Loss Of SNAP Is Associated With Food Insecurity And Poor Health In Working Families With Young Children

Ettinger de Cuba S, Chilton M, Bovell-Ammon A, Knowles M, Colema SM, Black MM, Cook JT, Becker DC, Casey PH, Heeren TC, Frank DA
Source: Health Affairs
Publication Year: 2019
Patient Need Addressed: Food insecurity
Population Focus: Low income
Demographic Group: Child
Study Design: Pre-post with Comparison Group
Type of Literature: White

The Supplemental Nutrition Assistance Program (SNAP) helps working families meet their nutritional needs. Families whose earned income increases in a given month may have their SNAP benefits abruptly reduced or cut off in the following month. Using sentinel sample data from 2007–15 for families with children younger than age four, we investigated how SNAP benefit reductions or cutoffs resulting from increased income were related to economic hardships (food and energy insecurity, unstable housing, forgone health and/or dental care, and health cost sacrifices) and to caregiver and child health. After we controlled for covariates, we found that the groups whose SNAP benefits were reduced or cut off had significantly increased odds of household and child food insecurity, compared to a group with consistent participation in SNAP. Reduced benefits were associated with 1.43 and 1.22 times greater odds of fair or poor caregiver and child health, respectively. Policy modifications to smooth changes in benefit levels as work incomes improve may protect working families with young children from increased food insecurity, poor health, and forgone care.

Insights Results

Overview of article

  • This study focuses on the Supplemental Nutrition Assistance Program (SNAP) as a work support by examining how SNAP benefit reduction or cutoff resulting from increased earned income relates to health and other aspects of working households’ budgets (i.e., food, medical and dental care, utilities, and housing)
  • SNAP is the primary public assistance program that helps low-income working families with children, seniors, and people with disabilities purchase food

Methods of article

  • Data were collected across 8 years through a cross-sectional surveys of caregivers of children younger than 4 who access healthcare in emergency departments or hospital primary care clinics across a number of cities
  • Outcome measures include food insecurity, energy insecurity, housing instability, forgone care, healthcare sacrifices, fair or poor health for caregiver or child, maternal depressive symptoms, and developmental risk


  • Compared to households with consistent participation, those with SNAP reduction had increased adjusted odds of household food insecurity, child food insecurity, housing instability, and energy insecurity. They were also more likely to forgo care for family members because they couldn’t afford it. Those with SNAP reduction were more likely to report having fair or poor health and maternal depressive symptoms and to report the reference child’s health as fair or poor. Developmental risk was marginally associated with reduced SNAP benefits. Healthcare scarifies and forgone care for the reference child were not significantly associated with reduced benefits
  • Compared to caregivers with consistent participation in SNAP, those who reported SNAP cutoff had increased odds of household food insecurity, child food insecurity, energy insecurity, and health cost sacrifices. They were also more likely to forgo care for family members and for the reference child. SNAP benefit cutoffs were also associated with caregivers’ reporting developmental risk. Associations of benefit cutoffs with housing instability, fair or poor caregiver and child health, and maternal depressive symptoms were nonsignificant

Key takeaways/implications

  • This study showed that families with children that participated in SNAP, increased their earned income, and therefore had their SNAP benefits reduced or cut off in response faced economic strain that diminished their ability to pay for housing, utilities, healthcare, or food when compared to families with consistent SNAP benefits. In turn, this may have adversely affected overall health for caregivers and children and increased household economic hardship
  • Among the SNAP cutoff group, there was a strong association with health cost sacrifices. Families whose benefits were reduced were more likely to have forgone health and/or dental care for family members because of constrained household resources, potentially affecting overall health
  • This study has policy implications including, thinking about potential policies that would make SNAP reductions less abrupt with participants’ income increases, and impact of eligibility restrictions on SNAP participants. Policy proposals that improve families’ upward economic mobility without placing them at risk of increased economic hardships or poor health are necessary
  • Implementing SNAP policies that buffer the unintended impacts of potentially short-lived income increases in a population prone to unstable employment and with limited reserves to compensate for sudden SNAP reductions or losses may promote family health and well-being. Additionally, smoothing the path for working families to transition out of receiving SNAP benefits as they increase their incomes and remain stable in their jobs may promote family economic stability
  • Strengths of the study include its focus on a large, diverse sample. Limitations include potential selection and reporting bias, limited generalizability, children identified in emergency departments