On Oct. 15 the Journal of the American Medical Association (JAMA) published the following study results: American Indian children whose families moved out of poverty because a casino opened on their reservation experienced a “significant decrease” in behavioral problems. The study concluded that the casino created an “income intervention” that had a “major effect” (positive) on the children’s symptoms. The improvement occurred with “remarkable speed.”

This information needs to be considered as Maine votes on the upcoming casino referendum.

The JAMA article, “Relationships Between Poverty and Psychopathology,” was written by Duke University researchers E. Jane Costello, Ph.D., Scott N. Compton, Ph.D., Gordon Keeler, MS, and Adrian Angold, MRCPsych. They analyzed an eight-year longitudinal study of 1,420 rural west North Carolina children ages 9 to 13 years. Twenty-five percent of the sample consisted of children living on a federal reservation of the Eastern Band of Cherokees.

The purpose of the study was to evaluate the role of social factors (like adversity or stress) vs. genetic factors on psychiatric problems in kids. At the beginning of the study, all the children were assessed for “2 broad categories of symptoms: those occurring in an emotional disorder (depression and anxiety) and those consistent with a behavioral disorder (conduct disorder or oppositional defiant disorder).”

The entire sample was then divided into three income categories: (1) “persistently poor” families living below the federal poverty line both before and after the casino opened; (2) “ex-poor” families who moved out of poverty after the casino opened: and (3) “never poor” families who lived above the poverty line both before and after the casino opened. Dropout and nonresponse rates in the study were equal among all ethnic and income groups.

Throughout the eight-year period, a consistent correlation between family poverty and psychiatric symptoms in children was observed. For both Indian and non-Indian families, children “living in poverty were more likely than non-poor children to have a psychiatric disorder.”

Then, halfway through the study, “tribal members began to receive income from a gambling casino that opened on the reservation.” This event created the opportunity for a “natural experiment” involving income. Tribal family incomes increased and jobs became more available. As tribal families moved out of poverty after the casino opened, their children showed “a significant decrease” in psychiatric symptoms.

There was no evidence that the improved kids belonged to an inherently healthier or stronger group of families. While they were poor, they had shown the same symptomatic level as other poor kids. The study concludes that it was the change in family income that made the difference, and it was a dramatic one. After a family moved out of poverty due to the casino opening, the family’s children showed the same number of psychiatric symptoms as kids from families that had never been poor.

More specifically, the decrease occurred in behavioral symptoms rather than in emotional symptoms. (The authors can’t say whether or not the emotional symptoms might have improved over a longer period of observation.) According to the data, the increased ability of parents to spend time supervising their children accounted for about 77 percent of the improvement attributable to moving out of poverty.

The study also found that “adding to the income of never-poor families had no effect on frequency of psychiatric symptoms.” It was the move out of poverty that was determinative for children of all ethnicities. All of them had a comparable decrease in symptoms when their families moved out of poverty.

But for the Native American children, it was the casino opening that allowed that movement out of poverty. Like most studies, this one had its limitations, and the casino revenues “did not succeed in lifting all Indian families out of poverty; more than half (54 percent) remained poor throughout the study (compared to only 20 percent of white children). However, a higher proportion of Indian than of white families moved out of poverty after the casino opened.”

The study presents the casino’s positive economic impact on Indian families and on their children’s behavior as unequivocal under the circumstances.

We have many things to think about. This is one of them.

Stephanie Cotsirilos is an attorney in Orono.