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Background: Adverse childhood experiences (ACEs) are linked to poor adult health outcomes, including cardiovascular disease. However, little is known about its prevalence, specifically in low-income populations. The objective of this study was to estimate the extent of ACEs in a low-income, nonclinical, uninsured adult population and assess the relationship between ACEs and cardiovascular disease risk factors., Methods and Results: This study leverages the OHIE's (Oregon Health Insurance Experiment) study population, uninsured adults who were randomly selected to apply for Medicaid, and data collected through in-person health screenings. We objectively measured obesity, cholesterol, blood pressure, and blood sugar. Smoking, physical activity, and history of chronic disease were self-reported. Independent variables were the 10-item ACEs questions covering neglect, abuse, and household dysfunction. The sample consisted of 12 229 low-income, nonelderly uninsured adults who participated in the OHIE health screenings from 2009 to 2010. A total of 5929 (48%) returned a follow-up survey reporting ACEs in 2012. ACEs were more prevalent in low-income adults compared with previous estimates in a general clinical population, with notably high rates of emotional abuse, emotional neglect, and household dysfunction. ACEs were statistically associated with higher rates of obesity, smoking, and physical inactivity, but not high cholesterol or diabetes mellitus. We detected a strong relationship between ACEs and a self-reported history of a hypertension diagnosis but no statistically significant differences in being hypertensive., Conclusions: This study design allowed us to assess the prevalence of ACEs among uninsured low-income adults and the association between ACEs and clinical indicators of cardiovascular disease risk that are difficult to ordinarily observe. Low-income adults have high rates of ACEs than previous prevalence estimates and ACEs were associated with higher rates of multiple cardiovascular disease risk factors. As states continue to expand Medicaid to the previously uninsured, providers may want to consider incorporating trauma-based approaches to care delivery.

Policy PointsThe Paycheck Plus randomized controlled trial tested a fourfold increase in the Earned Income Tax Credit (EITC) for single adults without dependent children over 3 years in New York and Atlanta.In New York, the intervention improved economic, mental, and physical health outcomes. In Atlanta, it had no economic benefit or impact on physical health and may have worsened mental health.In Atlanta, tax filing and bonus receipt were lower than in the New York arm of the trial, which may explain the lack of economic benefits. Lower mental health scores in the treatment group were driven by disadvantaged men, and the study sample was in good mental health. Context: The Paycheck Plus experiment examined the effects of an enhanced Earned Income Tax Credit (EITC) for single adults on economic and health outcomes in Atlanta, GA and New York City (NYC). The NYC study was completed two years prior to the Atlanta study and found mental and physical benefits for the subgroups that responded best to the economic incentives provided. In this article, we present the findings from the Atlanta study, in which the uptake of the treatment (tax filings and EITC bonus) were lower and economic and health benefits were not observed. Methods: Paycheck Plus Atlanta was an unblinded randomized controlled trial that assigned n = 3,971 participants to either the standard federal EITC (control group) or an EITC supplement of up to $2,000 (treatment group) for three tax years (2017–2019). Administrative data on employment and earnings were obtained from the Georgia Department of Labor and survey data were used to examine validated measures of health and well‐being. Findings: In Atlanta, the treatment group had significantly higher earnings in the first project year but did not have significantly higher cumulative earnings than the control group overall (mean difference = $1,812, 95% CI = −150, 3,774, p = 0.07). The treatment group also had significantly lower scores on two measures of mental health after the intervention was complete: the Patient Health Questionnaire 8 (mean difference = 0.19, 95% CI = 0.06, 0.32, p = 0.005) and the Kessler 6 (mean difference = 0.15, 95% CI = 0.03, 0.27, p = 0.012). Secondary analyses suggested these results were driven by disadvantaged men, but the study sample was in good mental health. Conclusions: The EITC experiment in Atlanta was not associated with gains in earnings or improvements in physical or mental health. [ABSTRACT FROM AUTHOR]

Antipoverty policies have the potential to improve mental health. We conducted a randomized trial (Paycheck Plus Health Study Randomized Controlled Trial, New York, New York) to investigate whether a 4-fold increase in the Earned Income Tax Credit for low-income Americans without dependent children would reduce psychological distress relative to the current federal credit. Between 2013 and 2014, a total of 5,968 participants were recruited; 2,997 were randomly assigned to the treatment group and 2,971 were assigned to the control group. Survey data were collected 32 months postrandomization (n  = 4,749). Eligibility for the program increased employment by 1.9 percentage points and after-bonus earnings by 6% ($635/year), on average, over the 3 years of the study. Treatment was associated with a marginally statistically significant decline in psychological distress, as measured by the 6-item Kessler Psychological Distress Scale, relative to the control group (score change = −0.30 points, 95% confidence interval (CI): −0.63, 0.03; P  = 0.072). Women in the treated group experienced a half-point reduction in psychological distress (score change = −0.55 points, 95% CI: −0.97, −0.13; P  = 0.032), and noncustodial parents had a 1.36-point reduction (95% CI: −2.24, −0.49; P  = 0.011). Expansion of a large antipoverty program to individuals without dependent children reduced psychological distress for women and noncustodial parents—the groups that benefitted the most in terms of increased after-bonus earnings. [ABSTRACT FROM AUTHOR]

Background: This study examined the association between Medicaid expansions under the Affordable Care Act (ACA) and births among low-income women of reproductive age in the United States. Materials and Methods: We used data from the 2008 to 2019 American Community Survey to estimate the association between state adoption of Medicaid expansion under the ACA and the percent of low-income women of reproductive age with a birth in the past year using a difference-in-difference research design. Subgroup analysis was explored by race and ethnicity, age group, educational attainment, marital status, and number of children. Results: We found that Medicaid expansion was associated with a small reduction in births among low-income women of reproductive age by 0.45 percentage points (95% confidence interval: −0.84 to −0.05). In subgroup analyses, we found reductions in births among Hispanic women, American Indian or Alaska Native women, women 25–29 years of age, women 35–39 years of age, unmarried women, and women with more than three children. Conclusions: Reductions in births associated with Medicaid expansion could suggest that expanding Medicaid addressed previously unmet reproductive health care needs among low-income women of reproductive age. The reductions in births among low-income women that we observe were occurring among some groups with higher unintended pregnancy rates, including Hispanic women, American Indian or Alaska Native women, young women, and unmarried women. These findings underscore the importance of reproductive health care access through insurance coverage on empowering women to have control over their reproductive decision-making and timing. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the effect of the Affordable Care Act (ACA) Medicaid expansions on national rates of home eviction and eviction initiation in the United States. Methods. Using nationally representative administrative data from The Eviction Lab at Princeton University, we estimated the effects of the ACA Medicaid expansions on county-level evictions and filings from 2000 to 2016 with a difference-in-difference regression design. Results. We found that Medicaid expansions were associated with an annual reduction in the rate of evictions by 1.15 per 1000 renter-occupied households (P <.001), a reduction of 1.59 eviction filings per 1000 renter-occupied households (P <.001), and a reduction in the average number of evictions by 46 (P <.05). We found additional evidence that increasing rates of African American residents in a county was associated with a greater rate of evictions filed, and increased rates of poverty and rent burdens relative to income were associated with more evictions both filed and completed. Conclusions. Evictions decreased after Medicaid expansion, demonstrating further evidence of the substantive financial protections afforded by this coverage. The reduction in the eviction filing rate suggests that Medicaid expansion could be reducing evictions by preventing the court proceeding entirely. [ABSTRACT FROM AUTHOR]