The association of Supplemental Nutrition Assistance Program (SNAP) benefits and breast, cervix, and colorectal cancer screening.

Abstract

131 Background: Food insecurity is associated with healthcare access and utilization. The Supplemental Nutrition Assistance Program (SNAP) was created to reduce food insecurity for low-income households and hence may enhance health-seeking behaviors. However, it is unknown whether receipt of SNAP benefits is associated with rates of cancer screening. Our objective was to quantify the relationship of SNAP benefit receipt with cancer screening among low income individuals at high risk for food insecurity. Methods: The National Health Interview Survey (NHIS) provided by the Center for Disease Control and Prevention was utilized to identify high-risk adults ages 21 to 74 years eligible for screening for female cervix (21-65 years), colorectal (40-74 years), and/or female breast cancer (40-74 years). Data was included from the 2019 and 2021 surveys, with 2020 excluded due to limited cancer screening information. High-risk was defined as low or very low food security, household income < 125% federal poverty level, or having Medicaid insurance. Up to date cancer screening was defined as receipt of mammography within 2 years for breast cancer; receipt of a cervical cancer test within 5 years for cervix cancer; and receipt of sigmoidoscopy within the past 5 years, colonoscopy within 10 years, fecal immunohistochemistry (FIT) testing within 1 year, or sDNA-FIT testing within 3 years for colorectal cancer. We utilized logistic regression to compare screening rates by receipt of SNAP benefits and accounted for the complex survey design of the NHIS. Models were adjusted for covariates including age, race, ethnicity, sex (colorectal cancer screening only), income, education, marital status, insurance status, metropolitan residence status, survey year, food insecurity, and comorbidities. Results: A total of 6,111, 4,141, and 7,015 respondents were identified for cervix, breast, and colorectal cancer screening analyses, respectively. Among these respondents, 67%, 61%, and 60% were up to date on cervix, breast, and colorectal cancer screenings, respectively. Among this high-risk cohort, 43% of respondents reported receipt of SNAP benefits. Receipt of SNAP benefits was associated with increased odds of cervical cancer screening (OR = 1.18, 95% CI = 1.00 – 1.39, P=.046), which was limited to females ages 21-39 (OR = 1.36, 95% CI = 1.05 – 1.77, P=.022). Receipt of SNAP benefits was not associated with increased rates of breast or colorectal cancer screening. Conclusions: Receipt of SNAP benefits is associated with higher rates of cervical cancer screening among low-income females at high risk of food insecurity, particularly among young adults. These data suggest that efforts to address social determinants of health may improve access to care.