Primary Submission Category: Interventions/Programs
Casino-based cash transfers and preterm birth among the Eastern Band of Cherokee Indians, 1990-2019
Authors: Julie Strominger Parvati Singh
Presenting Author: Julie Strominger*
Introduction
The United States has seen increasing interest in using cash transfers to alleviate economic insecurity. Whereas conditional cash transfers (CCTs) have requirements, unconditional cash transfers (UCTs) provide cash without conditions. Limited research examines the impact of UCTs on birth outcomes such as preterm births (PTBs). We use a quasi-experimental UCT that began in 1995 among the Eastern Band of Cherokee Indians (EBCI) in North Carolina (NC) to examine whether exogenous income receipt impacts PTB. After a casino opened on the reservation, adult EBCI members began receiving UCTs from casino profits starting December 1995, which continue to be disbursed twice a year. We examine the impact of these cash transfers on PTB.
Methods
We obtained 1990-2019 NC singleton birth data. EBCI mothers residing in Graham, Jackson, and Swain counties (treated region) formed the treated group. Non-American Indian/Alaska Native (AIAN) mothers residing in the treated region formed the first comparison group. AIAN mothers and non-AIAN mothers in untreated regions in NC were the second and third comparison groups, respectively. We defined PTB as a birth occurring before 37 weeks of gestation. Our exposure was the total cash transfer amount an EBCI mother received by her child’s birthdate. We used difference-in-difference-in-differences to examine the effect of the magnitude of cash receipt on risk of PTB in our treated group compared to the untreated groups. Analyses accounted for mother’s age, education, marital status, number of prior pregnancies, infant’s sex, and year and county fixed effects.
Results
Among EBCI women 21 years and older, for every thousand dollar increase in cumulative cash transfer amount, the risk of PTB increased by 0.02% (95% CI, 0.01-0.04). Exploratory analyses indicate that this increase may be due to increases in the risk of obese women giving birth. We found no relation between PTBs and cash transfer amount among EBCI women under 21 years.