Impacts of Social Safety Net Policies on Intentional and Unintentional Injury in Children

About This Grant

Summary Injury is the leading cause of death in children. Child injury research has traditionally examined intentional and unintentional injuries separately, but the research across these intent types indicates substantial shared etiologic risk factors, of which family poverty is among the strongest and most consistent. Family poverty may influence both injury types by increasing parent stress, reducing parent supervisory capacity, limiting access to quality schools and childcare, and increasing exposure to physical hazards such as sub-standard housing. It is likely that poverty-alleviating programs could have significant public health impacts for child injury as a whole, but there has been no empirical work examining this possibility. Further, existing evidence from other fields suggests that increases in income are not always health-promoting; it is plausible that the impacts of poverty- alleviating programs depend on other factors such as the mechanism of financial support (e.g., one-time versus staggered payments) and contextual factors that shape whether individuals can translate benefits into well-being (e.g., rurality, local availability of essential supports such as childcare). Although growing research on child abuse and neglect, risk factors for intentional injury, suggests that family financial support may be a powerful population-level prevention strategy, similar advances have not occurred in child injury as a whole. To address this gap, the overarching goal of the proposed study is to comprehensively estimate the impacts of major US poverty-alleviating programs on child injury rates. To do so, we will build a dataset comprising a complete census of fatal injuries and medically treated non-fatal injuries for over 300+ state-years, covering 60% of the US population. We will estimate program benefits with a novel benefits calculator that accounts for the complex non-linearities of program rules and the ways benefits from one program (e.g., TANF) affect eligibility and benefits for another (e.g., SNAP). These data will be made publicly available at the end of the project. This dataset will be used to address the following aims: (1) Identify effects of major poverty-alleviating programs (EITC, CTC, SSI, TANF, SNAP/WIC, UI, Medicaid/CHIP) on hospital-treated injuries and injury deaths in children (age <20 years); (2) Determine whether the effectiveness of poverty-alleviating programs for child injury prevention differs by rurality and area deprivation; and (3) Create a public repository of hospital- treated child injury data. Hybrid fixed effects models will provide strong confounding control and a rigorous basis for causal inference. The proposed research will provide the first estimates of the effects of poverty- alleviating programs on child injury, determining which programs have the greatest prevention potential. The project’s findings and data infrastructure will provide an important foundation for policy-focused prevention strategies and future child injury research.