Associate Professor of Pediatrics Children's Mercy Kansas City Prairie Village, Kansas, United States
Background: Food insecurity (FI) is associated with adverse child health outcomes. The Supplemental Nutrition Assistance Program (SNAP), the largest federal nutrition program, serves 1 in 4 US children. While SNAP has been associated with decreased food insecurity, the association between SNAP and overall child health is not well understood. Objective: To examine the association of SNAP with child health in a nationally representative sample. Design/Methods: We conducted a cross sectional study of the National Survey of Children’s Health (NSCH) 2018-2019 dataset. We included children from households with income slightly above and below the SNAP eligibility threshold (115%-145% federal poverty level) to reduce confounding from income. The primary exposure was parent-reported receipt of SNAP in the past 12 months. The primary outcome was parent-reported child general health status, dichotomized as excellent/very good and good/fair/poor. Covariates included child demographics (e.g., age, race, ethnicity, gender), insurance type, other government benefits (e.g., WIC, cash assistance) and degree of special health care needs (SHCN). X2 tests were used for bivariate comparisons; logistic regression were used to estimate adjusted odds ratios (OR). NSCH weights were used to approximate the national population. Results: Of the 4.7 million children meeting the inclusion criteria, 1.3 million (27.9%) received SNAP (Table 1). SNAP recipients were more likely to be non-Hispanic Black, speak English, and receive other government benefits. A greater percentage of SNAP recipients had higher SHCN compared to non-recipients (5.6% vs. 3.4%, p< 0.001). There were no differences in parent-reported child health (Table 2). A higher percentage of SNAP recipients reported FI compared to non-recipients (58.1% vs. 48.9%, p=.006). In multivariable analyses, there continued to be no association of SNAP with child general health (OR 1.25 [95% CI: 0.69, 2.27]) (Table 3). Factors associated with lower odds of excellent/very good child health included SHCN (Higher SHCN OR 0.03 [95% CI: 0.02, 0.97; Lower SHCN OR 0.13 [95% CI:0.08, 0.23]) and receipt of cash assistance (OR 0.24 [95% CI: 0.07, 0.78]).
Conclusion(s): In this study of households with similar incomes, there was no association of SNAP receipt and general child health, despite higher FI among the households receiving SNAP. Future investigations will examine potential associations of SNAP and nutrition-related outcomes.
