People with disabilities tend to participate in fewer out-of-home activities, raising concerns about their well-being. This paper investigates travel and activity barriers faced by people with disabilities using data from the American Time Use Survey from 2008 to 2019. Our dependent variable of interest is a measure of realized accessibility known as a travel time price: that is, the number of travel minutes associated with each minute of out-of-home activity time. In using this measure, we first confirm that out-of-home activities are associated with greater subjective well-being, that travel is associated with relatively low well-being, and that travel time prices are negatively associated with life satisfaction. We next find that people with disabilities typically pay a travel time price premium 50 percent higher than those without disabilities for all out-of-home activities, and 11 percent higher for work trips. These premiums narrow but persist when accounting for personal characteristics and travel mode. We discuss the unique contributions of simple linear and multiple regression results, given that disability is so closely linked to personal characteristics like employment, income, and marital status. We then disaggregate the results by type of disability and close by presenting ideas for removing transportation and activity barriers for the heterogenous population of people with disabilities.

In North Carolina, many women have made great strides towards economic equality. More women are earning bachelor’s degrees and the number of women entrepreneurs is growing. Yet not all women have equal access to these opportunities and the support they need to thrive, leaving many struggling to achieve financial and economic security. In the context of the COVID-19 pandemic and the economic “she-cession,” it is more important than ever to address poverty issues and barriers to opportunities for women in North Carolina. Access to quality education, responsive health care services, and dynamic business networks can help women thrive in the workforce and achieve economic success. These systems can help women bridge the divide between poverty and economic opportunity. This report provides data and analysis on several aspects of North Carolina women in the areas of poverty, economic security, access to opportunities, and support that helps women and families achieve economic stability. Data for this report was calculated based on a composite index generated from four key indicators: (1) health insurance coverage, (2) educational attainment, (3) business ownership, and (4) poverty rates. All 50 states and the District of Columbia are ranked on the composite score and component indicators. This report also examines data on topics such as poverty by household type, home ownership and houselessness, the number of public assistance recipients, and the impact of the pandemic on women in North Carolina. Each of these indicators are key components of poverty and opportunities for North Carolina women. Without adequate education, public support, or opportunities for advancement and entrepreneurship, women and families are more likely to face conditions of poverty. Throughout this report, data are analyzed by counties in North Carolina (when available) and disaggregated by racial and ethnic groups. Most of the data referenced in this report comes from 2019 and the year of data collection is noted. This report outlines the baseline of poverty and opportunity in North Carolina prior to the COVID-19 pandemic and shares emerging data on the impact of the pandemic. The final installment in a series of four publications, this report provides data and policy recommendations to improve the status of women in North Carolina—with a focus on poverty and opportunity. The first three reports focused on employment and earnings, health and wellness, and political participation. This series aims to provide critical data that can help build economic security and overall well-being among women in North Carolina. The reports serve as a resource that may be used to make data-driven decisions about how to shape public policies, prioritize investments, and set programmatic goals to improve the lives of women and families. This Poverty and Opportunity report highlights the status of women at the intersections of health, financial well-being, and education. These factors play a major role in determining the overall economic security of women and their families.

As concepts of mental health have advanced and social change has evolved, social psychiatry has adapted and influenced the contemporary delivery of mental health care to the sexual and gender minority (SGM) community. A neoteric understanding of sexual orientation was crucial in delineating a contemporary redefinition of that which constitutes a mental disorder when homosexuality was declassified in 1973. Subsequently, affirmative therapies emerged. Gender identity disorder was replaced by gender dysphoric disorder. Same-sex marriage, previously a fanciful notion, became legally recognized on a national basis. New and existing journals began to convey a corpus of novel research in sexual and gender minority studies that would be incorporated into educational curricula. And, SGM psychiatrists were, at last, free from the implications of pathology, to become active and open participants in the profession. Few classes of people within our society have undergone such dramatic change, even within the last decade. These gains have affected the well-being of SGM individuals in complex ways. This chapter explores these issues from a community psychiatry perspective, giving the community psychiatrist an essential perspective and understanding as providers of care to the SGM community.

We study the financial protection provided by health insurance through two natural experiments—the Affordable Care Act's under 26 provision and Medicare eligibility. In both cases, the coverage expansion sharply reduces medical debt in collections for consumers within the affected ages but does not systematically improve credit outcomes not directly related to medical care. This is consistent with the infrequent repayment rate and lack of persistence on credit reports that we document for medical collections, which mute a key channel through which reductions in medical collections could directly affect the other financial outcomes studied here. These results help clarify the role of health insurance in broader financial health and suggest that, at least among the populations studied here, medical debts in collection may often be a symptom rather than a cause of wider financial distress as measured on credit reports.

Parents’ time devoted to unpaid care for their children remains persistently gendered and is a key driver of gender inequality at home and work. At the same time, both mothers and fathers report a strong desire for more time with children, driven by norms prescribing an intensification of parenthood. These care pressures may be alleviated by work-family policy, an institutional tool that provides financial and normative imperatives for (re)shaping gendered arrangements of paid work and unpaid care. This dissertation explores how work-family policies aimed at or available to fathers – reserved paternity leave and workplace flexibility – shape parents’ time with children in Canada and the United States. These three chapters innovate on the conceptualization of parent-child time, considering a broader scope of time (total co-present time) and the co-presence of the other parent (solo versus family time). First, I examine how a state-provided reserved paternity leave policy in the quasi-experimental setting of Québec impacts fathers’ and mothers’ time with children. This policy led to a plausibly causal increase in fathers’ “responsibility time”, i.e., solo parenting time across activities when co-present with children. Similarly, this policy led to a plausibly causal increase in mothers’ solo parenting time in routine childcare, likely because of a corresponding decrease in housework time. Second, looking at employer-provided policy, I investigate how workplace flexibility policies are associated with fathers’ time with children in the United States. Flextime (control over start and stop times) and flexplace (work from home or remote work) are associated with increased “family” time with children – when the mother is also present – across activities. Taken together, these studies show that work-family policies aimed at or accessed by fathers can reshape gendered arrangements of unpaid care for children. However, this depends on the policy design (near-universal, state-provided reserved paternity leave versus selective, employer-provided flexibility policies) and the dimensions of parent-child time examined (total co-present time; solo or family time). Ultimately, this dissertation expands knowledge on and presents methodological considerations for the relationship between work-family policies and parent-child time, with key implications for family well-being and gender inequality.

Children who are nurtured, protected, and supported in the first years of life tend to have better individual outcomes and are more likely to grow to become healthy, productive adults. Child well-being varies across states, yet the field lacks a comprehensive review of infant and toddler indicators measured at the state-level. This paper reviews indicators of well-being from the prenatal period to three years that meet certain a priori criteria. Most of the child-level indicators identified were in the physical health domain; relatively fewer indicators were found in the early cognition and language or social-emotional-behavioral domains. While some states are making progress toward developing integrated early childhood data systems, more work is needed to provide robust data on infant and toddler development. These results highlight the need to develop a broader range of indicators of infant and toddler well-being and improve measurement sources to better inform policies and programs advancing population health.

In the United States, young adults raised in stably married two-parent families complete college, enter full-time employment and dealy family formation more often than peers raised in other fmaily forms (Fomby and Bosick 2013; Hofferth and Goldscheider 2010). These events and statuses mark the transition into adulthood and are associated with positive long-term economic, physical, and emotional well-being. Yes, two in five contemporary U.S. children grow up in other living arrangments, a disparity that largely cleaves along racial, ethnic, and social class lines (Payne 2019). Given the perceived long-term gains to growing up with stably married parents and children's divergent experiences of family composition, a substantial social science literature has emerged over the last 50 years to explore what sets paretns' marriage apart from other forms of family organization as a context for child rearing and why or whether family sturcture matters for the transition to adulthood.

Pharmaceutical and personal care products (PPCPs) are chemical compounds used by humans to improve health and well-being. Once these compounds have served their purpose, the remaining waste material often makes its way into the environment (Petrie et al 2015). Because of their widespread use and potential impacts, PPCPs have been a growing concern as environmental pollutants. Although PPCPs are usually found in the environment at the nanogram to microgram per liter scale, even at these low concentrations some PPCPs have been identified to cause detrimental environmental impacts (Korekar et al 2020, Havens et al 2020, Vo et al 2019). A comprehensive monitoring program for PPCPs remains a difficult prospect due to the approximately 3000 known pharmaceutical substances, with new substances constantly in development (Rodriguez-Narvaez et al. 2017). Compounding this issue is the effort required to monitor low concentration substances utilizing highly technical and expensive equipment, and the lack of historic data on these substances across the environment due to the relatively recent environmental concern over their pollution (Rodriguez-Narvaez et al. 2017). Questions have been raised regarding the ecosystem and anthropogenic variables that influence the distribution of PPCPs in aquatic environments, but the specific impact of human population size and density has been often overlooked. This thesis sought to identify generalized patterns in these anthropogenic variables affecting PPCP distribution.

This report provides a closer look at the well-being of the early care and education (ECE) workforce in California, using data collected by the Center for the Study of Child Care Employment (CSCCE) through the 2020 California Early Care and Education Workforce Study. For decades, low levels of public investment in this sector have kept the ECE workforce—largely women of color and immigrant women—in a grim financial bind. During the first year of the pandemic, the majority of early educators continued to work in person—risking their health and that of their families—while K-12 schools closed for distance learning. This report reveals new details on the economic realities of life as an early educator during the COVID-19 public health crisis.

Janitors are an essential part of California’s economy. Janitors clean, sanitize, and maintain buildings and other indoor spaces while being some of the most exploited workers in the service industry. Many private sector janitors earn poverty wages and lack benefits, are routinely misclassified, subjected to wage theft, experience sexual harassment, and are exposed to unsafe working conditions. Based on our analysis of government data from the 5-year sample (2015–2019) of the American Community Survey (ACS) and a pooled 10-year sample (2011–2020) of the Current Population Survey Outgoing Rotation Group (CPS ORG), this research brief finds that across almost all measures of job quality and economic well-being, private-sector female janitors are significantly worse off than their male counterparts, earning lower median wages than male janitors, and reporting higher rates of poverty at nearly 45%. Low wages are prevalent in the private sector, with almost two-thirds of private-sector janitors earning low wages. Subcontracting, a widespread practice in the janitorial industry, has contributed to the high rates of regulatory violations that undermine janitors’ employment conditions, such as misclassification, wage theft, tax fraud, gender discrimination, and sexual harassment and assault.

Importance Improving child and adolescent well-being is a critical public health goal, yet monitoring of this measure at the national level remains limited. Composite indices aggregate existing indicators from population data sources, but these indices currently have weaknesses that may inhibit widespread use. Objective To apply a novel, more child-centric index method to document changes in overall child and adolescent well-being in the US from 2000 to 2019, assess which states and racial and ethnic subpopulations experienced the greatest inequities in well-being, and identify the specific components associated with changes in the index over time. Design, Setting, and Participants This cross-sectional study applied the Child and Adolescent Thriving Index 1.0 to population-level data from 2000 to 2019 from several data sources. The area-based sampling frame for each of the component data sources allowed for nationally representative estimates for every year of the study period. The indices for every state and by race and ethnicity were also calculated. Due to the scope and breadth of the index components from across the life course, the Child and Adolescent Thriving Index 1.0 is intended to approximate the well-being of persons up to age 17 years. Data were analyzed from June 7, 2021, to March 17, 2022. Exposures Time in years. Main Outcomes and Measures The Child and Adolescent Thriving Index 1.0 is a weighted mean of 11 indicators intended to proxy well-being. The index comprises 11 components: non–low birth weight in neonates, preschool attendance in children aged 3 to 4 years, reading proficiency in fourth-grade students, math proficiency in eighth-grade students, food security in children younger than 18 years, general health status, nonobesity in high school students, nonsmoking in adolescents aged 12 to 17 years, non–marijuana use in adolescents aged 12 to 17 years, high school graduation in young adults aged 18 to 21 years, and nonarrest rate in children aged 10 to 17 years. The index ranges from 0 to 1, with 0 indicating minimum and 1 indicating maximum possible well-being at the population level. Results The Child and Adolescent Thriving Index 1.0 was applied to data from 12 320 national, state, and racial and ethnic population-level estimates. Over the study period, the Child and Adolescent Thriving Index 1.0 score increased from 0.780 points in 2000 to 0.843 points in 2019. Despite some convergence in geographic and racial and ethnic disparities, inequities were still present in 2019 in the South (−0.021 points) compared with the Northeast and among American Indian or Alaska Native (−0.079 points), Black (−0.053 points), and Latinx (−0.047 points) children and adolescents compared with White youths. Index components most associated with the overall increases in index scores of well-being were high school graduation rate (+0.028 units) and nonsmoking in adolescents (+0.022 units), amounting to 80.6% of the total increase. Conclusions and Relevance Results of this study suggest that child and adolescent well-being scores increased from 2000 to 2019, but substantial work remains to address persistent inequities across states and racial and ethnic populations. The newly developed Child and Adolescent Thriving Index 1.0 may be used in future work to evaluate which public policy types (economic, social, health care, housing, or education) are associated with higher levels of well-being.

More than 3.1 million immigrants reside in New York City, comprising more than a third of the city’s total population. The boroughs of Brooklyn and Queens are home to nearly 940,000 and more than 1 million immigrants, respectively. According to the New York City Department of Health and Mental Hygiene’s (DOHMH) Community Health Survey (CHS), foreign-born New Yorkers have poorer health and less access to healthcare than their US-born counterparts. For this study, the Center for Migration Studies of New York (CMS) focused on six neighborhoods in these two boroughs whose immigrant residents were identified by a previous CMS study, Virgin and Warren (2021), as most at risk of poor health outcomes: Brooklyn • Bay Ridge/Dyker Heights • Bushwick • Sunset Park/Windsor Terrace Queens • Elmhurst/South Corona • Flushing/Whitestone/Murray Hill • Jackson Heights/North Corona Immigrants comprise between 31 to 63 percent and undocumented immigrants comprise between 5 to 18 percent of the total populations in these neighborhoods. Though many of New York City’s health and social service programs are open to all residents, immigrants – especially the undocumented – remain at greater risk of poor health outcomes than US-born residents due to other barriers to access to healthcare. The CMS research team conducted a survey of 492 immigrants across these six neighborhoods and convened one focus group to collect data on immigrants’ health and well-being. CMS also surveyed 24 service providers including community health clinics, health-focused communitybased organizations (CBOs), and hospitals that work with immigrants in the studied neighborhoods. Analysis of these data, together with the US Census Bureau’s American Community Survey (ACS) and the DOHMH's CHS, provides insight into the factors that affect immigrants’ health and wellbeing across these neighborhoods. This study highlights several social determinants of health that likely contribute to the native-immigrant health gap. Finally, the study describes steps that can be taken to close this gap. The report offers the following top-line findings: Self-reported Health: • Immigrant respondents on average said they were in good health. Respondents from Mexico, Hong Kong, and Bangladesh had the worst self-reported average health. Among the neighborhoods studied, immigrant respondents from Flushing/Whitestone/Murray Hill had the worst self-reported health. Social Determinants of Immigrants’ Health in New York City: A Study of Six Neighborhoods in Brooklyn and Queens | June 2022 3 Access to Care: • Thirty-seven percent of immigrant respondents said they needed to access healthcare1 in the last 12 months but did not receive it. • Service providers identified different barriers than did immigrants to accessing healthcare for physical health concerns. The top three reasons immigrants said they did not receive the necessary physical healthcare were: 1. Lack of health insurance; 2. Inability to afford care; and 3. Inability to take time off due to work, childcare, or other responsibilities. By contrast, the top three reasons immigrant service providers said immigrants did not receive needed physical healthcare were: 1. Language barriers; 2. Fear of revealing documentation status; and 3. Inability to afford services. • These findings suggest that service providers overestimate the role culture plays as a barrier to immigrants receiving mental healthcare. • The top three reasons immigrants reported for not seeking mental health services were: 1. Inability to take time off due to work, childcare, or other responsibilities; 2. Lack of health insurance; and 3. Inability to afford services. By contrast, the top three reasons service providers said immigrants do not receive needed mental health services were: 1. Fear of stigma; 2. Cultural reasons; and 3. Language barriers. Cost was one of the top deterrents for immigrants in seeking medical care. More than half of respondents said the out-of-pocket costs or high-deductibles on their medical insurance plan “sometimes” or “regularly” discouraged them from seeking medical treatment. Twenty-nine percent of respondents said they had reduced spending on food or other essential items to cover the cost of healthcare in the previous year. Income: • Citizens, both US-born and naturalized, in New York City have much higher average earnings than legal noncitizens and undocumented immigrants. This large earnings gap between 1 "healthcare" refers to seeing a general practitioner, specialist doctor, dentist, or mental health professional, or using prescription or over-the-counter drugs. Social Determinants of Immigrants’ Health in New York City: A Study of Six Neighborhoods in Brooklyn and Queens | June 2022 4 citizens and noncitizens held across the six neighborhoods with the exception of Elmhurst/ South Corona, where the difference in earnings between citizens and noncitizens was smaller than in the other neighborhoods. Overall earnings for workers in Elmhurst/South Corona were the lowest of all the neighborhoods studied. Occupation: • Immigrant respondents who were exposed to mental and physical safety hazards at work were more likely to have a long-standing physical or mental illness. Education: • Immigrants with a lower level of education are less likely to have health insurance. While the gap in insurance coverage between the high- and low-educated is large among people of all immigration and citizenship statuses, it is especially pronounced among the undocumented. Between 2015 and 2019, 69 percent of undocumented immigrants in New York City with less than a 9th grade education had no health insurance compared to 25 percent of undocumented college graduates. Limited English Proficiency: • More than 69 percent of immigrants who speak Spanish and more than 75 percent who speak Chinese2 at home in the six neighborhoods have limited English proficiency. • English language proficiency is associated with immigrants’ likelihood of seeking out needed care, but it was not reported as a primary barrier among immigrant respondents to receiving healthcare. Some immigrants – especially Cantonese-, Hindi-, and Mandarin-speakers – reported language barriers to be a problem in accessing healthcare. Those immigrant groups, together with Urdu-speakers, were the most likely to report discrimination on the basis of language when seeking care. • Limited English proficiency may be a barrier to obtaining private health insurance, immigrants with limited English proficiency are more likely to use public health insurance or health insurance alternatives than remain uninsured. Food Insecurity: • Cost is the primary barrier which prevents immigrants from healthy eating. Nearly a quarter of immigrants across the six neighborhoods reported being food insecure (defined as going without eating at least once in the past month due to lack of resources) primarily due to a lack of funds to buy food, particularly healthy food. • Immigrants living in Bushwick and Jackson Heights/North Corona are more likely to live in areas considered “food deserts,” or live in areas without access to fresh food within a mile of their house. • Service providers reported lack of nearby fresh produce to be more of a barrier to healthy eating than did immigrants. Neighborhood Conditions: • Immigrants were asked about whether they felt safe in their neighborhoods and whether the following were problems in their neighborhood: access to public transportation, crime, lack of 2 Mandarin or Cantonese. Social Determinants of Immigrants’ Health in New York City: A Study of Six Neighborhoods in Brooklyn and Queens | June 2022 5 green spaces, litter, noise, pollution, and traffic. Better neighborhood quality along these metrics, was associated with better self-reported health among immigrants. Traffic was the top-reported problem overall across the neighborhoods, followed by noise, pollution, litter, and crime. • Distance and lack of transportation were reported as barriers to accessing healthcare among immigrants in Bushwick, Elmhurst/South Corona, and Flushing/Whitestone/Murray Hill. Discrimination: • Immigrants reported facing discrimination in their communities, which sometimes prevented them from seeking healthcare. Among those who said they had needed to see a healthcare professional3 in the previous 12 months but did not, 17 percent said fear of discrimination was one of the reasons they let their ailments go untreated. • Discrimination on the basis of race in seeking healthcare was the form of discrimination most reported by immigrants, followed by discrimination based on nationality/citizenship. Use of New York City Services: • Approximately half of immigrant respondents had heard of NYC Care, a public program that provides low- to no-cost healthcare for residents who do not qualify or cannot afford health insurance. Just over a third of respondents had heard of the Mayor’s Office of Community Mental Health (formerly ThriveNYC), a city-led mental health service network, and ActionNYC, a city program providing free immigration legal service, regardless of status. About a quarter of respondents used NYC Care, and less than a fifth of respondents used ThriveNYC and ActionNYC. Those who used these programs were satisfied with them. Based on these findings, CMS offers the following recommendations to improve immigrants’ health outcomes across the six neighborhoods studied: • The Biden Administration should continue the marketplace provisions of the American Rescue Plan Act of 2021.4 Part of this Act made Affordable Care Act (“Obamacare”) plans more affordable and expanded access to them by reducing the percentage of household income that people must spend on the benchmark for the plan and providing premium tax credits to households meeting more than 400 percent of the federal poverty level. • Governor Hochul should ensure that New York State proposed legislation which includes “Coverage for All” is enacted. This …

Summary: A majority of the largest single-site outbreaks of COVID-19 infections in the United States have been in prisons and jails since the beginning of the pandemic. These outbreaks threaten the lives and well-being of incarcerated people, correctional staff, and people who live in the communities to which incarcerated people return. This study employs both linear and logistic multivariate regression models to examine data from the UCLA’s COVID Prison Data Project, IPUMS CPS [Integrated Public Use Microdata Series—Current Population Survey], the National Center for Health Statistics, and the Prison Policy Initiative to better understand the facility, county, and state-level predictors of COVID-19 infections and deaths in correctional facilities. The study finds that while some facility-level characteristics are associated with infections and deaths, county-level racial and economic characteristics matter more. In particular, facilities in counties with more Latinx and Indigenous people and lower average incomes have higher infection rates. Likewise, the odds that someone in a facility has died from COVID-19 are higher in counties with more Latinx people, lower average incomes, more college graduates, and fewer people who never married. Moreover, state-level policy changes to address this crisis have failed to do so effectively. While this study is unable to access how county-level characteristics influence these facility-level outcomes, it does demonstrate a clear connection between racialization and exposure to early death.

Monitoring the well-being of children and adolescents is essential for improving overall population health. However, with only a few exceptions, direct measures of well-being are not currently collected at scale in the United States. Multidimensional indices of outcome indicators related to well-being have been proposed as an alternative, but existing indices have several weaknesses. This dissertation implements a novel methodology to derive an improved index of the outcome indicators of child and adolescent well-being that can be applied to existing population data. Using a nationally representative longitudinal panel, model selection and regression techniques are implemented to estimate the relationship between a collection of standard outcome indicators of well-being with several subjective scales collected directly from children and adolescents. This process results in an index methodology based on their actual lived experiences, making it a more child-centric measure. Within the panel, higher scores on the index are associated with improved health and higher earnings in young adulthood. When iii subsequently applying the methodology to population macrodata from 2000 to 2019, we find that the outcome indicators of child and adolescent well-being, as measured by the index, improved consistently throughout the past two decades. This overall advance was accompanied by some convergence in disparities by geography and race/ethnicity, but significant inequities remain. However, the progress exhibited by the outcome indicators of well-being contrasts sharply with recent declines in other measures of child and adolescent mental health. This contradiction suggests that the outcome indicators, which at one point tracked reasonably well alongside the subjective well-being of children and adolescents, are no longer performing as expected. Researchers, policymakers, advocates, and practitioners should therefore collectively recommit to expanding population health monitoring systems to better capture the most essential aspects of child and adolescent well-being.

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.

This report provides a closer look at the well-being of the early care and education (ECE) workforce in California, using data collected by the Center for the Study of Child Care Employment (CSCCE) through the 2020 California Early Care and Education Workforce Study. For decades, low levels of public investment in this sector have kept the ECE workforce—largely women of color and immigrant women—in a grim financial bind. During the first year of the pandemic, the majority of early educators continued to work in person—risking their health and that of their families—while K-12 schools closed for distance learning. This report reveals new details on the economic realities of life as an early educator during the COVID-19 public health crisis.

This chapter argues that money manager capitalism in the United States, which has resulted in greater income inequality and erosion of the middle class, has contributed much to the political polarization of recent years. It also argues the consequences of that capitalism have necessitated strengthening labor market institutions and coordinating the public and private sectors in ways that increase economic opportunity and protect working families. The chapter presents data showing the consequences of money manager capitalism are more visible in "blue" states than "red" states, making blue-state residents generally more open to pro-worker public policy reforms than red-state residents. Blue-state residents may have experienced a greater increase in economic insecurity in recent decades, but red-state residents may be experiencing greater economic anxiety. The task ahead is to craft and build support for policy changes that could unify red and blue voters by shoring up the middle class and improving worker well-being.

This work assesses the possibilities and limitations of reducing poverty among families with children by increasing the work effort of the adults in those families. Following a historical review of family poverty since 1995, the authors present several policy simulations, including increased employment, a higher minimum wage, more generous tax credits, a child allowance, and reduced childcare or medical expenses. Specific policy proposals—including the proposals of the Biden Administration—are assessed using four criteria: reducing child poverty; equitable treatment of the poorest groups; promotion of self-sufficiency; and cost-effectiveness. The authors conclude that while no single policy is able to reduce family poverty by half while meeting the other criteria, several combinations of policies have the potential to do so.

Objectives. To quantify the impact of telemedicine for medication abortion (TMAB) expansion or ban removal on abortion accessibility. Methods. We included 1091 facilities from the 2018 Advancing New Standards in Reproductive Health facility database and Planned Parenthood Web site, among which 241 did not offer abortion as sites for TMAB expansion. Accessibility was defined as the proportion of reproductive-aged women living within a 30-, 60-, or 90-minute drive time from an abortion-providing facility. We calculated accessibility differences between 3 scenarios: (1) facilities offering abortion in 2018 (reference), (2) the reference scenario in addition to all facilities in states without TMAB bans (TMAB expansion), and (3) all facilities (TMAB ban removal). We also stratified by state and urban–rural status. Results. In 2018, 65%, 81%, and 89% of women lived within a 30-, 60-, or 90-minute drive time from an abortion-providing facility, respectively. Expansion and ban removal expanded abortion accessibility relative to the current accessibility scenario (range: 1.25–5.66 percentage points). Women in rural blocks experienced greater increases in accessibility than those in urban blocks. Conclusions. TMAB program and policy changes could expand abortion accessibility to an additional 3.5 million reproductive-aged women. Public Health Implications. Our findings can inform where to invest resources to improve abortion accessibility. (Am J Public Health. 2022;112(8):1202–1211. https://doi.org/10.2105/AJPH.2022.306876) Obtaining a wanted abortion is a determinant of psychological, physical, social, and economic well-being among US women and of social and economic well-being among their children.1–9 (Not all individuals who seek abortion care identify as women. To date, much of the abortion literature has focused on the experience of “women.” When citing past literature reported as including “women,” we use that language. Similarly, the US census data we used included the population of US “women.” When referring to people who received abortion care, we use the term “client.”) Furthermore, abortion is legal, safe, and supported by major medical organizations.10 However, many state-level restrictions on abortion access and provision create barriers to care.11–19 Given these barriers, measuring access to abortion care in the United States is important for public health decision making. One component of access, accessibility (defined by Penchansky and Thomas as “the relationship between the location of supply and the location of clients”20(p128)), is often operationalized as how far people are from health services, regardless of their immediate need for those services. Studies in the United States indicate that implementation of antiabortion policies can decrease abortion accessibility.13,18 In 2008, to overcome a state-imposed physician medication abortion dispensing regulation, Planned Parenthood of the Heartland in Iowa launched a site-to-site telemedicine for medication abortion (TMAB) care delivery model. Under this model, clients visit a health center where an abortion provider is not physically present and meet with a remote clinician via videoconference. As in an in-person medication abortion visit, the clinician answers the client’s questions and may watch as the client is given the first dose of abortion medication. Relative to in-person medication abortion, TMAB is equally or more safe, effective, and acceptable to clients and providers.21–23 Furthermore, in comparison with clients seen at this clinic network before TMAB implementation, those seen after implementation traveled slightly shorter distances.24 Although Planned Parenthood has expanded use of TMAB since 2008 to additional states where the service is not banned, as of 2018 nearly half of Planned Parenthood health centers did not offer any abortion services.25 Furthermore, because of the politicization of abortion, use of telemedicine to deliver medication abortion, including via TMAB services, has been banned in 19 US states.26 We sought to expand on the existing literature by quantifying the potential impact of TMAB expansion, or removal of TMAB bans, on abortion accessibility among all US women of reproductive age.

Little is known about the financial security of Vietnam-era veterans now that most are over 65 and have left the labor force. Using 2018 survey data, we found that, on average, Vietnam-era veterans aged 63 to 78 had slightly less income than nonveterans of their ages: US$63,500 and US$65,000, respectively. Those veterans received more money from Social Security and retirement plans; nonveterans had more earnings and investment income. About 1.3 million Vietnam-era veterans collected an average of US$17,600 in disability compensation from the Department of Veterans Affairs, lifting their average total income above other veterans’ by about US$5,000. Overall, veterans were less likely to be poor or very wealthy than were nonveterans. Information on income provides insight to Congress and the public about the economic stability and, by extension, overall well-being of Vietnam-era veterans as they age.