摘要：Objectives. We compared the health of single mothers affected by welfare reform with the health of a nationally representative sample of women to document the prevalence of poor health as single mothers experience the effects of welfare reform. Methods. We compared risk factors and measures of health among women randomly sampled from the welfare rolls with similar data from a nationally representative sample of women. Results. Women in our welfare recipient sample had higher rates of elevated glycosylated hemoglobin (≥ 6%; prevalence ratio [PR]=4.87; 95% confidence interval [CI]=2.69, 7.04), hypertension (systole ≥ 140 or diastole ≥ 90; PR=2.36; 95% CI = 1.47, 3.24), high body mass index ( ≥ 30; PR = 1.78; 95% CI = 1.49, 2.08), and high-density lipoprotein cholesterol (≤ 35 mg/dL; PR=1.91; 95% CI=1.17, 2.65); lower peak expiratory flow; and less physical functioning. Current smoking rates were higher (PR = 1.85; 95% CI = 1.50, 2.19) and smoking cessation rates were lower (PR=0.62; 95% CI=0.37, 0.86) than in the national sample. Conclusions. Current and former welfare recipients bear a substantial burden of illness. Further studies are necessary to interpret our findings of worsened health in the wake of welfare reform. Despite previous research indicating that people who are poorer have worse health, and a recent exponential increase in such research, 1 , 2 relatively little attention has been given to the health of one of the poorest segments of the population—single mothers receiving welfare. Because these women experience chronic exposure to economic, social, and environmental stresses and have few resources with which to reduce these stresses, we have every reason to believe that their health is at risk. The introduction of the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, which dramatically altered cash assistance for poor families with children, may have led to changes in the health of that population. Welfare reform has been touted as a great success by its proponents. Welfare caseloads more than halved between 1996 and 2000. 3 This reduction has been attributed to the introduction of a new program called Temporary Aid to Needy Families (TANF) and its associated “welfare-to-work” provisions, as well as to a period of rapid economic expansion. 4 , 5 Still, the economic and social status of many current and former welfare recipients and their children, who all are part of this “natural experiment,” remains deeply at risk. 6 , 7 Although the proportion of poor women who are working has dramatically increased, many such women remain below the poverty level and in need of government assistance. 8 Typically, the new jobs held by these women involve constantly changing work schedules, less than full-time work opportunities, few or no fringe benefits, and long commutes. 9 – 11 Employment gains often are constrained by low levels of skill and lack of prior work experience, as well as by child care and transportation needs. 12 We know very little about the health of these women, let alone the effects of welfare reform on their health. The existing evidence generally suggests a population that is not as healthy as the general population. 13 – 17 Previous studies, however, were based on self-reported measures of physical health or self-reported medical diagnoses, either of which may cause many interpretive problems. In our study, we estimated the prevalence of measured health problems, disease markers, and important risk factors, as well as of self-reported medical conditions, in a population-based sample of poor mothers who were receiving cash assistance immediately following implementation of TANF, and we compared these prevalence levels with levels in a contemporary, nationally representative sample of women matched for age and race. We also compared health indicators in the welfare sample with indicators in a comparable nationally based sample surveyed before welfare reform was enacted.
