{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:59:46Z","timestamp":1790445586113,"version":"4.1.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"Importance<\/jats:title>Adverse birth outcomes in the US, including preterm birth and low birth weight, are strongly tied to socioeconomic disadvantage and disproportionately impact infants of Black mothers. Increasing investments in social programs represents a potential policy approach to addressing disparities in birth outcomes.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine state-level associations of government expenditures on social programs with rates of preterm birth and low birth weight both overall and by race.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional, ecological study was conducted among liveborn infants in the 50 US states between January 1, 2011, and December 31, 2019. Data analysis was performed from May 2022 to May 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Yearly state and local government expenditures per low-income person on social programs in the following categories: state refundable Earned Income Tax Credit; cash assistance; childcare assistance; housing and community development; and public health.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Yearly state-level rates of preterm birth (gestational age &amp;lt;37 weeks) and low birth weight (&amp;lt;2500 g).<\/jats:p><\/jats:sec>Results<\/jats:title>From January 1, 2011, to December 31, 2019, there were 35.1 million live births in the US, of which 3.4 million (9.8%) were preterm and 2.8 million (8.1%) were low birth weight. Median (IQR) state social expenditures per low-income person were $1546 ($1074-$2323). Greater total state social expenditures were associated with lower overall rates of preterm birth (adjusted prevalence ratio [aPR] for every increase of $1000 per low-income person, 0.99; 95% CI, 0.97-0.999) but not with overall rates of low birth weight. In secondary analyses, greater state social expenditures were associated with lower preterm birth rates for infants of Black mothers (aPR, 0.96; 95% CI, 0.92-0.999). Greater state expenditures specifically on cash assistance (aPR, 0.64; 95% CI, 0.43-0.94) and housing and community development (aPR, 0.91; 95% CI, 0.84-0.98) were associated with lower preterm birth rates for infants of Black mothers.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cross-sectional, ecological study, greater state-level expenditures on social programs were associated with reduced rates of preterm birth, particularly for infants of Black mothers. State and local governments may consider bolstering investments in cash assistance and housing and community development to address maternal and infant health disparities.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.4267","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T15:01:07Z","timestamp":1728918067000},"page":"1345","source":"Crossref","is-referenced-by-count":14,"title":["State Social Expenditures and Preterm Birth and Low Birth Weight in the US"],"prefix":"10.1001","volume":"178","author":[{"given":"Lawrence","family":"Chang","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"},{"name":"Now with Department of Emergency Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry T.","family":"Puls","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Mercy Kansas City, Kansas City, Missouri"},{"name":"University of Missouri\u2013Kansas City School of Medicine, Kansas City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Monuteaux","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Colvin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Mercy Kansas City, Kansas City, Missouri"},{"name":"University of Missouri\u2013Kansas City School of Medicine, Kansas City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"},{"name":"Department of Pediatrics, University of California, Los Angeles"},{"name":"Department of Health Policy and Management, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lois K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"poi240071r3","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1542\/peds.2008-1439","article-title":"Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life.","volume":"123","author":"McLaurin","year":"2009","journal-title":"Pediatrics"},{"key":"poi240071r4","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1146\/annurev-publhealth-090810-182459","article-title":"Prematurity: an overview and public health implications.","volume":"32","author":"McCormick","year":"2011","journal-title":"Annu Rev Public Health"},{"issue":"3","key":"poi240071r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.semperi.2021.151390","article-title":"Preterm birth lifetime costs in the United States in 2016: an update.","volume":"45","author":"Waitzman","year":"2021","journal-title":"Semin Perinatol"},{"issue":"9","key":"poi240071r6","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1001\/jamapediatrics.2017.1365","article-title":"Trends in differences in US mortality rates between Black and White infants.","volume":"171","author":"Riddell","year":"2017","journal-title":"JAMA Pediatr"},{"issue":"3","key":"poi240071r7","doi-asserted-by":"publisher","first-page":"179","DOI":"10.3233\/NPM-15814098","article-title":"Born early and born poor: an eco-bio-developmental model for poverty and preterm birth.","volume":"8","author":"Brumberg","year":"2015","journal-title":"J Neonatal Perinat Med"},{"issue":"22","key":"poi240071r8","doi-asserted-by":"publisher","first-page":"8659","DOI":"10.3390\/ijerph17228659","article-title":"Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes.","volume":"17","author":"Leifheit","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"poi240071r9","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.acap.2020.11.020","article-title":"Associations between prenatal food insecurity and prematurity, pediatric health care utilization, and postnatal social needs.","volume":"21","author":"Sandoval","year":"2021","journal-title":"Acad Pediatr"},{"issue":"5","key":"poi240071r10","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1001\/jamapediatrics.2020.6550","article-title":"Association of eviction with adverse birth outcomes among women in Georgia, 2000 to 2016.","volume":"175","author":"Himmelstein","year":"2021","journal-title":"JAMA Pediatr"},{"issue":"8","key":"poi240071r11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0182862","article-title":"Social disadvantage and the Black-White disparity in spontaneous preterm delivery among California births.","volume":"12","author":"Carmichael","year":"2017","journal-title":"PLoS One"},{"issue":"10","key":"poi240071r12","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1136\/archdischild-2018-316486","article-title":"Racial disparities in preterm birth in USA: a biosensor of physical and social environmental exposures.","volume":"104","author":"Burris","year":"2019","journal-title":"Arch Dis Child"},{"issue":"4","key":"poi240071r13","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.7612","article-title":"Evictions and infant and child health outcomes: a systematic review.","volume":"6","author":"Ramphal","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"poi240071r14","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1038\/s41390-022-02445-6","article-title":"Structural racism is associated with adverse postnatal outcomes among Black preterm infants.","volume":"94","author":"Karvonen","year":"2023","journal-title":"Pediatr Res"},{"issue":"1","key":"poi240071r15","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/107755870105800101","article-title":"The impact of the Medicaid expansions for pregnant women: a synthesis of the evidence.","volume":"58","author":"Howell","year":"2001","journal-title":"Med Care Res Rev"},{"issue":"2","key":"poi240071r16","first-page":"373","article-title":"Changes in prenatal care timing and low birth weight by race and socioeconomic status: implications for the Medicaid expansions for pregnant women.","volume":"36","author":"Dubay","year":"2001","journal-title":"Health Serv Res"},{"issue":"4","key":"poi240071r17","doi-asserted-by":"publisher","first-page":"2406","DOI":"10.1111\/1475-6773.12779","article-title":"The association of health reform and infant health: evidence from Massachusetts.","volume":"53","author":"Boudreaux","year":"2018","journal-title":"Health Serv Res"},{"issue":"16","key":"poi240071r18","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1001\/jama.2019.3678","article-title":"Association of state Medicaid expansion status with low birth weight and preterm birth.","volume":"321","author":"Brown","year":"2019","journal-title":"JAMA"},{"issue":"5","key":"poi240071r19","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1377\/hlthaff.2015.0814","article-title":"Variation in health outcomes: the role of spending on social services, public health, and health care, 2000-09.","volume":"35","author":"Bradley","year":"2016","journal-title":"Health Aff (Millwood)"},{"issue":"5","key":"poi240071r20","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-1134","article-title":"State and local government expenditures and infant mortality in the United States.","volume":"146","author":"Goldstein","year":"2020","journal-title":"Pediatrics"},{"issue":"5","key":"poi240071r21","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-050685","article-title":"State spending on public benefit programs and child maltreatment.","volume":"148","author":"Puls","year":"2021","journal-title":"Pediatrics"},{"issue":"4","key":"poi240071r22","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1177\/0003122410374086","article-title":"Effects of prenatal poverty on infant health: state Earned Income Tax Credits and birth weight.","volume":"75","author":"Strully","year":"2010","journal-title":"Am Sociol Rev"},{"key":"poi240071r23","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.socscimed.2017.10.016","article-title":"Effects of state-level Earned Income Tax Credit laws in the U.S. on maternal health behaviors and infant health outcomes.","volume":"194","author":"Markowitz","year":"2017","journal-title":"Soc Sci Med"},{"issue":"1","key":"poi240071r24","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1089\/heq.2018.0061","article-title":"Effects of state-level Earned Income Tax Credit laws on birth outcomes by race and ethnicity.","volume":"3","author":"Komro","year":"2019","journal-title":"Health Equity"},{"issue":"12","key":"poi240071r25","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.16722","article-title":"Association of Special Supplemental Nutrition Program for Women, Infants, and Children with preterm birth and infant mortality.","volume":"2","author":"Soneji","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"5","key":"poi240071r30","first-page":"1","article-title":"Measuring gestational age in vital statistics data: transitioning to the obstetric estimate.","volume":"64","author":"Martin","year":"2015","journal-title":"Natl Vital Statistics Rep"},{"issue":"5","key":"poi240071r32","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1215\/00703370-10230542","article-title":"Social spending and educational gaps in infant health in the United States, 1998-2017.","volume":"59","author":"Jackson","year":"2022","journal-title":"Demography"},{"issue":"4","key":"poi240071r33","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1542\/peds.2006-0860","article-title":"The contribution of preterm birth to infant mortality rates in the United States.","volume":"118","author":"Callaghan","year":"2006","journal-title":"Pediatrics"},{"issue":"3","key":"poi240071r34","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1093\/ser\/mwz025","article-title":"Temporary assistance for needy families and the Black\u2013White child poverty gap in the United States.","volume":"19","author":"Parolin","year":"2021","journal-title":"Socio-Economic Rev"},{"key":"poi240071r35","article-title":"Housing vouchers and tax credits: pairing the proposal to transform Section 8 with expansions to the EITC and the Child Tax Credit could cut the national poverty rate by half.","author":"Collyer","journal-title":"Poverty & Social Policy Brief"},{"issue":"8","key":"poi240071r37","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.27493","article-title":"Association of the 2021 Child Tax Credit advance payments with low birth weight in the US.","volume":"6","author":"Margerison","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"poi240071r38","doi-asserted-by":"publisher","first-page":"2180","DOI":"10.1186\/s12889-023-16920-0","article-title":"Estimating the effect of timing of Earned Income Tax Credit refunds on perinatal outcomes: a quasi-experimental study of California births.","volume":"23","author":"Karasek","year":"2023","journal-title":"BMC Public Health"},{"issue":"4","key":"poi240071r39","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1093\/humrep\/der480","article-title":"Selection against small males in utero: a test of the Wells hypothesis.","volume":"27","author":"Catalano","year":"2012","journal-title":"Hum Reprod"},{"key":"poi240071r40","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.ssmph.2018.05.010","article-title":"Selection in utero and population health: theory and typology of research.","volume":"5","author":"Bruckner","year":"2018","journal-title":"SSM Popul Health"},{"issue":"11","key":"poi240071r43","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1377\/hlthaff.2022.00740","article-title":"Easing cash assistance rules during COVID-19 was associated with reduced days of poor physical and mental health.","volume":"41","author":"Dore","year":"2022","journal-title":"Health Aff (Millwood)"},{"key":"poi240071r1","volume-title":"Preventing Low Birthweight","author":"Committee to Study the Prevention of Low Birthweight","year":"1985"},{"key":"poi240071r2","volume-title":"Preterm Birth: Causes, Consequences, and Prevention","author":"Behrman","year":"2007"},{"key":"poi240071r36","volume-title":"Fetal Growth Restriction","author":"Chew","year":"2023"},{"key":"poi240071r26","unstructured":"US Centers for Disease Control and Prevention. About Natality, 2007-2022. Accessed December 8, 2022. https:\/\/wonder.cdc.gov\/natality-current.html"},{"key":"poi240071r27","unstructured":"US Census Bureau. Annual survey of state and local government finances. Accessed January 8, 2022. https:\/\/www.census.gov\/programs-surveys\/gov-finances.html"},{"key":"poi240071r28","unstructured":"Federal Reserve Bank of St Louis (FRED). Gross domestic product: implicit price deflator (GDPDEF). Accessed March 1, 2023. https:\/\/fred.stlouisfed.org\/series\/GDPDEF"},{"key":"poi240071r29","unstructured":"US Census Bureau. American Community Survey, 2010\u20132018. Accessed December 5, 2022. https:\/\/www.census.gov\/programs-surveys\/acs"},{"key":"poi240071r31","unstructured":"Urban Institute. State and local backgrounders. Accessed January 1, 2024. https:\/\/www.urban.org\/policy-centers\/cross-center-initiatives\/state-and-local-finance-initiative\/state-and-local-backgrounders\/public-welfare-expenditures"},{"key":"poi240071r41","unstructured":"Hahn? H, Aron? LY, Lou? C, Pratt? E, Okoli? A. Why does cash welfare depend on where you live? Urban Institute. Accessed January 1, 2024. https:\/\/www.urban.org\/sites\/default\/files\/publication\/90761\/tanf_cash_welfare_final2_1.pdf"},{"key":"poi240071r42","unstructured":"Shrivastava? A. Policy brief: to strengthen economic security and advance equity, states should invest more TANF dollars in basic assistance. Center on Budget and Policy Priorities. Accessed January 1, 2024. https:\/\/www.cbpp.org\/sites\/default\/files\/1-5-17tanf-rev3-8-2023.pdf"}],"container-title":["JAMA Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/articlepdf\/2824894\/jamapediatrics_chang_2024_oi_240071_1732566596.69043.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T16:02:58Z","timestamp":1733155378000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2824894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":43,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapediatrics.2024.4267","relation":{},"ISSN":["2168-6203"],"issn-type":[{"value":"2168-6203","type":"print"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}