the earn-health trial of financial savings and health

Conditions: Depression; Anxiety; Alcohol Abuse; Tobacco Abuse

Summary: the current literature in social epidemiology and public health suggests that low financial savings has an unsurprising negative relationship with subjective well-being, and increases the odds of making visits to a healthcare provider, receiving a chronic disease diagnosis, and experiencing medical disability. earn.org is a community-based non-profit based in san francisco with a mission to help low-income workers build lifelong savings habits and financial capability. the organization is one of the largest providers of "goal-based savings accounts" or "matched savings accounts" in the us. the investigators propose to conduct a randomized controlled trial to determine the health effects of earn's savings program. through this trial, the investigators will test three principal hypotheses: (1) participants in the earn account, as compared to a control group, are hypothesized to demonstrate improved scores on mental health scales assessing depression and anxiety. (2) participants in the earn account, as compared to a control group, are hypothesized to experience lower odds of harmful behaviors associated with stress, specifically tobacco and alcohol abuse. the investigators hypothesize that the effect on behaviors will be of smaller effect size, and more delayed, than the effect on mental health outcomes, judging from similar effects observed in the micro-credit literature. (3) the mediating variables between earn account participation and beneficial health outcomes will include increased optimism and internal locus of control.

the investigators plan to conduct an rct comparing participants in the new earn program against wait-listed control subjects. the program provides low-wage workers with incentives and rewards for savings. the program involves a web-based platform that permits eligible savers to create a centralized savings account, which is a secure online account without fees. the account offers eligible savers small monetary rewards for dollars saved each month. the investigators plan to conduct a baseline online month 0 survey and a follow-up 6 month and 12 month online survey among participants and wait-listed nonparticipants, with telephone follow-up to maximize 6- and 12-month survey completion. the surveys consist of previously-validated instruments to assess key health behaviors self-reported well-being, and require approximately 20 minutes each. the surveys includes the cdc behavioral risk factor surveillance system scales for assessing demographics and income, overall self-rated health, tobacco and alcohol use, depression and anxiety symptoms, and optimism and locus of control. participants will receive prorated a gift card for each survey, to compensate participants for their time while avoiding a direct income effect of a cash incentive for participation.

Eligibility criteria:
inclusion criteria: * english-speaking us residents * ages 18 and older * below 50% of the area median income * have a regular internet connection exclusion criteria: * non-english speakers * non-us residents * children, * history of or current enrollment in other incentivized savings programs