Supplemental Nutrition Assistance Program Eligibility Research Articles

State expansion of Supplemental Nutrition Assistance Program eligibility and rates of firearm-involved deaths in the United States

IntroductionPoverty is a consistent correlate of firearm-involved mortality, yet little work has considered the effects of social and economic policies on these deaths. This study examined associations of state elimination...

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

BackgroundThe Supplemental Nutrition Assistance Program (SNAP) plays a critical role in alleviating poverty and food insecurity. Despite these benefits, many older Americans who are eligible for SNAP do not participate in the program. Few studies have explored household factors and food insecurity outcomes associated with nonparticipation among older Black Americans. ObjectivesThe study aim was to explore changes in food insecurity and related financial hardship outcomes between 2020 and 2021 among SNAP participants, eligible nonparticipants, and ineligible nonparticipants; compare reasons for not participating in SNAP; and to compare household factors associated with SNAP nonparticipation. MethodsLongitudinal design examining data from 2020 and 2021 to assess changes in food insecurity over the course of the coronavirus disease 2019 pandemic. Participants/settingParticipants were 528 adults (aged 30 to 97 years) in households randomly selected from a listing of all residential addresses in two predominantly Black neighborhoods with lower incomes in Pittsburgh, PA, and surveyed between March to May 2020 and May to December 2021. Main outcome measuresFood security was measured using the validated 6-item US Department of Agriculture Adult Food Security Survey Module. Statistical analyses performedFindings are based on a descriptive analysis of food security and related indicators. Statistical testing was performed to assess differences between SNAP participation status and individual characteristics, food security, and financial hardship using Wald F test for continuous measures and Pearson χ2 test for categorical measures. A multivariable linear model was used to assess the association of SNAP participation and eligibility status with change in food insecurity. ResultsIn cross-sectional analyses of 2021 data, no differences were observed between SNAP participants and eligible nonparticipants for food insecurity, food bank use, mean weekly food spending per person, and difficulty paying for basics. However, with respect to changes in food insecurity over the course of the pandemic, SNAP participants experienced a greater improvement in mean food security scores between 2020 and 2021 (–0.52 reduction in mean food insecurity score or a 16% improvement in food security; P ≤ 0.05) relative to SNAP-eligible nonparticipants. Perceived ineligibility (71.3%) and perceived lack of need (23%) were the most common reasons for not participating in SNAP. ConclusionsMore than one-third of SNAP participants and eligible nonparticipants experienced food insecurity and financial hardship. However, there were differences in the changes in food insecurity between these groups.

Association of state policies modifying Supplemental Nutrition Assistance Program (SNAP) eligibility and cancer stage at diagnosis.

214 Background: Food insecurity is associated with access to care and is particularly prevalent among adolescents and young adults (AYA) with cancer. The Supplemental Nutrition Assistance Program (SNAP) was designed to minimize food insecurity for low-income households. Under the broad-based categorial eligibility (BBCE) policy, states were given the ability to relax requirements for qualifying for SNAP through increasing the income limit or eliminating the asset test. While most SNAP policy changes under the BBCE policy occurred from 2009-2011, it is unknown whether these policies affect access to care among AYA with cancer. We sought to determine whether state SNAP eligibility policies were associated with stage at diagnosis among AYA patients. Methods: We utilized the Surveillance, Epidemiology, and End Results database to obtain data from 2006-2019 for newly diagnosed patients with cancer ages 18-39 years from 11 states. All cancer types were included with the exception of liquid tumors and other unstaged cancers. Difference-in-differences analyses were utilized to evaluate changes in the percentage of localized and distant stage diagnoses from pre- to post-policy enactment between states that enacted (1) asset test elimination or (2) increased income limit policies. Linear probability models were adjusted for state and year fixed effects, race, ethnicity, sex, metropolitan residence, marital status, county-level income, cancer type, and Medicaid expansion effects. We also accounted for state-level clustering via clustered standard errors. Event study analyses were utilized to assess the plausibility of the parallel trends assumption. Results: A total of 157,380 AYAs with cancer were identified. In adjusted difference-in-differences analyses, there was a 0.67 percentage point (PP) (95% CI = 0.15 to 1.19, P=.012) increase in localized stage cancer diagnoses and a -0.81 PP (95% CI = -1.41 to -0.21, P=.008) decrease in distant stage cancer diagnoses in states with increased income limits for SNAP eligibility relative to other states. There were no statistically significant changes in the percentage of localized (0.87 PP, 95% CI = -1.27 to 3.00, P=.43) or distant (0.05 PP, 95% CI = -1.44 to 1.55, P=.94) stage cancers with policies eliminating the asset test. Among patients with cervical cancer, where screening is recommended in this age group, there were extremely similar patterns. Conclusions: State policies increasing income eligibility limits for the Supplemental Nutrition Assistance Program were associated with a higher percentage of localized stage and a lower percentage of distant stage cancers among adolescents and young adults. These data add to a growing body of literature suggesting that policies that address social determinants of health may improve access to care.

State expansion of supplemental nutrition assistance program eligibility and rates of interpersonal violence

IntroductionFood insecurity is associated with an increased likelihood of interpersonal violence. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the U.S. States can eliminate the asset test and/or increase the income limit for SNAP eligibility, expanding the number of households receiving assistance. We examined the association of state elimination of the asset test and increases in the income limit with rates of interpersonal violence, including intimate partner violence (IPV), other relationship violence (violence by a parent, friend, etc.), and stranger violence. MethodsWe used data from the SNAP Policy Database and state-level estimates of rates of interpersonal violence per 1000 population ages ≥12 years from the 2012–2014 to 2016–2018 National Crime Victimization Survey. ResultsStates that adopted both SNAP eligibility policies (eliminated the asset test and increased the income limit) had a lower rate of IPV (β = −0.4, 95% CI -0.9, 0.0) and other relationship violence (β = −2.4, 95% CI -3.8, −1.1) compared to states that did not adopt either policy. The rate of stranger violence (β = −0.5, 95% CI -2.3, 1.4) did not differ for states that adopted both policies compared to states that did not adopt either policy. Rates of IPV (β = −0.4, 95% CI -0.9, 0.2), other relationship violence (β = −1.2, 95% CI -3.2, 0.7), and stranger violence (β = −0.2, 95% CI -2.0, 1.6) did not differ for states that eliminated the asset test only compared to states that did not adopt either policy. ConclusionExpanding SNAP eligibility may help prevent interpersonal violence at the population-level.

State expansion of Supplemental Nutrition Assistance Program eligibility and rates of foster care entries

BackgroundState expansion of Supplemental Nutrition Assistance Program (SNAP) eligibility under broad-based categorical eligibility (BBCE) is associated with decreases in household poverty and food insecurity, child protective services investigations, and mental health and substance use disorders among adults, key contributors to foster care entry. ObjectiveTo examine the association of state expansion of SNAP eligibility under BBCE with rates of foster care entries. ParticipantsFoster care entries among children ages <18 years. MethodsWe used 2005–2019 data from the SNAP Policy Database and the Adoption and Foster Care Analysis and Reporting System (AFCARS). We conducted difference-in-differences analyses and generated event study plots adjusting for state economic conditions (percent population unemployed, median household income) and policies (minimum wage, refundable Earned Income Tax Credits, maximum Temporary Assistance for Needy Families benefit for a family of 3). ResultsOn average, there were 1.8 fewer foster care entries (95 % confidence interval (CI) −2.8, −0.8) per 1000 children per year in states that expanded SNAP eligibility than there would have been if they had not expanded eligibility. Average decreases in foster care entries were similar among young (−1.7 per 1000 children per year, 95 % −3.1, −0.3) and school-age (−1.8 per 1000 children per year, 95 % CI −2.7, −0.8) children and larger among Black non-Hispanic (−5.6 per 1000 children per year, 95 % CI −9.1, −2.0) than among White non-Hispanic (−1.4 per 1000 children per year, 95 % CI −2.2, −0.6) children. The magnitude of these decreases increased with greater time since policy adoption. ConclusionsResults add to growing evidence that programs and policies that support and stabilize household economic and material conditions may contribute to reductions in foster care entries at the population-level.

County- and state-level immigration policies are associated with Supplemental Nutrition Assistance Program (SNAP) participation among Latino households

The purpose of this study was to investigate the association between county- and state-level immigrant criminalizing and integrating policies and Latino household participation in the largest safety net program against food insecurity in the U.S., the Supplemental Nutrition Assistance Program (SNAP). Our outcome, county-level proportion of SNAP-participating Latino households, and county-level covariates were obtained from the American Community Survey 1-year county files (N = 675 counties) for 13 years (2007–2019). Our exposures were county-level presence of sanctuary policies and a state-level immigrant friendliness score, created based on 19 immigrant criminalizing and integrating state-level policies obtained from the Urban Institute's State Immigration Policies Resource. We classified every county in the sample as 1) sanctuary policy + immigrant friendly state, 2) sanctuary policy + immigrant unfriendly state, 3) no sanctuary policy + immigrant friendly state, and 4) no sanctuary policy + immigrant unfriendly state. Using multivariable generalized linear models that adjusted for poverty levels and other social composition characteristics of counties, we found that county-level SNAP participation among Latino households was 1.1 percentage-point higher in counties with sanctuary policies (B = 1.12, 95%CI = 0.26–1.98), compared to counties with no sanctuary policies, and 1.6 percentage-point higher in counties with sanctuary policies in immigrant friendly states (B = 1.59, 95%CI = 0.33–2.84), compared to counties with no sanctuary policy in immigrant unfriendly states. Local and state immigration policy, even when unrelated to SNAP eligibility, may influence SNAP participation among Latino households. Jurisdictions which lack sanctuary policies or have more criminalizing and less integrating policies should consider adopting targeted outreach strategies to increase SNAP enrollment among Latino households.

Military Eligibility for the Supplemental Nutrition Assistance Program: Simulating the Exemption of the Basic Allowance for Housing from Gross Income

BackgroundTwenty-four percent of active-duty service member households experienced food insecurity in 2020; however, limited data have suggested that few participate in the Supplemental Nutrition Assistance Program (SNAP). A potential reason for low SNAP participation among active-duty military households is that the basic allowance for housing (BAH) is considered countable income for SNAP eligibility determination. ObjectivesThis study explores how many more service members’ households, referred to as “SNAP units” (that is, a group of individuals who live together and regularly buy food and prepare meals together), would become eligible for SNAP benefits if the BAH is excluded from countable income in deciding eligibility. MethodsThis study used 2016–2020 American Community Survey 5-y estimates to construct a sample of active-duty military households combined with data on military pay and allowances to simulate changes to SNAP eligibility and poverty status with a BAH exemption as well as impacts on federal spending on SNAP. ResultsEligibility for SNAP among military SNAP units increases from 0.4% to 1.5% (263% increase) if a service member’s BAH was exempted from their gross income. The increase was driven by SNAP units whose highest-ranking service member was from the noncommissioned officer ranks without dependents. As more military SNAP units became eligible and chose to participate, annual SNAP disbursements (that is, amount of funds spent on SNAP) for the whole program increased by up to 1.3%, compared with FY16–20 SNAP disbursements. With an increase in SNAP participation, the poverty rate among military SNAP units decreases from 8.7% to 1.4% (83.9% decrease). ConclusionsExempting service members’ BAH from their gross income would likely increase SNAP eligibility and participation among military households and, in turn, reduce poverty.

The associations of SNAP use and memory function among us older adults: Findings from the health and retirement study

AbstractBackgroundStudies on the health effect of Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. In this study, we examined the associations of SNAP use and memory function trajectories among US older adults.MethodOur sample included 3,555 SNAP‐eligible participants (aged 50+) from the 1996 Health and Retirement Study survey, among whom 559 were SNAP users and 2,996 were non‐users. SNAP eligibility was constructed based on household income and assets compared to the federal criterion. Memory function was assessed biennially from 1996 through 2016. To account for pre‐existing differences in characteristics and variations in survey attrition between SNAP users and non‐users, we modeled the probability of SNAP use and of attrition using pre‐SNAP exposure (i.e., 1994) demographic and health covariates. We then modeled trajectories of memory function across SNAP use using linear mixed effect models weighted by the inverse probability of treatment (i.e. SNAP use) and of attrition. We also cross‐examined the results in a propensity score (PS) matched sample (N = 1,050).ResultSNAP users in 1996 had lower socioeconomic status and worse health at baseline than SNAP non‐users, and were more likely to be lost to follow‐up. Results using IP‐weights suggested SNAP users had worse memory scores at baseline but slower memory decline compared with non‐users (annual decline rate is ‐0.038 standard units [95%CI = ‐0.044, ‐0.033] for non‐users and ‐0.043 [95%CI = ‐0.046, ‐0.040] for users). Results from the PS‐matched sample also showed SNAP users had slower memory declines compared with non‐users (annual decline rate was ‐0.052 units [95%CI = ‐0.055, ‐0.050] for non‐users and ‐0.048 units [95%CI = ‐0.051, ‐0.046] for users).ConclusionAfter accounting for pre‐existing differences between eligible SNAP users and non‐users as well as differential loss to follow‐up, our findings suggested that SNAP participation is associated with slower memory decline among eligible older adults.

Association of State Supplemental Nutrition Assistance Program Eligibility Policies With Adult Mental Health and Suicidality

Food insecurity is associated with an increased likelihood of poor mental health and suicidality. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the US; under broad-based categorical eligibility (BBCE), states have the option to expand SNAP eligibility to a greater number of households by eliminating the asset test or increasing the income limit for eligibility. To examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility with rates of mental health and suicidality outcomes among adults. This ecological cross-sectional study used 2014 to 2017 data on US adults from the National Vital Statistics System and 2015 to 2019 data on US adults from the National Survey on Drug Use and Health (NSDUH) State-Level Small Area Estimates. Analyses were conducted between September and November 2022. State elimination of the asset test only and state adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) for 2014 to 2017 from the SNAP Policy Database. Number of adults with a past-year major depressive disorder, mental illness, serious mental illness, or suicidal ideation and number of adults who died by suicide. Analyses included 407 391 adult NSDUH participants and 173 085 adults who died by suicide. State elimination of the asset test only was associated with decreased rates of past-year major depressive episodes (rate ratio [RR], 0.92; 95% CI, 0.87-0.98) and mental illness (RR, 0.91; 95% CI, 0.87-0.97) among adults. State adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) was associated with decreased rates of past-year major depressive episodes (RR, 0.92; 95% CI, 0.86-0.99), mental illness (RR, 0.92; 95% CI, 0.87-0.98), serious mental illness (RR, 0.91; 95% CI, 0.84-0.99), and suicidal ideation (RR, 0.89; 95% CI, 0.82-0.96). Results suggested a decreased rate of suicide death (RR, 0.93; 95% CI, 0.84-1.02) in states with both policies compared with states with neither policy, although this result was not statistically significant. State adoption of policies that expand SNAP eligibility may contribute to decreased rates of multiple mental health and suicidality outcomes at the population level.

Supplemental Nutrition Assistance Program Work Requirements and Emergency Food Assistance Usage

Policymakers have suggested and implemented work requirements for safety-net programs such as the Supplemental Nutrition Assistance Program. If these work requirements impact program participation, they may lead to greater food insecurity. This paper investigates the effects of implementing the work requirement for the Supplemental Nutrition Assistance Program on emergency food assistance usage. Data were used from a cohort of food pantries in Alabama, Florida, and Mississippi, which imposed the Supplemental Nutrition Assistance Program work requirement in 2016. Event study models were run in 2022, leveraging geographic variation in exposure to the work requirement to measure changes in the number of households served by the food pantries. The 2016 introduction of the Supplemental Nutrition Assistance Program work requirement increased the number of households served by food pantries. The impact is concentrated among urban food pantries. On average, an urban agency exposed to the work requirement served 34% more households in the 8 months after the work requirement than an agency with no exposure. Individuals who lose Supplemental Nutrition Assistance Program eligibility owing to the work requirement remain in need of assistance and seek other sources of food. Supplemental Nutrition Assistance Program work requirements thus increase the burden on emergency food assistance programs. Work requirements for other programs may also lead to increased emergency food assistance use.

Association of State Expansion of Supplemental Nutrition Assistance Program Eligibility With Rates of Child Protective Services–Investigated Reports

States in the US have the option to eliminate the asset test and/or increase the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility under a policy called broad-based categorical eligibility (BBCE). Given associations of economic hardships, including food insecurity, with child protective services (CPS) involvement, state adoption of these policies may be associated with changes in rates of CPS-investigated reports. To examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility under BBCE with rates of CPS-investigated reports. This cross-sectional ecologic study used data from 2006 to 2019 obtained from the SNAP Policy Database and the National Child Abuse and Neglect Data System Child Files and difference-in-differences analyses. The data were analyzed from March to September 2022. The study used CPS-investigated reports for suspected child abuse and neglect from 37 US states to examine elimination of the asset test, from 36 states to examine increases in the income limit, and from 26 states to examine adoption of both policies. State elimination of the asset test, increases in the income limit, and adoption of both policies to expand SNAP eligibility. Number of CPS-investigated reports, overall and specifically for neglect and physical abuse, per 1000 child population. From 2006 to 2019 for all 50 states and the District of Columbia, there were a total of 29 213 245 CPS-investigated reports. By race and ethnicity, 19.8% of CPS-investigated reports were among non-Hispanic Black children and 45.7% among non-Hispanic White children (hereafter referred to as Black and White children). On average, there were 8.2 fewer CPS-investigated reports (95% CI, -12.6 to -4.0) per 1000 child population per year in states that eliminated the asset test, 5.0 fewer CPS-investigated reports (95% CI, -10.8 to 0.7) per 1000 child population per year in states that increased the income limit, and 9.3 fewer CPS-investigated reports (95% CI, -15.6 to -3.1) per 1000 child population per year in states that adopted both SNAP policies than there would have been if these states had not adopted these policies. There were decreases in CPS-investigated reports for neglect in states that adopted either or both policies, and small decreases in CPS-investigated reports for physical abuse in states that increased the income limit or adopted both policies. There were decreases in CPS-investigated reports among both Black and White children. For example, there were 6.5 fewer CPS-investigated reports among Black children (95% CI, -14.6 to 1.6) and 8.7 fewer CPS-investigated reports among White children (95% CI, -15.8 to -1.6) in states that adopted both SNAP policies than there would have been if these states had not adopted these policies. Results from this cross-sectional study suggest that state expansion of SNAP eligibility through elimination of the asset test and increases in the income limit may contribute to decreases in rates of CPS-investigated reports. These results can inform ongoing debates regarding SNAP policy options, specifically BBCE, and prevention efforts for child abuse and neglect.

Abstract B096: 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 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 &amp;lt;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.

Association Between Supplemental Nutrition Assistance Program Use and Memory Decline: Findings From the Health and Retirement Study.

Studies on the effect of the Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. We sought to examine the associations between SNAP use and memory decline among SNAP-eligible US older adults. Participants aged 50+ years and SNAP-eligible in 1996 from the Health and Retirement Study were included. Participants' SNAP eligibility was constructed using federal criteria. Participants also self-reported whether they used SNAP. Memory function was assessed biennially from 1996 through 2016 using a composite score. To account for preexisting differences in characteristics between SNAP users and nonusers, we modeled the probability of SNAP use using demographic and health covariates. Using linear mixed-effects models, we then modeled trajectories of memory function for SNAP users and nonusers using inverse probability (IP) weighting and propensity score (PS) matching techniques. In all models, we accounted for study attrition. Of the 3,555 SNAP-eligible participants, a total of 15.7% were SNAP users. At baseline, SNAP users had lower socioeconomic status and a greater number of chronic conditions than nonusers and were more likely to be lost to follow-up. Our multivariable IP-weighted models suggested that SNAP users had worse memory scores at baseline but slower rates of memory decline compared with nonusers (the annual decline rate is -0.038 standardized units [95% CI = -0.044 to -0.032] for users and -0.046 [95% CI = -0.049 to -0.043] for nonusers). Results were slightly stronger from the PS-matched sample (N = 1,014) (the annual decline rate was -0.046 units [95% CI = -0.050 to -0.042] for users and -0.060 units [95% CI = -0.064 to -0.056] for nonusers). Put in other words, our findings suggested that SNAP users had approximately 2 fewer years of cognitive aging over a 10-year period compared with nonusers. After accounting for preexisting differences between eligible SNAP users and nonusers as well as differential attrition, we find SNAP use to be associated with slower memory function decline.

THE EFFECT OF SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM GENEROSITY ON DEPRESSIVE SYMPTOMS AMONG OLDER AMERICANS

Abstract Food insecurity has been indicated to associate with more depressive symptoms. Supplemental Nutrition Assistance Program (SNAP) is an established anti-poverty government program that targets food insecurity. The goal of this study was to assess whether SNAP generosity, defined at the state level, impacts the relationship of food insecurity and depressive symptoms among older Americans. We linked state-level SNAP policy data to the individual-level data of older adults (aged 60+) from the longitudinal Health and Retirement Study (Nf12,801). Our study baseline was survey year 2000. A state is considered SNAP generous when it eliminates income/assets limit from its SNAP eligibility criteria. All HRS participants reported their food insecurity status and depressive symptoms biennially. Participants were followed until 2018. We conducted state fixed-effect models adjusted for demographic and health measures. Results indicate household food insecurity was associated with higher risk of elevated depressive symptoms (OR=1.83, 95%CI=1.61, 2.07) from a fixed effect logistic model, and this effect was stronger when living in non-generous states compared with generous states though confidence intervals were too wide to be conclusive (OR_interaction =1.09, 95% CI= 0.83, 1.42). The relative excess risk due to interaction (RERI) was 0.17 (95%CI= -0.30, 0.63). Our study finding suggested that there is no to weak evidence that state-level SNAP generosity may alleviate or offset the risk of depressive symptoms associated with food-insecurity.

O06 University of North Carolina Charlotte Food Insecurity SNAP Initiative

<h3>Objective</h3> To develop a Supplemental Nutrition Assistance Program (SNAP) eligibility screening and application support system within a large public university <h3>Use of Theory/Research</h3> Recent research highlights food insecurity as a barrier to healthy eating and academic success among university students. Research also notes that university students are frequently struggling financially. <h3>Target Audience</h3> University students <h3>Program Description</h3> A 4-item SNAP Eligibility Screener was developed with input from partners at the University of Minnesota and the local Department of Social Services SNAP Office. Based on screener responses, if a student is deemed "potentially eligible" for SNAP they are provided information on how to apply for benefits. Once pilot testing on the screener was complete, the development team encouraged partners throughout the university to utilize the screener. The screener is now highlighted in instructor syllabi, on the university student support services website, and is being utilized by university financial aid officers when counseling students. <h3>Evaluation Methods</h3> There is an electronic record when a student completes the screener; therefore, there is a count of the number of students that completed the screener and the number that were determined to be "potentially eligible" for SNAP. When a student applies for SNAP, the university is contacted by the county social services office to verify student status. To evaluate whether "potentially eligible" students actually apply for SNAP benefits, University staff match ‘potentially eligible' students to those that applied for SNAP. <h3>Results</h3> Between October 27, 2021, and January 19th, 2022, approximately 159 students completed the SNAP Eligibility Screener. Of those 159 students, 29 students were ‘potentially eligible' for SNAP benefits. Among the ‘potentially eligible' students, 8 students have applied for SNAP benefits. <h3>Conclusions</h3> Educating students about SNAP and supporting them throughout the application process is one strategy that may lead to healthy eating and reduced food insecurity. <h3>Funding</h3> Center for Disease Control and Prevention; North Carolina Department of Health and Human Services.

Including Community Voices to Promote Equity in Online Grocery Shopping: Qualitative Findings From SNAP-Eligible Households With Young Children

ObjectivesOnline grocery shopping has grown in popularity among low-income households. Yet, few studies have explored how this service can equitably promote healthy food access and reduce food insecurity and nutritional inequities. Thus, this study explores community-identified recommendations for enhancing online grocery shopping to promote equitable food access. MethodsPrimary food purchasers of Supplemental Nutrition Assistance Program (SNAP) eligible, low-income households with children under 8 years old were recruited via Facebook to participate in audio-recorded focus groups and interviews as part of a larger mixed-methods study (Nov 2020 – March 2021). Participants were asked about their experiences with online grocery shopping, SNAP, and specific recommendations on how both programs could be improved to reduce inequities in food access. Recordings were transcribed and analyzed using an equity-oriented obesity prevention framework centered on 1) increasing healthy options, 2) reducing deterrents, 3) improving social and economic resources, and 4) building community capacity. ResultsA total of 44 primary food purchasers participated in in-depth interviews (n = 5) or one of 11 focus groups of 3–5 people (n = 39). Overall, 31 distinct recommendations emerged, which were grouped into 7 categories. Recommendations targeted four distinct stakeholder groups: grocery delivery service providers (D), grocery stores (G), health educators (H), and policy makers (P). To increase healthy options, participants emphasized improving access to services/foods and flexible methods of receiving groceries (D, G, P); to reduce deterrents through greater control of item selection and enhanced shopper interactions (D, G, P), to improve social and economic resources through more payment options and expanding SNAP eligibility and services (H, P), and to build on community capacity through meal planning support (G, H, P). ConclusionsFindings provide specific, actionable, community-informed trajectories for stakeholders to tailor online grocery shopping services to promote equitable food access for SNAP-eligible, low-income shoppers. Funding SourcesRobert Wood Johnson Foundation Healthy Eating Research (Grant # 77,246).

Helping College Students Get Supplemental Nutrition Assistance Program: Facilitators of and Barriers to Students Accessing the Federal Nutrition Assistance Program

ObjectiveTo identify effective practices for assisting college students with Supplemental Nutrition Assistance Program (SNAP) applications and explore challenges in student SNAP enrollment. DesignIn-depth interviews with key informants on experiences assisting college students with SNAP applications. SettingUniversity of California campuses. ParticipantsTwenty-one key informants, including staff from the University of California on-campus Basic Needs Centers, campus financial aid offices, county agencies, and food banks. Phenomenon of InterestFacilitators and barriers of college student SNAP enrollment. AnalysisTranscripts were coded to identify emerging themes. ResultsTwo of the most frequently mentioned facilitators were county staff presence on campus for application assistance and a strong relationship between campus staff and the county SNAP agency. A common barrier was inconsistent student SNAP eligibility information and procedures across county offices. Conclusion and ImplicationsFederal coordination with state agencies on student SNAP policy is much needed. This approach could help to eliminate heterogeneous interpretations of student exemptions across counties and between county staff. Future research is warranted to identify policy leverage points at the county, state, and federal levels, such as eliminating the student rule, to ensure equitable access to SNAP among college students.

Do state Supplemental Nutrition Assistance Program policies influence program participation among seniors?

AbstractSenior participation in the Supplemental Nutrition Assistance Program (SNAP) has traditionally been lower than other groups among those eligible, with historical estimates below 50%. We examine the impacts of state SNAP policies on program participation among low‐income senior (age 60 and older) and nonsenior households using data from the 2001 to 2014 December Current Population Survey Food Security Supplement. Our results suggest that policies designed to expand SNAP eligibility modestly increased participation among seniors but led to larger increases among nonseniors. In contrast, we find little evidence of effects of policies related to transaction costs, stigma, or outreach on either group.

Connecting Families at Risk for Food Insecurity With Nutrition Assistance Through a Clinical-Community Direct Referral Model

ObjectiveTo assess the feasibility of a clinical-community direct referral model to enroll eligible households in the Supplemental Nutrition Assistance Program (SNAP). MethodsPediatric clinics screening for food insecurity (n = 27) invited families experiencing food insecurity to participate in a direct referral to a local organization that assists with SNAP applications. A food stamp specialist telephoned participants to determine SNAP eligibility, assist with the application, and/or provide other supports. Referrals, eligibility determination, enrollment, and estimated benefits were tracked. ResultsA total of 486 families were referred to the community partner; 72% (n = 351) were successfully contacted by a food stamp specialist, with 17% (n = 83) applying for SNAP benefits. Another 16% (n = 79) were already enrolled in SNAP but received an additional service. Conclusions and ImplicationsThis referral model was feasible and increased the number of families who received nutrition assistance. This approach could be adapted for other health-related social needs.

Association between Food Insecurity, Mental Health, and Intentions to Leave the US Army in a Cross-Sectional Sample of US Soldiers.

Previous research has demonstrated that certain groups in the United States are at a greater risk for food insecurity. However, food insecurity has not been sufficiently characterized in active duty military populations. The primary objective of this study was to determine the prevalence of marginal food insecurity at a large US Army installation. The secondary objective was to determine how marginal food insecurity may be associated with intentions to leave the US Army after the current service period ("intentions to leave"). A cross-sectional, online survey was administered by the US Army Public Health Center at an Army installation in 2019 (n=5677). The main predictor was the 2-item food insecurity screener (Hunger Vital Signs), and the main outcome was a 5-point Likert question, "How likely are you to leave the army after your current enlistment/service period?" that was dichotomized for this analysis. Multiple logistic regression was used to assess the association between marginal food insecurity and intentions to leave. Mental health covariates were analyzed as a potential mediator. The sample was primarily male (83%), age <25 y (49%), and White (56%). One-third of respondents were classified as marginally food insecure using the Hunger Vital Signs, and 52% had intentions to leave. There was no significant association between marginal food insecurity and intentions to leave in the composite multivariable model, but mediation analyses revealed that food insecurity was significantly and independently associated with anxiety, depression, and suicidal ideation, which was in turn associated with intentions to leave. The association between marginal food insecurity and mental health showed that addressing food insecurity could improve mental health and subsequently reduce intentions to leave. Solutions to reduce military food hardship include expanding Supplemental Nutrition Assistance Program eligibility requirements, improving food resources communication, and expanding healthy food choices on-post.