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Week of 18 September 1998 Vol. II, No. 6 Feature Article December deadline looms Researchers monitor impact of welfare shake-up on children by Marion Sawey Fearing that welfare reforms will lead to hunger and malnutrition among poor families, Boston University pediatricians have taken the lead in a multistate investigation into the impact of the legislative changes on the health of young children. Associate Professor of Pediatrics Deborah Frank, who is leading the investigation into the effect of subsidy cuts on children's health. The three-year study by the Children's Sentinel Nutrition Assessment Program (C-SNAP), which is headed by researchers in Boston Medical Center's department of pediatrics working along with colleagues in five other states, has attracted a $2.4 million grant from the W. K. Kellogg Foundation. "No one is looking at how reforms such as cuts in food stamps and time limits on subsidies will affect children's health and growth," says Associate Professor of Pediatrics Deborah Frank, director of BMC's Grow Clinic and the principal investigator for C-SNAP. "Our study will allow us to monitor the health of Boston's most vulnerable population and will prove vital in evaluating the potential negative health impact associated with welfare reform." The Massachusetts researchers will be joined in their survey by pediatricians at health-care or emergency centers in Little Rock, Ark., Los Angeles, Calif., Washington, D.C., Baltimore, Md., and Minneapolis, Minn. Summaries of their findings will be sent to each state's policymakers for consideration. "Some people think that there will be a public health catastrophe when the first wave of grant cutoffs takes place in Massachusetts in December," says Frank. "I hope that I can encourage legislators to rethink the situation if in fact we do discover adverse consequences taking place." Frank says that she got the idea for the project from an earlier study she carried out locally that found that every winter the rate of underweight in small children increases by 30 percent. "If this can happen so quickly as a result of a short-term fluctuation in family income because money is diverted to buy fuel, I asked myself what the effects of long-term deprivation would be." She stresses that children in the survey who are found to be at risk of growth or nutrition problems will be referred to clinical, social, or other services, including the Grow Clinic. "We have to offer clinical support as a backup because it would be immoral to screen for serious health conditions and then fail to offer help," she says. "We are fearful that this could swamp our resources, but treatment must be made available for every child who needs it." Frank's coinvestigator, BUSM Assistant Professor of Pediatrics Alan Meyers, explains that the team is concerned about the replacement of the legislation Aid to Families with Dependent Children by the new Transitional Aid for Needy Families law, which imposes time limits on subsidies. He also points out that half the money being cut from poverty reduction programs overall is coming from food stamps. Assistant Professor of Pediatrics Alan Meyers examines a child in the BMC Grow Clinic. Photo by Vernon Doucette "Thousands of families are going to lose benefits on December 1, the end of the two-year time limit for some subsidies imposed by the state of Massachusetts," he says. "People are holding their breath and watching. The national welfare rolls have shrunk almost everywhere in advance of this legislation, but that probably means only that those most able to do so went out and found jobs. Unfortunately, not everyone is going to be able to find work. We are worried that among that first group of families there may be many who simply become destitute and are forced onto the street in increasing numbers. No one wants to see that happen, but our fear is that it will." Even before the latest reforms, food stamps did not entirely fill the gap that exists between the poverty level -- defined as having enough money to get an adequate diet -- and the minimum wage income, says Meyers. "Minimum income at best reached three quarters of the poverty level. So our concern is that these really significant cuts in food stamps will leave families with fewer resources to put food on the table, leading to a rise in the rate of hunger and malnutrition. If that is the case, we think that the public and our governmental representatives need to be on the lookout and to help families in a pinch." He points out that emergency food pantries, although they distributed 12 to 14 million tons of food in the greater Boston area last year alone, cannot fill the gap. "Emergency food is only available on a piecemeal basis, usually for up to three days, leaving families to search for help from a succession of charities in the emergency food network," he says. "Seeking emergency help is a stopgap measure at best, not a seamless method of providing an adequate diet, and can be a full-time job for some families." The BMC team, he says, will screen every child who passes through the emergency department, reviewing their growth parameters. "Of these, at least 500 per year will also be interviewed using a detailed face-to-face questionnaire in order to ascertain other variables, including demographics, program participation, and food security status. This should provide us with a series of snapshots of children's health as reforms are introduced." Overall, the sites taking part in the study were chosen for their diversity geographically and demographically and for the differences in the welfare reforms being implemented by the states where they are located, Meyers explains. "The fact that this is a multisite and multistate project should allow us to get a continuous view over time of whether the situation appears to be getting worse or better and of the factors contributing to any change. If there is a growth in food insecurity, the country needs to know about it as soon as possible." One of the advantages of the study, he says, is the rapidity with which the six sites will be able to collect and disseminate data, as compared to national nutritional surveys. "If what we fear is true, we want to make our findings known without waiting three, four, or five years, because the turnaround time on federal policy enacted by acts of Congress is glacial." The data will be coordinated and analyzed centrally at BUMC's School of Public Health and probably disseminated at six-month intervals. "We hope that this is going to help keep the issue in front of the public," says Meyers. "Most people would be surprised to learn, for example, that when we screened a random group of kids waiting for treatment in our primary care clinic a few months ago, we found that about 8 percent faced a food emergency -- in other words, their families didn't have food for that evening's meal. We want to document situations like this in our study, and we hope that by highlighting our findings, we can somehow help."