Objectives: Direct care workers (DCWs) play a central role in supporting individuals' health and well-being across care settings, yet may face barriers to accessing health care themselves, particularly because of high rates of uninsurance. Design: An observational study using pooled National Health Interview Survey (NHIS) data from 2014 to 2018. Setting and Participants: The sample included survey respondents employed as direct care workers (DCWs), including hospital aides, home care workers, and nursing and residential care aides. Methods: We used bivariate analyses to compare differences in health insurance coverage and health service use, defined in terms of access, utilization, and affordability, among DCWs by care setting. We then used stepwise multivariable logistic regression analyses to explore the associations between insurance coverage and health service use. Results: The sample included 1499 DCWs. Compared with hospital aides, home care workers and nursing and residential care aides had lower insurance coverage rates, were more likely to rely on Medicaid, and reported lower health care utilization and higher cost barriers. Health insurance through Medicaid was associated with the highest odds of health care access and utilization and the lowest odds of cost barriers for DCWs. Conclusions and Implications: Given the projected 9.3 million total job openings in the direct care workforce from 2021 to 2031, policy and practice interventions designed to support DCWs' health are essential for ensuring continuous and quality care for older adults and people with disabilities and serious illness.

Understanding the evolving interactions between employment, social benefits, and families’ well-being is key to designing better policies to both protect families and foster economic growth. Employment both overall and among those living in low-income families has been on a downward trajectory across the last three decades. One notable exception is that lowincome women with children were increasingly likely to work between 1992 and 1999 in the aftermath of large changes to social safety net programs to provide more incentives and rewards for work. Since then, low-income women with children have been more likely to be employed than childless women. Over time, payments from social benefits programs have made up a larger share of income among low-income families with children and relatively higher earnings. Among low-income families without children, social benefits have not changed much over time.

A central aspect of poverty measurement is how well the measure can identify the people and places that are experiencing financial hardships. This paper explores the relationship between poverty and financial hardship by using the CFPB’s financial well-being scale, which reflects individuals’ self-assessments of their financial challenges. Using this measure, for every 1 percentage point increase in a state’s official poverty rate for working-age adults, there is a 0.59 percentage point increase in the share of working-age adults with very low financial well-being. In contrast, the state’s supplemental poverty rate is negatively correlated with the rate of financial hardship using the CFPB measure. This finding is due to the supplemental poverty measure’s geographic adjustment shifting poverty towards areas that have lower rates of self- reported financial hardship.

This paper delves into the nuanced impact of the COVID-19 pandemic on time use activities in the United States, particularly examining gender and parental status differences. Drawing on data from the 2018–2022 American Time Use Survey, the study analyzes trends in six distinct time use categories: unpaid care work, leisure, employed activities, personal care, childcare, and household activities. The research sheds light on the evolving dynamics within households during the pandemic, emphasizing the potential implications for economic stratification and societal well-being. The COVID-19 pandemic completely disrupted established time use patterns, forcing a reconsideration of ‘traditional’ gender roles and caregiving responsibilities in certain countries. While early studies hinted at a temporary shift toward more equitable distribution of household activities, particularly childcare, this paper scrutinizes these trends over a more extended period. Despite the short-lived increases in fathers’ involvement in childcare during the pandemic, the study finds that the caregiving burden remained disproportionately on mothers and women. Notably, the analysis reveals persistent gender disparities in unpaid care work, with women and mothers spending a disproportionate amount of time on household activities, housework, and caring for children. This unequal distribution of caregiving responsibilities limits a women’s ability to engage in paid work activities, contributing to economic stratification and constraining their financial resources. While some activities demonstrated slight reductions in gender gaps, the overall picture suggests that the pandemic may not bring about lasting changes in how time is allocated within households.

The Tax Relief for American Families and Workers Act of 2024, which the US House of Representatives passed on January 31, 2024, and the Senate is now considering, would make important changes to the child tax credit (CTC) if enacted. The legislation would increase CTC payments for families with lower earnings, apply a one-year “lookback” provision to the refundable credit’s earnings test, and begin increasing the maximum benefit with inflation. We first summarize how this legislation would affect benefits for families based on their marital status, number of children, and earnings. Then we discuss how it would affect work and marriage incentives. We conclude by arguing that more research is needed to inform how behavioral responses to these changed incentives would ultimately shape the legislation’s effects on employment, marriage, and family well-being.

The national context of deportation threat, defined as the federal government's approach to deportation and/or deportation's salience to the US public, fluctuated between 2011 and 2018. US Latinos across citizenship statuses may have experienced growing psychological distress associated with these changes, given their disproportionate personal or proximal vulnerabilities to deportation. Drawing on 8 y of public- and restricted-access data from the National Health Interview Survey (2011 to 2018), this article examines trends in psychological distress among Latinos who are US-born citizens, naturalized citizens, and noncitizens. It then seeks to explain these trends by considering two theoretical pathways through which the national context of deportation threat could distress Latinos: 1) through discrete dramatic societal events that independently signal a change to the country's approach to deportation and/or that render deportation temporarily more salient to the public or 2) through more gradual changes to the country's everyday institutional (i.e., quotidian efforts to detain and deport noncitizens) and social (i.e., deportation's ongoing salience to a concerned public) environment of deportation threat. We find that, though both pathways matter to some degree, there is more consistent evidence that the gradual changes are associated with Latino US citizens and noncitizens' overall experiences of psychological distress. The article highlights how, even absent observable spillover effects of dramatic societal events bearing on deportation threat, the institutional and social environment in which they occur implicates Latinos' well-being.

Prior to the 2014 Affordable Care Act (ACA) expansion, 37% of young adults ages 19–25 in the United States were low-income and a third lacked health insurance coverage—both the highest rates for any age group in the population. The ACA's Medicaid eligibility expansion, therefore, would have been significantly beneficial to low-income young adults. This study evaluates the effect of the ACA Medicaid expansion on the health, health care access and utilization, and financial well-being of low-income young adults ages 19–25. Using 2010–2017 National Health Interview Survey data, I estimate policy effects by applying a difference-in-differences design leveraging the variation in state implementation of the expansion policy. I show that Medicaid expansion improved health insurance coverage, health care access, and financial well-being for low-income young adults in expansion states, but had no effect on their health status and health care utilization. I also find that the policy was associated with larger gains in health coverage for racial minorities relative to their Non-Hispanic White counterparts. With the continued health policy reform debates at the state and federal levels, the empirical evidence from this study can help inform policy decisions that aim to improve health care access and utilization among disadvantaged groups.

The material well-being of veterans and their families is an important, policy-relevant topic. I research this topic through two crucial measures. In Chapters 1 and 2, I focus on wages, and in Chapter 3, I focus on poverty. In Chapter 1, I estimate the effect of veteran status on unconditional quantiles of wages for males across the period 1979-2017. I show there are important changes to the veteran wage differential over time across the entire wage distribution. In earlier periods, veterans enjoyed wage premiums across the entire wage distribution. Beginning in the early 1990s, wage premiums systematically declined across the wage distribution and largely became slight wage penalties across the wage distribution.

How did Progressive era reforms affect the lives of urban residents across U.S. cities? Some scholars argue that racist and nativist impulses permeated this movement, which primarily benefited white business owners. Others emphasize that reformers sought to improve urban living and working conditions and expand educational access, generating economic opportunity for disadvantaged groups. We answer this question leveraging new data on 455 U.S. cities from 1900-1940 combining dates of reform-style government adoption, deanonymized census records, voter turnout, and municipal budget data. Using a difference-indifferences design, we document the impact of Progressive reforms on political participation, public goods spending, and the relative socioeconomic well-being of black, immigrant, and working class residents visa -vis whites, natives, and business elites. While voter turnout decreased in reformed cities, we uncover only modest increases in earnings inequality across more and less advantaged groups and no significant differences in expenditure patterns as a consequence of reform.

Governments, civic society, businesses, and citizens all strive to make cities more livable. However, evidence about what aspects of cities actually contribute to the subjective well-being of their residents is incomplete. This paper examines the links between life satisfaction and indicators of the “quality” of U.S. metropolitan areas such as leisure/cultural opportunities, crime, climate, transportation, racial/ethnic diversity, incomes, cost of living, income inequality, the environment, healthcare, population growth, and political affiliation and polarization. Using mixed-effects regression and controlling for individual demographics, data on 9,498 respondents in 161 U.S. metropolitan statistical areas (MSAs) suggest that MSA characteristics have little relationship with life satisfaction. The only consistently significant characteristics are the natural log of median MSA per capita income, which is negatively associated with life satisfaction, and climate quality, which is positively associated with it. The association between the percentage of the population voting Republican and life satisfaction is negative but only borderline significant. Further, principal components analysis shows that MSAs with characteristics similar to California's Central Valley or the Texas/Mexico border are actually associated with higher life satisfaction. The finding that subjective well-being tends to be higher in places with better climates is well-supported by prior literature; past research also helps explain why poorer places may be happier, since people tend to be happier when their income compares favorably to their peer group's.

Rurality is often viewed as presenting challenges to community sustainability, well-being, and equity. To address the unique challenges of rural areas, policies and practices have been designed specifically for application in places designated as “rural”. Yet what is “rural”? Some recent measures of rurality have gone beyond a dichotomous rural-urban divide conceptualization of rural communities. However, most measures still emphasize proximity to metropolitan areas and population density as the primary components of rurality. Few studies consider the critical role that services and amenities play in the life of a community. We suggest a new measure based on the concept of sustainable development that integrates measures of environmental, social, and economic resources. We present the Community Assets and Relative Rurality index for census block-groups in the coterminous United States and illustrate how this measure is consistent with existing measures of rurality yet offers additional insight into issues of sustainable rural development.

The Appalachian Mountain Club (AMC) and several partners within the Pennsylvania Highlands Trail Network (PHTN) are working to expand accessibility of trails, parks, and open spaces to accommodate users with varying sets of abilities. As part of their mission, the Appalachian Mountain Club and the network of organizations that make up the Highlands Trail in Pennsylvania, envision a world where the outdoors occupies a place of central importance in every person’s life and believe that the outdoors is for everyone, especially in recognizing the numerous health benefits related to outdoor recreation for physical and mental well-being. Equity and accessibility are the integral components to advance this work, recognizing that the outdoor recreation and conservation industries have more work to do in expanding access to create holistic community integration in the engagement process. To make nature accessible is to protect it. When the outdoors is made as accessible and inclusive as possible, all individuals regardless of their race, color, national origin, age, ability level, religion, gender, or sex are provided a shared sense of belonging and community.

More than 8.1 million Americans with disabilities qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Individuals with disabilities were particularly vulnerable to COVID-19, which may have altered individual and household behavior. Research on the impact of COVID-19 on individuals with disabilities and their families remains limited. Authors analyzed 2020 National Health Interview Survey data. Logistic regression models were applied, controlling for the effects of age, race, sex, income, education, employment, and health status. Households with SSI/SSDI beneficiaries with disabilities were associated with significantly greater odds of delaying or forgoing medical care and receiving needed personal and household care at home due to COVID-19 compared with households without beneficiaries. The health and well-being of households with individuals with disabilities may require more robust and inclusive social work initiatives that aim to reduce adverse pandemic impacts.

There are significant costs to rising unemployment. For workers, particularly those being paid low wages, higher unemployment rates nationally are associated with worse employment prospects, health outcomes, and general well-being. In 2020, these dynamics played out rapidly. The COVID-19 pandemic brought a massive shock to the labor market and the unemployment rate climbed from 3.5 percent, a low level not seen since the 1960s, to 14.7 percent.1 By July 2022, 28 months after the start of the crisis, sizable public investments helped foster a remarkably rapid turnaround and bring the unemployment rate back to its prepandemic level. The speedy recovery of the US economy, in contrast to the slow rebound after the Great Recession, minimized many of the severe problems of sustained high unemployment. By understanding the dynamics of high unemployment, policymakers, practitioners, and employers can work to alleviate its detrimental consequences. This report summarizes existing research on the effects of rising unemployment on three different areas: first, on workers, their workplaces, remuneration, and job quality; second, on the social factors that are indirectly affected by rising unemployment, such as enrollment in education, health outcomes, crime rates, and family well-being, particularly for low-income workers; and third, on the wider economic effects of unemployment on social spending, productivity, national income, and future unemployment rates. One strand of research explores the impact of long-term employment on factors such as income, labor market attachment, and health (Nichols, Mitchell, and Lindner 2013). This paper aims to frame the parameters of a different but complementary research area: the impacts of rising unemployment at large, both in the short and medium term. The contemporary labor market is unusually tight and provides a prime opportunity for researchers to better understand the benefits of low unemployment as well as the risks of rising unemployment. This report serves as a first step in that process and as a potential foundation for future research.

This paper estimates experimental impacts of a supported work program on employment, earnings, benefit receipt, and other outcomes. Case managers addressed employment barriers and provided targeted financial assistance while participants were eligible for 30 weeks of subsidized employment. Program access increased employment rates by 21 percent and earnings by 30 percent while participants were receiving services. Though gains attenuated after services stopped, treatment group members experienced lasting improvements in employment stability, job quality, and well-being, and we estimate the program’s marginal value of public funds to be 0.64. Post-program impacts are entirely concentrated among participants whose subsidized job was followed by unsubsidized employment with their hostsite employer. This decomposition result suggests that encouraging employer learning about potential match quality is the key mechanism underlying the program’s impact, and additional descriptive evidence supports this interpretation. Machine learning methods reveal little treatment effect heterogeneity in a broad sample of job seekers using a rich set of baseline characteristics from a detailed application survey. We conclude that subsidized employment programs with a focus on creating permanent job matches can be beneficial to a wide variety of unemployed workers in the low-wage labor market.

This paper revisits the cyclical nature of births and infant health and investigates to what extent the relationship between aggregate labor market conditions and birth outcomes is mitigated by unemployment insurance (UI). We introduce a novel empirical test of standard neoclassical models of fertility that directly tests the prediction of opposite-signed income and intertemporal substitution effects of business cycles by examining the interaction of the aggregate unemployment rate with a measure of potential income replacement from UI. Our results show that as UI benefit generosity reaches 100 percent income replacement, there is no effect of the unemployment rate on births. This implies that the well-documented cyclical nature of births is about access to liquidity. We also provide novel evidence that infant health is countercyclical based on timing of conception, but procyclical based on time in utero. The negative relationship between the in utero aggregate unemployment rate and infant health also disappears when potential UI replacement rates reach 100 percent. Our results imply that the social insurance provided by UI has a pro-natalist effect and improves the health and economic well-being of the next generation.

Administrative data allow researchers to examine the reach and composition of the child welfare system service population, as well as the correlates and consequences of child welfare involvement. State- and regional-level analyses have been carried out with a range of linked administrative data systems. At the national level, two federal data systems provide a means to estimate population-level patterns of involvement, the National Child Abuse and Neglect Data System (NCANDS), and the Adoption and Foster Care Analysis and Reporting System (AFCARS). This chapter details the use of synthetic cohort life table methods to leverage these cross-sectional national data files to examine lifetime prevalence and distribution of child welfare system involvement. This chapter also addresses an important challenge to the assumptions of these methods—the lack of harmonization across state reporting agencies—which limits the ability to account for cross-state migration and may bias prevalence estimates.

Ventura County is home to approximately 55,000 children under age six, many of whom enroll in early care and education (ECE) programs (KidsData, 2023). The ECE workforce provides vital learning and growth for these children, complex work that demands energy and expertise. Around 140 child care centers operate in the county, along with 540 family child care (FCC) providers operating in their homes. Building on the California Early Care and Education Workforce Study conducted by the Center for the Study of Child Care Employment (CSCCE), this report offers a snapshot of the licensed ECE workforce in Ventura County.1 In Chapter 1, we provide a profile of its core members: FCC providers and center-based educators (directors, teachers, and assistants).2 In Chapter 2, we describe the state of educator well-being; and in Chapter 3, we explore current headwinds affecting the field.

Lack of access to safe, affordable, timely and adequate pregnancy termination care, and the stigma associated with abortion in low-middle income countries (LMICs), pose a serious risk to women’s physical and mental well-being throughout the lifespan. Factors associated with pregnancy termination and their heterogeneity across countries in LMICs previously have not been thoroughly investigated. We aim to determine the relative significance of factors associated with pregnancy termination in LMICs and its variation across countries. Analysis of cross-sectional nationally representative household surveys carried out in 36 LMICs from 2010 through 2018. The weighted population-based sample consisted of 1,236,330 women of childbearing aged 15–49 years from the Demographic and Health Surveys. The outcome of interest was self-report of having ever had a pregnancy terminated. We used multivariable logistic regression models to identify factors associated with pregnancy termination. The average pooled weighted prevalence of pregnancy termination in the present study was 13.3% (95% CI: 13.2%-13.4%), ranging from a low of 7.8 (95% CI: 7.2, 8.4%) in Namibia to 33.4% (95% CI: 32.0, 34.7%) in Pakistan. Being married showed the strongest association with pregnancy termination (adjusted OR, 2.94; 95% CI, 2.84–3.05; P < 0.001) compared to unmarried women. Women who had more than four children had higher odds of pregnancy termination (adjusted OR, 2.45; 95% CI, 2.33–2.56; P < 0.001). Moreover, increased age and having primary and secondary levels of education were associated with higher odds of pregnancy termination compared to no education. In this study, married women, having one or more living children, those of older age, and those with at least primary level of education were associated with pregnancy termination in these 36 LMICs. The findings highlighted the need of targeted public health intervention to reduce unintended pregnancies and unsafe abortions.

This thesis investigates the effectiveness and impact of protected areas (PAs) on biodiversity conservation and human well-being in Zambia's Muchinga Province. Using a postpositivist lens and primarily quantitative methodologies, the research explores the potential placement of PAs based on geographic information systems (GIS) and statistical analyses and examines the outcomes of existing PAs in protecting biodiversity and promoting human health and material well-being. The results show promising siting of PAs from a conservation perspective, but also reveal challenges, such as forest loss within protected boundaries. The analysis on human well-being indicates mixed results, with no significant correlation between PAs and childhood health, but a significant association between PA proximity and household wealth. Addressing the shortcomings of PAs, particularly in game management areas, is recommended to enhance their effectiveness in both conserving biodiversity and supporting local livelihoods. The thesis underscores the need for a community- centered approach to PA management and calls for further research on community perceptions and additional well-being indicators to guide future conservation strategies and sustainable development efforts in Muchinga Province.