detriments were reported for children who were transitioning into early adolescence.

Casino Income and Poverty Reduction: Evidence from a Natural Experiment

No existing trial has specifically assessed the impact of poverty reduction programs on MEB disorders among young people. However, a study by Costello, Compton, and colleagues (2003) used a natural experimental situation to provide evidence of the benefit of increasing family income in reducing these disorders. Four years into a longitudinal study of a representative sample of 1,420 children ages 9-13, 350 of whom were American Indian, a casino was opened on the Indian reservation. Income from the casino significantly reduced the percentage of American Indian families in poverty, but did not affect the poverty rate among non-Indian families. Across the eight years of the study, small but significant correlations were seen between family income and the occurrence of psychiatric diagnosis and the number of psychological symptoms in both Indian and non-Indian children.

Costello, Compton, and colleagues (2003) also looked at changes in symptoms of externalizing disorders (conduct disorder and oppositional defiant disorder) and internalizing disorders (anxiety and depression) following the casino’s opening. Behavioral symptoms increased significantly among children in families that remained poor as the children moved into adolescence, but declined significantly over the same period for the Indian children who were lifted out of poverty. Similarly, there was a significant decline in the rates of internalizing symptoms for those lifted out of poverty but not in persistently poor Indian children. Although many fewer non-Indian families moved out of poverty, some did. The pattern of changes in total psychological symptoms was the same as in the Indian children.

This study has the key features of a multiple-baseline design (Biglan, Ary, et al., 2000); after baseline observations, some of the participants received an “intervention” and others did not. Although the increases in income were not assigned randomly to both Indian and non-Indian participants, it is difficult to imagine what other variable might have confounded the change in economic fortunes that occurred for the Indian children.

Potential for Future Research on Poverty Reduction

Gershoff, Aber, and Raver (2003) identify multiple programs that could improve families’ economic well-being: Medicaid, the earned income tax credit, Temporary Assistance to Needy Families, food stamps, federal housing subsidies, the School Lunch Program, minimum wage policy, and WIC.



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