Factors associated with food insecurity in children and adolescents with type 1 diabetes mellitus.

In 2023, 3.7 million children were the subject of a child protective services (CPS) investigation for alleged child abuse or neglect, nearly 15% of whom were substantiated as victims of child maltreatment (). Cumulative lifetime rates are even higher; before turning 18, more than 1 in 3 U.S. children are subject to a CPS investigation (). Identifying policy strategies for reducing risk of child maltreatment remains a critical social and economic concern. Research demonstrates that maltreatment increases risk for mental health challenges, substance abuse, criminal and delinquent behavior, and health and economic well-being (; ; ; ). The annual cost of maltreatment to society is non-trivial, ranging from $592 billion for substantiated CPS investigations, to $2.96 trillion for all investigated CPS cases (). Further, child maltreatment is a key factor that reinforces social inequality in the U.S., as lower income and racial-ethnic minority children are at greater risk of CPS involvement (; ). We examine whether greater total safety net support in U.S. states is associated with lower CPS investigation rates, overall and by race and ethnicity, for all children and for children under age five. Prior research suggests that poverty and material hardship contribute to an elevated risk of both child maltreatment and CPS involvement (; ; ; ; ; ; ; ; ; ; ; ; , ; ; ; ; ). Thus, it stands to reason that policies that support families’ economic wellbeing and financial security may help prevent CPS involvement. While prior research provides powerful insights, it has largely focused on a single program, such as the Earned Income Tax Credit (EITC), Supplemental Nutrition Assistance Program (SNAP), child support enforcement (IV-D), Temporary Assistance for Needy Families (TANF), Medicaid, and early care and education (ECE) programs (; ; ; ; ; ; ), or on only a limited subset of U.S. safety net programs (; , ). Our study extends prior research by taking a more holistic view of the U.S. state social safety net landscape. Specifically, we construct a state-level measure of average expected safety net support that captures both program (program expenditures or benefit amount per recipient) and (likelihood of receiving a benefit for a potentially needy family) to compute the average amount of social welfare program support that a potentially needy family can expect to receive in a given state and year. Our measure includes nine safety net policies and programs, many, though not all, of which are means-tested, and for which U.S. states have substantial discretion in setting eligibility rules, benefit levels, financing, or administration. These include cash and near-cash programs—TANF, Supplemental Security Income (SSI), Unemployment Insurance (UI), child support, state income taxes for low-income families, and SNAP—as well as in-kind programs, such as childcare subsidies, early education (state pre-kindergarten (pre-k) and Head Start), and public health insurance (Medicaid and State Children’s Health Insurance Program (SCHIP)).