title: Cash plus care: social protection cumulatively mitigates HIV-risk behaviour among adolescents in South Africa The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks Impact of the Kenya Cash Transfer for Orphans and Vulnerable Children on early pregnancy and marriage of adolescent girls. The Government of Kenya's Cash Transfer Program Reduces the Risk of Sexual Debut among Young People Age 15-25 A multilevel analysis of the effect of Malawi's Social Cash Transfer Pilot Scheme on school-age children's health. Effects of cash transfers on Children’s health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial Preventing Acute Malnutrition among Young Children in Crises: A Prospective Intervention Study in Niger Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: a propensity-score-matched case-control study. Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia. Cash and in-kind transfers in poor rural communities in Mexico increase household fruit, vegetable, and micronutrient consumption but also lead to excess energy consumption. Effect of Ecuador's cash transfer program (Bono de Desarrollo Humano) on child development in infants and toddlers: a randomized effectiveness trial. Does money matter? The effects of cash transfers on child development in rural Ecuador. Cash and in-kind transfers lead to excess weight gain in a population of women with a high prevalence of overweight in rural Mexico. Comparing personal trajectories and drawing causal inferences from longitudinal data. Cash transfers and domestic violence.
abstract: Objectives : It is not known whether cumulative ‘ cash plus care ’ interventions can reduce  adolescent HIV-infection risks in sub-Saharan Africa . This study investigated whether parental AIDS and other environmental adversities increase  adolescent HIV-risk behaviour  and whether social protection provision of ‘ cash ’ or integrated ‘ cash plus care ’ reduces HIV-risk behaviour . Design : A prospect i ve observational study with r and om sampling ( < 2.5 % baseline refusal , 1-year follow-up , 96.8 % retention ) . Methods : Three thous and five hundred and fifteen 10–18 year-olds ( 56.7 % girls ) were interviewed in South Africa between 2009–2010 and 2011–2012 . All homes with a resident adolescent were sample d , within r and omly selected census areas in two urban and two rural districts in two provinces . Measures included potential environmental risks ( e.g. parental HIV/AIDS , poverty ) , social protection : receipt of cash/food support ( e.g. child grants , school feeding ) , care ( e.g. positive parenting ) and HIV-risk behaviours ( e.g. unprotected sex ) . Analyses used logistic regression . Results : Cash alone was associated with reduced HIV risk for girls [ odds ratio ( OR ) 0.63 ; 95 % confidence interval ( 95 % CI ) 0.44–0.91 , P = 0.02 ] but not for boys . Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes ( girls OR 0.55 ; 95 % CI 0.35–0.85 , P = 0.007 ; boys OR 0.50 ; 95 % CI 0.31–0.82 , P = 0.005 ) , compared with no support and controlling for confounders . Follow-up HIV-risk behaviour was reduced from 41 to 15 % for girls and from 42 to 17 % for boys . Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour , but were less likely to access integrated social protection . Conclusion : Integrated cash plus care reduces  male and female adolescent HIV-risk behaviours . Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa Introduction The objective of this article is to present the rationale and baseline results for a r and omized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection ( STI ) risk among male sex workers ( MSWs ) in Mexico City . Methods Participants ( n=267 ) were tested and treated for STIs ( chlamydia , gonorrhoea , syphilis and HIV ) and viral hepatitis ( hepatitis B and C ) , received HIV and STI prevention education  and were r and omized into four groups : ( 1 ) control , ( 2 ) medium conditional incentive ( $ 50/six months ) , ( 3 ) high conditional incentive ( $ 75/six months ) and ( 4 ) unconditional incentive ( $ 50/six months ) . In the conditional arms , incentives were contingent upon testing free of new curable STIs ( chlamydia , gonorrhoea and syphilis ) at follow-up assessment s. Results Participants ’ mean age was 25 years ; 8 % were homeless or lived in a shelter , 16 % were unemployed and 21 % lived in Mexico City less than 5 years . At baseline , 38 % were living with HIV , and 32 % tested positive for viral hepatitis or at least one STI ( other than HIV ) .  Participants had a mean of five male clients in the previous week ; 18 % reported condomless sex  with their last client . For 37 % , sex work was their main occupation and was conducted mainly on the streets ( 51 % ) or in bars/discotheques ( 24 % ) and hotels ( 24 % ) . The average price for a sex transaction was $ 25 with a 35 % higher payment for condomless sex . Conclusions The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs , given the market-based inducements for unprotected sex . This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts There is promising evidence that poverty-targeted cash transfer programs can have positive impacts on  adolescent transitions to adulthood in re source poor setting s , however existing research is typically from small scale programs in diverse geographic and cultural setting s. We provide estimates of the impact of a national unconditional cash transfer program , the Kenya Cash Transfer for Orphans and Vulnerable Children  , on pregnancy and early marriage among females aged 12 to 24 , four years after program initiation . The evaluation was design ed as a clustered r and omized controlled trial and ran from 2007 to 2011 , capitalizing on the existence of a control group , which was delayed entry to the program due to budget constraints . Findings indicate that , among 1549 females included in the study , while the program reduced the likelihood of pregnancy by five percentage points , there was no significant impact on likelihood of early marriage . Program impacts on pregnancy appear to work through increasing the enrollment of young women in school , financial stability of the household and delayed age at first sex . The Kenyan program is similar in design to most other major national cash transfer programs in Eastern and Southern Africa , suggesting a degree of generalizability of the results reported here . Although the objective of the program is primarily poverty alleviation , it appears to have an important impact on facilitating the successful transition of adolescent girls into adulthood The aim of this study is to assess whether the Government of Kenya 's Cash Transfer for Orphans and Vulnerable Children ( Kenya CT-OVC ) can reduce the risk of HIV among young people by postponing sexual debut . The program provides an unconditional transfer of US$ 20 per month directly to the main caregiver in the household . An evaluation of the program was implemented in 2007–2009 in seven districts . Fourteen Locations were r and omly assigned to receive the program and fourteen were assigned to a control arm . A sample of households was enrolled in the evaluation in 2007 . We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age . We used logistic regression , adjusted for the respondent 's age , sex and relationship to caregiver , the age , sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline , to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program . Our results , adjusted for these covariates , show that the program reduced the odds of sexual debut by 31 percent . There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use , number of partners and transactional sex . Since the CT-OVC provides cash to the caregiver and not to the child , and there are no explicit conditions associated with receipt , these impacts are indirect , and may have been achieved by keeping young people in school . Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa OBJECTIVE The primary goal was to examine whether Malawi Social Cash Transfer Pilot Scheme , initially implemented in a rural district in central Malawi , improved health outcomes for children aged 6 - 17 . Secondary goals were to examine the effects of individual child- ( orphan status and gender ) and household-level factors ( number of working-age adults and sick adults ) on health outcomes . Another secondary goal was to examine whether orphan status modified the cash transfer effect on health outcomes . METHODS This multilevel study used panel data collected in 2007 - 08 from a r and omized controlled evaluation study of phase one of the programme . The analyses included 1197 children aged 6 - 17 in 486 households . The four outcomes of interest were : illness in the past month , illness that stopped normal activities in the past month , missing school due to illness or injury in the past month and health care use for worst illness in the past year . FINDINGS Approximately two-thirds of children in cash transfer eligible households were orphans . Compared with children in non-beneficiary households , those in beneficiary households had a 37 % lower odds of child illness ( P<0.05 ) , 42 % lower odds of illness that stopped normal activities ( P<0.01 ) and substantially higher odds of utilizing health services for a serious illness ( odds ratio=10.98 ; P<0.01 ) . An increase in the household number of working-age adults was associated with 34 % lower odds of child illness ( P<0.01 ) . An increase in the household number of sick adults increased the odds of child illness by 97 % ( P<0.01 ) and serious illness by 49 % ( P<0.01 ) . No statistically significant differences were observed by orphan status and child 's gender . Consistent differential programme effects by orphan status were not observed . CONCLUSION Unconditional cash transfer programmes to poor households have the potential to improve health outcomes for all vulnerable children aged 6 - 17 Background Unconditional and conditional cash transfer programmes ( UCT and CCT ) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS ( OVC ) . We address the gap in current underst and ing about the extent to which household-based cash transfers differentially impact individual children ’s outcomes , according to risk or protective factors such as orphan status and household assets . Methods Data were obtained from a cluster-r and omised controlled trial in eastern Zimbabwe , with r and om assignment to three study arms – UCT , CCT or control . The sample included 5,331 children ages 6 - 17 from 1,697 households . Generalized linear mixed models were specified to predict OVC health vulnerability ( child chronic illness and disability ) and social protection ( birth registration and 90 % school attendance ) . Models included child-level risk factors ( age , orphan status ) ; household risk factors ( adults with chronic illnesses and disabilities , greater household size ) ; and household protective factors ( including asset-holding ) . Interactions were systematic ally tested . Results Orphan status was associated with decreased likelihood for birth registration , and paternal orphans and children for whom both parents ’ survival status was unknown were less likely to attend school . In the UCT arm , paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans . Effects of study arms on outcomes were not moderated by any other risk or protective factors . High household asset-holding was associated with decreased likelihood of child ’s chronic illness and increased birth registration and school attendance , but household assets did not moderate the effects of cash transfers on risk or protective factors . Conclusion Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based setting s. UCT and CCT each produced direct effects on children ’s social protection which are not moderated by other child- and household-level risk factors , but orphans are less likely to attend school or obtain birth registration . The effects of UCT and CCT are not moderated by asset-holding , but greater household assets predict greater social protection outcomes . Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children . These efforts might include caregiver education , and additional incentives based on efforts made specifically for orphaned children Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT group and 1·8 % ( −5·0 to 8·7 ) greater in the CCT group than in the control group . The proportions of children aged 6–12 years who attended school at least 80 % of the time was 7·2 % ( 0·8–13·7 ) higher in the UCT group and 7·6 % ( 1·2–14·1 ) in the CCT group than in the control group . Interpretation Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa , but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region . Funding Wellcome Trust , the World Bank through the Partnership for Child Development , and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children Céline Langendorf and colleagues conducted a pragmatic intervention  study in Niger to assess whether distributions of supplementary foods in addition to household support by cash transfer effectively reduced malnutrition in children aged 6 to 23 months . Please see later in the article for the Editors ' BACKGROUND Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women . We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women . METHODS In this cluster r and omised trial , never-married women aged 13 - 22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and r and omly assigned with computer-generated r and om numbers by enumeration area ( 1:1 ) to receive cash payments ( intervention group ) or nothing ( control group ) . Intervention enumeration areas were further r and omly assigned with computer-generated r and om numbers to conditional ( school attendance required to receive payment ) and unconditional ( no requirements to receive payment ) groups . Participants in both intervention groups were r and omly assigned by a lottery to receive monthly payments ranging from US$ 1 to $ 5 , while their parents were independently assigned with computer-generated r and om numbers to receive $ 4 - 10 .  Behavioural risk assessment  s were done at baseline and 12 months ; serology was tested at 18 months . Participants were not masked to treatment status but counsellors doing the serologic testing were . The primary outcomes were prevalence of HIV and herpes simplex virus 2 ( HSV-2 ) at 18 months and were assessed by intention-to-treat analyses . The trial is registered , number NCT01333826 . FINDINGS 88 enumeration areas were assigned to receive the intervention and 88 as controls . For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data , weighted HIV prevalence at 18 month follow-up was 1·2 % ( seven of 490 participants ) in the combined intervention group versus 3·0 % ( 17 of 799 participants ) in the control group ( adjusted odds ratio [ OR ] 0·36 , 95 % CI 0·14 - 0·91 ) ; weighted HSV-2 prevalence was 0·7 % ( five of 488 participants ) versus 3·0 % ( 27 of 796 participants ; adjusted OR 0·24 , 0·09 - 0·65 ) . In the intervention group , we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence ( 3/235 [ 1 % ] vs 4/255 [ 2 % ] ) or weighted HSV-2 prevalence ( 4/233 [ 1 % ] vs 1/255 [ < 1 % ] ) . For individuals who had already dropped out of school at baseline , we detected no significant difference between intervention and control groups for weighted HIV prevalence ( 23/210 [ 10 % ] vs 17/207 [ 8 % ] ) or weighted HSV-2 prevalence ( 17/211 [ 8 % ] vs 17/208 [ 8 % ] ) . INTERPRETATION Cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low-income setting s. Structural interventions that do not directly target sexual behaviour change can be important components of HIV prevention strategies . FUNDING Global Development Network , Bill & Melinda Gates Foundation , National Bureau of Economic Research Africa Project , World Bank 's Research Support Budget , and several World Bank trust funds ( Gender Action Plan , Knowledge for Change Program , and Spanish Impact Evaluation fund ) BACKGROUND Effective and scalable HIV prevention for adolescents in sub-Saharan Africa is needed . Cash transfers can reduce HIV incidence through reducing risk behaviours . However , questions remain about their effectiveness within national poverty-alleviation programmes , and their effects on different behaviours in boys and girls . METHODS In this case-control study , we interviewed South African adolescents ( aged 10 - 18 years ) between 2009 and 2012 . We r and omly selected census areas in two urban and two rural districts in two provinces in South Africa , including all homes with a resident adolescent . We assessed household receipt of state-provided child-focused cash transfers , incidence in the past year and prevalence of transactional sex , age-disparate sex , unprotected sex , multiple partners , and sex while drunk or after taking drugs . We used logistic regression after propensity score matching to assess the effect of cash transfers on these risky sexual behaviours . FINDINGS We interviewed 3515 participants ( one per household ) at baseline , and interviewed 3401 at follow-up . For adolescent girls ( n=1926 ) , receipt of a cash transfer was associated with reduced incidence of transactional sex ( odds ratio [ OR ] 0·49 , 95 % CI 0·26 - 0·93 ; p=0·028 ) , and age-disparate sex ( OR 0·29 , 95 % CI 0·13 - 0·67 ; p=0·004 ) , with similar associations for prevalence ( for transactional sex , OR 0·47 , 95 % CI 0·26 - 0·86 ; p=0·015 ; for age-disparate sex , OR 0·37 , 95 % CI 0·18 - 0·77 ; p=0·003 ) . No significant effects were shown for other risk behaviours . For boys ( n=1475 ) , no consistent effects were shown for any of the behaviours . INTERPRETATION National , child-focused cash transfers to alleviate poverty for households in sub-Saharan Africa can substantially reduce unsafe partner selection by adolescent girls . Child-focused cash transfers are of potential importance for effective combination strategies for prevention of HIV . FUNDING UK Economic and Social Research Council , South African National Research Foundation , Health Economics and AIDS Research Division at University of KwaZulu-Natal , South African National Department of Social Development , Claude Leon Foundation , John Fell Fund , Nuffield Foundation , and Regional Interagency Task Team for Children affected by AIDS-Eastern and Southern Africa There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes ; however , questions remain surrounding design features responsible for impacts . In addition , virtually no evidence exists from the African region . This study explores the impact of Zambia 's Child Grant Program  on a range of maternal health utilization outcomes using a r and omized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012 . Results indicate that while there are no measurable program impacts among the main sample , there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services . The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar setting s to impact maternal health Conditional transfer programs are increasingly popular , but the impact on household nutrient consumption has not been studied . We evaluated the impact of the Programa de Apoyo Alimentario ( PAL ) , a cash and in-kind transfer program , on the energy and nutrient consumption of poor rural households in Mexico . The program has been shown to reduce poverty . Beneficiary households received either a food basket ( including micronutrient-fortified milk ) or cash .  A r and om sample of 206 rural communities in Southern Mexico was r and omly assigned to 1 of 4 groups : a monthly food basket with or without health and nutrition education , a cash transfer with a cost to the government equivalent to the food basket ( 14 USD/mo ) with education , or control . The impact after 14 mo of exposure was estimated in a panel of 5823 households using a double difference regression model with household fixed effects . PAL was associated with increases ( P < 0.01 ) in the consumption of total energy ( 5 - 9 % ) , energy from fruits and vegetables ( 24 - 28 % ) , and energy from animal source foods ( 24 - 39 % ) . It also affected iron , zinc , and vitamin A and C consumption ( P < 0.05 ) . The consumption of energy and all nutrients was greater in the food basket group ( P < 0.05 ) . Cash and in-kind transfers in population s that are not energy-deficient should be carefully re design ed to ensure that pulling poor families out of poverty leads to improved micronutrient intake but not to increased energy consumption We examined the effects of Ecuador 's  Bono de Desarrollo Humano (BDH)--an unconditional cash transfer program that was rolled-out using a r and omized design --on health and development outcomes in very young children . Communities that were r and omly assigned to the treatment group began receiving the BDH  in 2004 and those r and omly assigned to the comparison group began receiving benefits two years later . Families enrolled in the BDH  received a monthly cash stipend ( $ 15USD ) representing an approximate 6 - 10 % increase in household income . Participants analyzed in this study are children aged 12 - 35 months from treatment ( n = 797 ) and comparison ( n = 399 ) communities in rural and urban Ecuador . Main outcomes measured were language skills ( the Fundación MacArthur Inventorio del Desarollo de Habilidades Comunicativas-Breve ) , height-for-age z-score , and hemoglobin concentration . Results indicate that in rural areas , being r and omized to receive the BDH in very early childhood led to significantly better performance on the number of words a child was saying , and on the probability that the child was combining two or more words . There were no significant effects on language development for children in urban areas and there were no effects on height-for-age z-score or hemoglobin concentration in rural or urban areas . A limited number of potential pathways with respect to cognitive/ language stimulation , health behaviors , and parenting quality were also explored . Findings indicate that compared to children in comparison areas , rural children in treatment areas were more likely to have received vitamin A or iron supplementation and have been bought a toy in the past six months . This study provides evidence for significant benefits of an unconditional cash transfer program for language development in very young children in rural areas A large body of research indicates that child development is sensitive to early-life environments , so that poor children are at higher risk for poor cognitive and behavioral outcomes . These developmental outcomes are important determinants of success in adulthood . Yet , remarkably little is known about whether poverty-alleviation programs improve children 's developmental outcomes . We examine how a  government-run cash transfer program for poor mothers in rural Ecuador influenced the development of young children .  R and om assignment at the parish level is used to identify program effects . Our data include a set of measures of cognitive ability that are not typically included in experimental or quasi-experimental studies of the impact of cash transfers on child well-being , as well as a set of physical health measures that may be related to developmental outcomes . The cash transfer program had positive , although modest , effects on the physical , cognitive , and socioemotional development of the poorest children in our sample There is a growing concern that food or cash transfer programs may contribute to  overweight and obesity in adults . We studied the impact of Mexico 's Programa de Apoyo Alimentario ( PAL ) , which provided very poor rural households with cash or in-kind transfers  , on  women 's body weight .  A r and om sample of 208 rural communities in southern Mexico was r and omly assigned to 1 of 4 groups : food basket with or without health and nutrition education , cash with education , or control . The impact on women 's weight was estimated in a cohort of 3010 women using a difference-in-difference model . We compared the impact between the food basket and cash groups and evaluated whether the impact was modified by  women 's BMI status at baseline . With respect to the control group , the program increased women 's weight in the food basket ( 550 ± 210 g ; P = 0.004 ) and the cash group ( 420 ± 230 g ; P = 0.032 ) ; this was equivalent to 70 and 53 % increases in weight gain , respectively , over that observed in the control group in a 23-mo time period . The greatest impact was found in already obese women : 980 ± 290 g in the food basket group ( P = 0.001 ) and 670 ± 320 g in the cash group ( P = 0.019 ) . Impact was marginally significant in women with a preprogram BMI between 25 and 30 kg/m2 : 490 ± 310 g ( P = 0.055 ) and 540 ± 360 g ( P = 0.067 ) , respectively . No program impact was found in women with a BMI < 25 kg/m2 . Providing households with a considerable amount of unrestricted re sources led to excess weight gain in an already overweight population . Research is needed to develop cost-effective behavior change communication strategies to complement cash and in-kind transfer programs such as PAL and to help beneficiaries choose healthy diets that improve the nutritional status of all family members This review considers statistical analysis of data from studies that obtain repeated measures on each of many participants . Such studies aim to describe the average change in population s and to illuminate individual differences in trajectories of change . A person-specific model for the trajectory of each participant is viewed as the foundation of any analysis having these aims . A second , between-person model describes how persons very in their trajectories . This two-stage modeling framework is common to a variety of popular analytic approaches variously labeled hierarchical models , multilevel models , latent growth models , and r and om coefficient models . Selected published examples reveal how the approach can be flexibly adapted to represent development in domains as diverse as vocabulary growth in early childhood , academic learning , and antisocial propensity during adolescence . The review then considers the problem of drawing causal inferences from repeated measures data Violence against women  is a major health and human rights problem yet there is little rigorous evidence as to how to reduce it . We take advantage of the r and omized roll-out of Ecuador 's  cash transfer program to mothers to investigate how an exogenous increase in a woman 's income affects domestic violence . We find that the effect of a cash transfer depends on a woman 's education and on her education relative to her partner 's . Our results show that for women with greater than primary school education a cash transfer significantly decreases psychological violence from her partner . For women with primary school education or less , however , the effect of a cash transfer depends on her education relative to her partner 's . Specifically , the cash transfer significantly increases emotional violence in households where the woman 's education is equal to or more than her partner 's
target: The evidence was uncertain for whether UCTs impacted livestock ownership , extreme poverty , participation in child labour , adult employment or parenting quality .
  This body of evidence suggests that unconditional cash transfers ( UCTs ) may not impact a summary measure of health service use in children and adults in LMICs .
  However , UCTs probably or may improve some health outcomes ( i.e. the likelihood of having had any illness , the likelihood of having been food secure , and the level of dietary diversity ) , one social determinant of health ( i.e. the likelihood of attending school ) , and healthcare expenditure .
background: BACKGROUND Unconditional cash transfers ( UCTs ; provided without obligation ) for reducing poverty and vulnerabilities ( e.g. orphanhood , old age or HIV infection ) are a type of social protection intervention that addresses a key social determinant of health ( income ) in low- and middle-income countries ( LMICs ) .
  The relative effectiveness of UCTs compared with conditional cash transfers ( CCTs ; provided so long as the recipient engages in prescribed behaviours such as using a health service or attending school ) is unknown .
  OBJECTIVES To assess the effects of UCTs for improving health services use and health outcomes in vulnerable children and adults in LMICs .
  Secondary objectives are to assess the effects of UCTs on social determinants of health and healthcare expenditure and to compare to effects of UCTs versus CCTs .