Abstract
Temporary expansion of the Child Tax Credit (CTC) during the COVID-19 pandemic provided additional monthly income for US families, with no restrictions on use, from July through December 2021. This study examined food security and children’s dietary intake after three months of expanded CTC payments. Parents completed online surveys before and after three months of CTC payments. Among parents participating in the expansion, food and beverage purchases were the most common use of expanded CTC funds (45.9 percent), particularly in households with very low food security (63.0 percent). From before to midway through the CTC expansion, very low food security decreased from 12.7 percent to 5.6 percent, and simultaneously, food security increased from 57.4 percent to 66.4 percent. The CTC expansion was also associated with decreases in children’s consumption of added sugar, sugar-sweetened beverages, and sweetened fruit beverages. No changes were observed in children’s intake of other dietary components. Our findings suggest that the expanded CTC payments may have helped lessen food insecurity and supported reductions in children’s intake of added sugar in participating households.
Economic inequities drive child nutrition disparities.1 Almost half of US children under age nine live in low-income households,2 and one in seven families with children experience food insecurity.3 The COVID-19 pandemic exacerbated these economic challenges and increased food insecurity for households with children.4,5 As a result, pandemic relief packages introduced novel policy changes to provide families with economic support.
One of the most noteworthy policy changes was the expansion of the Child Tax Credit (CTC). Historically, the CTC was distributed in a lump sum upon income tax return,6 thus limiting families’ ability to use these funds for routine basic needs. Under the expanded CTC (ECTC), which was passed as part of the American Rescue Plan Act of 2021 and became effective in July 2021, the CTC increased in value, with monthly, unconditional cash allotments distributed between July and December 2021 (that is, a maximum amount of $250-$300 per month per child). This routine payment structure provided the opportunity to use these funds on more immediate needs each month while benefiting sixty-six million children and resulting in historic reductions in child poverty.7,8 In December 2021 the ECTC monthly payments expired without legislative action to extend or renew this policy. As of March 2022, its future remained the subject of legislative debate.
Monthly ECTC payments may have contributed to reduced food insecurity if some of these funds went toward food each month. Although existing federal nutrition programs (for example, the Supplemental Nutrition Assistance Program, or SNAP) lower the prevalence of food insecurity,9,10 many families experience barriers to obtaining this food assistance, and others are not eligible.11,12 Moreover, benefits of these ongoing programs do not often last the entire month; for example, the majority of SNAP funds are often spent within two weeks of receipt.13 Thus, monthly ECTC payments may have filled critical gaps in nutrition assistance by providing additional income for food access.
Initial evidence on the ECTC was collected from the Census Bureau’s Household Pulse Survey after the first monthly payment. Almost half of respondents reported spending ECTC benefits on food, and an even higher percentage did so among Black and Asian non-Hispanic women and Latino families.14 Further, households with children experienced a 3-percentage-point decline in food insufficiency (defined as not having enough food to eat15), after the first ECTC payment; this was ascertained via a single item on the Household Pulse Survey.16 These reported immediate benefits are promising. Yet they warrant further investigation, using a more comprehensive measure of food insecurity that may be more reflective of what policy makers need to consider when debating the ECTC’s potential future via its extension, reauthorization, or incorporation into standing policy.
Household Pulse Survey respondents reported spending some of their first ECTC payment on nonfood needs, reflecting the competing immediate financial priorities of low-income families, such as housing, transportation, and child care.17 However, spending patterns after multiple ECTC payments may be more representative of long-term choices once immediate needs are met. Further, it remains unknown how food purchases may be affecting children’s dietary intake. Given the relatively high cost of healthier food,18 ECTC payments might have contributed to improved diet quality via increased income to afford nutrient-rich food; alternatively, families could have used these funds to purchase energy-dense, nutrient-poor items or greater quantities of the same food items, yielding no improvements in dietary intake. Thus, research is needed to examine the potential changes in children’s dietary consumption when their families receive monthly ECTC payments, including any un-intended consequences (that is, less healthful dietary consumption).
This study examined longitudinal patterns of food insecurity and children’s dietary intake across the first half of monthly ECTC payments. Data represented initial patterns of this expansion so we could disseminate timely evidence and inform pending decisions regarding the long-term reinstatement of the ECTC. The first aim was to describe patterns of food security and children’s dietary intake from before to halfway through the CTC expansion. The second aim was to examine whether changes in children’s dietary intake patterns differed by baseline food security status. Given the observational study design, we aimed to quantify these initial patterns instead of establishing causal claims.
Study Data And Methods
STUDY DESIGN
This longitudinal, observational study used data from two online surveys. The first was completed between June 18 and July 14, 2021, before the ECTC took effect July 15. The second survey was completed between September 17 and October 18, 2021, after three ECTC monthly payments in July, August, and September. For context, ECTC payments were distributed midmonth and ranged from a maximum of $250 per month per child ages 6–17 to $300 per month per child younger than age 6. Surveys included questions about household food security, children’s dietary intake and sugar-sweetened beverage consumption, family characteristics, and ECTC-specific questions.
PARTICIPANTS
Parents were recruited using medical record extractions from an urban safety-net academic medical center in the southeastern US. Data queries were created using computer codes that scanned electronic medical records and output contact information for potential participants who were at least age 18, lived in the US, had a child ages 2–12, and attended a medical visit in the past year. Parents of younger and older children were not included, given infants’ unique dietary needs (for example, breast-feeding) and adolescents’ autonomy regarding dietary choices that would increase the potential for less accurate parental report. Approximately 6,500 email addresses were pulled in this manner. Parents were emailed a letter asking them to complete the eligibility screener via REDCap. Inclusion criteria included having at least one child ages 2–12, parents and children being US citizens with Social Security numbers, children living with their parent for more than six months a year, parents having filed income taxes in 2020, and parents meeting ECTC income requirements based on 2020 tax filing status.19 Based on these inclusion criteria, parents were expected to receive the full ECTC benefit. If parents had more than one child ages 2–12, answers to the survey questions regarding their children were for the youngest child within that range.
PROCEDURES
At the start of the baseline survey, parents read an informational letter and a question asking whether they consented to participate. The baseline survey took approximately fifteen minutes to complete and remained active until 680 responses were completed (an approximately 10 percent response rate from the initial email; the sample size was capped because of funding). Data from 17 parents who completed the survey referring to children outside our age criteria were excluded. Thus, 663 families were retained from the baseline survey. Of these, 621 completed the second survey (94 percent retention), which makes up these analyses. There were no differences in demographics or food security status based on retention. All study procedures were approved by the Institutional Review Board at Virginia Commonwealth University.
FAMILY CHARACTERISTICS AND ECTC-SPECIFIC QUESTIONS
Family characteristics were reported in the first online survey, including parent and child age, sex, race, and ethnicity; parent education, marital status, and insurance status; and the number of children and adults in the home. Household monthly income was reported at each time point. ECTC-specific questions included which months families received ECTC payments, the amount of money received each month, the number of children who qualified for payments, whether payments were helpful, why payments were not helpful, and how the additional income was spent. A list of options for how the additional income was spent was developed by the authors and provided in a checklist format to select all that applied. A write-in “other” option was provided. If parents reported not receiving ECTC payments they were asked why not (for example, they opted out).
MEASURES
FOOD INSECURITY:
The Department of Agriculture’s eighteen-item U.S. Household Food Security Survey Module assessed household food security,20 using a thirty-day reference period in accordance with the scoring guidelines. Affirmative responses were summed and categorized as “high” (0 items), “marginal” (1–2 items), “low” (3–7 items), or “very low” (8 or more items) food security at each time point.
DIETARY INTAKE:
The National Cancer Institute’s Dietary Screener Questionnaire assessed children’s dietary consumption at each time point.21 The Dietary Screener Questionnaire is a brief and valid measure, with estimates in close agreement to twenty-four-hour dietary recalls,22,23 yet the questionnaire’s thirty-day reference period maybe more reflective of a sustained response to ECTC payments. Twenty-six items asked about the consumption of fruit and vegetables, dairy and calcium, added sugars, red meat, processed meat, and whole grains and fiber. Parents reported on the frequency with
The percentage of families with very low food insecurity dropped substantially after three months of ECTC payments.
which their child consumed these items in the past month. A publicly available SAS algorithm converted responses into intake estimates,24 using age- and gender-specific portion sizes from data in the 2009–10 National Health and Nutrition Examination Survey. Two questions on red and processed meats were excluded, given that they are not part of the scoring algorithm.
SUGAR-SWEETENED BEVERAGE CONSUMPTION:
The fifteen-item Beverage Intake Questionnaire in Children and Adolescents estimated children’s habitual beverage intake during the past month.25 This reliable indicator has produced results similar to those of twenty-four-hour dietary recalls.25 Parents reported on children’s consumption frequency and amount for six beverages (water, 100 percent fruit juice, sweetened juice, regular soda, sweetened tea, and sports drinks). Flavored milk was also added, given the frequency with which children consume this beverage, including at school.26 Scoring guidelines determined children’s average daily fluid ounce intake for each beverage and daily calorie consumption for the volume of each beverage consumed. For flavored milk, data from the Department of Agriculture estimating 20.8 calories per fluid ounce of chocolate milk27 were used to calculate average daily calorie intake.
STATISTICAL ANALYSIS
Descriptive statistics were calculated as means, standard deviations, and percentages. The full sample (N = 621) was used to describe family characteristics and ECTC payment experiences. For the remaining analyses, 577 parents were used (44 families who did not receive any monthly ECTC payments were excluded, given that hypothesized changes in food insecurity were a result of receiving monthly payments). Although nonrecipients did not constitute a control group, we analyzed their food security data to examine whether trends were discernable among families that believed themselves to be eligible for the ECTC payments but did not receive them. We also performed post hoc analyses for this group of nonrecipients on dietary intake items that changed significantly in the ECTC recipient group.
The percentage of parents in each food security status category was calculated at each time point (before and during CTC expansion). Paired sample t-tests examined changes in children’s dietary intake for each nutrient, food group, and beverage category from before to during CTC expansion.
Data were stratified by food security status before CTC expansion to examine differences in dietary intake patterns from before to during CTC expansion by food security status. Changes were calculated as [during CTC expansion] – [before CTC expansion], with negative values indicating a decrease and positive values an increase over time. Data were analyzed with SAS Studio in SAS OnDemand for Academics, version 3.8. False discovery rate28 corrected for multiple testing, where corrected p values (indicated as q values) are reported to provide more stringent thresholds for statistical significance when using multiple comparisons. q values of <0.05 were considered significant.
LIMITATIONS
This study had several limitations. It used observational data; thus, causal conclusions cannot be made. The universal policy that we studied did not allow for a suitable control group; however, post hoc analyses were conducted among families that did not receive monthly ECTC payments, to partially overcome this limitation. Natural experiment methods to estimate causality were beyond the scope of these data, but the collection of baseline data before ECTC monthly payments and the longitudinal, within-person design strengthened the study. Findings cannot be generalized to other populations or geographical locations, and food insecurity was likely affected by schools reopening and the receipt of school-provided meals. Further, it is plausible that diet quality was influenced by children’s return to school, as school meals are typically more nutrient-rich than meals from home.29 Yet with COVID-19, it is unknown how school meal pattern waivers affected dietary intake, with concern from researchers that diet quality decreased.30 Last, dietary intake was measured via parental report, which is subject to recall reporting bias. More rigorous twenty-four-hour dietary recalls were not feasible for this large sample and time-sensitive research. The Dietary Screener Questionnaire was chosen, given its brief and valid nature and close alignment with twenty-four-hour recalls.22,23
Study Results
FAMILY CHARACTERISTICS
Characteristics of the full sample are summarized in exhibit 1 (see online appendix exhibit A for more details).31 The average number of adults in the home was 1.9 ± 0.7, and the average number of children was 2.2 ± 1.0 (data not shown). There were no differences in income, education, insurance, race, ethnicity, or food security before the ECTC for families who did versus did not receive the ECTC (q > 0.05).
Exhibit 1.
Sample characteristics of responding parents and their children, survey of patients from an urban safety-net academic medical center, June–October 2021
| Characteristics | Parent | Childa |
|---|---|---|
| Age, meanb (years) | 36.0 | 5.6 |
| Gender (%) | ||
| Female | 96.0 | 44.6 |
| Male | 3.9 | 54.9 |
| Nonbinary | 0.2 | 0.5 |
| Race (%) | ||
| Caucasian or White | 61.2 | 61.0 |
| African American or Black | 36.6 | 41.7 |
| Asian | 2.7 | 3.4 |
| American Indian or Alaska Native | 1.9 | 1.5 |
| Native Hawaiian or other Pacific Islander | 0.2 | 0.3 |
| Other | 1.6 | 2.3 |
| Hispanic or Latino (%) | 4.0 | 6.8 |
| Employment status (%) | ||
| Employed or in school | 71.3 | —c |
| Unemployed | 28.7 | —c |
| Monthly household income (%) | ||
| <$2,000 | 22.5 | —c |
| $2,000–2,999 | 19.7 | —c |
| $3,000–3,999 | 12.1 | —c |
| $4,000–4,999 | 13.4 | —c |
| $5,000–5,999 | 10.1 | —c |
| $6,000–6,999 | 8.5 | —c |
| $7,000+ | 13.7 | —c |
| Received monthly ECTC payments | ||
| Number | 577 | —c |
| Percent | 92.9 | —c |
| Did not receive monthly ECTC payments | ||
| Number | 44 | —c |
| Percent | 7.1 | —c |
| Received SNAP benefits (%) | ||
| Before CTC expansiond | 28.2 | —c |
| During CTC expansione | 29.8 | —c |
SOURCE Authors’ analysis of survey data. NOTES N = 621 subjects; includes all survey participants, regardless of expanded Child Tax Credit (ECTC) monthly payment receipt. SNAP is Supplemental Nutrition Assistance Program.
If parents had more than one child ages 2–12, they reported on their youngest child in this age range.
Standard deviation values for parent age: 7.2; for child age: 3.1.
Not applicable.
Measured in June and July 2021.
Measured in September and October 2021.
ECTC PAYMENT EXPERIENCES
Most families received ECTC payments in all three months—July (84.4 percent), August (83.6 percent), and September (79.7 percent)—for 2.1 ± 1.0 children per home who qualified. Almost all reported that ECTC payments were very (67.8 percent) or somewhat (29.3 percent) helpful. Only 2.9 percent of respondents reported that payments were not helpful; reasons included that they did not need the money (n = 5), it was too little money (n = 2), they were worried about paying it back (n = 7), or they preferred having the CTC applied toward their income tax return (n = 3) (data not shown).
Families used ECTC funds on food and beverages (45.9 percent), housing (for example, rent or mortgage payments; 39.9 percent), utilities (for example, electricity; 35.5 percent), and goods and services (for example, clothing; percent) (exhibit 2). As expected, a higher percentage of families with marginal (46.9 percent), low (56.5 percent), and very low (63.0 percent) food security spent ECTC funds on food and beverages, yet even among food-secure families, the most common use of the funds remained purchases of food and beverages (39.0 percent) (data not shown).
Exhibit 2.
Expenses toward which parents reported applying their monthly expanded Child Tax Credit (ECTC) payments, percent of households, survey of patients from an urban safety-net academic medical center, June-October 2021
SOURCE Authors’ analysis of survey data. NOTES n = 577, excluding 44 families that did not receive any monthly ECTC payments. Participants were asked to indicate all applicable spending categories from a provided list. A write-in “other” option was provided. Responses in the “other” category included school tuition or supplies (n = 8), household needs or improvements (n = 3), savings (n = 4), bills (n = 2), items for child (for example, toys, phone, or laptop) (n = 3), gas for doctors’ appointments (n = 1), and whatever is needed at the time (n = 1).
Few families (n = 44, 7.1 percent) did not receive ECTC monthly payments because they opted out (47.7 percent), thought they qualified but did not (15.9 percent), or were not sure why payments were not received (36.4 percent). Of the twenty-one families who opted out, twelve were worried that they would have to pay the money back, and nine preferred a lump sum (data not shown).
FOOD INSECURITY
Before CTC expansion, 57.4 percent of families were food secure (exhibit 3). The remaining families had marginal (14.0 percent), low (15.9 percent), or very low (12.7 percent) food security. During CTC expansion, the prevalence of food security increased to 66.4 percent, whereas marginal (12.3 percent) and low (15.8 percent) food security remained similar to baseline; very low food security decreased to 5.6 percent.
EXHIBIT 3.
Levels of food security reported by participants before receipt of expanded Child Tax Credit (ECTC) monthly payments (June 2021) and after the third monthly payment (September 2021), percent of households, survey of patients from an urban safety-net academic medical center
SOURCE Author’s analysis of survey data. NOTES n = 577, excluding 44 families that did not receive any monthly ECTC payments. From the Department of Agriculture’s 18-item U.S. Household Food Security Survey Module (possible score range: 0–18): food insecure, 0 affirmative items; marginal food security, 1–2 items; low food security, 3–7 items; and very low food security, 8 or more items.
The percentage of families with very low food security who did not receive monthly ECTC payments increased from before to during CTC expansion (6.8 versus 9.1 percent, respectively; see appendix exhibit B).31 The percentage of families with food security also increased (from 47.7 percent to 56.8 percent), and the percentage of those with marginal food security decreased (from 18.2 percent to 6.8 percent).
DIETARY INTAKE
Parents reported a decreased consumption of total added sugar among their children (before CTC expansion: 16.1 ± 5.7 teaspoon equivalents per day; during CTC expansion: 15.3 ± 5.1 teaspoon equivalents per day; q < 0.01; approximately 68 versus 64 grams per day, respectively, as 1 teaspoon equivalent = 16 calories = approximately 4 grams). These patterns appear to have been driven by changes in families with food security (before CTC expansion: 15.9 ± 5.6 teaspoon equivalents per day; during CTC expansion: 15.0 ± 5.1 teaspoon equivalents per day; q = 0.04) and very low food security (before CTC expansion: 16.5 ± 7.5 teaspoon equivalents per day; during CTC expansion: 15.1 ± 5.3 teaspoon equivalents per day; q = 0.04). There was no change in added sugar consumption among families who did not get monthly ECTC payments (q = 0.44; data not shown). No differences emerged in intake of fruit, vegetables, dairy and calcium, or whole grains and fiber (q > 0.05) (see appendix exhibit C).31
SUGAR-SWEETENED BEVERAGE CONSUMPTION
Average daily consumption of sugar-sweetened beverages ([during CTC expansion] - [before CTC expansion]: −2.9 ± 17.9 fluid ounces per day, −44 ± 286 calories per day; q < 0.01) and sweetened juice (−1.7 ± 9.3 fluid ounces per day, −25 ± 134 calories per day; q < 0.01) decreased over time among ECTC recipients (appendix exhibit D),31 but not for families who did not receive monthly ECTC payments (q > 0.05) (data not shown). These patterns appear to have been driven by changes in families with food security and very low food security. Average changes from before to during CTC expansion for food-secure families were −2.0 ± 11.3 fluid ounces per day (q = 0.02); for those with marginal food security,2.2 ± 18.3 fluid ounces per day (q = 0.52);for those with low food security, −7.7 ± 30.6 fluid ounces per day (q = 0.14); and for those with very low food security, −7.7 ± 18.8 fluid ounces per day (q = 0:01) (data not shown). Similar patterns emerged for sweetened juice: Average changes from before to during CTC expansion for food-secure families were −1.3 ± 7.5 fluid ounces per day (q = 0.02); for those with marginal food security, 0.5 ± 8.9 fluid ounces per day(q = 0.73); for those with low food security, −3.5 ± 14.1 fluid ounces per day (q = 0.13); and for those with very low food security, −4.1 ± 9.4 fluid ounces per day (q < 0.01) (data not shown). Consumption of other beverages did not change over time (q > 0.05) (see appendix exhibit D).31
Discussion
This study examined patterns of household food insecurity and children’s dietary intake across the first three months of the historic CTC expansion (ECTC), occurring during July-December 2021. Findings for the 577 households in our data that received monthly ECTC payments indicated a sharp reduction in families experiencing very low food security, dropping from 12.7 to 5.6 percent. Parent-reported intakes of total added sugar, sweetened fruit juice, and sugar-sweetened beverages for children ages 2–12 decreased from before to during the ECTC monthly payments, whereas children’s consumption of nutrient-rich foods did not change over time.
USE OF ECTC FUNDS
The CTC expansion provided families with monthly unconditional cash assistance, and most families reported using this income on items related to their basic needs. The most common expense was food and beverages; other common expenses, particularly among families experiencing food insecurity, included housing, utilities, and transportation. Similar spending patterns were seen in the Household Pulse Survey,32 where almost half of families reported using their ECTC money on food after the first monthly payment.16 Very few parents reported spending these funds on discretionary items, such as vacations or recreational goods.33 The ECTC had unique aspects relevant to the use of these funds: It conferred flexibility to use the funds on different expenses, without restriction, and on a month-to-month basis. For this reason, and because spending priorities likely change over time, future research is needed to examine monthly spending patterns during the second half of ECTC payments and—once these monthly payments ended—to enhance understanding of the economic impact of this policy change.
FOOD SECURITY
Our findings indicate that the percentage of families with very low food insecurity dropped substantially after three months of ECTC payments. Other, concurrent factors may have influenced this decline (for example, SNAP policy changes), yet just under one-third of families in our sample received SNAP benefits. Although causality cannot be inferred, ECTC payments likely contributed to these positive patterns, given that 63.0 percent of families with very low food security reported using ECTC funds on food each month. The percentage of families with very low food security increased across the same period for respondents who did not receive monthly ECTC payments, which is consistent with a positive role of the ECTC, but nonreceipt merits further investigation. If sustained over time, such findings, and particularly the reduction in very low food security, might be associated with long-term improvements in food security beyond what federal nutrition assistance programs alone have achieved. These existing nutrition assistance programs provide substantial food assistance, yet the prevalence of food insecurity remains high.3 The ECTC payments may have provided additional resources to fill gaps in food expenditures and shortfalls in household food supply.
Our findings on food security affirm and build on reported positive impacts of the ECTC funds on food sufficiency, as reported in the Household Pulse Survey.32 Whereas the Household Pulse Survey employed a brief index of food insufficiency, our surveys used the eighteen-item U.S. Household Food Security Survey Module that determines food security. This more comprehensive measure of reliable food access is critical to informing policy decisions. Given the ECTC expiration in December 2021, longitudinal research is needed to track food insecurity changes in its aftermath, using this more comprehensive and policy-relevant measure if the ECTC is restored.
DIETARY INTAKE
Changes in children’s dietary intake were observed for added sugar and sugar-sweetened beverage consumption when measured using a thirty-day food frequency questionnaire. US children consume approximately seventeen teaspoons of added sugar per day,34 despite recommendations to consume less than six teaspoons per day;35 each teaspoon of sugar provides sixteen calories. In this study, children’s
Our findings may help inform policy discussion regarding the future of the ECTC and its specific provisions.
total added sugar intake decreased, on average, by the equivalent of approximately one teaspoon per day among families who experienced both food security and very low food security before starting to receive monthly ECTC payments. Before this study, it was unknown whether and how dietary intake changed after many families used the monthly ECTC payments toward food each month. These data suggest that families did not seem to be spending the ECTC funds on food items with higher added sugar or may have started purchasing different food items lower in added sugar. One of the largest contributors to children’s added sugar intake is sugar- sweetened beverages, and findings showed a reduction in the reported consumption of total sugar-sweetened beverages—specifically sweetened juice. Excess added sugar is associated with greater chronic disease risk;35 thus, policies that yield lower added sugar consumption are important for disease prevention and widespread health impacts. Families not receiving the monthly ECTC did not show reduced total added sugar, sugar-sweetened beverage, or sweetened juice consumption during this period, providing some additional support that the ECTC may have contributed to the observed reductions; this merits further examination. Moreover, causality cannot be determined from these data.
Children’s consumption of nutrient-rich foods did not change during the first three months of the period when ECTC payments were being made. In a recent survey, about half of parents reported that ECTC payments were used to purchase “more or better quality food.”17 Yet it remains unknown whether subjective perceptions of higher-quality food relate to more nutrient-rich or less nutrient-poor items. Moreover, this study quantified children’s dietary consumption, rather than families’ food purchasing behaviors or household-level dietary changes. Thus, future research is needed to understand what types of food were purchased with ECTC funds each month and who consumed the food. It is plausible that healthier food was purchased but that children did not consume the healthier food items, given less preference or greater novelty. In contrast, ECTC funds were also used for nonfood needs, such as transportation and housing, which have upstream implications for the adoption of healthy dietary patterns. Thus, families with pressing nonfood needs would likely have addressed these demands before using ECTC dollars on healthier food.
Conclusion
Our findings indicate parallel reductions in very low food security and children’s added sugar consumption across the first three months of ECTC payments. These initial patterns suggest promise for the public health impact of the CTC expansion on nutrition-related outcomes for children and their families. The ECTC expired in January 2022; thus, our findings may help inform policy discussion regarding the future of the ECTC and its specific provisions.
Supplementary Material
Acknowledgments
This study was funded by the Child Health Research Institute at Virginia Commonwealth University. This work was also supported in part by the National Institutes of Health (Grant No. 2T32CA093423) for Elizabeth Adams’ effort. Additional support was provided from Clinical and Translational Science Award No. UL1TR002649 from the National Center for Advancing Translational Science, awarded to Virginia Commonwealth University and the Children’s Hospital Foundation.
Contributor Information
Elizabeth Adams, University of South Carolina, Columbia, South Carolina..
Tegwyn Brickhouse, Virginia Commonwealth University, Richmond, Virginia..
Roddrick Dugger, University of South Carolina..
Melanie Bean, Virginia Commonwealth University..
NOTES
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