A randomized controlled trial to improve health among women receiving welfare in the U.S.: The relationship between employment outcomes and the economic recession
Open accessAbstract
The high prevalence of health conditions among U.S. women receiving Temporary Assistance for Needy Families (TANF, or 'welfare') impedes the ability of many in this group to move from 'welfare-to-work', and the economic recession has likely exacerbated this problem. Despite this, few interventions have been developed to improve employment outcomes by addressing the health needs of women receiving TANF, and little is known about the impact of economic downturns on the employment trajectory of this group. Using data from a recent randomized controlled trial (RCT) that tested the efficacy of a public health nursing (PHN) intervention to address the chronic health condition needs of 432 American women receiving TANF, we examine the effect of the intervention and of recession exposure on employment. We further explore whether intervention effects were modified by select sociodemographic and health characteristics. Both marginal and more robust intervention effects were noted for employment-entry outcomes (any employment, p = 0.05 and time-to-employment, p = 0.01). There were significant effects for recession exposure on employment-entry (any employment, p = 0.002 and time-to-employment, p < 0.001). Neither the intervention nor recession exposure influenced longer-term employment outcomes (employment rate or maximum continuous employment). Intervention effects were not modified by age, education, prior TANF receipt, functional status, or recession exposure, suggesting the intervention was equally effective in improving employment-entry across a fairly heterogeneous group both before and after the recession onset. These findings advance our understanding of the health and employment dynamics among this group of disadvantaged women under variable macroeconomic conditions, and have implications for guiding health and TANF-related policy.
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Employment can affect health both positively and negatively through resources, chronic stress, and political power.
“Employment can have positive and negative impacts on health via effects on resources, chronic stress, and political power.(48)”
From Evaluating strategies for reducing health disparities by addressing the social determinants of health. (2016) · cites this paper as [48]
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- U.S. Department of Health and Human Services TANF Caseload Data - Number of Families and Recipients - 2007, 2008, 2009, 2010 2011 Administration for Children & Families Washington, D.C.
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Thornton, R. L. J., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016) · Health Affairs · doi:10.1377/hlthaff.2015.1357 · Cited by 591 · see citing works
- Authors
- Kneipp, S. M., Kairalla, J. A., & Sheely, A. L.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Florida (US)
- Corresponding author
- Kneipp, Shawn M.
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2013-03
- Volume
- 80
- Pages
- 130-140
- ISSN
- 0277-9536 (ISSN-L)
- PMC
- PMC3577993
- OpenAlex
- W1991048848
- Cited by
- 15
- References
- 46
- Citations by year
- 2024: 1 · 2022: 1 · 2021: 1 · 2020: 3 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 1 · 2013: 1
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- UNC Libraries
- Funders
- National Institutes of Health
- National Institute of Nursing Research (5R01NR009406)
- Topics
- Social Sciences › Gender Studies › Gender, Labor, and Family Dynamics
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Social Sciences › Gender Studies › Labour Market and Migration
- Keywords
- welfare recipients, TANF, employment effects, economic recession, women's health, chronic disease, welfare-to-work transition, time to employment, employment entry, health policy
- MeSH terms
- Adult, Employment, Female, Follow-Up Studies, Health Promotion, Humans, Social Welfare, United States, Program Evaluation, Young Adult, Economic Recession
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