Effect of a financial education program on the health of single, low-income women and their children

IntroductionIn 2012, 40% of households reported living paycheck to paycheck, a trend more common in women than men, 36% versus 44% (1). The same survey demonstrated that 20% of workers were unable to make ends meet, which can lead to significant financial and socioeconomic stress. Increases in perceived life stress and impairments in well-being have been documented in individuals enduring financial strain (2-6).Persons under stress can be more socially isolated and report elevated depressive and psychosomatic symptoms (7). They also engage in unhealthy behaviors such as smoking, alcohol consumption, overspending, and poor diet and exercise (8). This has been recently explained by the limited-resource model of self-control (8). Because the poor have less money, food, and expendable time, they are challenged to control behavior and resist urges more than others which exhaust self-control resources. Over time, people under stress are at a greater risk for chronic illness, particularly cardiovascular disease. Financial stress was shown to predict myocardial infarction and cardiac death in women in the Framingham Study and has been associated with coronary heart disease (9, 10).While lifestyle factors can contribute to the development of chronic illness, lower socioeconomic status is also associated with biologic risk factors including hyperlipidemia, obesity, metabolic syndrome, diabetes, elevations in fibrinogen, cardiac rhythm abnormalities, and procoagulant blood profiles (11-13). Many researchers have postulated that the link between stress and poor health outcomes is sustained activation of autonomic and neuroendocrine responses (14). Increased activation of the hypothalamic-pituitary-adrenal axis leading to increased levels of cortisol is a major component of the stress pathway. Chronic cortisol elevations may contribute to insulin resistance, muscle atrophy, diabetes, abdominal fat, immune impairment, and hypertension (7,15). Furthermore, increased sympathetic nervous system activity, specifically elevations in catecholamines, epinephrine and norepinephrine, has been shown in those of lower socioeconomic status (16). Poverty, low socioeconomic status, and financial stress can also affect health outcomes in children. Financial stress during childhood has been associated with increased childhood obesity and the development of diabetes and cardiovascular disease later in life (17-20).The Financial Success Program (FSP), founded in 2010 at Creighton University, was developed to explore which financial education program components are most effective in creating behavior change for low-income single mothers. The FSP focuses on three core components: an outstanding trainer, one-on-one financial coaching, and an easy to use money management system. The program serves women in the Omaha, Nebraska metropolitan area who are predominantly African American. Participants have significantly more cardiovascular risk factors than other women in Nebraska including obesity, smoking, diminished exercise, hypertension, and diabetes (21).During the FSP, participants meet weekly for nine weeks followed by monthly group meetings for one year. Participants are also assigned a coach for long-term financial advice. Based on anecdotally-reported positive health changes in prior graduates of the FSP, this study was designed to evaluate the effect of the FSP on cardiovascular risk health indicators and financial outcomes in participants and their children. Figure 1 depicts a conceptual model to describe the relationship between financial education and health indicators. To date, there are no published studies assessing the effect of financial education interventions on health indicators.MethodsThis study was approved by the Creighton University Institutional Review Board (#11-16171). All participants provided written informed consent/assent as applicable. The study was registered on clinicaltrials.gov as Impact of a Financial Success Education Program in Women and Children, NCT01409291, on July 29, 2011. …