ArticleJAMA health forum2025
Supplemental Nutrition Assistance Program Policies and Food Insecurity.
Article in JAMA health forum, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- More expansive state supplemental nutrition assistance program eligibility, intimate partner violence, and mental health during the preconception, prenatal, and postpartum periods.SSM - population health · 2026Article
- State Supplemental Nutrition Assistance Program Policies and Cardiovascular Mortality.JAMA network open · 2026Article
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Authors and funding
5 authors.
Funding
Abstract
Importance: 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. Objectives: To evaluate the association between changes in state SNAP policies and county FI rates. Design, Setting, and Participants: 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. Exposures: Changes in state SNAP policies from 2009 to 2019. Due to incomplete policy data, the analysis was not extended beyond 2019. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.
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