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Explores the following policy approaches to drug use by pregnant women: (1) criminal prosecution of the mother; (2) allegations of child neglect against the mother with interruption of custody; and (3) drug treatment. Discusses whether each reduces drug use during pregnancy or improves maternal and infant health and well-being. (JS)

Objectives. This study assessed chronic child illness among recipients of Temporary Assistance for Needy Families (TANF) benefits and poor families not receiving benefits. Methods. Data from the 1998 National Health Interview Survey were used to examine chronic child illness, enrollment in TANF, health insurance status, and selected access indicators. Results. One quarter of TANF-enrolled children had chronic illnesses. Unenrolled children were 3 times as likely as TANF-enrolled children to be uninsured. Among the chronically ill, 31.7% of unenrolled and 14.3% of enrolled children experienced gaps in insurance coverage that were associated with access barriers. Conclusions. Welfare policies should consider the effects of chronic illness and gaps in insurance coverage on the health of poor children.

Objectives. This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment. Methods. Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex. Results. There were distinct health differences according to mothers' TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems. Conclusions. Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children.

Objectives. The purpose of this study was to assess changes in health insurance and food assistance enrollment following passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Methods. Extant data sources were used to calculate changes in Temporary Assistance for Needy Families (TANF), Medicaid, and Food Stamp program enrollment in medically underserved Manhattan communities after 1996. Results. Dramatic declines in TANF enrollment were accompanied by declines in Food Stamp program enrollment and a deceleration in Medicaid enrollment among several communities. Conclusions. As the Personal Responsibility and Work Opportunity Reconciliation Act comes up for reauthorization later in 2002, policymakers should revise legislation so that needy families do not lose health insurance or food assistance support.

Objectives. This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma. Methods. Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices. Results. Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured. Conclusions. Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.

Objectives. This study evaluated the association of chronic child illness with parental employment among individuals who have had contact with the welfare system. Methods. Parents of children with chronic illnesses were interviewed. Results. Current and former welfare recipients and welfare applicants were more likely than those with no contact with the welfare system to report that their children's illnesses adversely affected their employment. Logistic regression analyses showed that current and former receipt of welfare, pending welfare application, and high rates of child health care use were predictors of unemployment. Conclusions. Welfare recipients and applicants with chronically ill children face substantial barriers to employment, including high child health care use rates and missed work. The welfare reform reauthorization scheduled to occur later in 2002 should address the implications of chronic child illness for parental employment.

Through simulated calls to 294 drug treatment programs in five cities, this study investigated access for pregnant women and compared New York City's provision of services in 1989 to that in 1993. In all sites, the majority of programs accepted pregnant women. There was also a marked improvement in the availability of services in New York City. Yet options were more limited for Medicaid recipients and women needing child care, and an appointment or referral for prenatal care was usually not offered. Although the door for treatment may be opening for pregnant women, institutional barriers still remain., Substance abuse treatment programs in large cities may accept pregnant women, but payment policies and a lack of prenatal and child care may pose barriers to poor women. A study of 294 drug treatment programs in five cities revealed that most outpatient and residential programs accepted pregnant women. The five cities studied were Albuquerque, NM; Charleston, SC; Detroit, MI; New York, NY, and Portland, OR. Only half of outpatient programs in Albuquerque accepted pregnant women on Medicaid; non-acceptance of pregnant women on Medicaid was a trend in the other four cities as well. Drug treatment programs in New York City were found to be more accepting of pregnant women in 1993 than they were in 1989, but not all of these programs were open to pregnant women on Medicaid. Programs also may not be sensitive to the prenatal care and child care needs of pregnant women.