credit (1975), the child tax credit (1997), and the Children’s Health Insurance Program (1997). These and dozens of other programs provide an array of cash, food, housing, health, and other benefits designed to assist families, including those with children, with material and other needs.1 Drawing on data from the Urban Institute, the Roadmap displays annual federal expenditures on children between 1960 and 2017, in inflation-adjusted terms.2 Figure 4-5 in the Roadmap shows that spending grew from $60.5 billion in 1960 to $516.4 billion in 2010, before moderating to $481.5 billion by 2017 “largely due to the decrease in transfers during the economic recovery that followed the Great Recession.” The Roadmap finds that “the eight-fold growth in real spending between 1960 and 2010 is striking, and it is many times larger than the 15-percent increase in the number of children in the population.”3 Table D4-1 breaks out federal expenditures on children by program for selected years between 1960 and 2017, in constant dollars. It shows how real spending almost universally grew in those programs between those years, including because most current programs didn’t exist in 1960.4 State spending adds to that federal spending on children.

Since the early 1990s, the social safety net for families with children in the United States has undergone an epochal transformation. Aid to poor working families has become more generous. In contrast, assistance to the deeply poor has become less generous, and what remains more often takes the form of in-kind aid. A historical view finds that this dramatic change parallels others. For centuries, the nature and form of poor relief has been driven in part by shifting cultural notions of which social groups are "deserving" and "undeserving." This line was firmly redrawn in the 1990s. Did the re-institutionalization of these categorizations in policy have material consequences? This study examines the relationship between the decline of traditional cash welfare between 2001 and 2015 and two direct measures of wellbeing among households with children: household food insecurity and public school child homelessness. Using models that control for state and year trends, along with other factors, we find that the decline of cash assistance was associated with increases in both forms of hardship.

Almost one-fifth of tropical forest cover has been lost in the last two decades, leading to local temperature increases that can surpass warming from 21st century climate change projections. Although it is known that working outdoors in high temperatures reduces worker productivity and increases heat strain, the extent to which deforestation-driven temperature change affects people across the tropics is unknown. Using satellite data combined with worker health guidelines, we show that warming associated with deforestation is already impacting human health and well-being in low latitude countries. We estimate that more than 2.5 million people in recently deforested tropical biome now face heat exposure that reduces safe work hours by at least two hours per day. This warming has particularly large impacts on populations in Brazil, Belize, Cambodia, Vietnam, Malaysia, Myanmar, Nigeria, and Cameroon. We highlight these effects by examining the Brazilian states of Mato Grosso and Pará, which have experienced particularly large-scale deforestation, and showing that temperatures and human heat exposure are increasing disproportionately quickly in these locations. Future global climate change magnifies heat exposure in deforested areas across the tropics; an additional 2°C of global warming will increase exposure to multiple hours of unsafe working conditions for over 1.6 million people in recently deforested areas. Tropical deforestation is hastening the arrival of climate change impacts in the tropics, highlighting the need to shift local land use practices and to slow global greenhouse gas emissions so the most vulnerable populations are not forced to bear the brunt of warming impacts.

Whether parents have health insurance coverage affects not only their health care access but the financial stability and well-being of the entire family. The harmful consequences of parents' uninsurance may be magnified for young children, given early childhood's importance for long-term growth and development. Moreover, compared with a vast body of evidence on maternal and child health, research on fathers' insurance coverage and its implications for children and families is limited. In this brief, we assess uninsurance among parents living with young children from birth to age 5, using National Health Interview Survey (NHIS) data from 2017 and 2018, and report separate estimates for mothers and fathers. Our main findings are as follows: - More than 4 million parents living with young children-2.2 million mothers and 2.2 million fathers-were uninsured in 2017-18, representing a 40 percent decline in uninsurance since 2013, following implementation of the major coverage provisions of the Affordable Care Act (ACA). - In 2018, fathers living with young children were more likely to be uninsured than mothers living with young children (15.2 percent versus 13.0 percent). Both mothers and fathers who were living with young children and were Hispanic, noncitizens, living in the South, lacking a high school diploma, or in a family with low income faced uninsurance rates greater than 20 percent. - Of the estimated 4.4 million uninsured parents living with young children in 2017-18, most were under age 35, about half were Hispanic, and more than half lived in the South. Compared with uninsured fathers, uninsured mothers living with young children were considerably less likely to be working and more likely to have low incomes. - Both mothers and fathers living with young children most commonly reported being uninsured because of cost, and many reported becoming uninsured after losing employer or public coverage. Uninsured fathers living with young children were more likely than such mothers to have gone more than three years without coverage. - Many uninsured parents living with young children also reported problems affording needed health care, low levels of health care use, and concerns about affording other basic needs. Many uninsured parents experience unmet health needs, financial hardships, and worries about affording the family's medical care, which can have adverse effects on both their and their children's health in the short and long run. Reducing uninsurance among parents-such as through Medicaid expansion in the remaining states, increasing coverage affordability and accessibility for people who are eligible for Medicaid or Marketplace coverage but not enrolled, and eliminating eligibility restrictions based on immigration status-would likely improve parents' ability to access and afford needed care and reduce related financial concerns. Moreover, expanding coverage for parents could improve family financial stability and long-term well-being for approximately 4.0 million children under 6 who live in a family with at least one uninsured parent.

In April, 1970, Atlanta Journal Constitution (AJC) reporter Lorraine M. Bennet wrote an article headlined, “How Far Yet to Go, Baby? Some Atlanta Women in Revolt.” It focused on how the Atlanta Women’s Liberation Movement was the only organization in the metro area fi ghting discrimination against women whose members were publicly labeled “man-haters.” In one passage, a member responded, “Certainly Not!” Bennet goes on to write: “responds one member, a dark-eyed brunette with a masters degree” (40). By today’s standards, the fact that this article described the eye and hair color, as well as the education level of this member would be considered irrelevant. Was this “code” for describing a nontraditional southern woman? Indeed, things have come a long way for the women of Georgia: in the workforce, in family life, education, employment income, healthcare, and in elected offi ce. And yes, you can be a dark-eyed brunette with a master’s degree and belong to a women’s rights organization without being labeled a “man-hater.” Georgia’s women make a signifi cant contribution to the state’s GDP, now the ninth largest in the country. Yet Georgia continues to lag behind other states, the nation as a whole, and other developed Western countries on many measures of women’s equality and well-being: earnings parity, maternal mortality, family planning, family and maternity leave, and aff ordable childcare (Phadke, Ravi, and McGrew 2018). The poor status of reproductive health and justice in Georgia is compounded by the persistence of racial inequality, compromising the lives of women of color (Prather et al. 2018).

Working longer – in the sense of choosing to delay retirement beyond traditional retirement ages – is widely proposed as the best way for older Americans to boost their fragile retirement security. But the policy goal of increasing labor force participation among older Americans is fundamentally in tension with a precarious low-wage economy because jobs that feature low wages, high turnover rates, and few benefits do not provide a solid foundation for sustained employment at older ages. Many Americans in their 50s are already out of the labor force, and many retire involuntarily before traditional retirement ages – a situation that has been exacerbated by the COVID-19 pandemic. Better jobs for prime-age workers help to pave the way for longer working lives. I outline three specific policy proposals: improved minimum wage, fair workweek laws, and a universal paid family and medical leave benefit. As others have argued, these policies would improve the well-being of prime-age workers. What has been less appreciated is that these policies would also put older Americans in a better position to extend their working years.

The time after giving birth is critical to the health of new mothers and their children. Though most women have health insurance coverage during their pregnancy and delivery, new mothers often become uninsured postpartum, which can threaten their abilities to access and afford needed health care. Following implementation of the coverage provisions of the Affordable Care Act (ACA) in 2014, thousands of new mothers gained insurance coverage, but few analyses have assessed how much new mothers’ health care access and affordability have improved under the law. In this brief, we examine changes in access to and affordability of health care services for new mothers under the ACA using data from the National Health Interview Survey (NHIS). 1 We also assess whether changes in the demographic and socioeconomic characteristics of our sample of new mothers contributed to observed changes in health care access and affordability. We find the following: ◼ The uninsurance rate for new mothers fell from 20.2 percent in 2011 to 11.3 percent in 2015 and remained relatively stable through 2018. ◼ New mothers were less likely to report unmet health care needs due to cost after implementation of the ACA coverage expansions in 2014; between 2011–13 and 2015–18, the share of new mothers reporting unmet needs for medical care dropped by 60 percent, and the shares reporting unmet needs for prescription medicines and specialist care fell by 40 percent and 44 percent. ◼ The share of new mothers very worried about paying their medical bills also fell from 20.9 percent in 2011–13 to 15.5 percent in 2015–18. ◼ In 2015–18, new mothers were more likely to report having seen a general doctor (60.9 percent versus 55.6 percent) and received a flu vaccine (52.5 percent versus 44.6 percent) in the past 12 months than in 2011–13. ◼ Changes in health care affordability and access were generally consistent with and without adjusting for new mothers’ changing demographic and socioeconomic characteristics, suggesting these changing characteristics were not driving health care access and affordability improvements during the study period. We find that new mothers experienced significant improvements in health care access and affordability after implementation of the ACA’s major coverage provisions. Together with other evidence on the ACA’s role in reducing uninsurance among women and new mothers and improving access to and affordability of health care among parents with low incomes and other adults, our results suggest the ACA likely contributed to new mothers’ gains in health care access and affordability over the study period. But even after ACA implementation, many new mothers still faced barriers to accessing needed health care services, which can negatively affect their health and their family’s well-being.

Private vehicle travel entails costs to society. However, in a world designed around the automobile, adults who lack access to a vehicle for economic reasons may experience a significant handicap due to constrained mobility and accessibility. This paper examines whether private vehicle access is associated with the quantity and quality of out-of-home activities in which low-income individuals participate. We use pooled data from multiple time use surveys drawn from the Netherlands, Canada, Spain, and the United Kingdom, and employ Cragg two-part hurdle modeling to determine whether there is an association between household vehicle access and participation in twelve out-of-home activity types. As a robustness check, we also estimate multiple discrete continuous extreme value (MDCEV) models. Further, we examine travel time by mode for those with and without vehicles. Finally, we use American Time Use Survey data and fixed-effects panel models to determine the subjective well-being that is associated with our out-of-home activity types. A lack of private vehicle access is associated with significantly less frequent out-of-home activity participation, both in the aggregate and for seven of the twelve individual activities. Moreover, the activities most likely to be foregone are generally associated with high subjective well-being, suggesting that constrained mobility comes with significant emotional costs. We find a greater “activity penalty” for rural residents and for Canadian residents without vehicle access; urbanites without vehicles in the U.K. are the only geographic group which do not exhibit an activity penalty. Finally, respondents with vehicle access spend more total time traveling, although those without private vehicles partially offset spending less time in them with higher use of alternative modes. Overall, the findings suggest that the lack of a private vehicle is deleterious for quality of life, raising troubling questions about inequity possibly arising when people are denied access to vehicles for economic reasons.

We contribute to literature exploring the socioecological impact of urban development as a multidimensional project, one in which changes to landscape features complement changes in demographic and administrative measures to co-constitute the socioecological impact of urbanity. We use a random coefficients modeling approach to examine U.S. relationships between the intensity of impervious surface within a county, population density in impervious areas, and carbon intensity of well-being (CIWB)—here constructed using industrial emissions. We then explore the moderating association that another component of social settlement patterns, household median income, has on the impervious surface–population density–CIWB nexus. Findings suggest that landscapes featuring greater development of impervious surface are associated with increased CIWB. Further exploration indicates that income acts to attenuate the association of urban space and CIWB. Ultimately, we argue that such attenuation indicates that more affluent areas are able to shift production-based processes associated with urban forms to less affluent areas.

Sociologists have long struggled to explain the minority mental health paradox: that racial-ethnic minorities often report better mental health than non-Hispanic whites despite social environments that seem less conducive to well-being. Using data from the 2008–2013 Medical Expenditure Panel Survey (MEPS), this study provides a partial explanation for the paradox rooted in a very different disparity. Evidence from MEPS indicates that non-Hispanic whites consume more pharmaceuticals than racial-ethnic minorities for a wide variety of medical conditions. Moreover, non-Hispanic whites consume more pharmaceuticals that although effective in treating their focal indication, include depression or suicide as a side effect. In models that adjust for the use of such medications, the minority advantage in significant distress is reduced, in some instances to statistical nonsignificance. Although a significant black and Hispanic advantage in a continuous measure of distress remains, the magnitude of the difference is reduced considerably. The relationship between the use of medications with suicide as a side effect and significant distress is especially large, exceeding, for instance, the relationship between poverty and significant distress. For some minority groups, the less frequent use of such medications is driven by better health (as in the case of Asians), whereas for others, it reflects a treatment disparity (as in the case of blacks), although the consequences for the mental health paradox are the same. The implications of the results are discussed, especially with respect to the neglect of psychological side effects in the treatment of physical disease as well as the problem of multiple morbidities.

Exposure to conflict is associated with multiple impacts on youth populations in developing countries, predominantly in the areas of health and nutrition. Where many previous works have examined large-scale impacts of exposure to conflict on the civilian population, this study will analyze the effects of exposure to conflict specific to the experiences of children under the age of five. Where experiences of armed conflict are often indiscriminately destructive to individual well-being, West African conflicts have been characterized by disproportionately high levels of violence, with their most extreme consequences forced upon women and children. Research has suggested that accepted gender norms and levels of women’s agency may be strongly associated with children’s health responses to exposure to increased violence and conflict. To test this association this thesis assumes a critical analysis of reduced educational attainment and low marital age among women in relation to the effects of conflict on measures of childhood food security. Through the use of high-resolution conflict data from the Armed Conflict Location and Event Database (ACLED) and the Demographic and Health Survey (DHS), this thesis examines the effects of armed conflict on children under five years of age across seven West African nations. Along with previous works exploring the relationship between conflict and childhood nutrition, this study finds a negative, albeit small and statistically insignificant, impact on measures of weight-for-height (WFH). Surprisingly, there is a significant and positive response in children’s height-for-age (HFA) associated with exposure to conflict during one’s lifetime.

Social media permeates many aspects of our lives, including how we connect with others, where we get our news and how we spend our time. Yet, we know little about the economic effects for users. In 2017, we ran a large field experiment with over 1765 individuals to document the value of Facebook to users and its causal effect on news, well-being and daily activities. Participants reveal how much they value one week of Facebook usage and are then randomly assigned to a validated Facebook restriction or normal use. One week of Facebook is worth $67. Those who are off Facebook for one week reduce news consumption, are less likely to recognize politically-skewed news stories, report being less depressed and engage in healthier activities. These results are strongest for men. Our results further suggest that, after the restriction, Facebook’s value increases, consistent with information loss or that using Facebook may be addictive.

In the U.S., women are entering motherhood at older ages, with the age at first birth rising from a mean of 21.4 in 1970 to 26.8 in 2017 (FP-18-25). Women who have first births at younger ages differ on a range of characteristics compared to women who become mothers at later ages, and maternal age is linked to children’s well-being (Gibson-Davis & Rackin, 2014; Brown, Stykes, & Manning, 2016; Rackin & Gibson-Davis, 2018). This profile uses the Current Population Survey’s 2018 June Fertility Supplement to identify mothers who had a first birth between 2015 and 2018. Education level, race/ethnicity, and union status of mothers are compared across three groups classified by age at first birth: younger mothers (less than 24 years old), mid-range age mothers (24 to 29 years old), and older mothers (30 years or older). Additional profiles using the June Fertility Supplement analyze trends in completed family size among women aged 40-44 by education and race/ethnicity (FP-20-04) and by union status (FP-20-03).

As the COVID-19 pandemic took deeper hold in the United States in March 2020, fears of exposure to the novel coronavirus caused many people to restrict activities outside their homes. To reduce the spread of the coronavirus and maintain sufficient hospital capacity to meet the potential need, governors and local officials instituted states of emergency. These declarations required that people remain at home, only going out for groceries and prescriptions, doctor’s appointments, exercise, and other essential activities; defined the essential businesses that could remain open; and ordered nonessential businesses to shut down most operations that could not be done remotely or through telework.

The health-care sector is in many ways the most consequential part of the United States economy. It is a fundamental part of people’s lives, supporting their health and well-being. Moreover, it matters because of its economic size and budgetary implications. The health-care sector now employs 11 percent of American workers (Bureau of Labor Statistics [BLS] 1980– 2019b and authors’ calculations) and accounts for 24 percent of government spending (Centers for Medicare & Medicaid Services [CMS] 1987–2018; Bureau of Economic Analysis 1987–2018; authors’ calculations).1 Health insurance is the largest component (26 percent) of nonwage compensation (BLS 2019b) and health care is one of the largest categories of consumer spending (8.1 percent of consumer expenditures; BLS 2019a).

Importance Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. Objectives To examine whether participation in the US Department of Housing and Urban Development’s (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). Design, Setting, and Participants This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Exposures Participation in rental assistance provided by HUD. Main Outcomes and Measures Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. Results This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, −29.7 to −6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, −36.6; 95% CI, −54.8 to −18.4) but not housing choice vouchers (percentage point change, −7.2; 95% CI, −24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, −2.7; 95% CI, −12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (−4.3; 95% CI, −8.8 to 0.2 percentage points). Conclusions and Relevance Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.