Food Insecurity and the Food Stamp Program

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

The Supplemental Nutrition Assistance Program (SNAP) is a federally funded and state adminis­tered program to combat food insecurity. Analyz­ing factors in SNAP participation is important to understanding consumption in food systems and supporting community development. As of 2019, 565,900 Oklahomans participate in the SNAP pro­gram, approximately 84% of those eligible for the program. This leads to two questions: why do those who are eligible participate, and how can we better reach those who do not? We analyzed county-level SNAP participation among the income-eligible to identify explanatory characteris­tics of SNAP usage. Data from sources such as the U.S. Department of Agriculture Economic Research Service (USDA ERS) and the U.S. Census Bureau were used to perform a regression analysis on 12 variables, such as store access and number of dependents. The percentage of house­holds with children under 18 and the unemploy­ment rate are associated with increases in SNAP participation among those eligible. Store access and rurality are associated with a decline in SNAP usage. These findings will aid policymakers, SNAP administrators, and outreach education groups in improving program participation by targeting groups susceptible to food insecurity and with low SNAP usage who could benefit from participation.

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

Background Food insecurity (FI) is an adverse social determinant of health (SDoH) prevalent among pediatric cancer patients and associated with poorer health outcomes in general pediatrics. Receipt of federal SNAP benefits reduces FI in general pediatrics, and is thus a marker of appropriate resource support to mitigate adverse SDoH. Dana-Farber Cancer Institute (DFCI) Acute Lymphoblastic Leukemia (ALL) Consortium Trial 16-001 is the first pediatric oncology clinical trial to prospectively collect parent-reported SDoH, including income, SNAP receipt, and FI. We investigated whether income-eligible pediatric ALL families were successfully receiving SNAP benefits, and whether SNAP receipt was associated with FI. Methods Secondary analysis of children aged 1-17 years with de novo ALL enrolled on the DFCI 16-001-embedded SDoH cohort study at 6 US centers from 2017-2022. We utilized parent-reported SDoH data at diagnosis (T0) and 6-mos (T1) into therapy to identify families as (1) SNAP-eligible, proxied as household income <130% Federal Poverty Level based on federal guidelines; and (2) food insecure, based on validated 2-item screen. McNemar’s test compared SNAP receipt at T0 vs T1 among those eligible at both timepoints. Associations between SNAP eligibility, SNAP receipt, and FI were evaluated with chi-square tests. Results At T0, among 262 evaluable families, 21% reported FI. A total of 20% (n=53) were SNAP-eligible, of whom 60% (n=32) reported FI and 53% (n=28) were receiving SNAP. Among 28 SNAP-recipient families, 61% reported FI. Similarly, at T1, among 223 evaluable families, 25% reported FI. A total of 28% (n=62) were SNAP-eligible, of whom 58% (n=36) reported FI and 58% (n=36) were receiving SNAP. Among 36 SNAP-recipient families, 56% reported FI. A significantly higher proportion of the 33 families SNAP-eligible at both T0 and T1 were receiving SNAP at T1 (70%) compared to T0 (52%) (p=0.034). Among eligible families, SNAP receipt was not associated with lower odds of FI at T0 (OR 1.03, p=0.96) or T1 (OR 0.83, p=0.73). Discussion FI, a well-defined adverse SDoH associated with inferior health outcomes, is highly prevalent among a trial-enrolled pediatric ALL population. Despite care delivery at highly resourced centers with dedicated staff to address social needs, a substantial proportion of likely eligible families (as proxied by income) were not receiving SNAP benefits 6-mos into therapy. Further, receipt of SNAP was inadequate to ameliorate FI in this cohort, with ~60% of SNAP recipients reporting concurrent FI both at T0 and T1. Ensuring successful connection of eligible families to existing benefits is an essential first step. However, high rates of FI among SNAP recipients indicate that resource navigation, though necessary, is not sufficient to address FI for this population. These data provide immediate targets for health equity interventions—including systematic benefits navigation, direct resource provision, and policy-based approaches for benefits augmentation—to address adverse SDoH and improve cancer outcomes. Citation Format: Rahela Aziz-Bose, Yael Flamand, Puja J. Umaretiya, Lenka Ilcisin, Ariana Valenzuela, Peter D. Cole, Lisa M. Gennarini, Justine M. Kahn, Kara M. Kelly, Bruno Michon, Thai-Hoa Tran, Jennifer J. G. Welch, Lewis B. Silverman, Kira Bona. Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B096.

Obesity and Hunger Threaten the Foundations of Child Health

Racial and ethnic minority groups disproportionately experience food insecurity. During the COVID-19 pandemic, the US enacted temporary food assistance policies, including emergency allotments for Supplemental Nutrition Assistance Program (SNAP) benefits. The effects of the pandemic and these policies on food insecurity by race and ethnicity are unclear. To examine prevalence trends in food insecurity by racial and ethnic groups and SNAP use before and during the pandemic. This cross-sectional survey study analyzed National Health Interview Survey data before (January 2019 to March 2020) and during the COVID-19 pandemic (April 2020 to December 2022). Participants were noninstitutionalized US adults (≥18 years) with low income (<200% federal poverty level). Statistical analysis was performed from September 25, 2023, to February 27, 2024. COVID-19 pandemic time period. Food insecurity was measured using the 10-item US Department of Agriculture Adult Food Security Survey module, categorizing participants as food secure (high or marginal food security) or insecure (low or very low food security). Survey-weighted Poisson regressions were modeled to examine changes in food insecurity prevalence over time by race and ethnicity (Asian, Black, Hispanic, and White) and by race and ethnicity and SNAP use (yes or no) including a 3-way interaction term (time × race and ethnicity × SNAP). Among 30 396 adults with low income, approximately one-half were female (56.0% [95% CI, 54.7%-57.2%] during the pre-COVID-19 time period; 57.4% [95% CI, 56.4%-58.4%] during the COVID-19 time period). Food insecurity prevalence decreased from 20.9% (95% CI, 19.9%-22.0%) before the COVID-19 pandemic to 18.8% (95% CI, 17.9%-19.7%) during the pandemic (P < .001). SNAP use prevalence increased overall (from 31.5% [95% CI, 30.1%-32.9%] to 36.0% [95% CI, 34.8%-37.3%]; P < .001) and for each racial and ethnic group. There were no significant differences in food insecurity changes over time by racial and ethnic group (Wald test F = 1.29; P = .28 for 2-way interaction). Among SNAP participants, food insecurity decreased for Asian, Hispanic, and White adults but did not change for Black adults; among non-SNAP participants, food insecurity did not change for Black, Hispanic, and White adults but increased for Asian adults (Wald test F = 4.43; P = .02 for 3-way interaction). During the COVID-19 pandemic, food insecurity decreased among SNAP participants in most racial and ethnic groups but did not decrease among non-SNAP participants in any group. These results suggest that during the pandemic, increased SNAP benefit amounts were associated with ameliorating food insecurity for many US adults who were able to access SNAP but did not reduce racial and ethnic disparities in food insecurity.

The Need for Investment in Rigorous Interventions to Improve Child Food Security

Racially minoritized people experience disproportionately high rates of food insecurity. The Supplemental Nutrition Assistance Program (SNAP) reduces food insecurity. To evaluate SNAP access with regard to racial disparities in food insecurity. This cross-sectional study used data from the 2018 Survey of Income and Program Participation (SIPP). On the basis of random sampling strategies, 44 870 households were eligible for the SIPP, and 26 215 (58.4%) participated. Sampling weights accounted for survey design and nonresponse. Data were analyzed from February 25 to December 12, 2022. This study examined disparities based on household racial composition (entirely Asian, entirely Black, entirely White, and multiple races or multirace based on SIPP categories). Food insecurity during the prior year was measured using the validated 6-item US Department of Agriculture Food Security Survey Module. SNAP participation during the prior year was classified based on whether anyone in the household received SNAP benefits. Modified Poisson regression tested hypothesized disparities in food insecurity. A total of 4974 households that were eligible for SNAP (income ≤130% of the poverty threshold) were included in this study. A total of 218 households (5%) were entirely Asian, 1014 (22%) were entirely Black, 3313 (65%) were entirely White, and 429 (8%) were multiracial or of other racial groups. Adjusting for household characteristics, households that were entirely Black (prevalence rate [PR], 1.18; 95% CI, 1.04-1.33) or multiracial (PR, 1.25; 95% CI, 1.06-1.46) were more likely to be food insecure than entirely White households, but associations differed depending on SNAP participation. Among households that did not participate in SNAP, those that were entirely Black (PR, 1.52; 97.5% CI, 1.20-1.93) or multiracial (PR, 1.42; 97.5% CI, 1.04-1.94) were more likely to be food insecure than White households; however, among SNAP participants, Black households were less likely than White households to be food insecure (PR, 0.84; 97.5% CI, 0.71-0.99). In this cross-sectional study, racial disparities in food insecurity were found among low-income households that do not participate in SNAP but not among those that do, suggesting that access to SNAP should be improved. These results also highlight the need to examine the structural and systemic racism in food systems and in access to food assistance that may contribute to disparities.

Food Insecurity Among Aging SNAP Participants and Eligible Nonparticipants in Two Predominantly Low-Income Black Neighborhoods: Implications for SNAP Enrollment and Outreach for Older Adults

Purpose: Food insecurity, which leads to adverse health outcomes, has even more severe implications for cancer patients. Yet medically underserved cancer patients are more likely to be food insecure than the general population.Methods: This study is a cross-sectional analysis of intake data from patients who participated in the Integrated Cancer Care Access Network (ICCAN). ICCAN is a specialized program that addresses socioeconomic barriers to cancer care among underserved cancer patients in NYC. This study utilized ICCAN data from 2011 to 2017. The USDA food insecurity score, self-reported SNAP receipt, and SNAP eligibility based on household income were compared between SNAP and non-SNAP recipients.Results: 681 patients were assessed for food insecurity. Sixty-nine percent of participants lived in food insecure households. Despite SNAP assistance, most SNAP recipients (68%) were food insecure; 69% of respondents who did not receive SNAP were also food insecure.Conclusions: Underserved cancer patients who receive SNAP are still food insecure, hence at more significant risk for its associated negative outcomes. Supplemental programs for patients with chronic diseases are needed in clinics with large low income populations. SNAP benefits should account for the additional financial burden posed by treatment costs and exceptional circumstances faced by cancer patients.

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately strained households experiencing poverty, particularly Black and Latino households. Food insecurity, which entails having limited or uncertain access to a sufficient quantity of nutritious food, is a key pandemic-related consequence. We examined how people enrolled in the Supplemental Nutrition Assistance Program (SNAP) have been affected by the pandemic, particularly Black participants and participants residing in food deserts. Using survey data from a longitudinal cohort study of predominantly Black low-income adults aged ≥18 residing in urban food deserts in Pittsburgh, Pennsylvania, we examined changes in food insecurity and SNAP participation before COVID-19 (2018) and early in the COVID-19 pandemic (March-May 2020). We modeled changes in food insecurity from 2018 to 2020 via covariate-adjusted logistic regression. Food insecurity increased significantly among participants enrolled in SNAP and surveyed in both 2018 and 2020 (from 25.9% in 2018 to 46.9% in 2020; P < .001). Compared with cohort participants not enrolled in SNAP at both points, cohort participants enrolled in SNAP in 2018 and 2020 had the highest rates of using a food bank in 2020 (44.4%) and being newly food insecure in 2020 (28.9%) (ie, they were food insecure in 2020 but not in 2018). Food insecurity during the COVID-19 pandemic increased among low-income Black households enrolled in SNAP and residing in a food desert. Public health recovery efforts might focus on modifying SNAP to improve the food security of people experiencing poverty.

Food insecurity gaps in the Supplemental Nutrition Assistance Program based on disability status

Food insecurity (FI) is associated with poor health and has risen in the US. The Supplemental Nutrition Assistance Program (SNAP) is the largest US food-purchasing assistance program. Policies related to eligibility assessment and administrative burden that impact SNAP participation vary between states. How such policies influence FI is not well known. To evaluate the association between changes in state SNAP policies and county FI rates. This repeated cross-sectional study used annual county-level FI estimates from the Feeding America Map the Meal Gap dataset, state-level SNAP policy data from the US Department of Agriculture from 2009 to 2019, and data on economic and demographic measures from the US Census Bureau for county residents. Data were analyzed from August 2024 to August 2025. Changes in state SNAP policies from 2009 to 2019. Due to incomplete policy data, the analysis was not extended beyond 2019. County-level FI rates for individuals. An annual index of SNAP policy adoption was calculated, scaled from 0.1 to 10, with a higher level indicating a greater adoption of policies associated with SNAP participation. G-computation, a robust causal inference methodology, was used to evaluate the association between change in the SNAP index and state-level SNAP participation rates and county-level FI rates. The model accounted for demographic and clinical factors, state and year fixed effects, and baseline SNAP index levels. Of a total of 3143 US counties, 3134 were included in the analysis. A 1-point increase in the SNAP policy index was associated with a 0.7-percentage point (pp; 95% CI, 0.3-1.2 pp; P = .002) higher state-level SNAP participation rate and a 0.1-pp (95% CI, 0.02-0.2 pp; P = .02) lower county-level FI rate from 2009 to 2019. In 2019, an estimated 6.5 million (95% CI, 3.8-9.1 million) fewer individuals would have experienced FI if all states had adopted policies equivalent to the most generous state in each year compared to if all states had adopted policies equivalent to the least generous state. In this cross-sectional study, adoption of state-level policies associated with higher SNAP participation was also associated with lower county-level FI rates. Policies that lower barriers to SNAP participation may help address rising FI rates observed in 2022 and 2023.

The objective of this study was to examine food insecurity and knowledge of the Supplemental Nutrition Assistance Program (SNAP), including barriers to and facilitators for enrolling in SNAP among college students in the Midwest. An obser­vational, cross-sectional online survey was admini­stered during Fall 2021 to Spring 2022. Participants included 844 college students from nine higher education institutions across Missouri. Of students who participated, 44.9% reported being food insecure, 67.9% reported knowing what SNAP was, and only 34.3% knew if they were eligible for SNAP. Students at private colleges [unadjusted odds ratio (OR) and 95% confidence interval (CI) = 4.79 (2.45-9.36), p&lt;0.001)], community colleges [OR 3.21 95% CI (2.26-4.56), p&lt;0.001)], technical schools [OR 2.21 95% CI (1.08-4.53), p=0.031], and Historically Black Colleges and Universities (HBCUs) [OR 2.05 95% CI (1.37-3.07)., p&lt;0.001] reported higher odds of food security compared to public institutions. College students reported lack of knowledge of SNAP in general as the main barrier for enrollment and campus assistance as the main facilitator. Food insecurity is highly prevalent in Missouri college students, where SNAP knowl­edge and enrollment barriers persist. Findings sup­port a need for increased attention and resources to target college food insecurity.

USDA’s Supplemental Nutrition Assistance Program (SNAP) is designed to increase the food purchasing power of low-income households. A recent USDA survey—the National Household Food Acquisition and Purchase Survey (FoodAPS)—provides a unique opportunity to gain a comprehensive understanding of the food spending of SNAP households. This study finds that, when adjusted for household size and composition, average food spending in SNAP households is lower than in other U.S. households, even those that are eligible for SNAP but choose not to participate. Food-at-home spending accounts for a greater share of the total food expenditures of SNAP households than of other households. SNAP benefits account for over 60 percent of the average food-at-home expenditures of SNAP households. They also play a strong role in the food budgets of households with children and those in poverty, especially those in deep poverty. Among both SNAP households and eligible nonparticipant households, those that are food secure spend more on food than those that are food insecure. Finally, this study finds clear evidence of a cyclical pattern in the food spending of SNAP households across the benefit month.