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Unemployment rates soared at the beginning of the COVID-19 pandemic in the US, increasing financial stress that can affect physical and mental health. Temporary Assistance for Needy Families (TANF) is the primary cash assistance program for low-income families in the US, with benefits conditional on work activities and subject to suspension. However, many states loosened requirements during the pandemic. Using TANF policy data and data from the Behavioral Risk Factor Surveillance System from the period January 2017-December 2020 with a triple-difference design, we found a general protective effect of supportive changes to TANF on poor physical and mental health days and binge drinking during the COVID-19 pandemic for likely TANF participants. For example, providing emergency cash benefits to those not already participating in TANF, waiving work requirements, waiving or pausing sanctions, and automatically recertifying benefits were associated with reductions in the number of mentally unhealthy days. This study provides support for increasing generosity and easing administrative burdens in safety-net programs to buffer against negative impacts of public health and economic crises.

Objective COVID-19 mitigation measures prompted many states to revise the administration of their welfare programs. States adopted policies that varied across the U.S. to respond to the difficulties in fulfilling program requirements, as well as increased financial need. This dataset captures the changes made to Temporary Assistance for Needy Families (TANF) programs during the COVID-19 pandemic, from March 2020 through December 2020. The authors created this dataset as part of a larger study that examined the health effects of TANF policy changes during the COVID-19 pandemic. Data description TANF is the main cash assistance program for low-income families in the U.S., but benefits are often conditional on work requirements and can be revoked if an individual is deemed noncompliant. Structural factors during the COVID-19 pandemic made meeting these criteria more difficult, so some states relaxed their rules and increased their benefits. This dataset captures 24 types of policies that state TANF programs enacted, which of the states enacted each of them, when the policies went into effect, and when applicable, when the policies ended. These data can be used to study the effects of TANF policy changes on various health and programmatic outcomes.

Economic coercion is a form of intimate partner violence (IPV) that is distinct from but often co-occurs with physical, psychological, and sexual IPV. Women’s experiences of economic coercion are understudied in low- and middle-income countries, despite increases in women’s economic opportunities in these settings. Bangladesh is a salient site to understand how women experience, interpret and give meaning to economic coercion because historical gender inequalities in access to economic opportunities and resources are changing in favor of greater participation of women in economic activities. We conducted in-depth qualitative interviews with 24 married women aged 19–47 years to understand their experiences of economic coercion with respect to their involvement in income-generating activities in rural Bangladesh. Overall, we found that women’s experiences of economic coercion were multi-dimensional, and influenced by women’s participation in income-generating activities. In this setting, three major domains of economic coercion by husbands emerged from women’s narratives: denial of access to income-generating activities, coercive control over resources, and economic neglect. Furthermore, participant narratives reflected the continued influence of the patriarchal family system, and the gendered power relations therein, on women’s experiences of economic coercion, despite increases in women’s involvement in income-generating activities. Our results suggest that women’s experiences of economic coercion influence their participation in income-generating activities in Matlab, Bangladesh. Interventions to increase women’s economic opportunities should consider the barriers and potential repercussions of women’s involvement.

To explain observed disparities in health outcomes between men and women, sex essentialist approaches assign causal primacy to sex-related biology. In this essay, we present three case studies to illustrate how sex essentialism can distort human biomedical research and distill three maxims for countering this distortion: (1) engage in responsible citation practices; (2) generate and weigh alternative hypotheses for apparent observations of sex differences; (3) take care in constructing the appropriate denominator when making sex comparisons. We offer these maxims as broadly applicable standards of evidence to guide biomedical research that includes analysis of potential sex differences, as well as to support Institutional Review Boards (IRBs), funders, publishers, and peer reviewers in evaluating sex difference findings. If widely applied, these maxims would substantially improve the rigor, precision, and utility of the knowledge base of sex and gender science. Highlights Sex essentialism distorts human biomedical research by assigning causal primacy to sex-related factors and ignoring how gender-related factors impact biology To illustrate strategies for countering sex essentialism, we offer case studies of sex differences in COVID-19, adverse drug events, and anterior cruciate ligament injury Engaging in responsible citation practice can combat the uncritical repetition of sex difference claims that embed sex essentialism in human biomedical research Generating and weighing alternative hypotheses for apparent sex differences found in data can reveal the important role of gender-related social factors in shaping human biology Constructing appropriate denominators for making sex comparisons can help account for the gendered social processes that shape data generating mechanisms

This paper explores extreme response style to the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a measure of social participation in burn survivors. We fit a Multidimensional Generalized Partial Credit Model (MGPCM) with a positive extreme response style (PERS) factor and compared this model with the original MGPCM, estimated the impact that PERS has on scores, and examined the personal characteristics that may result in an individual more likely to respond in a fashion that would inflate their true low scores. The average impact of the PERS, based upon the root mean squared bias, ranged from 0.27 to 0.50 of a standard deviation of the scale. Individuals who were older, had participated in a burn survivor support group, and had selected to self-administer the measure were less likely to have a high PERS bias that masks low scores. Future work can consider PERS when measuring the psychosocial impacts of burn injuries and other health conditions.

Abstract Global self-rated health as a predictor of mortality has become one of the most reliable outcomes in population-based follow-up studies. However, few studies focus on age or birth cohort differences in the mortality predictiveness of self-ratings of health. Personal knowledge of health accumulates throughout the life course, leading to the hypothesis that self-rated health would be most predictive in old age or in earlier birth cohorts. However, the pronounced effect of self-rated health on mortality means that those with the higher mortality risk of poor self-rated health in earlier adulthood would be less likely to survive to old age, potentially diminishing the effect through selective survival. In this paper we test for potential variations in the effects of age and birth cohort on the association between self-rated health and mortality in a large sample of adults aged 25-101 in the Panel Study of Income Dynamics (N=6437) followed from 1999-2019. We ask if self-rated health -- net of sociodemographic factors, physical and mental health conditions, and health risk behaviors – is equally predictive of mortality in three age groups spanning young, middle, and late adulthood, and in four birth cohorts. Fully adjusted models show that self-rated health was the most predictive for the group aged 41-64, and for those born 1946-1980, and that there were nearly null effects for those aged 25-40 or born 1981-1994. Thus, the effects of self-rated health on mortality vary by age and cohort, in ways that support both knowledge-based and selective survival interpretations of the association.

Research has repeatedly shown that individual-level measures of childhood socioeconomic status (SES), such as parental income, education, occupation, or wealth, are positively associated with adult health. This is a powerful finding that points to the importance of early intervention to improve long-term health, especially for children who grew up in poverty. Less explored is the role of structural and political context in shaping childhood SES and its relationship to adult health. An understanding of structural and political conditions places individual-level behaviors, choices, and outcomes into a social context that impacts access and opportunities differently for people based on demographic characteristics, including place of residence. Illuminating structural and political determinants of health along the life span could improve interventions by broadening their reach to the population level, complimenting interventions that concentrate on individual behavioral changes.This dissertation highlights the importance of a structural approach to understanding life course health by illuminating the work that has already been done and making new theoretical and empirical contributions to the literature. The first chapter is a scoping review of an emerging field that examines the impact of childhood exposure to social and economic policies on adult health. In general, findings from the 18 articles identified suggest that more equity-centered and generous policies have positive effects on long-term health. The second chapter is a descriptive study of state-variation in the relationship between childhood SES and self-rated health. This study identifies important differences in the size of health disparities by childhood SES across states and examines potential reasons for these findings. The final chapter examines the long-term health impact of welfare reform exposure in childhood, as one example of a policy exposure that has not yet been analyzed in this way. This study found little evidence of welfare reform on long-term health but elaborates on future avenues of research. Taken together, the chapters of this dissertation suggest that childhood social, economic, and political context plays a role in shaping long-term health and should be considered more often by researchers and policymakers as a way to improve population health.

Purpose Measuring the impact burn injuries have on social participation is integral to understanding and improving survivors' quality of life, yet there are no existing instruments that comprehensively measure the social participation of burn survivors. This project aimed to develop the Life Impact Burn Recovery Evaluation Profile (LIBRE), a patient-reported multidimensional assessment for understanding the social participation after burn injuries. Methods 192 questions representing multiple social participation areas were administered to a convenience sample of 601 burn survivors. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to identify the underlying structure of the data. Using item response theory methods, a Graded Response Model was applied for each identified sub-domain. The resultant multidimensional LIBRE Profile can be administered via Computerized Adaptive Testing (CAT) or fixed short forms. Results The study sample included 54.7% women with a mean age of 44.6 (SD 15.9) years. The average time since burn injury was 15.4 years (0-74 years) and the average total body surface area burned was 40% (1-97%). The CFA indicated acceptable fit statistics (CFI range 0.913-0.977, TLI range 0.904-0.974, RMSEA range 0.06-0.096). The six unidimensional scales were named: relationships with family and friends, social interactions, social activities, work and employment, romantic relationships, and sexual relationships. The marginal reliability of the full item bank and CATs ranged from 0.84 to 0.93, with ceiling effects less than 15% for all scales. Conclusions The LIBRE Profile is a promising new measure of social participation following a burn injury that enables burn survivors and their care providers to measure social participation.

Abstract How can we differentiate distinct phases of aging in later life? Theorizations of the third and fourth age posit that later life often involves a time of continued growth and increased opportunity (the “third age”) as well as a time marked by growing cognitive, physical, and social losses (the “fourth age”). In contrast to population-based definitions that place this transition around the age of 80, a person-based definition using frailty as a marker offers more sensitivity by focusing on ability and agency instead of age alone. In this study, we apply both definitions in order to examine the social characteristics of the fourth age. Using a nationally representative sample of adults over the age of 65 from from the National Health and Aging Trends Study (NHATS) seventh round (n=6,312) we find that the population-based definition overestimates the number of adults in the fourth age (2,834 vs 569; p<0.001). Additionally, social network patterns observed when comparing adults above and below the age of 80 - increased rates of including a daughter or son and a decreased rate of including a friend - are not seen when comparing adults who do and do not meet criteria for frailty. Our findings suggest that common understandings of the social characteristics of the oldest old - understandings with important implications for policy and the promotion of human dignity - may be biased by focusing on age alone as a marker of change instead of ability and agency.