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Concerns about the well being of children and adolescents who live in poverty have grown as the nation has embarked on cz major restructuring of welfare, income support, health, and social service policies over recent years. As such decisions are macle, it is critical that they consider the most current research regarding the effects of poverty anc3 welfare clepenclency on chil- ciren, anc3 the outcomes of efforts to inter- vene in the lives of children anc3 their fami- lies. Although the attention of those who craft welfare reform proposals has been focused largely on the objectives of job training anc3 placement of welfare clients, the new fec3- eral welfare law highlights the health anc3 well-being of children as outcomes that warrant assessment in efforts to evaluate the effects of welfare reform. And while a grow- ing number of interdisciplinary teams are engaged in empirical anc3 evaluation work focused on children living in poverty anc3 in families receiving welfare, little of this re- search actresses issues related to physical health anc3 nutrition. Furthermore, although there is a broacler research literature on the links between income anc3 health (Newacheck et al., 1994; Wise anc3 Meyers, 1988; Wilkinson, 1996), as well as on low-income chilciren's access to health care (Fossett et al., 1992), more information is needled about this complex relationship, including the reasons for anc3 extent of the links. Moreover, although scientists are studying issues related to chilciren's nutrition, their work is largely being carried out in Third World countries. Complicating efforts to assure health care for impoverished children anc3 adolescents are difficulties obtaining accurate estimates of the number lacking health insurance. In an effort to bring together researchers engaged in current studies of poverty anc3 child health anc3 nutrition, to encourage discussion of these issues, anc3 to identify the gaps in U.S.-basec3 research in this field, the Board on Children, Youth, anc3 Families (of the National Research Council anc3 the Institute of Medicine) chose this issue as the subject of its third annual research briefing on welfare anc3 chilciren's development. The briefing, held in May 1997, was co- sponsorec3 by the Family anc3 Child Well- Being Research Network (of the National Institute of Child Health anc3 Human De- velopment, U.S. Department of Health anc3 Human Services). The briefing hac3 three objectives: to highlight research that bears on contemporary clebates about welfare policy anc3 health care policy for the poor, to bring this research some of it preliminary to the attention of federal anc3 state policy makers, anc3 to consider next steps for research that confirms some of these findings, anc3 to explore areas of new research on the well- being of children anc3 youth in the context of devolving responsibility for welfare anc3 health care. 1

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This report is organized around the follow- ing three questions that emerged from the presentations and discussions at the briefing: . How do income and poverty affect the health of children and adolescents? How does nutritional status affect children's development? How are children and youth affected by changing patterns of health insurance coverage? Each of these Questions has been the tonic ~ . ~ ot research tor a number ot years. But as with any research, the accumulation of knowledge is incremental and new policy contexts pose new questions that can chal- lenge prior evidence. The briefing as- sembled both well-known and new re searchers investigating these questions to present new findings that, collectively, can expand the knowledge base. In some cases their findings were generated from reanaly- ses of existing datasets (e.g., the Infant Health and Development Project, the Na- tional Health Interview Survey). In other cases, new datasets were analyzed specifi '' r ~. a. ~ 1 ~ catty tor the briefing te.g., the Add Health Study, the Iowa Youth and Family Project, the Community Tracking Study). Most of these data were collected before the enact- ment of major changes in federal welfare and health care policy. In every case, the researchers tried to respond to new informa- tion requirements emerging because of con- temporary policy changes. In the area of child and adolescent health, 2 for example, there is new interest in exam- ining neighborhood-level influences on health care and health status. The ~resent ~ ~ . a. ~ ~ ers at the briefing shared an interest in ex- amining the context in which health care is sought and provided, and in understanding the family processes that may mediate the effects of both neighborhood and economic factors on child and adolescent health. In the area of child nutrition, emerging issues addressed at the briefing include the re- versability of different types and degrees of early malnutrition, the differing conse- quences of the developmental timing of malnutrition, and how environmental fac- tors interact with malnutrition to affect development. r The briefing included pre- sentat1ons trom new longitudinal and evalu- ation research designed to address these questions. Research on children's insurance coverage, as a major determinant of their access to care, is relatively new and has received focused attention in today's policy context. The research on this issue pre- sented at the briefing comes from the new Community Tracking Study, new analyses of the National Health Interview Survey, and a new survey of state Medicaid officials. The briefing also featured a discussion by state health administrators of data and re- search needs from the perspective of state and local officials. Comments from this discussion are presented in quotations that appear throughout the report. Participants' . . . . r. 1 Ideas about topics that warrant turtner re- search are included in a section at the end of the report.

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The research briefing also incluclec3 presen- tations anc3 discussions of several new child health interventions, some of which are expected to yield data in the near future. These projects are clescribec3 in Appenclix A. Appenclix B contains a list of projects monitoring the effects of welfare reform. The presenters were selected through a lengthy process of peer nominations, start- ing with calls to major experts on child poverty, health, anc3 nutrition. The goal was to identify investigators who hac3 new findings on the issues of concern so that the information could move quickly from re- searchers to policy makers. Although efforts were macle to identify the most significant new research at the intersection of child poverty, health, anc3 nutrition, some rel- evant areas of inquiry were not incluclec3 (for example, although incidence in children of asthma anc3 injuries can be related to pov- erty status see Halfon anc3 Newacheck, 1993, anc3 Rivara, 1995 this report floes not include literature on these areas because they were not part of the research briefing) anc3 there is uncloubtecily much more re- search uncler way than we iclentifiec3 in our planning process. This summary of findings is best viewed as a supplement to the literature on child pov- erty, health, anc3 nutrition, rather than a comprehensive or representative review of current research on these issues. The report offers important new incremental eviclence on these topics from one of a series of re- search briefings of the Board on Children, Youth, anc3 Families that present work in progress anc3 recent findings on various as- pects of welfare anc3 chilciren's development. 3

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HOW DO INCOME AND POVERTY AFFECT THE HEALTH OF CHILDREN AND ADOLESCENTS? At a time of tightening health care budgets and enormous health system change, re- searchers are attempting to determine the specific ways in which poverty affects the health of children and youth, and policy makers are searching for the most effective solutions to poor children's lack of health care. Twenty-one percent of children were poor in 1995 (U.S. Bureau of the Census, 1996~.1 The association between poverty and poor child health outcomes has been well documented. For example, research has shown that low-income children were 73 percent more likely to have a severe health condition than nonpoor children (Newacheck, 1994~. Further studies have found that poverty is associated with in- creased neonatal and post-neonatal mortal- ity rates, higher risk of injuries from acci- dents or physical abuse and neglect, higher risk of asthma, and lower developmental scores in a range of tests at multiple ages (Aber et al., 1997~. Less is known about the mechanisms through which poverty oper ates, which aspects of poverty are most dam aging, and the multivariate nature of pov erty and its effects on children and youth. Longitudinal studies show that family income is more strongly associated with children's ability and achievement than emotional outcomes, and early childhood poverty may have an even larger impact (Brooks-Gunn and Duncan, 1997~. Re- searchers studying the relation between income and poverty and the health of chil- dren and youth have found that child health varies by family income, with the percentage of children and adolescents in very good or excellent health rising as fam- ily income increases2 (Federal Interagency Forum on Child and Family Statistics, 1997~. Researchers have also shown that health problems affecting children in the United States, including iron deficiency anemia, underweight and obesity, and asthma, are more prevalent among the poor (Newacheck et al., 1994; Wise and Meyers, 1988~. Research on child health outcomes pre- sented at the briefing addresses these issues by focusing on the context (e.g., families, neighborhoods, etc.) in which health care is provided and seeking to understand how poverty affects children's health. (The sec- ond and third sections of this report also 1This statistic uses the official poverty line, which has been criticized for being too low (Betsen and Michael, 1997~. 2About 88 percent of children and youth in families with annual incomes of $35,000 or more were in very good or excellent health in 1994, compared to 63 percent of children and youth in families with annual incomes under $10,000 (Federal Interagency Forum on Child and Family Statistics, 1997~. 4

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explore how poverty influences child health anc3 nutrition anc3 health insurance cov- erage. ~ A study presented by Jeanne Brooks-Gunn of Columbia Univer- sity examined the ef- fect of family anc3 neighborhood income 1 1 1 1 "There has been a transition away from being able to name and count the problems to wanting to know what are our strengths, what is protective of our problems." Susan Nalcler, New Mexico Department of Health on the health care use of young children who were born premature anc3 at low birth- weight (Brooks-Gunn et al., 1997~. The study used data from the Infant Health anc3 Development Program (1HDP), which in- clucles 985 low-birthweight preterm infants anc3 their families in eight sites across the country; the children were seen ~ ~ times from birth to age 8 (Gross et al., 1997~. A quarter of the mothers were white, half were black, anc3 the rest were I-atina. Maternal reports about health care use, family in- come, health insurance, anc3 family charac- teristics were obtained when the children were 12, 24, anc3 36 months of age. Neigh- borhooc3 income was based on census tract residence at time of birth. In the study, the mothers proviclec3 information on hospital- izations. clays spent in the hospital, doctor visits (for well-baby care as well as illness), anc3 emergency room visits in the past year. Data were averaged over the chills first three years of life. Low-birthweight chil- ciren from poorer3 families were more likely to be hospital- izec3, to spend more clays in the hospital, anc3 to have more visits to the emergency room than low- birthweight children from more affluent families, taking into account all other vari- ables, including public and private health insurance. Number of doctor visits was not associated with poverty status. Residence in poor and middle-income neighborhoods was associated with more visits to the emergency room than residence in affluent neighbor- hoods, independent of family-specific in- come and all other characteristics measured (a finding that has heretofore been largely linked to low-income families and low- income neighborhoods). Interestingly, the finding about middle-income families runs counter to the conventional wisdom that low-income families primarily account for 3Families in the study were classified as poor or nonpoor using the 1986 U.S. poverty thresholds, based on family income and size at the 12-month assessment (conducted in 1996~. Regarding neighborhood income, families living in neighborhoods in which fewer than 10 percent of neighbors earned more than $30,000 were designated as poor; families in neighborhoods in which 10 to 29 percent or more of neighbors earned $30,000 or more were designated as middle income; and families in neighborhoods in which 30 percent or more of the neighbors earned more than $30,000 were designated as affluent. 5

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emergency room visits. Families in middle- income neighborhoods also reported more well-baby visits than families in poor or affluent neighborhoods, controlling for health insurance coverage. The study also found that health insurance was associated with more doctor visits for the low-birth- weight babies, but not with hospitalizations or emergency room use. Based on the findings of this study. Brooks ~1 1 11 i, Dunn and ner colleagues concluded that among families with low-birthweight babies not only does family income shape the pat- tern of health care use, but the neighbor- hood in which the family resides also plays a role. They called for further exploration 1 . ~ . 1 into identi~vina how novertv affects chil a variety of neighborhoods may alter the relationship between neighborhood and . . emergency V1S1tS. A study presented at the briefing by Kathleen Mullan Harris of the University of North Carolina looked at the effects of nov . i' erty anct welfare receipt on physical health and health risk behavior among adolescents (Harris, 1997~. The study used data from the National Longitudinal Study of Adoles- cent Health (Add Health), a nationally representative sample of 12,105 adolescents in grades 7 to 12 in the United States in 1995. The Add Health survey, which fea- tures a school-based design, was geared to help explain the causes of adolescent health and health behavior. with special emphasis ,, ~ - - -- - - ~ 0 - - - r - - - ~ - - - -- - - -- - - - -- - - - ~ - - - -A - - - - r 1 ~ 1 1 1 A ~ 1 ~1 '' ~1 1 . 1 . ~ dren s health care use. As ~rooks-~unn noted, the study suggests that reducing fam- ily poverty might reduce emergency room use and the number of hospitalizations among low-birthweight babies. In contrast, increasing the number of children with insurance would be more likely to affect . ... . . routine and well-baby doctor V1S1tS. 1 bus, this study suggests that a combination of economic and health care policies would be most effective in improving health care use among poor families with low-birthweiaLt 1 1 . A 1 .1 1 babies. As children are increasingly covered by health maintenance organizations (HMOs) and similar plans, efforts to pre- vent emergency room visits may increase. The ability of HMOs to offer urgent care in on the ettects ot the multiple influences on adolescent life.4 Among the sample, 7,644 adolescents (63 ~ ~ A. percent' were non-~1snanic white. 2.294 is ~ ~ , , id percept J were non-Hispanic black, 1,442 (12 percent) were Hispanic, and 667 (5 percent) were non-Hispanic other. Eigh- teen percent of the adolescents surveyed lived below the poverty line ($16,000 in 1995) and 29 percent lived within 150 per- cent of poverty ($24,000~; 19 percent lived in families that had received some form of social welfare within the previous month. The study found that the effects of poverty and welfare receipt on health and risk be 4Subsequent to the research briefing, the first data from the Add Health study were released (in September 1997~. 6

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havior were negative and consistent across a range of outcomes (see Table ~ ). that is. for , , , each neattn outcome, adolescents who live below poverty experience poorer health than nonpoor adolescents; in most cases, the welfare poor those receiving either Aid to Families with Dependent Children (AFDC) or food stamps have the poorest 1 1 1 1 . 1 neattn ancr engage In the riskiest health behavior. Specifically, adolescents living below the poverty line had poorer general health (as reported by the adolescents and their parents); were more likely to miss school due to health or emotional problems; were more likely to have neurological im' pairment, obesity, and asthma; and were more likely to engage in risky behaviors than nonpoor adolescents. The only nega' live behavior that low income adolescents engaged in at a lower rate than or at the same rate as nonpoor adolescents was sub' stance abuse (defined as use of drugs, alco' hoi, and tobacco). This finding may indi' care that this behavior occurs across income lines, although different factors may account for the same rates of use within the two income groups. Furthermore, no differences on any of these outcome measures were found between adolescents who lived below the poverty line and those living in families who were also poor and received welfare. Harris explained the study's findings by noting that access to health care and insure ance coverage differs between nonpoor and poor adolescents, with poor adolescents more likely to lack insurance or have trouble obtaining medical care. Even if they are covered by Medicaid, poor adolescents can encounter difficulties obtaining high' quality care (see section on health insure ance). In addition, when low income ado' lescents have health insurance, they are less likely than adolescents without health in' surance to report that they are in poor health, but they still report poorer health than nonpoor adolescents, according to Harris. Characteristics associated with increased risks of poverty (e.g., family structure- living with a single mother, urban residence, minority and immigrant status) are also 1 . 1 . 1 assoc~atecr with ~ncreasecr risks of health problems among adolescents, according to Harris. In addition, contextual influences, such as family interaction and parenting behaviors, affect adolescents' health and risk behavior. Parents in low~income families tend to monitor their teenage children's behavior to the same extent or more than nonpoor parents, the study found, while low-income parents seem to be less involved in other dimensions of their adolescents' lives (e.g., talking to other parents; becom' 1 1 . ing involved in their children's school; and 5Risky behaviors include ever having sex, lack of birth control at first intercourse, lack of birth control at last intercourse, ever having a sexually transmitted disease, excessive symptoms of depression, delinquent behavior, violence toward another, violence as a victim, and substance abuse. 7

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Table Adolescent Health Status and Health Behavior by Poverty Status Percent Percent Nonpoora poorb Percent Welfare PoorC Physical Health General health fair to poor Missed school due to health or emotional problem Neurological impairment Obesity Asthma 4.6 33.7 15.9 24.5 31.2 1.5 9.1 10.1 40.8 13.2 44.5 26.4 32.0 13.9 Health Risk Behavior Ever had sex 35.3 47.0 48.3 Birth control at first intercourse 66.5 58.9 55.0 Birth control at last intercourse 69.8 62.5 62.5 Ever had a sexually transmitted disease 5.7 8.4 10.0 Depression 19.8 29.5 32.5 Delinquency 21.8 25.5 25.5 Violence toward others 32.0 44.2 47.5 Violence as a victim 18.4 26.0 28.1 Substance abuse 20.0 17.3 17.9 a Nonpoor adolescents live in families with incomes above the poverty line for a family of four {$ 16,000 in 1995~. b Poor adolescents live in families with incomes below the poverty line. c Welfare poor adolescents live in families with income below the poverty line and receipt of either AFDC or food stamps. SOURCE: Data from Harris ~ 1 997] . communicating with their children about friends, personal problems, anc3 school ac- tivities). The study also found that in fami- lies that ate dinner together anc3 parented clemocratically,6 aclolescents were less likely to have sex, be clepressec3, or act violently toward others. School anc3 neighborhood effects, which the presentation clic3 not ex- plore, could also play a role in explaining the findings, Harris said; among the school anc3 neighborhood effects that research has shown as most promising are neighborhood anc3 community resources such as youth groups anc3 community centers, the quality of schools anc3 teachers, levels of crime anc3 6Shared meals, one of the measures of "family connectedness," represent parents' involvement with their children by virtue of their presence during the meal and the likely communication exchanged, according to Harris; demo' cratic parenting represents a type of parenting behavior (which has beneficial eEects on most outcomes) in which parents and adolescents jointly make decisions about the adolescent's life. 8

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violence in neighborhoods, and the socio- economic status of neighborhoods. This study suggests that adolescent health, broadly defined, is associated with poverty, and that family behavior such as sharing meals may contribute to improved out comes among low-income adolescents. Ad- ditiona1 longitudinal research is needed to uncover the causal direction of these rela- tionships and isolate parenting behaviors that improve outcomes. Another study, presented by K.A.S. Wickrama of Iowa State University, ex- plored adolescent health in a rural economy, specifically the effect of family economic pressure on adolescent physical health status. The study (Conger and Wickrama, 1997) used as its sample the Iowa Youth and Family Project, which in- cludes 350 white adolescents and their par- ents in a rural, predominantly agricultural, eight-county area in northern Iowa. Data were collected from ~ 989 to ~ 994. The study considered three variables- economic pressure, parental rejection (signi- fying parents' feelings about their children), and adolescent physical complaints7 as well as changes in these variables over a period of a few years. According to the researchers, economic pressure contributes to the psychological well-beina of parents. . .. . - - O - r- - --, and distressed parents tend to be more irri- table, more power-assertive, less tolerant, more rejecting, and more hostile toward their children. Among the questions the study asked: Does family economic pressure during early adolescence influence parental rejection? Does parental rejection influence adolescent physical health? Does growth or decline in parental rejection parallel growth or decline in family economic pressure? Does growth or decline in adolescent physi- cal health parallel growth or decline in pa- rental rejection? Does parental rejection ~ J during early adolescence directly influence later growth in adolescent physical health complaints? At the outset of the study, parental rejec- tion was higher in families experiencing high economic pressure and both of these factors were associated with more physical complaints by the adolescents. Further- more, these dimensions of family economics and functioning interacted over time so that changes in adolescents' physical complaints co-occurred with changes in economic pres- sure and in parental rejection. 7Family economic pressure was measured by parents' responses to questions about ability to meet their basic mate' . 1 1 r 1 . 1 1 1 . 1 1 1 1 . ~1 rial needs tor such items as a home, clothing, household items, a car, food, medical care, and recreational activities. Parental rejection was measured by parents' and adolescents' responses to allestions aholit parents' feelings of trilst. 1 1 . r . . 1 1 . 1 .1 1 love, and satisfaction with their children. Adolescent nhvsical health status was determined bv responses to Guess tions about common physical -~---r2~- diarrhea, stomach aches, and skin rashes. ~/ / ~1 complaints over the past three months, including headaches, coughs, sore throats, 9

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The findings presented at the workshop confirm previous findings that illustrate an association between poverty anc3 health. They further suggest that community anc3 family may alter the relationship between the two. As policy makers seek to improve health outcomes for children anc3 families living in poverty, findings such as these are relevant because they suggest options for intervention. For example, the association between community income anc3 emergency room visits for low- anc3 moclerate-income low-birthweight babies suggests that inter- ventions targeting the incliviclual overlook the potential value in community-level responses. The research presented raises a diverse set of questions for study, many of which are not commonly brought up in discussions of health care among the poor. What is the role of neighborhood context in families' access to health care? How can research explore aspects of health care delivery (i.e., proximity anc3 hours of operation of physi- cian versus hospital services), family anc3 community norms, anc3 prevailing health behaviors? What are the likely conse ~ . quences ot 1mprovmg access to insurance among children with special health risks (such as low birthweight or special health care needs), as compared to children with- out these special circumstances? Should differential effects on amounts anc3 types of health care used be anticipated? 10 The unique health risk behaviors anc3 needs of adolescents, which appear to be worse among the poor, raise questions about the need to adapt tociay's institutions anc3 mech- anisms for delivering health care for cliffer- ent age groups. Does the location of health care facilities anc3 the type of professionals who provide health care affect access to anc3 effectiveness of health care for adolescents, particularly those living in poverty? What is the role of the family alone anc3 jointly with health providers in promoting health among adolescents living in high-risk com- munities? How will recent changes in health care delivery affect this age group, anc3 will the effects cliffer by family income anc3 economic composition of the neighbor- hooc3? Will managed care contracts for the care of adolescents take into consideration the longstanding recognition by medical professionals that special skills anc3 knowl- ecige are required to treat adolescents? Furthermore, what can be learned from families that have successfully navigated their way out of poverty in crafting effective health-care programs for low-income chil- ciren anc3 youth? Does urban poverty affect the health of children anc3 adolescents clif- ferently than rural poverty? What clifferent challenges JO the geographic location of poor populations pose to the health care delivery system? How can racial anc3 income-basec3 disparities in health outcomes be reclucec3?

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As states contend with the redesign of health-care delivery systems now uncler ways amid major health system change, how should low-income children anc3 youth, anc3 those with special needs, be tracked to en- sure that they c30 not fall through the cracks? How will cutbacks in state anc3 local funding, the diversion of Meclicaic3 revenues to managed care organizations, anc3 pro- posec3 reductions in disproportionate share funding uncler Medicare anc3 Meclicaic3 affect the ability of public hospitals, teaching hos- pitals, academic health centers, community health centers, anc3 others who have tracli- tionally served the poor anc3 uninsured to continue to serve these populations? Under the proposed Performance Partnership Grants Program, each state must negotiate a maternal and child health action plan with the U.S. Department of Health and Human Services in 1998; the plan will include perfor' mance objectives that are specific in terms of outcomes, processes, and capacity, and that can be achieved over 3 to 5 years. 11

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Roncagliolo, M., M. Garrido, A. Williamson, B. Lozoff, and P. Peirano 1996 Delayed maturation of auditory brainstem . . . . . . . responses In lron-ueflclent anemic infants. Pediatric Research (39~:20A. Rosenbach, M.L. 1985 Ir~surar~ce Coverage arid Ambulatory Medical Care of Low~lr~come Children: fruited States, 1980. Series C Analytical Report No. 1. National Medical Care Utilization Expendi ture Survey, National Center for Health Statistics, Public Health Service, U.S. Department of Health and Human Services. Rowland, D., and K. Hanson 1996 Medicaid: Moving to Managed Care. Health Affairs 15:150-152. Rush, David, Daniel G. Horvitz, W. Burleigh Seaver, Jose M. Alvir, Gail C. Garbowski, Jessica Leighton, Nancy L. Sloan, Sally S. Johnson, Richard A. Kulka, and David S. Shanklin 1988 The National WIG Evaluation: Evaluation of the Special Supplemental Food Program for Women, Infants, and Children. Back ground and introduction. American ;Iourr~al of C lyrical Nutrition 48:389 - 393. Scholle, S.H., K.~. Kelleher, G. Childs, I. MendeloE, and W.P. Gardner 1997 Changes in Medicaid managed care enroll ment among children. Health Affairs 17: 164-170. Schonfeld-Warden, N., and C.H. Warden Walka 1997 Pediatric obesity: An overview of etiology 1997 and treatment. Pediatric Clinics of North America 44~2~:339-361. Short, P.F., and D.C. Leftkowitz 1992 Encouraging preventive services for low income children: The eEect of expanding Walter, Medicaid. MedicalCare30:766-780. 1989 Sigman, Marian 1995 Nutrition and child development: More food for thought. Current Directions ire P. s y c h o l o g i c a l S c i e r I c e ~ 4 ~ 2 ~ A p r i l ~ : 52 - 55. 52 Simpson, G., B. Bloom, R.A. Cohen, and P.E. Parsons 1997 Access to Health Care. Part 1: Chillers. National Center for Health Statistics, Vital end Hearth Statistics. Series 10: Data from the National Health Survey, No. 196. Hyattsville, Md.: U.S. Department of Health and Human Services, July. Spillman, Brenda 1992 The impact of being uninsured on the use of basic health care services. Inquiry (29)win- ter 1992:457-466. Troiano, Richard P., Katherine M. Flegal, Robert I. Kuczmarski, Stephen M. Campbell, and Clifford L. Johnson 1995 Overweight prevalence and trends for chil- dren and adolescents: The National Health and Nutrition Examination Surveys, 1963- 1991. Archives of Pediatrics arid Adolescent Medicine 149~10~:1085-1091. U.S. Bureau of the Census 1995 Ir~come,Poverty,ar~dValuatior~ofNor~cash Benefits: 1993. Current Population Re ports, Consumer Income, Series P60- 188. Washington, D.C.: U.S. Department of Commerce, February. 1996 Poverty in the Urlited States: 1995. Current Population Reports, Series P60- 194. Wash ington, D.C.: U.S. Department of Com merce, September. H., E. Pollitt, N. Triana, and A.B. Jahari Early supplemental feeding and spontaneous play in West Java, Indonesia. Paper pre sented at meeting of Society for Research in Child Development, Washington, D.C., April. , T. Infancy: mental and motor development. American ;Jourrlal of Clinical Nutrition 50~3 supplement) :655 -661. 1994 EEect of iron-deficiency anemia on cogni- tive skills in infancy and childhood. Baillieres Clinical Haematology 7~4~:815-827.

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Wilde, Parke 1997 A Monthly Cycle in Food Use by Food Stamp Recipients. Paper presented at research briefing, Board on Children, Youth, and Families, May 19-20, 1997. Cornell University. Wilde, Parke, and Christine Ranney 1997 A Monthly Cycle in Food Expenditure and Intake by Participants in the U.S. Food Stamp Program. Working Paper 97-04. Department of Agricultural, Resource, and Managerial Economics, Cornell University, March. Wilkinson, Richard G. 1996 Unhealthy Societies: The Afflictions of Ir~- equality. New York: Routledge. Willis, E., R.M. Kliegman, I.R. Meurer, and I.M. Perry 1997 Welfare reform and food insecurity: Influ- ence on children. Archives of Pediatric Adolescent Medicine 151:871 -875. Wise, P., and A. Meyers 1988 Poverty and child health. Pediatric Clinics of North America 35:1169-1186. Yip, R., I. Parvanta, K. Scanlon, E.W. Borland, C.M. Russell, and F.L. Trowhridge 1992 Pediatric nutrition surveillance system- United States, 1980-1991. Morbidity arid Mortality Weekly Report 41 (ss-7~:1-24. Yudkowsky, B.K., I.D. Cartland, and S.S. Flint 1990 Pediatrician participation in Medicaid, 1978 to 1989. Pediatrics 85:567-577. Further Reading on Child Health and Nutrition Board on Children, Youth, and Families and Board on Health Promotion and Disease Prevention 1996 Paying Atter~tior~ to Chillers ire a Charging Health Care System: Summaries of Work- shops. National Research Council and Institute of Medicine. Washington, D.C.: National Academy Press. Dallek, Geraldine 1996 Learning the Lessons of Medicaid Managed Care. December. Washington, D.C.: Families USA. Athttp://epn.org/families/ medaid.html; July 18, 1997. Division of Health Care Services 1994 America's Health ire Trar~sitior~: Protecting arid Improving Quality. Institute of Medi- cine. Washington,D.C.: NationalAcad- emy Press. Earl, Robert, and Catherine E. Wotecki, eds. 1994 Iron Deficiency Anemia: Recommended Guidelines for the Preverltiorl, Detection, arid Marlagemerlt Among U.S. Children arid Women of Childbearing Age. Committee on the Prevention, Detection, and Manage- ment of Iron Deficiency Anemia Among U.S. Children and Women of Childbearing Age, Institute of Medicine. Washington, D.C.: National Academy Press. Edmunds, Margaret, Richard Frank, Michael Hogan, Dennis McCarty, Rhonda Robinson-Beale, and Constance Weisner, eds. 1997 Marlagirlg Managed Care: Quality Improve- merlt in Behavioral Health. Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care, Division of Neuroscience and Behav- ioral Health, Division of Health Care Ser- vices, Institute of Medicine. Washington, D.C.: National Academy Press. Green, M., ed. 1994 Bright Futures: Guidelines for Preventive Services for Irlfarlts, Children, arid Adoles- cer~ts. Arlington,Va.: NationalCenter for Education in Matemal and Child Health. Holahan, John 1997 Expanding Insurance Coverage for Chil- dren. May 1997. Washington, D.C.: Ur- banInstitute. Athttp:///www.urban.org/ family/expanding.htm; July 11, 1997. 53

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Koppelman, Jane 1997 Reaching Ur~ir~sured Chillers Eligible for Medicaid arid Other Publicly Forged Ir~surar~ce Programs: Federal arid State Issues. Issue Brief. Washington, D.C.: National Health Policy Forum. Lewit, Eugene, and Linda Schuurmann Baker 1995 Health insurance coverage. The Future of Chillers 5 (3 ~ winter: 1 - 13. Milman, M., ed. 1993 Access to Health Care ire America. Commit- tee on Monitoring Access to Personal Health Care Services, Institute of Medicine. Washington,D.C.: NationalAcademy Press. Newacheck, Paul W., Dana C. Hughes, and Miriam Cisternas 1995 Children and health insurance: An over- view of recent trends. Health Affairs 14(1 spring:244-254. Newacheck, Paul W., Dana C. Hughes, and Jeffrey I. Stoddard 1996 Children's access to care: Differences by race, income, and insurance status. Pediat rics 97~1~Ianuary:26-32. Newacheck, Paul W., Jeffrey I. Stoddard, Dana C. Hughes, and Michelle Pearl 1997 Children's access to health care: The role of social and economic factors. Pp. 53-76 in Ruth E.K. Stein, ea., Health Care for Chil- drer~: What's Right, What's Wrong, What's Next. New York: United Hospital Fund. Perrin, Edward B., and Jeffrey I. Koshel, eds. 1997 Assessment of Performance Measures for Public Health, Substance Abuse, arid Mental Health. Panel on Performance Measures and Data for Public Health Performance Partnership Grants, Committee on National Statistics, National Research Council. Washington,D.C.: NationalAcademy Press. 54 Schneider, Andy 1997 Reducing the Number of Ur~ir~sured Chillers: Building Sport Medicaid Coverage is a Better Approach Third Creating a New Block Grant totheStates. Washington,D.C.: Center on Budget and Policy Priorities, June 5. Wise, Paul H. 1993 Confronting racial disparities in infant mortality: Reconciling science and politics. In Diane Rowley and Heather Tosteston, eds., American ;Iourr~al of Preventive Medicine Supplement to Vol. 9~6)November/Decem- ber. Oxford University Press. Further Reading on Income and Poverty Aber, Lawrence I., Jeanne Brooks-Gunn, and Rebecca A. Maynard 1995 EEects of welfare reform on teenage parents and their children. The Future of Childrer 5 ~ 2 Summer/fall 1995:53 - 71. Bane, Mary Jo 1992 How much does poverty matter? Pp.37-44 in P.N. Van de Water and L.B. Schorr, eds., Security for America's Children: Proceedings of the Fourth Corlfererlce of the National Academy of Social Ir~surar~ce. Dubuque, Iowa: Kendall/Hunt. Bane, Mary Jo, and David Ellwood 1994 Welfare Realities: From Rhetoric to Reform. Cambridge, Mass: Harvard University Press. Chase-Lansdale, P. Lindsay, and Jeanne Brooks- Gunn, eds. 1995 Escape from Poverty: What Makes a Differ er~ce for Children. New York: Cambridge University Press.

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Citro, Constance A., and Robert T. Michael, eds. 1995 Measuring Poverty: A New Approach. Panel on Poverty and Family Assistance: Con cepts, Information Needs and Measurement Mead, Lawrence M. Methods, Committee on National Statistics, National Research Council. Washington, D.C.: National Academy Press. Danziger, Sheldon H., Gary D. Sandefur, and Daniel H. Weinberg, eds. 1994 Cor~fror~tir~g Poverty: Prescriptions for Charge. New York: Russell Sage Founda tion, and Cambridge, Mass.: Harvard Uni versity Press. Duncan, Greg I., and Jeanne Brooks-Gunn, eds. 1997 Cor~sequer~ces of Growing Up Poor. New York: Russell Sage. Duncan, Greg I., Jeanne Brooks-Gunn, and Pamela Klebanov 1994 Economic deprivation and early childhood 1997 development. Child Development 65:296 318. Duncan, Greg I., Wei-Jun Young, Jeanne Brooks Gunn, and Judith Smith 1996 Does Childhood Poverty Affect the Life Chances of Children? Unpublished paper. Department of Education and Social Policy, Northwestem University. Edin, Kathryn, and Christopher Jencks 1992 Reforming welfare. Pp. 204-234 in Christo pher Jencks, ea., Rethir~kir~g Social Policy: Race, Poverty, arid the Underclass. Cam bridge, Mass.: Harvard University Press. Huston, Aletha C., ed. 1994 Childrer~ir~Poverty. New York: Cambridge University Press. Huston, Aletha C., Vonnie C. McLoyd, and Cynthia Garcia Coll 1994 Children and poverty: Issues in contempo rary research. Child Development 65~2)April:275-282. Korenman, S., and I. Miller 1995 Long-Term Poverty and Child Develop ment in the United States: Results from the NLSY. Institute for Research on Poverty Discussion Paper 1044-94. Madison: Uni- versity of Wisconsin. 1992 The New Politics of Poverty: The Norlworkirlg Poor ire America. New York: Basic Books. Moore, Kristin A., Donna Ruane Morrison, Martha Zaslow, and Dana A. Glei 1995 Ebbing and Flowing, Learning and Growing: Family Economic Resources and Children's Development. Unpublished paper. Wash- ington, D.C.: Child Trends, Inc. Phillips, Deborah, and Anne Bridgman, eds. 1995 New Fir~dir~gs ore Children, Families, arid Economic Self-Sufficier~cy: Summary of a Research Briefing. Board on Children, Youth, and Families, National Research Council and Institute of Medicine. Wash- ington, D.C.: National Academy Press. New Firldirlgs on Welfare arid Childrerl's Development: Summary of a Research Brief- ir~g. Board on Children, Youth, and Fami- lies, National Research Council and Insti- tute of Medicine. Washington, D.C.: Na- tional Academy Press. Rainwater, Lee, and Timothy M. Smeeding 1995 Doing Poorly: The Reallr~comeofAmericar~ Children in a Comparative Perspective. Work- ing paper #127. Department of Economics, Syracuse University. Shinn, Marybeth, Beth C. Weitzman, Rachel Becker-Klein, Kirsten Cowal, Lisa Duchon, Yvonne Rafferty, Nancy Bialo, and Judith Schteingart 1997 NYU Studies of Homeless Families. Paper presented at research briefing, Board on Children, Youth, and Families, May 19-20, 1997. Department of Psychology, New York University. U.S. Department of Health and Human Services 1996 Indicators of Welfare Deperlderlce arid Well- Beirlg: Interim Report to Congress. Washing- ton, D.C.: U.S. Department of Health and Human Services, October. 55

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56

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BOARD ON CHILDREN, YOUTH, AND FAMILIES JACK P. SHONKOFF (Chair), Heller Graduate School, Brandeis University DAVID V.B. BRITT, Children's Television Workshop, New York City LARRY BUMPASS, Center for Demography and Ecology, University of Wisconsin FERNANDO A. GUERRA, San Antonio Metropolitan Health District, Texas BERNARD GUYER, Department of Maternal and Child Health, Johns Hopkins University AI-ETHA C. HUSTON, Department of Human Ecology, University of Texas, Austin RENEE JENKINS, Department of Pediatrics and Child Health, Howard University Hospital SARA McI-ANAHAN, Office of Population Research, Princeton University ROBERT MICHAEI-, Harris Graduate School of Public Policy Studies, University of Chicago PANIC NEWACHECK, Institute of Health Policy Studies and Department of Pediatrics, University of California, San Francisco MARTHA PHII-I-IPS, The Concord Coalition, Washington, D.C. JULIUS B. RICHMOND, Department of Social Medicine, Harvard University Medical School TIMOTHY M. SANDOS, TCI Central, Inc., Denver, Colorado DEBORAH STIPEK, Graduate School of Education, University of California, I-os Angeles DIANA TAYLOR, Women's Health Program, Department of Family Health Care Nursing, University of California, San Francisco GAIL WII-ENSKY, Project Hope, Bethesda, Maryland EVAN CHARNEY (Liaison), Council, Institute of Medicine RUTH T. GROSS (Liaison), Board on Health Promotion and Disease Prevention, Institute of Medicine ELEANOR E. MACCOBY (Liaison), Commission on Behavioral and Social Sciences and Education DEBORAH A. PHII-I-IPS, Director ANNE BRIDGMAN, Program Officer for Commur~icatiorts DRUSII-I-A BARNES, Admir~istrative Associate NANCY GEYEI-IN, Project Assistant KAREN KUHI-THAU, Cor~sultar~t 57

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PARTICIPANTS, RESEARCH BRIEFING ON POVERTY AND CHILDREN'S HEALTH AND NUTRITION WILLIAM G. BITHONEY, Brookciale University Hospital, State University of New York Health Sciences Center NTRA BONDER, Office of Chilciren's Health, Maryland Department of Health anc3 Mental Hygiene JEANNE BROOKS'GUNN,* Center for Children anc3 Families, Teachers College, Columbia University PATRICK CASEY, Center for Applied Research anc3 Evaluation anc3 Department of Pediatrics, University of Arkansas for Medical Sciences SUSAN CASTELLANO, Maternal anc3 Chilc3 Health Assurance, Minnesota Department of Human Services SALLY DAVIS, Center for Health Promotion, University of New Mexico BARBARA DEVANEY, Mathematica Policy Research, Inc. JEFFREY EVANS,* National Institute of Chilc3 Health anc3 Human Development, U.S. Department of Health anc3 Human Services AMY FINE, Association of Maternal anc3 Chilc3 Health Programs HARRIETTE FOX, Fox Health Policy Consultants DEBORAH FRANK, Growth anc3 Development Program, Boston Medical Center RUTH T. GROSS, Department of Pediatrics (Emerita), Stanford University School of Medicine BERNARD GUYER, Department of Maternal anc3 Chilc3 Health, Johns Hopkins University KATHLEEN MULLAN HARRIS, Carolina Population Center, University of North Carolina at Chapel Hill JAY HIRSCHMAN, Food anc3 Consumer Service, U.S. Department of Agriculture ANDREA KANE, National Governors' Association ROBERT KARP, Pediatric Resource Center of Kings County Hospital Center anc3 Chilciren's Medical Center of State University of New York Health Science Center at Brooklyn CLAIRE KOHRMAN. Department of Pediatrics, University of Chicago BETSY LOZOFF, Center for Human Growth anc3 Development, University of Michigan CINDY MANN, Center on Budget anc3 Policy Priorities MARIE McCORMICK, Department of Maternal anc3 Chilc3 Health, Harvard School of Public Health anc3 Department of Pediatrics, Harvard Medical School * Members, Family and Child Well-Being Research Network, NICHD 58

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MICHAEL McGINNIS, National Research Council (Scholar~in'Residence) PEGGY McMANUS, McManus Health Policy, Inc. KRISTIN A. MOORE,* Child Trends, Inc. SUSAN NALDER, Maternal Child Health Epidemiology, Public Health Division, New Mexico Department of Health PAUL NEWACHECK, Institute of Health Policy Studies and Department of Pediatrics, University of California at San Francisco ERNESTO POLLITT, Department of Pediatrics, University of California at Davis, and Visiting Scholar, The World Bank JAMES RESCHOVSKY, Center for Studying Health System Change MARYBETH SHINN, Department of Psychology, New York University MARIAN SIGMAN, Department of Psychiatry, University of California at Los Angeles THEODORE WACHS, Department of Psychological Sciences, Purdue University JAMES WELSH, Division of Planning and Policy and Resource Development, New York State Department of Health KATHY WIBBERLY, Office of Health Policy, Virginia Department of Health K.A.S. WICKRAMA, Center for Family Research, Iowa State University PARKE WILDE, Department of Agricultural Resource and Managerial Economics, Cornell University PAUL H. WISE, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Children's Hospital, Harvard Medical School KATHRYN TAAFFE YOUNG, The Commonwealth Fund Other members of the network are: GREG J. DUNCAN, Institute for Policy Research, Northwestern University ELIZABETH PETERS, Department of Consumer Economics and Housing, Cornell University DESMOND K. RUNYAN, Department of Social Medicine, University of North Carolina JAY D. TEACHMAN, Department of Human Development, Washington State University ARLAND THORNTON, Institute for Social Research, University of Michigan * Members, Family and Child Well'Being Research Network, NICHD 59

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Other Reports from the Board on Children, Youth, and Families Educatir~gLar~guage-Mirrority Chit~rerr (1998) Violence ire Families: Assessing Prever~tiorr Arid Treatment Programs (1998) Improving Schooling for L-arlguage-Mirlority Chimer: A Research Agenda (1997) New Firrdir~gs or Welfare Arid Chit~rer`'s Development: Summary of a Research Briefing ~ 1997 ~ Youth Development arid Neighborhood frlfuerlces: Challenges arid Opportunities: Summary of a Workshop (1996) Paying Atter~tiorr to Chit~rerr ire a Chart g Health Care System: Summaries of a Workshop (with the Board on Health Promotion and Disease Prevention of the Institute of Meclicine) (1996) Beyond the Blueprint: Directions for Research or Head Start's Families: Report of Three Rourrdtable Meetings ~ 1996) Child Care for Low-Ir~come Families: Directions for Research: Summary of a Workshop (1996) Service Provider Perspectives or Family Violence Ir~terver~tior~s: Proceedings of a Workshop (1995) "Immigrant Children and Their Families: Issues for Research and Policy" in The Future of Chit- drerr (1995) Ir~tegratir~g Federal Statistics or Chit~rerr (with the Committee on National Statistics of the Na- tional Research Council) ~1995) Child Care for Low-Ir~come Families: Summary of Two Workshops (1995) New Firrdir~gs or Chit~rerr, Families, Arid Economic Self-Sufficier~cy: Summary of a Research Briefing (1995) The Impact of War or Child Health ire the Countries of the Former Yugoslavia: A Workshop Sum- mary (with the Institute of Medicine and the Office of International Affairs of the National Research Council) ~1995) 60

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Cultural Diversity Arid Early Education: Report of a Workshop (1994) Benefits Arid Systems of Care for Maternal Arid Child Health: Workshop Highlights (with the Board on Health Promotion and Disease Prevention of the Institute of Meclicine) (1994) Protecting and Improving the Quality of Care for Children Under Health Care Reform: Workshop Highlights (with the Board on Health Promotion and Disease Prevention of the Institute of Meclicine) (1994) America's Fathers Arid Public Policy: Report of a Workshop (1994) Violence Arid the American Family: Report of a Workshop (1994) 61

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The National Academy of Sciences is a private, nonprofit, self~perpetuating society of distin' guished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the char- ter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the Na' tional Academy of Sciences, as a parallel organization of outstanding engineers. It is autono' mous in its administration and in the selection of its members, sharing with the National Acad- emy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and educa- tion. Dr. Kenneth T. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in I 9 1 6 to associate the broad community of science and technology with the Academy's purposes of fur' thering knowledge and advising the federal government. Functioning in accordance with gen- eral policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering commu- nities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council. 62