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Journal Issue: Children and Poverty Volume 7 Number 2 Summer/Fall 1997

Programs That Mitigate the Effects of Poverty on Children
Barbara L. Devaney Marilyn R. Ellwood John M. Love


  1. Ohls, J., and Beebout, H. The Food Stamp Program: Design tradeoffs, policy, and impacts. Washington, DC: Urban Institute Press, 1993.
  2. Center on Budget and Policy Priorities. The depth of the food stamp cuts in the final welfare bill. Washington, DC: Center on Budget and Policy Priorities, 1996.
  3. Trippe, C., and Sykes, J. Food Stamp Program participation rates: January 1992. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis and Evaluation, October 1994.
  4. Fraker, T. The effects of food stamps on food consumption: A review of the literature. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis and Evaluation, October 1990.
  5. Devaney, B., and Moffitt, R. Dietary effects of the Food Stamp Program. American Journal of Agricultural Economics (February 1991) 73,1:202–11.
  6. Cook, J., Sherman, L., and Brown, L. Impact of food stamps on the dietary adequacy of poor children. Boston, MA: Tufts University School of Nutrition, Center on Hunger, Poverty, and Nutrition Policy, June 1995.
  7. Fraker, T., Martini, A., and Ohls, J. The effect of food stamp cashout on food expenditures: An assessment of the findings from four demonstrations. Journal of Human Resources (Fall 1995) 30,4:633–49.
  8. Rossi, P. Feeding the poor: Assessing federal food aid. Washington, DC: American Enterprise Institute, 1997.
  9. U.S. Department of Agriculture, Food and Consumer Service, Office of Analysis and Evaluation. Special Supplemental Food Program for Women, Infants, and Children (WIC): Eligibility and coverage estimates, 1994 update—U.S. and outlying areas. Alexandria, VA: USDA, April 1995. Several methodological issues affect these participation estimates. For any program, it is very difficult to estimate income eligibility based on survey data, while generally accurate data on number of participants are available from administrative data. In addition, for the WIC program, all income-eligible individuals must also be at nutritional risk, and very little information is available concerning the percentage of those who are income eligibles and also demonstrate nutritional risk. Given these potential errors in measuring eligibility, which most likely lead to underestimating the size of the eligible population, participation rates of more than 100% may be possible, especially if the program has achieved basically full coverage.
  10. Rush, D., Leighton, J., Sloan, N., et al. The National WIC Evaluation: Evaluation of the Special Supplemental Food Program for Women, Infants and Children. VI. Study of infants and children. The American Journal of Clinical Nutrition (August 1988, Supplement) 48,2:484–511.
  11. The WIC food packages for infants who are not being breast-fed consist of iron-fortified formula, iron-fortified cereal, and vitamin C-rich juices. For children up to age five, the food packages include milk or milk substitutes, eggs, iron-fortified cereal, vitamin C-rich juice, and either dried beans or peas or peanut butter. Thus, the WIC food packages target the following specific nutrients: protein, vitamin A, vitamin C, calcium, and iron.
  12. Gordon, A., and Nelson, L. Characteristics and outcomes of WIC participants and nonparticipants: Analysis of the 1988 National Maternal and Infant Health Survey. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis and Evaluation, March 1995.
  13. U.S. Department of Health and Human Services, Public Health Service, Center for Disease Control, Nutrition Section. CDC analysis of nutritional indices for selected WIC participants. Atlanta, GA: Center for Disease Control, 1978.
  14. Vazquez-Seoane, P., Windom, R., and Pearson, H. Disappearance of iron-deficiency anemia in a high-risk infant population given supplemental iron. New England Journal of Medicine (November 7, 1985) 313,19:1239–40.
  15. Yip, R., Binkin, N., Fleshood, L., et al. Declining prevalence of anemia among low-income children in the United States. Journal of the American Medical Association (September 25, 1987) 258,12:1619–23.
  16. Yip, R., Parvanta, I., Scanlon, K., et al. Pediatric nutrition surveillance system-United States, 1980-1991. Morbidity and Mortality Weekly Report (November 27, 1992) 41,7:1–2
  17. Edozien, J., Switzer, B., and Bryan, R. Medical evaluation of the Special Supplemental Food Program for Women, Infants, and Children. The American Journal of Clinical Nutrition (March 1979) 32,3:677–92.
  18. Kennedy, E., Gershoff, S., Reed, R., et al. Evaluation of the effect of WIC supplementary feeding on birth weight. Journal of the American Dietetic Association (March 1982) 74,3:220–27.
  19. Kotelchuck, M., Schwartz, J., Anderka, M., et al. WIC participation and pregnancy outcomes: Massachusetts statewide evaluation project. American Journal of Public Health (October 1984) 74,10:1086–92.
  20. Metcoff, J., Costiloe, P., Crosby, W., et al. Effect of food supplementation (WIC) during pregnancy on birth weight. The American Journal of Clinical Nutrition (May 1985) 41,5:933–47.
  21. Devaney, B., Bilheimer, L., and Schore, J. Medicaid costs and birth outcomes: The effects of prenatal WIC participation and the use of prenatal care. Journal of Policy Analysis and Management (1992) 11,4:573–92.
  22. Birkhead, G., LeBaron, C., Parsons, P., et al. The immunization of children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC): The impact of different strategies. Journal of the American Medical Association (July 26, 1995) 274,4:312–16. In a field trial, WIC sites were randomly assigned to different immunization strategies: (1) escort model, where the child was escorted for immunizations; (2) voucher incentive model, where the family had to return to the WIC clinic more frequently for vouchers until proof of immunization was obtained; and (3) the usual referral role of the WIC program. Both the escort and voucher models resulted in children being immunized more rapidly than the traditional referral model.
  23. U.S. Department of Agriculture, U.S. Department of Health and Human Services. Nutrition and your health: Dietary guidelines for Americans. 4th ed. Washington, DC: U.S. Government Printing Office, 1995.
  24. Burghardt, J., and Devaney, B. School Nutrition Dietary Assessment study: Summary and discussion. The American Journal of Clinical Nutrition (January 1995) 61,1 Supplement: 252S–57S.
  25. Meyers, A.F., Simpson, A.E., Weitzman, M., et al. School breakfast program and school performance. American Journal of Diseases of Children (October 1989) 143,10:1234–39.
  26. Klerman, L.V. Alive and well?: A research and policy review of health programs for poor young children. New York: National Center for Children in Poverty, Columbia School of Public Health, 1991.
  27. Lewit, E., and Schuurmann Baker, L. Child indicators: Health insurance coverage. The Future of Children (Winter 1995) 5,3:192–204.
  28. Dubay, L., and Kenney, G. Revisiting the issues: The effects of Medicaid expansions on insurance coverage of children. The Future of Children (Spring 1996) 6,1:152–61.
  29. U.S. General Accounting Office. Health insurance for children: Private insurance continues to deteriorate. Washington, DC: U.S. Government Printing Office, June 1996.
  30. Shuptrine, S., and Grant, V. Assuring access to health coverage: A discussion of eligibility and enrollment issues. Columbia, SC: Sarah Shuptrine and Associates, 1994.
  31. Rosenbaum, S., and Darnell, J. An analysis of the Medicaid and health-related provisions of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Washington, DC: Center for Health Policy Research, August 1996.
  32. Gavin, N. The impact of Medicaid on children's health service use: A ten-year retrospective analysis. Durham, NC: Research Triangle Institute, September 1996.
  33. St. Peter, R., Newacheck, P., and Halfon, N. Access to care for poor children: Separate and unequal. Journal of the American Medical Association (1992) 267,20:2760–64.
  34. Gavin, N. The impact of Medicaid on children's health service use: 1987 National Medical Expenditure Survey. Durham, NC: Research Triangle Institute, October 1995.
  35. Yudkowsky, B.K., Cartand, J.D., and Flint, S.S. Pediatrician participation in Medicaid: 1978 to 1989. Pediatrics (April 1990) 85,4:567–77.
  36. Physician Payment Review Commission. Physician payment under Medicaid. Report No. 91–4, 1991. Available from Physician Payment Review Commission, 2120 L Street NW, Suite 200, Washington, DC 20037.
  37. Wade, M. Medicaid fee levels and Medicaid enrollees' access to care. Washington, DC: Urban Institute Press, 1992.
  38. Perloff, J. Health care resources for children and pregnant women. The Future of Children (Winter 1992) 2,2:78–94.
  39. Starfield, B. Child and adolescent health status measures. The Future of Children (Winter 1992) 2,2:25–39.
  40. For example, a report from the Office of Technology Assessment noted that data collected regularly through national health surveys on health measures such as the prevalence of chronic conditions or self-reported health status are not easily interpreted because they can be affected by improvements in diagnosis, medical advances, and differences in individuals' expectations about what constitutes good health or how illness should be treated. U.S. Congress, Office of Technology Assessment. Healthy children: Investing in the future. OTA-H-345. Washington, DC: U.S. Government Printing Office, February 1995.
  41. For example, Starfield estimated that, for the RAND Health Insurance Study, a sample size of 21,500 children would have been required to detect a small difference in health status for children ages zero to four. Almost 5,000 children would have been required to detect a medium size effect, and 2,100 children to detect a large effect. Such sample sizes were well beyond the resources of the experiment; Starfield, B. Giant steps and baby steps: Toward child health. American Journal of Public Health (June 1985) 75,6:599–602.
  42. Gavin, N. Review and synthesis of the literature on financial barriers to health care services for children. Washington, DC: SysteMetrics/McGraw-Hill, November 1991.
  43. Starfield, B. Motherhood and apple pie: The effectiveness of medical care for children. Milbank Memorial Fund Quarterly (1985) 63,3:523–46.
  44. Currie, J., and Gruber, J. Saving babies: The efficacy and cost of recent changes in the Medicaid eligibility of pregnant women. Journal of Political Economy (December 1996) 104,6:1263-96.
  45. A related study using National Health Interview Survey data from 1984 to 1992 found that Medicaid reduces child mortality as well. See Currie, J., and Gruber, J. Health insurance, eligibility, utilization of medical care, and child health. Quarterly Journal of Economics (May 1996) 111,2:431–66.
  46. Haas, J.S., Udvarhelyi, I.S., Morris, C.N., and Epstein, A.M. The effect of providing health coverage to poor uninsured pregnant women in Massachusetts. Journal of the American Medical Association (January 1993) 269,1:87–91.
  47. Piper, J.M., Ray, W.A., and Griffin, M.R. Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. Journal of the American Medical Association (November 1990) 264,17:2219–23.
  48. Moffitt, R., and Wolfe, B. Medicaid, welfare dependency, and work: Is there a causal link? Health Care Financing Review (Fall 1993) 15,1:123–33.
  49. Ellwood, D., and Adams, E.K. Medicaid mysteries: Transitional benefits, Medicaid coverage, and welfare exits. Health Care Financing Review (December 1990) Annual Supplement: 119–31.
  50. Cutler, D., and Gruber, J. Does public insurance crowd out private insurance? Quarterly Journal of Economics (May 1996) 111,2:391–430.
  51. Swartz, K. Medicaid crowd out and the inverse Truman bind. Inquiry (Spring 1996) 33,1:5–8.
  52. President Lyndon B. Johnson, quoted by Ross, C. Early skirmishes with poverty: The historical roots of Head Start. In Project Head Start: A legacy of the war on poverty. E. Zigler and J. Valentine, eds. New York: Free Press, 1979.
  53. U.S. Department of Health and Human Services, Administration for Children and Families. Head Start Program Performance Standards. Federal Register (November 5, 1996) 61,215:57186–227.
  54. U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Head Start Bureau. Project Head Start statistical fact sheet. Washington, DC: Head Start Bureau, May 1996.
  55. Calculation by Head Start Bureau using 1996 Current Population Survey. See Current Population Survey (CD-ROM), U.S. Bureau of the Census, 1980–96. Available from U.S. Department of Commerce, Bureau of the Census, P.O. Box 277943, Atlanta, GA 30384-7943.
  56. Korenman, S., Miller, J.E., and Sjaastad, J.E. Long-term poverty and child development in the United States: Results from the NLSY. Children and Youth Services Review (1995) 17,1/2:127–56.
  57. Many of the demonstration program evaluations have reported favorable Head Start effects. See, for example, Love, J.M., and Nauta, M. Evaluation of the Home Start demonstration program: Final report. Ypsilanti, MI: High/Scope Educational Research Foundation, 1976. Their findings are not reviewed here because the demonstrations were special programs that went beyond standard Head Start practices and because they were implemented in a small number of selected locations.
  58. New directions are leading Head Start to a greater focus on programs for infants and toddlers, but few data currently exist for that age group. Existing research does suggest that, by serving families when their children are younger, programs may have greater impacts in comparison with waiting until the children are preschool age. See Barnett, W.S. Long-term effects of early childhood programs on cognitive and school outcomes. The Future of Children (Winter 1995) 5,3:25–50; Carnegie Corporation of New York. Starting points: Meeting the needs of our youngest children. New York: Carnegie Corporation of New York, 1994; Yoshikawa, H. Longterm effects of early childhood programs on social outcomes and delinquency. The Future of Children (Winter 1995) 5,3:51–75.
  59. McKey, R., Condelli, L., Ganson, H., et al. The impact of Head Start on children, families and communities: Final report of the Head Start Evaluation, Synthesis and Utilization Project. Washington, DC: CSR, Inc., June 1985. This report is the only formal, analytic attempt to combine findings from many disparate studies, following a careful process of including research studies in the meta-analysis only if they met strict criteria, including designs that were either experimental or studies comparing children before and after Head Start participation and having adequate information for calculating statistical effect sizes.
  60. Cohen, J. Statistical power analyses for the behavioral sciences. 2nd ed. New York: Academic Press, 1977; and Barnett, W.S. Long-term effects of early childhood programs on cognitive and school outcomes. The Future of Children (Winter 1995) 5,3:27. In addition, Hebbeler points out that the demographic differences between Head Start children and non-Head Start comparison children are often so great (the comparison group being generally better off) as to call into question the ability of typical covariance analysis to "control for" these differences, thus leading to underestimates of Head Start's impacts. Hebbeler, K. An old and a new question on the effects of early education for children from low-income families. Educational Evaluation and Policy Analysis (Fall 1985) 7,3:207–16.
  61. Currie, J., and Thomas, D. Does Head Start make a difference? American Economic Review (June 1, 1995) 85,3:341–64.
  62. Abt Associates, Inc. The effects of Head Start health services: Report of the Head Start health evaluation. Cambridge, MA: Abt Associates, 1984.
  63. Barnett, for example, argues that the so-called fade-out effect is an artifact of the positive impact that Head Start has on grade retention and special education placements, and over time children retained or placed drop out of the longitudinal follow-up sample. Barnett, S. Commentary: Does Head Start fade out? Education Week. May 19, 1993, p. 40.
  64. The winter 1995 issue of The Future of Children (vol. 5, no. 3) reviewed much of this literature. Particularly relevant to this discussion are the papers by Barnett and Yoshikawa (see note no. 58). Barnett reviewed 36 studies and found that large-scale programs can produce long-term cognitive and academic benefits for disadvantaged children. Yoshikawa argues that programs combining family support with early education (which the best Head Start programs do) show the greatest promise in reducing antisocial behavior and delinquency.
  65. McCall, R.B. Head Start: Its potential, its achievements, its future; a briefing paper for policymakers. Pittsburgh, PA: Office of Child Development, University of Pittsburgh, 1993; Brush, L., Gaidurgis, A., and Best, C. Indices of Head Start program quality. Washington, DC: Pelavin Associates, 1993.
  66. U.S. Department of Housing and Urban Development, Office of Policy Development and Research. Rental Housing Assistance at a crossroads: A report to Congress on the worst case housing needs. Washington, DC: U.S. Department of Housing and Urban Development, Office of Policy Development and Research, March 1996, Table A1.
  67. U.S. House of Representatives, Ways and Means Committee. Overview of entitlement programs: 1996 green book. Washington, DC: U.S. Government Printing Office, 1996.
  68. U.S. Conference of Mayors. A status report on hunger and homelessness in America's cities: 1996. Information from cities compiled by Laura Waxman and Sharon Hinderliter. Washington, DC: U.S. Conference of Mayors, December 1996.
  69. U.S. Congress, Congressional Budget Office. The challenges facing federal rental assistance programs. Washington, DC: Congressional Budget Office, December 1994.
  70. For an excellent description of the broad role of housing in society, see Shlay, A. Housing in the broader context in the United States. Housing Policy Debate (1995) 6,3:695–720.
  71. Goering, J., Stebbins, H., and Siewert, M. Promoting housing choice in HUD's rental assistance programs: A report to Congress. Washington, DC: U.S. Department of Housing and Urban Development, April 1995.
  72. Johnson, G. Rent paying ability and racial settlement patterns: A review and analysis of recent housing allowance evidence. American Journal of Economics and Sociology (January 1996) 45,1:17–26.
  73. Rosenbaum, J. Black pioneers-Do their moves to the suburbs increase economic opportunity for mothers and children. Housing Policy Debate (1991) 2,4:1179–213.
  74. Currie, J. Welfare and the well-being of children. Switzerland: Harwood Academic Publishers, 1995.
  75. Olsen, E., and Barton, D.M. The benefits and costs of public housing in New York City. Journal of Public Economics (April 1983) 20,3:299–332.
  76. Reeder, W.J. The benefits and costs of the Section 8 existing housing program. Journal of Public Economics (April 1985) 26,3:349–77.