Association of Family Income Supplements in Adolescence With Development of Psychiatric and Substance Use Disorders in Adulthood Among an American Indian Population
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CONTEXT: In a natural experiment in which some families received income supplements, prevalence of adolescent behavioral symptoms decreased significantly. These adolescents are now young adults. OBJECTIVE: To examine the effects of income supplements in adolescence and adulthood on the prevalence of adult psychiatric disorders. DESIGN: Quasi-experimental, longitudinal. POPULATION AND SETTING: A representative sample of children aged 9, 11, or 13 years in 1993 (349 [25%] of whom are American Indian) were assessed for psychiatric and substance use disorders through age 21 years (1993-2006). Of the 1420 who participated in 1993, 1185 were interviewed as adults. From 1996, when a casino opened on the Indian reservation, every American Indian but no non-Indians received an annual income supplement that increased from $500 to around $9000. MAIN OUTCOME MEASURES: Prevalence of adult psychiatric disorders and substance use disorders based on the Diagnostic and Statistical Manual of Mental Disorders in 3 age cohorts, adjusted for age, sex, length of time in the family home, and number of Indian parents. RESULTS: As adults, significantly fewer Indians than non-Indians had a psychiatric disorder (106 Indians [weighted 30.2%] vs 337 non-Indians [weighted 36.0%]; odds ratio [OR], 0.46; 95% confidence interval [CI], 0.30-0.72; P = .001), particularly alcohol and cannabis abuse, dependence, or both. The youngest age-cohort of Indian youth had the longest exposure to the family income. Interactions between race/ethnicity and age cohort were significant. Planned comparisons showed that fewer of the youngest Indian age-cohort had any psychiatric disorder (31.4%) than the Indian middle cohort (41.7%; OR, 0.43; 95% CI, 0.24-0.78; P = .005) or oldest cohort (41.3%; OR, 0.69; 95% CI, 0.51-0.94; P = .01) or the youngest non-Indian cohort (37.1%; OR, 0.66; 95% CI, 0.48-0.90; P = .008). Study hypotheses were not upheld for nicotine or other drugs, or emotional or behavioral disorders. The income supplement received in adulthood had no impact on adult psychopathology. CONCLUSION: Lower prevalence of psychopathology in American Indian youth following a family income supplement, compared with the nonexposed, non-Indian population, persisted into adulthood.
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Conditional cash transfers may reduce disparities most when designed to benefit people with the lowest baseline incomes most.
“Conditional cash transfers may be most effective in reducing disparities when they are structured to have maximum impact for those with lower baseline incomes.”
From Evaluating strategies for reducing health disparities by addressing the social determinants of health. (2016) · cites this paper as [44]
In the Great Smoky Mountain Study, the effect of additional income on psychiatric disorders was present only for those in the youngest cohort (age 12 when supplements began) who had the longest exposure, with no effect in the two older cohorts (age 14 and 16 at initial supplement).
“subgroup analyses revealed that this effect was present only for those in the youngest cohort (age 12 when the supplements began) who had had the longest exposure to the additional income with no effect of income evident in the two older cohorts who were age 14 and age 16 at the time of the initial supplement.”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [29]
Some limited research indicates that income supplementation to racial minorities can lead to improved health and the reduction of at least some racial differences in health.
“Some limited research also indicates that income supplementation to racial minorities can lead to improved health and the reduction of at least some racial differences in health.”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [29]
The lower risk of psychiatric disorders in adolescence when the youth lived at home persisted into young adulthood when most had established their own residence.
“this lower risk of psychiatric disorders in adolescence when the youth lived at home persisted into young adulthood when most had established their own residence [29].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [29]
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- Authors
- Costello, E. J.
- Affiliations
- Duke University (US)
- Corresponding author
- Costello, E. Jane
- ORCID
- Costello, E. Jane
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2010-05-19
- Volume
- 303
- Issue
- 19
- Pages
- 1954
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3049729
- OpenAlex
- W2125592779
- Cited by
- 233
- References
- 46
- Citations by year
- 2026: 7 · 2025: 23 · 2024: 15 · 2023: 27 · 2022: 22 · 2021: 16 · 2020: 13 · 2019: 16 · 2018: 14 · 2017: 10 · 2016: 17 · 2015: 11 · 2014: 11 · 2013: 13 · 2012: 6
- FWCI
- 18.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression (MH63970, MH48085, MH63671)
- National Institute of Mental Health (MH-63671, R01MH063970, R01MH048085, MH-63970, MH-48085, K23MH080230, R01MH063671)
- National Institute on Drug Abuse (DA 11301, MH63671, MH63970, MH48085, P30DA023026, R01DA011301, DA023026)
- Topics
- Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- Native American youth, adult psychiatric disorders, substance use disorders, alcohol abuse, cannabis use disorder, alcoholism, age cohort effects, racial and ethnic differences, natural experiment, mental health outcomes, substance use prevention
- MeSH terms
- Adolescent, Adult, Mental Disorders, Child, Female, Humans, Income, Indians, North American, Longitudinal Studies, Male, North Carolina, Prevalence, Odds Ratio, Substance-Related Disorders, Young Adult
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