# Unstable Income, Rising Stress? The Effects of Income Instability on Psychological and Physiological Health

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2022 · $681,873

## Abstract

Summary/Abstract
The poor suffer disproportionally from poor mental and physical health. Many causes for these
disparities have been considered, including low income. But, poor families' incomes are not only
low, but also often unstable and unpredictable. This instability creates uncertainty about
whether they will be able to safeguard their future wellbeing. According to the allostatic load
framework, prolonged activation of physiological stress responses will cause “wear and tear” on
the body, heightening risks of cardiovascular disease and of age-related metabolic diseases,
promoting cognitive decline and dementia, and accelerating cellular aging.
This R01 will study the causal effects of income instability on the psychological and physical
health of the poor. Our specific aims are to: 1) Identify the causal effect of income instability on
psychological health (e.g. depression, anxiety), biomarkers of stress (e.g. cortisol), and physical
health (e.g. blood pressure), 2) Decompose the effects identified in aim 1 into the effects of
predictable and unpredictable instability and compare to the impact of increasing the average
level of income, and 3) Investigate the channels through which effects on health occur,
including both economic and behavioral channels and estimate the impact of key moderating
factors (e.g. age, gender, baseline mental health).
The trial will be conducted in southwestern Bangladesh. We will manipulate income instability
by varying the number of work hours (and hence earnings) of participants in a cash-for-work
program. Participants in the first treatment arm will have a fixed work schedule, with the same
hours and earning each period. The hours and earnings of a second treatment arm will vary over
time, but the fluctuations will be known in advance. Finally, the number of work hours and
earnings of a third treatment arm will fluctuate unpredictably. Each of these arms will be
compared to a control group that is surveyed, but not offered additional work. Importantly, we
will vary income instability while holding the average level of income constant in order to
disentangle the impact of instability from the level-effect.
The study will create 1,867 new jobs that would not otherwise be available during the lean
season when jobs are scarce. The intervention has been designed so that the job opportunity
cannot make them worse off than they would otherwise have been in the absence of research.

## Key facts

- **NIH application ID:** 10412446
- **Project number:** 1R01AG076655-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Heather Schofield
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $681,873
- **Award type:** 1
- **Project period:** 2022-08-15 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10412446

## Citation

> US National Institutes of Health, RePORTER application 10412446, Unstable Income, Rising Stress? The Effects of Income Instability on Psychological and Physiological Health (1R01AG076655-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10412446. Licensed CC0.

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