Date of Award

January 2025

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Benjamin A. Howell

Abstract

People with a recent history of incarceration have poor health outcomes compared to non-incarcerated community members. Sequelae of uncontrolled chronic disease are responsible for a large amount of this disparity; chronic disease in this population is in turn worsened by poverty and its associated determinants of health. To investigate the potential health effects of financial interventions on the recently incarcerated, we partner with a Connecticut-based 501(c)3 organization, 4-CT, to evaluate the feasibility and acceptability of an unconditional cash transfer program in which 30 individuals with chronic health conditions recently released from prison received $500 monthly for 6 months. Using an approach combining qualitative interviews and quantitative analysis of changes in health care use, we examine the experience of receipt of unconditional cash transfers in a 16-person cohort via semi-structured qualitative interviews. Orthogonally, we evaluate primary care versus emergency department (ED) utilization in this cohort as compared to community controls and additionally record objective measures of psychosocial / financial health in this population.In our semi-structured interviews, participants report universal acceptability of the intervention as well as varied and sometimes significant potential health benefits. Materially, this includes increased access to housing, fresh foods, and transportation to healthcare appointments. Many individuals also describe significant psychosocial advantages, such as closer relationships with family members, decreased recidivism, decreased psychological stress, and the start of deliberate budgeting behaviors. With respect to healthcare utilization, we find no significant difference in healthcare-seeking behavior between historical controls and the cash-receiving cohort prior to and after the intervention period (except in the cash-receiving group’s ED usage and PCP enrollment at baseline and after cash aid as compared to controls (p < 0.05)). Validated survey tools assessing post-intervention financial and psychosocial wellbeing in the cash cohort indicate moderate psychological stress, moderately high numbers of lived adverse experiences, and high levels of financial distress. Overall, unconditional cash transfers appear to be acceptable and feasible in this population. They appear to have a mixed but beneficial effect on health in the short term, with no observed effect on healthcare utilization within a six-month period, though our ability to observe a difference in this pilot study was limited. However, given the gradual nature of the positive changes described in our interviews, further study over longer periods of time is needed to elucidate whether there is a measurable, net-positive difference in biomarkers, measures of psychosocial / financial stress, and healthcare engagement.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

Download

Share

COinS