摘要：Objectives. We examined whether Jobs First, a multicenter randomized trial of a welfare reform program conducted in Connecticut, demonstrated increases in employment, income, and health insurance relative to traditional welfare (Aid to Families with Dependent Children). We also investigated if higher earnings and employment improved mortality of the participants. Methods. We revisited the Jobs First randomized trial, successfully linking 4612 participant identifiers to 15 years of prospective mortality follow-up data through 2010, producing 240 deaths. The analysis was powered to detect a 20% change in mortality hazards. Results. Significant employment and income benefits were realized among Jobs First recipients relative to traditional welfare recipients, particularly for the most disadvantaged groups. However, although none of these reached statistical significance, all participants in Jobs First (overall, across centers, and all subgroups) experienced higher mortality hazards than traditional welfare recipients. Conclusions. Increases in income and employment produced by Jobs First relative to traditional welfare improved socioeconomic status but did not improve survival. Randomized welfare experiments, which were often large and conducted in multiple locations in the United States, sought to study the effect of limits on the amount of time a participant could receive cash welfare benefits. 1 These studies contributed to the end of “welfare as we know it” under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) enacted in 1996. The majority of the randomized experiments leading up to PRWORA, and PRWORA itself, showed beneficial effects of welfare reform on earnings and employment. 1,2 Earnings and employment are thought to increase human longevity by improving material and psychosocial circumstances, and by increasing health insurance coverage. 3–7 However, welfare reform essentially works by cutting income benefits and thereby forcing recipients of welfare back into the job market. This could produce stressors on the families receiving these benefits, particularly single mothers with multiple children who must balance family obligations with new employment commitments. 2,8–11 It is also plausible that employment brings with it occupational exposures and dangers associated with increased travel (e.g., traffic accidents). In this study, we linked participant identifiers in one successful welfare reform experiment—Connecticut Jobs First—to mortality data. We explored the mortality experiences of participants overall, as well as those of various subgroups, including Blacks, Latinos, and families with more or less than 2 children.
