Impact of welfare reform on mortality: an evaluation of the Connecticut jobs first program, a randomized controlled trial

Abstract

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.

FIGURE 1—

Sample allocation for Connecticut Jobs First Study. Note. AFDC = Aid to Families with Dependent Children; SSN = Social Security number. A small portion (8%) of participants in the AFDC sample moved during the study and therefore might have been exposed to a month or more of the Jobs First Program. In addition, some members of the Jobs First sample did not receive cash assistance. ^aMDRC sample. ^bAnalytic sample.