Long-term Impacts and Mechanisms of Financial Programming on Mental Health of Young Adults - PROJECT SUMMARY The period of emerging adulthood (ages 18-24) is a particularly critical developmental period in which significant decisions are made that set a life course towards adulthood, including training/education, employment/career, residential independence, relationships, and parenthood. The substantial physical, emotional, and developmental changes that occur during this developmental period put young people at risk for increased mood disorders, increased risk-taking behaviors, and decreased health seeking behaviors. Further, emerging adults experience the highest poverty rates of any group, contributing to their disproportionately adverse mental and physical health outcomes. Economic interventions have demonstrated improvements in economic stability and health for low-income communities. For young people transitioning to adulthood, an economic intervention could provide the support needed to develop healthy educational and employment trajectories before financial strain instills deepening disparities. The BEEM study (U01OD033266/ U01MD019398) is an NIH-supported randomized wait-list-controlled trial to determine the impact of an economic intervention including cash payments and opt- in financial mentoring on the physical, emotional, and financial well-being of low-income emerging adults. Since 2022, we have recruited and delivered the economic intervention to 300 emerging adults residing in low-income neighborhoods. We later began recruitment of a comparison cohort with 150 young adults from the same communities who were offered only tailored financial mentoring, without the cash payments, to work towards their financial goals. The current BEEM study is providing critical data on the short-term impact of cash on mental health and economic well-being. We have found that anxiety and depression were significantly lower after one year for participants receiving the cash compared to those who did not. However, the long-term sustainability of the health and wellbeing outcomes in BEEM needs to be established. Further, identifying the pathways and malleable targets for adjunctive interventions for those participants with suboptimal response can maximize the impact of economic interventions. We propose to follow these 450 low-income emerging adults, 300 who received cash and 150 who have not for an additional 3 years, collecting extensive information on psychosocial, economic, household, and neighborhood characteristics to : 1) assess longer term impacts of the economic intervention on mental health, 2) explore three mediating pathways (economic, psychosocial, and physical/behavioral) through which the economic intervention impacts mental health outcomes, and 3) identify malleable moderators operating at multiple levels (individual, household, neighborhood) that could be intervened on to maximize the impact of the economic intervention. This study will provide a roadmap to develop future economic interventions that are optimized to effectively address mental health in emerging adults.
